AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected...AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.展开更多
Purpose:To investigate the pathological changes of epiretinal membranes(ERM)and internal limiting membrane (ILM) removed during idiopathic macular hole surgery.Methods:Ten consecutive patients with a unilateral idiopa...Purpose:To investigate the pathological changes of epiretinal membranes(ERM)and internal limiting membrane (ILM) removed during idiopathic macular hole surgery.Methods:Ten consecutive patients with a unilateral idiopathic macular hole underwent pars plana vitrectomy(PPV) with the surgical removal of the ERMs overlying the hole and ILM surrounding the hole. The pathological features of the excised tissues were examined under the microscope. Results:According to the morphological changes, four ERMs showed cellular elements which looked like glia cells, macrophages, plasma cells, lymphocytes and fibroblast cells. Two of the ILM appeared as transparent membranes without cellular elements. The other eight ILM showed cellular elements on the transparent membranes.Conclusion: Our study supports the hypothesis that the tangential traction of vitreous and proliferative cellular elements on the inner surface of ILM causes idiopathic macular holes. Removal of the posterior cortical vitreous, ILM and proliferative cellular tissue is a valid treatment for IMH.展开更多
AIM:To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens(IOL)implantation in patients with severe idiopathic epiretinal membrane(iERM)and concurrent cataract.METHOD...AIM:To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens(IOL)implantation in patients with severe idiopathic epiretinal membrane(iERM)and concurrent cataract.METHODS:A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane(ERM)peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017.The best-corrected visual acuity(BCVA)and central foveal thickness(CFT)were measured preoperatively and at 1,3,6 mo and 1 y postoperatively.Temporal changes and bivariate correlations of these parameters were analyzed.RESULTS:Mean logMAR BCVA improved and CFT decreased significantly(P<0.001)until 6 mo after surgery.Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA(r=0.716,P<0.001 at 1 mo,r=0.417,P=0.014 at 3 mo,r=0.359,P=0.037 at 6 mo,and r=0.369,P=0.032 at 12 mo post-op respectively),but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA.There was a positive correlation between CFT and logMAR BCVA at 1 mo(r=0.346,P=0.045),6 mo(r=0.347,P=0.045),and 12 mo(r=0.342,P=0.048)post-operatively.The intraand postoperative complications were relatively mild,and the incidences were generally low.CONCLUSION:For severe iERM patients with significant visual symptoms,combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT.Early surgery in selected patients may help preserving better visual function.展开更多
AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique an...AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.展开更多
Purpose:To outline the characteristics of Combined Hamartoma of the Retina and Retinal Pigmentation Epithelium(CHRRPE)and provide a comprehensive overview of surgical management of epiretinal membrane(ERM)caused by CH...Purpose:To outline the characteristics of Combined Hamartoma of the Retina and Retinal Pigmentation Epithelium(CHRRPE)and provide a comprehensive overview of surgical management of epiretinal membrane(ERM)caused by CHRRPE.Main text:CHRRPE is a rare ocular tumor.It clinically mimics other diseases such as retinoblastoma and choroidal melanoma.The present study reviewed the multimodal imaging of CHRRPE,highlighted the multimodal imaging modalities which are useful for revealing the unique features of CHRRPE and hence allowing physicians to confirm the diagnosis.Although most of CHRRPEs are benign harmatoma,progressive visual loss may occur because of the traction of the tumor and other complications.It is treated through surgical removal of the ERM caused by CHRRPE to free retina from the traction.Currently,there is no consensus on the surgical management of CHRRPE.Therefore,the current review was designed to explore the surgical management of ERM caused by CHRRPE and hence provide updated data on this subject.Conclusions:Multimodal imaging technologies,especially optical coherence tomography(OCT),significantly contributes to the diagnosis of CHRRPE and visual prognosis.Surgical management of CHRRPE through removal of ERM is beneficial in patients with worsening VA which is secondary to ERM which is associated with CHRRPE.However,the strategy is limited to patients with long-standing poor vision.However,earlier surgical therapy and subsequent postoperative amblyopia therapy can be explored for children of amblyogenic age.展开更多
目的观察基于OCT不同分期的特发性黄斑前膜(IMEM)手术前后视力及黄斑微结构的改变。方法选取2021年10月至2023年1月于沧州爱尔眼科医院确诊为IMEM的患者82眼纳入研究,所有患者行25G经睫状体扁平部玻璃体切除联合黄斑前膜及内界膜(ILM)...目的观察基于OCT不同分期的特发性黄斑前膜(IMEM)手术前后视力及黄斑微结构的改变。方法选取2021年10月至2023年1月于沧州爱尔眼科医院确诊为IMEM的患者82眼纳入研究,所有患者行25G经睫状体扁平部玻璃体切除联合黄斑前膜及内界膜(ILM)剥除、空气填充,其中59眼联合白内障超声乳化摘除、人工晶体植入术。依据2017年IMEM分期标准分为A组21眼(2期),B组39眼(3期),C组22眼(4期)。分别于术前及术后3个月行最佳矫正视力(BCVA)、光学相干断层成像(OCT)检查。结果3组术后BCVA(LogMAR)较术前均降低(P均<0.05)。术前3组比较BCVA(LogMAR)差异无统计学意义(P>0.05);术后3组BCVA(LogMAR)比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05)。A组术后黄斑中心凹厚度(CMT)较术前差异无统计学意义(P=0.393);B组和C组术后CMT较术前均降低(P均<0.01)。术前3组CMT比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05);术后3组CMT比较差异有统计学意义(P<0.01),A组和B组、A组和C组比较差异均有统计学意义(P均<0.01),B组和C组比较差异无统计学意义(P>0.05)。82眼术后BCVA(LogMAR)与术前BCVA(LogMAR)、术前CMT、术后CMT均呈正相关(P均<0.01)。En face OCT发现7眼黄斑区可见同心圆状改变,B扫描呈柱状或锯齿状改变。结论特发性黄斑前膜患者OCT分期越早,术后视力及黄斑微结构恢复越好。应用OCT进行分期可以为手术时机选择及预后判断提供重要的依据。展开更多
目的根据OCT检查结果对特发性黄斑前膜进行分级,评估其预判患者术后视力恢复的应用价值。方法选取2013年2月至2016年5月在深圳市眼科医院接受手术治疗的29例(30眼)特发性黄斑前膜患者为研究对象,根据术前OCT检查显示的黄斑中心凹形态变...目的根据OCT检查结果对特发性黄斑前膜进行分级,评估其预判患者术后视力恢复的应用价值。方法选取2013年2月至2016年5月在深圳市眼科医院接受手术治疗的29例(30眼)特发性黄斑前膜患者为研究对象,根据术前OCT检查显示的黄斑中心凹形态变化将该病分为4级。各级患者均进行微创玻璃体切割术剥除黄斑前膜,术后6个月对所有患者进行检查,分析各级患者最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)情况。结果随着分级增高,患者的黄斑中心凹形态改变越紊乱,黄斑前膜出现和中心凹部丢失也越明显。各级患者术前与术后的Log MAR BCVA比较差异均有统计学意义(均为P<0.01)。各级患者术前及术后的Log MAR BCVA随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P<0.05)。提示特发性黄斑前膜分级越高患者的视力越差。特发性黄斑前膜Ⅱ级患者术前和术后Log MAR BCVA差值最大,且与其他各级比较差异均有统计学意义(均为P<0.001)。提示特发性黄斑前膜Ⅱ级患者的BCVA在术后的改善程度最大。除Ⅲ级患者外,其余各级患者术前与术后CFT比较,差异均无统计学意义(均为P>0.05)。术前及术后各级患者间的CFT随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P<0.001)。提示特发性黄斑前膜分级越高患者的黄斑厚度越高。结论基于OCT检查图像对特发性黄斑前膜患者进行分级,不仅有助于预判患者术后视力和CFT的恢复情况,还有利于特发性黄斑前膜患者手术时机的选择。展开更多
文摘AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.
文摘Purpose:To investigate the pathological changes of epiretinal membranes(ERM)and internal limiting membrane (ILM) removed during idiopathic macular hole surgery.Methods:Ten consecutive patients with a unilateral idiopathic macular hole underwent pars plana vitrectomy(PPV) with the surgical removal of the ERMs overlying the hole and ILM surrounding the hole. The pathological features of the excised tissues were examined under the microscope. Results:According to the morphological changes, four ERMs showed cellular elements which looked like glia cells, macrophages, plasma cells, lymphocytes and fibroblast cells. Two of the ILM appeared as transparent membranes without cellular elements. The other eight ILM showed cellular elements on the transparent membranes.Conclusion: Our study supports the hypothesis that the tangential traction of vitreous and proliferative cellular elements on the inner surface of ILM causes idiopathic macular holes. Removal of the posterior cortical vitreous, ILM and proliferative cellular tissue is a valid treatment for IMH.
文摘AIM:To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens(IOL)implantation in patients with severe idiopathic epiretinal membrane(iERM)and concurrent cataract.METHODS:A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane(ERM)peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017.The best-corrected visual acuity(BCVA)and central foveal thickness(CFT)were measured preoperatively and at 1,3,6 mo and 1 y postoperatively.Temporal changes and bivariate correlations of these parameters were analyzed.RESULTS:Mean logMAR BCVA improved and CFT decreased significantly(P<0.001)until 6 mo after surgery.Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA(r=0.716,P<0.001 at 1 mo,r=0.417,P=0.014 at 3 mo,r=0.359,P=0.037 at 6 mo,and r=0.369,P=0.032 at 12 mo post-op respectively),but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA.There was a positive correlation between CFT and logMAR BCVA at 1 mo(r=0.346,P=0.045),6 mo(r=0.347,P=0.045),and 12 mo(r=0.342,P=0.048)post-operatively.The intraand postoperative complications were relatively mild,and the incidences were generally low.CONCLUSION:For severe iERM patients with significant visual symptoms,combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT.Early surgery in selected patients may help preserving better visual function.
基金Supported by the National Natural Science Foundation of China(No.81770944,No.81800846)Shanghai Hospital Development Center(No.SHDC2020CR2041B)。
文摘AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.
基金Shanghai Sailing Program(No.20YF1429700)the Clinical Research Plan of SHDC(No.SHDC2020CR5014-002)+1 种基金the National Natural Science Foundation of China(No.82171069)Hospital Funded Clinical Research,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine(No.21XHDB08).
文摘Purpose:To outline the characteristics of Combined Hamartoma of the Retina and Retinal Pigmentation Epithelium(CHRRPE)and provide a comprehensive overview of surgical management of epiretinal membrane(ERM)caused by CHRRPE.Main text:CHRRPE is a rare ocular tumor.It clinically mimics other diseases such as retinoblastoma and choroidal melanoma.The present study reviewed the multimodal imaging of CHRRPE,highlighted the multimodal imaging modalities which are useful for revealing the unique features of CHRRPE and hence allowing physicians to confirm the diagnosis.Although most of CHRRPEs are benign harmatoma,progressive visual loss may occur because of the traction of the tumor and other complications.It is treated through surgical removal of the ERM caused by CHRRPE to free retina from the traction.Currently,there is no consensus on the surgical management of CHRRPE.Therefore,the current review was designed to explore the surgical management of ERM caused by CHRRPE and hence provide updated data on this subject.Conclusions:Multimodal imaging technologies,especially optical coherence tomography(OCT),significantly contributes to the diagnosis of CHRRPE and visual prognosis.Surgical management of CHRRPE through removal of ERM is beneficial in patients with worsening VA which is secondary to ERM which is associated with CHRRPE.However,the strategy is limited to patients with long-standing poor vision.However,earlier surgical therapy and subsequent postoperative amblyopia therapy can be explored for children of amblyogenic age.
文摘目的观察基于OCT不同分期的特发性黄斑前膜(IMEM)手术前后视力及黄斑微结构的改变。方法选取2021年10月至2023年1月于沧州爱尔眼科医院确诊为IMEM的患者82眼纳入研究,所有患者行25G经睫状体扁平部玻璃体切除联合黄斑前膜及内界膜(ILM)剥除、空气填充,其中59眼联合白内障超声乳化摘除、人工晶体植入术。依据2017年IMEM分期标准分为A组21眼(2期),B组39眼(3期),C组22眼(4期)。分别于术前及术后3个月行最佳矫正视力(BCVA)、光学相干断层成像(OCT)检查。结果3组术后BCVA(LogMAR)较术前均降低(P均<0.05)。术前3组比较BCVA(LogMAR)差异无统计学意义(P>0.05);术后3组BCVA(LogMAR)比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05)。A组术后黄斑中心凹厚度(CMT)较术前差异无统计学意义(P=0.393);B组和C组术后CMT较术前均降低(P均<0.01)。术前3组CMT比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05);术后3组CMT比较差异有统计学意义(P<0.01),A组和B组、A组和C组比较差异均有统计学意义(P均<0.01),B组和C组比较差异无统计学意义(P>0.05)。82眼术后BCVA(LogMAR)与术前BCVA(LogMAR)、术前CMT、术后CMT均呈正相关(P均<0.01)。En face OCT发现7眼黄斑区可见同心圆状改变,B扫描呈柱状或锯齿状改变。结论特发性黄斑前膜患者OCT分期越早,术后视力及黄斑微结构恢复越好。应用OCT进行分期可以为手术时机选择及预后判断提供重要的依据。
文摘目的根据OCT检查结果对特发性黄斑前膜进行分级,评估其预判患者术后视力恢复的应用价值。方法选取2013年2月至2016年5月在深圳市眼科医院接受手术治疗的29例(30眼)特发性黄斑前膜患者为研究对象,根据术前OCT检查显示的黄斑中心凹形态变化将该病分为4级。各级患者均进行微创玻璃体切割术剥除黄斑前膜,术后6个月对所有患者进行检查,分析各级患者最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)情况。结果随着分级增高,患者的黄斑中心凹形态改变越紊乱,黄斑前膜出现和中心凹部丢失也越明显。各级患者术前与术后的Log MAR BCVA比较差异均有统计学意义(均为P<0.01)。各级患者术前及术后的Log MAR BCVA随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P<0.05)。提示特发性黄斑前膜分级越高患者的视力越差。特发性黄斑前膜Ⅱ级患者术前和术后Log MAR BCVA差值最大,且与其他各级比较差异均有统计学意义(均为P<0.001)。提示特发性黄斑前膜Ⅱ级患者的BCVA在术后的改善程度最大。除Ⅲ级患者外,其余各级患者术前与术后CFT比较,差异均无统计学意义(均为P>0.05)。术前及术后各级患者间的CFT随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P<0.001)。提示特发性黄斑前膜分级越高患者的黄斑厚度越高。结论基于OCT检查图像对特发性黄斑前膜患者进行分级,不仅有助于预判患者术后视力和CFT的恢复情况,还有利于特发性黄斑前膜患者手术时机的选择。
