Retina-The Journal of Retinal and Vitreous Diseases最新文献

Purpose: To present a novel bended-needle drainage system in vitreous cavity lavage (VCL) for postoperative vitreous cavity hemorrhage (POVCH).

Methods: This retrospective case series include all patients with POVCH who received VCL with the bended-needle drainage system at ophthalmology department of Peking Union Medical College Hospital from January 2022 to May 2024. Patients adopted a supine position that allows preparation and draping. Balanced salt solution was injected with a 30 Ga needle. One bended 25 Ga needle was used to drain the blood. Primary outcomes include the visual acuity and short-term post-procedure complications. Secondary outcomes include preoperative and postoperative intraocular pressure (IOP) and long-term complications.

Results: Three patients with POVCH received the procedure, with two cases of proliferative diabetic retinopathy and one case of primary central nervous system lymphoma. All patients recovered well after the procedure with minimal complications. Long-term prognosis largely depends on the primary retinal conditions.

Conclusions: In conclusions, VCL with the bended-needle system is safe and effective to manage POVCH with an outpatient surgery, which potentially benefits patients with similar conditions.

Purpose: To describe a simplified technique for correcting intraocular lens (IOL) decentration during scleral-sutured IOL fixation surgery.

Methods: During surgery, Purkinje images were utilized to assess IOL positioning. A straightforward IOL decentration adjustment technique was employed when necessary. Patients in whom IOL position were corrected and who were followed up for at least three months after surgery were included in the study.

Results: From June 2023 to February 2024, six patients with noticeable IOL decentration were successfully treated using this technique. After a mean follow-up of 3.17 ± 0.37 months, there was a significant change in spherical equivalent (preoperative +10.55 ± 2.48 D, postoperative -1.58 ± 2.19 D). While the best-corrected visual acuity, refractive cylinder, intraocular pressure, and corneal endothelium density remained unchanged. Importantly, the IOL was well-centered in all six patients, with average horizontal and vertical IOL decentration of 0.21 ± 0.16 mm and 0.20 ± 0.15 mm, respectively.

Conclusion: This simple IOL decentration correction technique demonstrated favorable results and may enhance IOL positioning in scleral fixation procedures.

Purpose: To characterize retinal vessel whitening (RVW) in Retinitis Pigmentosa (RP).

Methods: Single-center cross-sectional study. Review of clinical notes of clinically confirmed RP patients was performed followed by grading ultra-widefield imaging. Data collected included Best corrected visual acuity (BCVA), presence or absence and location of RVW and were correlated with disease.

Results: In total, 120 RP patients' charts were reviewed. Of these, 116 patients (232 eyes) were included in the final analysis with a mean age of 43.2 (39.8, 46.6) and a 1:1 male to female ratio. RVW was seen in either eye of 44 (38%) subjects, most frequently in the inferotemporal quadrant (p< 0.001). Total retinal thickness within the ETDRS area was significantly less in eyes with RVW (p<0.001), a mean difference of 151.7 µm. Both the inner and outer retina were thinner in the RVW group (p<0.001). There was also a significant association (p<0.04) between the number of quadrants of the retina affected by RVW and the reduction in retinal thickness.

Conclusion: RVW is a common finding in RP, suggesting that it should be considered as a phenotypic feature of RP. RVW is also associated with structural changes to the central macula indicating its potential use as a marker of retinal disease severity.

Purpose: To identify optical coherence tomography (OCT)-based imaging biomarkers that can localize focal leakage points without fluorescein angiography in central serous chorioretinopathy (CSC).

Methods: This retrospective case-control study analyzed 119 consecutive patients (123 eyes) with CSC between April 2018 and February 2024, comprising 66 eyes with focal-leakage type and 57 eyes with diffuse-leakage type. We assessed leakage sites using OCT, and the proportions of OCT findings were compared between focal- and diffuse-leakage types.

Results: Hyporeflective lucency signs were observed in 27 eyes (40.9%) with focal-type CSC, while no such signs were detected in diffuse-type CSC cases (0.0%; P < 0.001). In focal-type CSC, these signs were exclusively localized to leakage points, with no occurrence in other areas within serous retinal detachment. Microrip of retinal pigment epithelium and subretinal hyperreflective material were identified in 23 (34.8%) and 47 (71.2%) eyes with focal-type CSC, respectively, and also in eyes with diffuse-type CSC (5.3% and 19.3%, respectively; P < 0.001 for both comparisons).

Conclusions: Only the hyporeflective lucency sign is present exclusively in focal leakage points of fluorescein angiography. Our findings suggested that the hyporeflective lucency sign may serve as a potential therapeutic target in CSC.

Purpose: To investigate the effect of Henle fiber layer hemorrhage (HFLh) on retinal sensitivity (RS) before and after displacement of the submacular hemorrhage (SMH) caused by retinal arterial macroaneurysm (RAM) rupture.

Methods: This retrospective study included 31 eyes undergoing vitrectomy for SMH. Eyes were grouped based on the presence or absence of HFLh (HFLh [+/-] group). RS was assessed in the fovea and in the area of the HFLh present preoperatively.

Results: The HFLh (+) and HFLh (-) groups had 21 and 10 eyes, respectively. Both groups showed improved postoperative foveal RS (both P < 0.05), which was significantly higher in the HFLh (-) group (P = 0.02). In the HFLh (+) group, RS was significantly lower in the affected eye when compared to the fellow eye (P < 0.01), whereas in the HFLh (-) group, no significant difference was noted between both eyes (P = 0.58). Despite the significant improvement in the postoperative RS in areas with preoperative HFLh (P < 0.001), it remained lower than the RS of the fellow eye (P < 0.05).

Conclusion: SMH displacement improved RS regardless of HFLh presence, although the degree of improvement was limited in the presence of HFLh.

Purpose: Formation of a full thickness macular hole (FTMH) after vitrectomy is rare. The aim of this study was to describe risk factors, clinical course, anatomical and functional prognosis of secondary FTMH development following surgery for primary rhegmatogenous retinal detachment (RRD).

Methods: Retrospective study. Eyes treated for RRD at two centers between 01/2012 and 12/2022 were screened and those that developed secondary FTMH after pars plana vitrectomy (PPV) without membrane peeling were included in our analysis.

Results: 29 eyes (mean age 58.9±9.5 years, 51.7% female) of 5,219 eyes developed secondary FTMH following PPV for retinal detachment, equaling a rate of 0.56%. Median interval between vitrectomy and FTMH diagnosis was 14.0 months (Q1 2.0; Q3 61.0; range 1 - 373). FTMH was treated by re-PPV, Membrane limitans interna peeling, sulfur hexafluoride (SF6 20-25%) endotamponade in 22, silicone oil in 6, and heavy silicone oil in 1 eye. In 88.0% FTMH closure was observed after surgery. Postoperative mean visual acuity of all eyes was 20/145 Snellen (0.86±0.76 logMAR) versus preoperative 20/215 (1.03±0.43; p<0.001).

Conclusion: Secondary FTMH after RRD repair is a rare occurrence complication and can often be successfully treated by re-PPV. Visual acuity improves following successful hole closure, but less than in primary FTMHs.

Purpose: To study the role of intravitreal clindamycin with dexamethasone as an adjuvant to systemic co-trimoxazole and steroids in macular Toxoplasma retinochoroiditis.

Methods: Retrospective study of Toxoplasma retinochoroiditis cases from January 2014 to December 2021 treated with a combination of oral and intravitreal therapy in immunocompetent patients.

Results: 39 eyes of 39 patients were included in this study after meeting the inclusion criteria with the mean age of presentation being 25.25 years (± 9.30; range 4-52 years). Male preponderance with 61.53 % of males (n = 24) and 38.47% of females (n = 15) was observed. Active retinitis was unilateral in all eyes (20 right eyes; 19 left eyes). Five lines of improvement in vision acuity on ETDRS chart were noted at final visit. The location of retinitis was either foveal (n=24) or extrafoveal (n=15). The mean size of retinitis was 1.24 ± 0.70-disc diameter. The mean number of injections given was 1.79 with a mean interval of 1.39 weeks.

Conclusions: Intravitreal clindamycin with dexamethasone when used as an adjunct to systemic therapy showed resolution of retinitis in all cases with visual improvement.

Purpose: We report a novel technique which enables to cut any kind of foldable lens and extract it using capsulorhexis forceps and a 1.2 mm single-use slit angled knife.

Methods: The technique consists in using the capsulorhexis forceps to mantain and stabilize the IOL in the anterior chamber, and while one hand holds the IOL in that way, the second hand introduces a 1.2 mm slit angled knife through a paracenthesis and cuts the IOL on 3/4 of his diameter. The IOL is then extracted in one or twe pieces.

Results: Since march 2021 we performed the technique in 82 eyes of 79 patients. Learning curve was very fast and the technique was easily managed by two experimented surgeons.

Conclusion: Intraocular lens (IOL) explantation is not a simple surgical technique, and requires potentially dangerous surgical maneuvers hence the description of several surgical techniques, and the existence of expensive extraction kits which provide micro scissors and micro forceps to cut the lens more easily. We believe that the knife cut technique, which has never described to this day, is particularly interesting since it is cheap, easy to do, and useful for all foldable IOL explantation.

Purpose: To describe effects of sustained-release steroid delivery devices on intraocular pressure (IOP) in eyes with glaucoma drainage devices (GDD).

Methods: Retrospective case series of eyes with steroid implants (dexamethasone or fluocinolone acetonide) and prior GDD (Ahmed, Baerveldt) without uveitis. Outcomes included IOP, IOP rise, central foveal thickness (CFT), and IOP medications.

Results: We included 14 eyes (14 patients, 38% male, 94% pseudophakic). Mean age at steroid implantation was 64 ± 12 years. Baerveldt (64%) was more common than Ahmed (36%). Tubes were in the anterior chamber (57.1%), sulcus (28.6%), and pars plana (14.3%). Ozurdex (93%) was more common than Yutiq (7%). Mean IOP was 13.5 ± 3.4 mmHg pre-implant, 11.8 ± 3.7 mmHg at month 1, 13.3 ± 3.6 mmHg at month 3 (p=0.35), and 11.3 ± 3.8 mmHg at 1 year (p=0.032). Mean antihypertensive medications was unchanged at month 3 (p = 1.0), and -0.36 medications at last follow-up (p = 0.35). Mean CFT change was -204 ± 158 μm (p = 0.001). There were no cases of endophthalmitis.

Conclusions: Intravitreal steroid implants were safe and effective for the treatment of post-surgical CME in patients with pre-existing GDD. There was no increase in IOP and no increase in antihypertensive drops.

Purpose: To assess the effectiveness of split-thickness amniotic membrane (SAM) grafts in achieving closure of refractory or large macular holes (MH).

Methods: This retrospective study reviewed data from patients who underwent surgical repair of MHs using SAM grafts between January 2019 and December 2023. Key parameters, including best-corrected visual acuity (BCVA) and MH size, were evaluated both preoperatively and postoperatively.

Results: The study included 13 patients (9 females; mean age 63.5 years). Before surgery, the median BCVA was 1.30 ± 0.56 LogMAR (approximate Snellen equivalent: 20/400), and the median MH size measured 717 ± 246.6 µm. After an average follow-up period of 28 months, the median BCVA improved significantly to 1.00 ± 0.52 LogMAR (p < 0.05) (approximate Snellen equivalent: 20/200). All MHs were successfully closed, and no intraoperative complications were observed.

Conclusion: SAM grafting is a safe and reliable option for closing refractory or large MHs, resulting in significant improvements in BCVA and successful hole closure. Compared to full-thickness grafts, SAM grafts offer advantages such as increased flexibility in placement and ease of removal post-closure, due to their thinner and more pliable nature, which facilitates easier handling and positioning within the MH.