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

Purpose: Retinal detachment is a sight-threatening condition that requires surgical intervention. However, conventional surgical procedures for retinal detachment repair often adversely affect patients' quality of life. Identifying key factors affecting quality of life is crucial for designing effective clinical interventions.

Methods: This study included 120 patients who underwent retinal detachment repair at our hospital between January 2020 and July 2021. Postoperative quality of life was assessed using the National Eye Institute Visual Function Questionnaire. Univariate and multiple linear regression analyses were conducted to evaluate factors influencing quality of life.

Results: The mean National Eye Institute Visual Function Questionnaire score was 74.82 ± 8.44. The lowest scores were observed in the dimensions of overall vision, distance activities, and mental health. Univariate analysis revealed that gender, education level, occupation, monthly income, preoperative waiting time, surgical method, and visual acuity of both the operative and contralateral eyes significantly affected postoperative quality of life ( P < 0.05). Multivariate regression analysis identified gender, education level, economic status, preoperative waiting time, surgical method, and visual acuity of both the operative and contralateral eyes as independent influencing factors ( P < 0.05).

Conclusion: Postoperative vision-related quality of life among patients with retinal detachment remains suboptimal. Significant influencing factors include gender, education level, economic status, surgical method, preoperative waiting time, and visual acuity of the operative and contralateral eyes. Targeted interventions addressing these factors could improve patient outcomes.

Purpose: To evaluate the regional variation in choroidal vascularity index (CVI) in polypoidal choroidal vasculopathy and its association with intervortex anastomosis (IA).

Methods: Fifty-one eyes with polypoidal choroidal vasculopathy were included. Volumetric optical coherence tomography scans were acquired on a 6 × 6 mm 2 macula area and divided into 36 individual squares. Choroidal vascularity index was calculated using an automated algorithm. The different regions were central, superior-temporal, inferior-temporal (IT), superior-nasal (SN), and inferior-nasal (IN). Intervortex anastomosis was detected using en-face optical coherence tomography.

Results: The mean (SD) CVI of the whole macula was 61.01% (1.46), similar to all the other regions (pairwise comparisons, all P > 0.05). Choroidal vascularity index range was 48.75% to 69.48%. The mean (SD) coefficient of variation was 1.9% (1.3). Intervortex anastomosis was present in 64.7% of eyes. Eyes with IA had higher mean (SD) whole macula CVI (61.39% [1.43] vs. 60.30% [1.26], P = 0.01) and subfoveal CT (265.8 µ m [103.4] vs. 190.1 µ m [78.3], P = 0.01) compared to those without, and a lower mean (SD) CVI range (6.08% [2.38] vs. 8.27% [4.13], P = 0.04). Although the mean CVI coefficient of variation was lower in eyes with IA, 1.6% (0.8) versus 2.4% (1.8), this was not statistically significant ( P = 0.14).

Conclusion: Regional CVI variability may precede the formation of IA supporting the hypothesis that IA could be a compensatory mechanism for choroidal congestion.

Purpose: This study introduces the cloverleaf internal limiting membrane (ILM) flap technique for managing challenging macular holes, aiming to enhance ILM flap placement and improve functional and anatomical outcomes.

Methods: A retrospective review of cases undergoing the cloverleaf ILM flap technique was conducted at a single center. This technique involves creating multiple ILM flaps in a cloverleaf configuration to enhance the stability and coverage of the macular hole. Clinical characteristics, surgical details, and outcomes were analyzed. Visual acuity measurements were converted to logMAR values.

Results: The study included 29 eyes of 29 patients with a mean age of 65.3 years, and 58.6% females. Macular hole aperture and base sizes were 423.7 (±264.9) µ m and 1017.5 (±229.0) µ m, respectively. Preoperatively, 62.1% of cases were phakic and 37.9% were pseudophakic. The median duration of symptoms was 90 (interquartile range: 60-300) days, with surgery performed approximately 34 (interquartile range: 28-69) days after presentation. Anatomical closure was achieved in 93.1% of cases. Patients had a mean 4.5 (±4.4) Snellen lines of improvement in their visual acuity. The median duration of follow-up was 118 (interquartile range: 36-1,491) days.

Conclusion: The cloverleaf ILM flap technique may serve as a promising approach for challenging macular holes. By creating a cloverleaf configuration of quadratic ILM flaps folded over the macular hole, this technique enhances flap stability, potentially improving macular hole closure success.

Purpose: To present a modification of the internal limiting membrane (ILM) peeling technique, transposing a non-inverted autologous ILM patch to resurface the macula for the treatment of epiretinal membrane (ERM).

Methods: This retrospective case series included eight eyes from eight patients with ERM. All patients underwent vitrectomy with ILM peeling and a single-layer, non-inverted autologous ILM patch transposing assisted by subperfluorocarbon liquid injection and ophthalmic viscoelastic device. The anatomical and functional outcomes were evaluated based on the examination of optical coherence tomography and best-corrected visual acuities.

Results: In total, eight eyes with ERM underwent ILM patch transposition technique. The mean age was 69.4 ± 9.8 years. All patients were followed up over 5 months, with the mean duration of 8.3 ± 2.0 months. The surgery significantly improved the best-corrected visual acuities from a mean of 0.8 ± 0.2 logMAR (20/63 ± 32) to 0.2 ± 0.1 logMAR (20/32 ± 25) ( P < 0.001). The reduction in central macular thickness (CMT) was not statistically significant ( P = 0.21). No cases showed ERM recurrence during the follow-up period.

Conclusion: The non-inverted autologous ILM patch transposition technique is feasible for the treatment of ERM and has potential to improve the postoperative best-corrected visual acuity early. However, its effect on reducing CMT may require further investigation with larger cohorts and extended follow-up.

Purpose: To evaluate the efficacy of serial intravitreal methotrexate injections as an adjunct to surgical repair in the management of recurrent rhegmatogenous retinal detachment because of proliferative vitreoretinopathy.

Methods: A retrospective cohort study was conducted involving 41 eyes with a history of failed rhegmatogenous retinal detachment repair presenting with recurrent rhegmatogenous retinal detachment and grade C1 to D proliferative vitreoretinopathy, treated with pars plana vitrectomy and serial methotrexate injections were included, separated into group 1 (with modified Gain Understanding Against Retinal Detachment protocol, n = 27) and group 2 (without modified Gain Understanding Against Retinal Detachment protocol, n = 14). The primary outcome was retinal reattachment rate, and secondary outcomes were changes in visual acuity and postoperative complications.

Results: Retinal reattachment was achieved without additional surgery in 21 (77.8%) eyes in group 1 and 10 (71.4%) in group 2 at final follow-up, with no statistical significance. Improvement in logarithm of the minimal angle of resolution was 0.50 in group 1 and 0.44 in group 2, with a median follow-up of 12.1 months from surgery and no differences in postoperative complications.

Conclusion: There were no differences in retinal reattachment or visual acuity outcomes between both methotrexate regimens. The overall reattachment rate exceeded previously reported rates for recurrent rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Further research is needed to optimize the injection protocol for better clinical outcomes.

Purpose: To report a new technique using tailored corneal punches to prepare round human amniotic membrane (hAM) plugs for the treatment of large full-thickness macular holes (FTMHs).

Methods: Eight eyes with large FTMHs (>650 µ m) in eight patients were included. Pars plana vitrectomy (23 G) was performed, and round hAM plugs were prepared from the hAM patch by using tailored corneal punches. The size of the hAM plug was chosen according to the size of the FTMH. Endotamponade was performed using 14% C 3 F 8 after subretinal implantation of the hAM plugs. The patients were followed up for ≥6 months.

Results: The mean FTMH size was 737.0 ± 86.2 µ m. All FTMHs (100%) were closed within the 6-month follow-up period. The best-corrected visual acuity (LogMAR, [Snellen]) improved significantly from 1.74 ± 0.30 (20/1,000) before surgery to 0.76 ± 0.32 (20/100) at 6 months after surgery ( P < 0.05). No iatrogenic injuries associated with the surgical procedure, rejection of the hAM plug, or parafoveal atrophy was observed throughout the 6-month follow-up.

Conclusion: Subretinal implantation of hAM plugs prepared using tailored corneal punches was safe and effective for repairing large FTMHs. The procedures were successful and associated with promising visual acuity recovery.

Purpose: To report a "sandwich" technique for covering extensively exposed retinal pigment epithelium using large-sized human amniotic membrane (hAM) patches during vitrectomy.

Methods: The study examined six complex cases of rhegmatogenous retinal detachment after open globe injury, using a large hAM to cover exposed retinal pigment epithelium during vitrectomy with the "sandwich" technique. Data were collected preoperatively and during follow-up for at least six months.

Results: In vitrectomy, a "sandwich" of perfluorocarbon liquid, fluid, and air tamponade was formed in the vitreous cavity. All eyes achieved full retinal pigment epithelial coverage, with no intraoperative complications detected. On average, 2.83 ± 1.33 hAM pieces were used, covering an area of 3.53 ± 1.50 cm 2 . Silicone oil tamponade was used in all eyes. During postoperative follow-up, none of the eyes developed postoperative proliferative vitreoretinopathy. Six months later, all patients had successful retinal reattachment, with silicone oil removed from four eyes. Mean best-corrected visual acuity improved from 2.3 ± 0.25 logarithm of the minimum angle of resolution (mean Snellen:20/3990) to 1.42 ± 0.56 logarithm of the minimum angle of resolution (mean Snellen: 20/526) 6 months after surgery ( P = 0.006). No cases of endophthalmitis or hAM rejection were observed during follow-up.

Conclusion: The "sandwich" technique can safely cover exposed retinal pigment epithelium with single or multiple large-sized hAM patches, inhibit postoperative proliferative vitreoretinopathy, and improve the success rate of surgery in patients with complex rhegmatogenous retinal detachment.

Purpose: This study aimed to describe the structural and clinical characteristics of optic disk pit maculopathy-like retinoschisis without a clinically visible optic disk pit and discuss possible pathogenesis and treatment.

Methods: This retrospective observational case series reviewed 20 eyes in 19 patients diagnosed with peripapillary retinoschisis without a visible optic disk pit. Patients were divided into three groups according to the management method: observation, intraocular pressure control, and vitrectomy. Clinical features, optical coherence tomography findings, and clinical outcomes were analyzed.

Results: Eighteen patients had unilateral retinoschisis, and one had bilateral involvement. Initial mean best-corrected visual acuity was 20/40. Eight eyes had glaucoma, and 11 eyes had posterior vitreous detachment. Optical coherence tomography revealed foveal detachment in five eyes and abnormal lamina cribrosa findings in all 20 eyes, including focal lamina cribrosa defects and lamina cribrosa disinsertions. The vitrectomy group showed improvement in best-corrected visual acuity and central foveal thickness compared with the observation and intraocular pressure control groups ( P = 0.016 and 0.011, respectively).

Conclusion: Lamina cribrosa defects were associated with peripapillary retinoschisis without a visible optic disk pit. Vitrectomy may play a role in managing retinoschisis in eyes with peripapillary retinoschisis without a visible optic disk pit.

Purpose: To investigate the retinal displacement and metamorphopsia in patients with primary rhegmatogenous retinal detachment treated with pars plana vitrectomy or scleral buckling.

Methods: This is a prospective nonrandomized interventional study. A total of 107 patients were studied over a period of 6 months postoperatively. The vessel printing on the fundus autofluorescence photos and the M-CHART were used to evaluate the retinal displacement and the metamorphopsia, respectively. We also assessed the vision-related quality of life, the postoperative visual acuity, and the optical coherence tomographic findings.

Results: Sixty-five male and 42 female patients were recruited in the study. The mean age was 54.8 years (SD 14.7, range 18-82). The proportion of eyes detected with retinal displacement at 6 months postoperatively was significantly lower in the scleral buckling group (4.3%) than in the pars plana vitrectomy group (30.9%) (26.6% difference, 95% CI 13.1%-40.1%, P < 0.001). The scleral buckling group had significantly lower postoperative vertical and horizontal metamorphopsia (45.5% difference, 95% CI 28.3%-62.7% P < 0.001 and 38.2% difference 95% CI 20.7%-55.7%, P < 0.001, respectively). There was no significant difference between the two study groups regarding the vision-related quality of life (1.19 difference, 95% CI -5.76 to 7.70, P = 0.783) and visual acuity (0.08 difference, 95% CI 0.00-0.17, P = 0.051).

Conclusion: Although scleral buckling is not superior in visual acuity improvement and quality of life, it improves anatomical outcomes with less retinal displacement and functional outcomes with less metamorphopsia.

Purpose: This study aimed to evaluate the fellow eyes of patients with idiopathic macular hole using optical coherence tomography angiography.

Methods: This retrospective observational case series assessed 48 fellow eyes of patients with idiopathic macular hole and 52 healthy eyes. The data for all patients were recorded, including the findings of the complete ophthalmologic examination, optical coherence tomography, and optical coherence tomography angiography. The patients were classified based on the presence of posterior vitreous detachment, foveal bulge, and foveal base shape.

Results: The foveal vessel densities in the superficial capillary plexus and deep capillary plexus in the fellow eye group were statistically significantly lower than those in the control group. Based on the presence of posterior vitreous detachment and the absence of a foveal bulge, no statistical difference was observed between the optical coherence tomography angiography parameters. The eyes with a smooth base had a significantly lower foveal vessel densities in the superficial capillary plexus compared with those having an irregular base.

Conclusion: While it is well-established that features of vitreomacular traction in the fellow eye may progress to a full-thickness macular hole, even without optical coherence tomography-evidenced vitreomacular interface abnormalities, there can be alterations in the microvasculature. This suggests a possible role in the pathogenesis of a macular hole.