Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyalo...Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyaloid and have been refractory to standard laser treatment. Methods: Review of 26 eyes of 20 patients consecutively were treated with PPV with ILM peel for refractory diabetic macular edema. Eyes were included if they had been unresponsive to conventional treatment defined as at least two focal laser applications by a retina specialist. Paired t- testing was performed to determine if a change in both optical coherence tomography (OCT)-Measured retinal thickness and logarithm of the minimum angle of resolution (logMAR) visual acuity occurred prior to and following PPV with epiretinal membrane vitrectomy. In addition, we performed multivariate regression analysis to determine if any clinical variables predicted a change in visual acuity. Results: The mean age in the sample was 65 years (range 29- 81 years). The mean follow-up time was 242 days (range35- 939). Sixteen of the 26 eyes were phakic and the remaining ten were pseudophakic. There was a statistically significant improvement of mean visual acuity from a preoperative logMAR vision of 1.0 to a best postoperative vision of 0.75 (P=0.016, paired t-test). Thirteen (50% ) of the 26 eyes gained at least two lines of best-corrected Snellen acuity, three (11.5% ) had a decline of at least two lines, and ten (38.5% ) showed stable visual acuity. Regression analysis demonstrated that baseline worse visual acuity was the only clinical variable that was associated with improvement in visual acuity (beta=0.602, P=0.016; R2=28.7). Fourteen eyes had preoperative and postoperative OCT. Thirteen eyes (93% )-had a significant decrease in foveal thickness; with an average preoperative thickness of 575 μ m compared to a postoperative average of 311 μ m (t=3.65, P=0.002). No surgical complications were observed during the follow-up period. Conclusions: Surgery for refractory diabetic edema without a taut hyaloid is associated with a significant improvement in visual acuity and diminution of retinal thickness as measured by OCT. Further investigations are warranted to define the role of surgery in the management of persistent diabeticmacular edema.展开更多
Purpose: To investigate ultrastructural changes in the aqueous outflow route and discuss the mechanisms associated with intraocular pressure (IOP) elevation ina patient with presumably early stage Chandler’s syndrome...Purpose: To investigate ultrastructural changes in the aqueous outflow route and discuss the mechanisms associated with intraocular pressure (IOP) elevation ina patient with presumably early stage Chandler’s syndrome. Methods: A 47-yea r-old man underwent trabeculectomy because of elevated IOP. A specimen obtained during surgery was studied by transmission electron microscopy. Results: Electr on microscopy showed the presence of a monolayer composed of corneal endothelium -like cells and thick basement membrane-like material. Neovascularization was also observed in the corneoscleral trabeculum. Conclusions: Our results indicate that several mechanisms, including the formation of basement membrane-like tis sue, infiltration of inflammatory cells and neovascularization, might contribute to the elevation of IOP in Chandler’s syndrome. These may occur even when ther e is no history of conspicuous inflammatory reaction in the anterior ocular segm ents.展开更多
Objective: To identify the characteristics of patients with myopic choroidal neovascularization (CNV) who had a favorable visual prognosis without treatment. Methods: We reviewed the medical records of 52 conse cutive...Objective: To identify the characteristics of patients with myopic choroidal neovascularization (CNV) who had a favorable visual prognosis without treatment. Methods: We reviewed the medical records of 52 conse cutive patients (57 eyes) with myopic CNV who were followed for at least 5 years after the onset of CNV. Clinical characteristics (patient age, CNV size and location, visual acuity at onset, chorioretinal atrophy development around CNV, and degree of myopia) were compared between patients whose visual acuity 5 years after CNV onset was better than 20/40 and those whose visual acuity was worse than 20/200. Results: Among 57 eyes, eight eyes (14.0% ; 8 patients) had a final visual acuity better than 20/40. On the other hand,37 eyes (64.9% ;33 patients) had a final visual acuity worse than 20/200. Statistical analysis revealed that the patients with a good prognosis (final visual acuity better than 20/40) were significantly younger, had significantly smaller CNV, and significantly better initial visual acuity (Mann-Whitney U-test, P < 0.05). Juxtafoveal CNV was more frequently observed in patients with a good prognosis than in those with a poor prognosis (Fisher’ s exact probability test, P < 0.05). Only one patient (12.5% ) in the good prognosis group developed a very limited area of chorioretinal atrophy around the regressed CNV, while 91.9% of the patients in the poor prognosis group developed chorioretinal atrophy. Refractive status and the axial length measurements did not differ between the two groups. Conclusions: Some young patients with myopic CNV retain favorable vision over the long term without active treatment. These informationmight be useful to predict the visual outcome of patients with myopic CNV.展开更多
文摘Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyaloid and have been refractory to standard laser treatment. Methods: Review of 26 eyes of 20 patients consecutively were treated with PPV with ILM peel for refractory diabetic macular edema. Eyes were included if they had been unresponsive to conventional treatment defined as at least two focal laser applications by a retina specialist. Paired t- testing was performed to determine if a change in both optical coherence tomography (OCT)-Measured retinal thickness and logarithm of the minimum angle of resolution (logMAR) visual acuity occurred prior to and following PPV with epiretinal membrane vitrectomy. In addition, we performed multivariate regression analysis to determine if any clinical variables predicted a change in visual acuity. Results: The mean age in the sample was 65 years (range 29- 81 years). The mean follow-up time was 242 days (range35- 939). Sixteen of the 26 eyes were phakic and the remaining ten were pseudophakic. There was a statistically significant improvement of mean visual acuity from a preoperative logMAR vision of 1.0 to a best postoperative vision of 0.75 (P=0.016, paired t-test). Thirteen (50% ) of the 26 eyes gained at least two lines of best-corrected Snellen acuity, three (11.5% ) had a decline of at least two lines, and ten (38.5% ) showed stable visual acuity. Regression analysis demonstrated that baseline worse visual acuity was the only clinical variable that was associated with improvement in visual acuity (beta=0.602, P=0.016; R2=28.7). Fourteen eyes had preoperative and postoperative OCT. Thirteen eyes (93% )-had a significant decrease in foveal thickness; with an average preoperative thickness of 575 μ m compared to a postoperative average of 311 μ m (t=3.65, P=0.002). No surgical complications were observed during the follow-up period. Conclusions: Surgery for refractory diabetic edema without a taut hyaloid is associated with a significant improvement in visual acuity and diminution of retinal thickness as measured by OCT. Further investigations are warranted to define the role of surgery in the management of persistent diabeticmacular edema.
文摘Purpose: To investigate ultrastructural changes in the aqueous outflow route and discuss the mechanisms associated with intraocular pressure (IOP) elevation ina patient with presumably early stage Chandler’s syndrome. Methods: A 47-yea r-old man underwent trabeculectomy because of elevated IOP. A specimen obtained during surgery was studied by transmission electron microscopy. Results: Electr on microscopy showed the presence of a monolayer composed of corneal endothelium -like cells and thick basement membrane-like material. Neovascularization was also observed in the corneoscleral trabeculum. Conclusions: Our results indicate that several mechanisms, including the formation of basement membrane-like tis sue, infiltration of inflammatory cells and neovascularization, might contribute to the elevation of IOP in Chandler’s syndrome. These may occur even when ther e is no history of conspicuous inflammatory reaction in the anterior ocular segm ents.
文摘Objective: To identify the characteristics of patients with myopic choroidal neovascularization (CNV) who had a favorable visual prognosis without treatment. Methods: We reviewed the medical records of 52 conse cutive patients (57 eyes) with myopic CNV who were followed for at least 5 years after the onset of CNV. Clinical characteristics (patient age, CNV size and location, visual acuity at onset, chorioretinal atrophy development around CNV, and degree of myopia) were compared between patients whose visual acuity 5 years after CNV onset was better than 20/40 and those whose visual acuity was worse than 20/200. Results: Among 57 eyes, eight eyes (14.0% ; 8 patients) had a final visual acuity better than 20/40. On the other hand,37 eyes (64.9% ;33 patients) had a final visual acuity worse than 20/200. Statistical analysis revealed that the patients with a good prognosis (final visual acuity better than 20/40) were significantly younger, had significantly smaller CNV, and significantly better initial visual acuity (Mann-Whitney U-test, P < 0.05). Juxtafoveal CNV was more frequently observed in patients with a good prognosis than in those with a poor prognosis (Fisher’ s exact probability test, P < 0.05). Only one patient (12.5% ) in the good prognosis group developed a very limited area of chorioretinal atrophy around the regressed CNV, while 91.9% of the patients in the poor prognosis group developed chorioretinal atrophy. Refractive status and the axial length measurements did not differ between the two groups. Conclusions: Some young patients with myopic CNV retain favorable vision over the long term without active treatment. These informationmight be useful to predict the visual outcome of patients with myopic CNV.
