Effectiveness of intravitreal ranibizumab for diabetic macular edema in vitrectomized versus non-vitrectomized eyes:a Meta-analysis

AIM:To evaluate the effectiveness and safety of intravitreal ranibizumab(IVR)for diabetic macular edema(DME)in vitrectomized versus non-vitrectomized eyes.METHODS:The PubMed,EMBASE,Web of Science,Cochrane,EBSCO were comprehensively searched for studies comparing vitrectomized and non-vitrectomized eyes with DME.Clinical outcomes of best-corrected visual acuity(BCVA),central macular thickness(CMT),the mean number of intravitreal injection and adverse events were extracted and analyzed.RESULTS:Six studies involving 641 eyes were included.Final visual gain significantly improved and CMT significantly reduced in vitrectomized eyes at 6mo and 12mo visits(P<0.05).Although the mean reduction in CMT among non-vitrectomized eyes was significantly greater than in vitrectomized eyes at the 6mo[mean difference(MD)=53.57,95%confidence interval(CI):28.03 to 78.72,P<0.0001]and 12mo(MD=49.65,95%CI:19.58 to 79.72,P=0.01),no significant difference was detected in improvement in BCVA at either 6mo(MD=0.05,95%CI:-0.02 to 0.13,P=0.14)or 12mo(MD=0.03,95%CI:-0.04 to 0.09,P=0.43).Injection number of ranibizumab in non-vitrectomized eyes was significantly less than that in vitrectomized eyes during 6-month period(MD=0.60,95%CI:0.16 to 1.04,P=0.008),while there was no statistically significant difference between the two groups during 12mo of follow-up.CONCLUSION:Evidence from current study suggests that IVR was useful for both vitrectomized group and nonvitrectomized group with DME.Although less reduction in macular thickness is found in vitrectomized group,visual improvement between two groups is similar.

Safety and effectiveness of an iris hook assisted phacoemulsification in vitrectomized eyes

AIM:To introduce a simple iris hook assisted phacoemulsification(PE)procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes.METHODS:A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery.Patients were randomly divided into 3 groups.Patients received PE,and intraocular lens(IOL)implantation with the assistance of iris hook(SynergetiesTM)as group A(25 eyes);patients who received PE assisted with a 25 G pars plana irrigation as group B(20 eyes),and patients who received PE performed without the help of any instrument as group C(20 eyes).Main outcome measures were surgery duration,Ultrasound(U/S)total time,endothelial cell density(ECD),cumulative dissipated energy(CDE)and complications of the procedures.RESULTS:With the help of iris hook,the patients in group A had the lowest ECD loss rate(0.07±0.03,0.09±0.03,and 0.10±0.03,P<0.05),shortest CDE(12.2±4.1,15.8±6.0,and 16.0±6.0,P<0.05)and U/S total time(36.6±13.0 s,46.3±16.4 s,and 47.6±16.1 s,P<0.05),and minimal incidence of complications.The longest surgery duration was in group B(19.4±1.6 min)and maximum complications rate in group C(20%miosis,10%posterior capsular tears,5%zonular dialysis,5%cystoid macular edema).While best-corrected visual acuity(BCVA),intraocular pressure(IOP)and ECD did not show a significant difference among the three groups.CONCLUSION:Without prolonged surgery duration,the iris hook assistant method can minimize heat generation during surgery and incidence of complications,which transfer the challenged PE in vitrectomized eyes into a regular surgery.It does not need any change in the hydrodynamic parameters and in the bag PE technique,easy to operate even for junior surgeons.

A reasonable option in vitrectomized eyes: manual small incision cataract surgery

Dear Sir,It is known that cataract surgery is challenging in vitrectomized eyes.Cataract surgeons may have encountered with posterior capsular complications and nucleus drop events even with minimal ocular manipulations and low irrigation bottle height.Inadvertent damage to the zonular fibers,posterior or peripheral lens capsule with ocutome or microvitreoretinal(MVR)blade in previous

Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye

Lee SM, Jung JW, Park SW, Lee JE, Byon IS. Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye. Int J Ophthalmo12017; 10（6）： 1019-1020

Coreoplasty and Artisan Intraocular Lens Implantation for Mydriasis and Aphakic Correction in Post-traumatic Vitrectomized Eyes

Purpose:.To evaluate the efficacy and safety of using coreoplasty,.and an iris-supported Artisan intraocular lens (IOL), for mydriasis and aphakic correction in post-traumatic vitrectomized eyes. Methods:.A total of 17 aphakic patients were admitted between April 2009 and April 2010 to the ophthalmologic department of Xiamen Eye Centre..All eyes had previously received lens removal and vitrectomy. After the retina stabilized and corrected visual acuity improved,.the iris was sutured. The Artisan IOL was fixated onto the iris surface..Patients were followed-up at one day, one week,.one month and three months postoperatively..The following outcomes were assessed: symptoms of photophobia and glare, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell density (ECD). The diameter of pupil and the anterior chamber depth (ACD) were measured by the anterior segment optical coherence tomography (OCT). Results:.Artisan IOLs were successfully implanted in all aphakic eyes. Postoperatively, improvement was observed in photophobia and glare symptoms..UCVA was enhanced in all patients.(six eyes had better UCVA postoperatively than BCVA preoperatively)..However,.there were no significant changes in IOP. Mean loss of ECD was 336.06/mm2. Mean postoperative pupil diameter was 3.67±0.41 mm, compared with 5.67±0.57 mm preoperatively(P<0.05). Mean ACD was reduced by 0.88 mm.(3.38±0.33 mm preoperatively vs 2.50±0.35 mm postoperatively, P<0.05). Conclusion:.Surgery that combined coreoplasty and Artisan IOL implantation was a safe and effective treatment for correcting aphakia and mydriasis in post-traumatic vitrectomized eyes.

玻璃体切除治疗非严重性PVR视网膜脱离

目的探讨PPV在治疗非严重性PVR视网膜脱离中的作用。方法研究15眼有裂孔边缘卷曲的PVR-B级网脱，11眼裂孔在赤道后的PVR-C1或C2级网脱及28眼眼底可视度差的网脱共54眼。结果一次手术成功率为76％。总的成功率是96％。术后视力提高43眼（79．6％）。不变9眼（16．7％），下降2眼（3．7％）。结论PPV是治疗非严重性PVR视网膜脱离的有效方法。

后巩膜加固术在高度近视性黄斑病变手术中的应用

近视性黄斑病变致盲率高,常用治疗手段为玻璃体切割术,然而单纯玻璃体切割术对于已出现严重后巩膜葡萄肿的超高度近视患者疗效欠佳。近年来临床应用玻璃体切割术联合后巩膜加固术治疗高度近视继发眼底病变,特别在黄斑劈裂及黄斑裂孔病例中,疗效肯定,前景可期。我们针对近年来后巩膜加固术的材料与术式变迁作一全面综述,并进一步讨论其应用于眼底手术中的发展远景。

硅油填充眼手法小切口与超声乳化白内障手术的并发症（英文）

目的:比较超声乳化联合硅油取出术与硅油填充眼手法小切口白内障手术(MSICS)的安全性。方法:回顾性对比研究。162例患者162眼接受白内障手术,超声乳化联合硅油取出术与硅油填充眼手法小切口白内障手术均行玻璃体切除。结果:超声乳化白内障手术组术后低眼压21眼(18.91%)MSICS组术后低眼压8眼(15.68%),两组间无明显统计学差异(P=0.666)。术后1mo两组间视网膜复位率无明显统计学意义;超声乳化白内障手术组8例患者(7.2%)复发,硅油填充眼手法小切口白内障手术组9例(17.64%)复发,两组复发率比较,差异无统计学意义(P=0.055)。结论:硅油填充眼手法小切口白内障手术相较于超声乳化联合硅取出术在低眼压、渗漏、脉络膜脱离、视网膜复位率方面结果无劣效性。

超声乳化术中25G玻璃体腔灌注的应用效果

目的 评价25G玻璃体腔灌注在玻璃体切除术后的白内障超声乳化手术中的应用效果.方法 采用预置25G玻璃体腔灌注的方法对41例（42只眼）玻璃体切除术后的白内障施行超声乳化联合人工晶状体植入术,观察并记录术后视力、眼压、患者自觉症状、巩膜穿刺口情况及术中、术后并发症.结果 所有手术均顺利完成.术后3个月时,40只眼最佳矫正视力较术前有不同程度提高,最佳矫正视力＞0.1者30只眼,手术前后比较,差别有统计学意义（x2=13.77,P＜0.01）,其中最佳矫正视力≥0.3者20只眼,手术前后比较,差别有统计学意义（x2=12.81,P＜0.01）.2只眼因原有的眼底病复发导致玻璃体积血,视力再度下降.术后1d、1周、末次随访时平均眼压分别为（14.62±0.56） mmHg、（14.82±0.54） mmHg和（14.83±0.57） mmHg,与术前平均眼压（14.86±0.59） mmHg（1 mmHg=0.133 kPa）比较,差别均无统计学意义（t=1.70,0.19,0.40,P＞0.05）.所有患者眼部刺激症状轻微,巩膜穿刺口愈合良好,术中及术后均未见严重并发症发生.结论 在玻璃体切除术后的白内障超声乳化术中,应用25G玻璃体腔灌注有利于维持眼压、稳定前房、减少手术并发症,是一种安全有效的辅助措施.

微创玻璃体切除术对手术切口的影响及护理观察

目的探讨微创玻璃体切除术对手术切口、手术并发症及手术时间的影响，并观察术后手术切口的变化。方法将2012年1～7月在天津市眼科医院就诊的120例患者分为A组和B组各60例，年龄18—65岁（平均年龄50．5岁）。病情诊断包括牵拉性视网膜脱离，特发性黄斑裂孔，糖尿病视网膜病变继发玻璃体积血，孔源性视网膜脱离，单纯玻璃体积血。两组患者年龄，性别，病情诊断等比较差异无统计学意义（P〉0．05），具有可比性。A组接受微创玻璃体切割术，B组接受20G玻璃体切割术。记录手术时间，手术切口渗漏、手术并发症、切口炎性反应、术后疼痛、住院时间，对相关记录指标进行统计学分析比较。结果A组和B组的手术时间分别为（55．2±9．8）min，（64．8±11．2）min，差异有统计学意义（P〈0．05）。切口炎性反应分别为7例和16例（P〈0．05）具有统计学意义。其余项目两组间无统计学意义（P〉0．05）。结论微创玻璃体切除手术，手术时间明显缩短，术后伤口局部炎性刺激症状轻微，眼内异物感较轻。术后视功能恢复快。而术前的充分准备，如术前应用抗生素，局部用聚维酮碘冲洗结膜囊，则最大限度的避免术后切口渗漏引起的低眼压和眼内炎的发生。术后护理则加强病情及切口的观察，对出现眼压升高的患者及时发现，及时处理，控制了眼压的持续性升高，减少了并发症的发生。