This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians...This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians in determining surgical indications,assessing patient conditions,and offering valuable assistance in formulating surgical strategies and predicting outcomes.Developed by a collaborative team of experts from the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,in conjunction with the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,these guidelines have been formulated through extensive research and evaluation,incorporating the latest technological advancements and studies on a global and domestic scale in vitreoretinal surgery.After extensive deliberations and incorporation of up-to-date clinical data,these guidelines have been developed to assist in standardizing preoperative examinations for vitreoretinal surgery.The overarching goals include improving medical quality,maximizing resource allocation,offering decision-making assistance,and safeguarding patient rights.This document provides a comprehensive analysis of preoperative assessments for vitreoretinal procedures,covering principles,methodologies,and precautions related to a range of diagnostic techniques including ultra-wide-angle fundus imaging,fluorescein angiography,indocyanine green angiography,ophthalmic B-ultrasound examinations,ultrasound biomicroscopy,optical coherence tomography,optical coherence tomography angiography,orbital CT scan,orbital MRI,and ophthalmic electrophysiology tests such as electroretinograms,visually evoked potentials,and visual field testing.展开更多
Epstein-Barr virus(EBV)infection is well-known for its association with lymphoproliferative disorders and various lymphomas,causing significant global morbidity and mortality.EBV-positive vitreoretinal lymphoma(VRL)is...Epstein-Barr virus(EBV)infection is well-known for its association with lymphoproliferative disorders and various lymphomas,causing significant global morbidity and mortality.EBV-positive vitreoretinal lymphoma(VRL)is exceedingly rare.As a result,the pathogenic role and genomic characteristics of EBV in VRL remain poorly understood.In this study,we employed droplet digital PCR(ddPCR)combined with EBV-specific immunofluorescence assay to detect EBV in the vitreous fluid of fifty-three VRL patients.We found that approximately 28%(15/53)of the patients were EBV positive.Analysis of clinical data showed that EBV-positive VRL patients had shorter progression-free survival(PFS)compared to EBV-negative patients(P=0.004).Additionally,through integration of EBV-targeted sequencing and PCR-based deep sequencing,we found that all five VRL-derived EBV genomes formed a distinct cluster within one phylogenetic branch.Meanwhile,several non-synonymous mutations were exclusively detected in the VRL group,including S229T in latent membrane protein 1(LMP1)and G2248R in the Epstein-Barr virus BamHI-PraL fragment 1(BPLF1).In conclusion,our findings suggest that EBV as a risk factor associated with poor prognosis in VRL,and we provide a genome-wide view of EBV sequence variations from VRL patients.This may offer insights into the pathogenic role of EBV in VRL and could potentially assist in the diagnosis and treatment of this disease.展开更多
AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.M...AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.展开更多
AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival su...AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and complications.RESULTS: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) eye.CONCLUSION: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.展开更多
Objective To examine the hyperglycemic effects of periocular dexamethasone injection in type 2 diabetic patients after vitreoretinal surgery （VRS）. Methods This was a retrospective non-randomized controlled trial. T...Objective To examine the hyperglycemic effects of periocular dexamethasone injection in type 2 diabetic patients after vitreoretinal surgery （VRS）. Methods This was a retrospective non-randomized controlled trial. Twenty consecutive hospitalized patients with type 2 diabetes and ocular inflammatory reaction after VRS were enrolled in this study. Ten patients received 2.5 mg dexamethasone and 10 patients received 5 mg dexamethasone. Fourteen consecutive type 2 diabetic patients without ocular inflammatory reaction after VRS were used as control group. We measured fasting blood glucose （FBG） and at 2 h after each meal （post prandial glucose, PBG; 09：00, 13：00, and 19：00 h） after periocular dexamethasone injection. Differences among three groups were determined by q tests. Results The PBG levels in both dexamethasone-treated groups started to increase within 5 h after injection （i.e., PBG at 13：00 h）, and were significantly increased at 29：00 h after injection （P〈0.05）. BG levels were almost 2-fold higher than at baseline and compared with the control group. The BG values declined gradually by 24 h to 48 h after injection. There were no differences in BG levels between the two dexamethasone-treated groups （P〉0.05）, except for PBG at 19：00 h on day 2 after injection （P〈0.05）. Conclusion Periocular dexamethasone injection can cause transient hyperglycemia in diabetic patients after VRS. BG monitoring should be performed following such injection.展开更多
AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients wh...AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.展开更多
AIM:To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional(3D) visualization system.METHODS:Enucleated porcine eyes were estab...AIM:To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional(3D) visualization system.METHODS:Enucleated porcine eyes were established as an animal model for removing foreign bodies.Forty medical students were recruited to remove foreign bodies to compare the traditional microscope and the 3D system.One junior resident performed the surgical task with manual and robot-assisted operations on 20 porcine eyes for each group.One senior surgeon evaluated the retinal invasion by a graded injury degree.The learning curve for minimally invasive vitreoretinal surgery was described.RESULTS:Compared with the robot-assisted group,the injury degree was higher in the manual group.For the first ten surgeries,the manual and robot-assisted groups had injuries of 2.60±1.35(4 to 0) and 1.80±1.62(4 to 0),respectively.For the last ten surgeries,the injury degrees were 1.90±1.20(3 to 0) and 0.80±0.42(1 to 0).Considering the manual and robot-assisted groups together,95%,75% and 60% of the students considered surgical manipulation with the 3D visualization system to be more comfortable,easier and clearer,respectively.CONCLUSION:The robot-assisted surgical system and 3D visualization system may have value in teaching minimally invasive vitreoretinal surgery.展开更多
The objective is to introduce the application of intraoperative optical coherence tomography(iOCT)in pars plana vitrectomy(PPV)for various vitreoretinal diseases,and to report the 4-year assessment of feasibility and ...The objective is to introduce the application of intraoperative optical coherence tomography(iOCT)in pars plana vitrectomy(PPV)for various vitreoretinal diseases,and to report the 4-year assessment of feasibility and utility in Chinese population.We reported a retrospective case series of patients who underwent PPV and iOCT scan at Eye Hospital of Wenzhou Medical University from January 2016 to January 2020.Clinical characteristics were documented before operation,and we intraoperatively recorded the time and results of iOCT scanning,specific surgical maneuvers performed,the consistency with the planned strategies before surgery,the type of OCT images obtained,and adverse events(AEs).The surgeon feedback was collected to evaluate the utility of iOCT during surgery.In total 339 eyes successfully completed iOCT scan,with an average scanning time of 3.54±2.3 min,including 59 cases of idiopathic macular hole(iMH),134 cases of idiopathic epiretinal membrane(iERM),33 cases of lamellar macular hole(LMH),40 cases of high myopic maculopathy,13 cases of vitreous macular traction(VMT),60 cases of dense vitreous hemorrhage(VH).The iOCT findings were not consistent with exami-nation under the operating microscope in 49 cases(14.5%),including 29 cases(8.6%)which changed the operation strategies during surgery.The Hole-door phenomenon arose in 20 cases(33.9%)of iMH and 3 cases(25%)of high myopic MH after ILMs peeling.Moreover,the residue ERM was observed in nine cases(6.7%)of iERM and two cases(14.3%)in high myopic ERM after ILMs peeling.Some new surgical methods could also be confirmed using iOCT.The ap-plication of iOCT has a significant clinical functionality in vitreoretinal surgery,providing the surgeon with a new surgical understanding,guiding the selection of a more reasonable operative procedure during surgery,predicting postoperative recovery and improving postoperative outcomes.展开更多
AIM： To evaluate the outcomes of vitreoretinal surgery for four different phenotypes of X-linked retinoschisis （XLRS）. METHODS： This study included thirty-one eyes of 25 patients who developed XLRS with severe...AIM： To evaluate the outcomes of vitreoretinal surgery for four different phenotypes of X-linked retinoschisis （XLRS）. METHODS： This study included thirty-one eyes of 25 patients who developed XLRS with severe complications. Among the 31 eyes, there were 7 eyes with vitreous hemorrhage, 8 eyes with retinal detachment and vitreous hemorrhage, and 16 eyes with rhegmatogenous retinal detachment. All of the patients underwent standard three-port pars plana vitrectomy. All of the eyes were divided into 4 groups before surgery according to a modified classification scheme, with the first three groups as follows： group A, with foveal cystic schisis; group B with macular lamellar schisis; and group C with foveolamellar changes. Peripheral schisis was not present in these 3 groups; however, group D was a complex group with both macular and peripheral changes. One year after surgery, we analyzed the best corrected visual acuity and postoperative anatomical and functional outcomes of these 4 groups. RESULTS： There were 7 eyes in group A （22.6%）, 1 eye in group B （3.2%）, 15 eyes in group C （48.4%） and 8 eyes in group D （25.8%）. Postoperative anatomical and functional outcomes were satisfactory at the last visit, while the mean visual acuity was increased to 0.27±0.11, with a significant difference （t=-1.049, P=0.000） compared with the results before surgery （0.1±0.08）. Visual acuity was improved in 23 eyes （74.2%）. Complications were found in three eyes： two eyes with proliferative vitreoretinopathy and traction retinal detachment 10 and 12mo after surgery, respectively; and one eye with vitreous hemorrhage 15mo after surgery. These eyes were in groups C and D. The retinas remained attached in these 3 eyes after reoperation. CONCLUSION： We should pay greater attention to XLRS with foveolamellar changes because it is the most changeable phenotype. Once complications occur, vitreoretinal surgery can significantly improve visual acuity and restore the anatomic structure of the retina.展开更多
AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all p...AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study.Subjects with CED 1 d after surgery without intraoperative corneal debridement was defined as the postoperative CED group.Subjects who underwent intraoperative debridement were defined as intraoperative debridement group.Eyes were matched 2:1 with controls(eyes without postoperative CED)for comparative assessment.The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement.Secondary outcomes included time to defect closure,delayed healing(>2 wk),visual acuity(VA)and presence of scarring at one year and cornea consult.RESULTS:This study included 856 eyes that underwent vitreoretinal surgery.Intraoperative corneal debridement was performed to 61(7.1%)subjects and postoperative CED developed spontaneously in 94(11.0%)subjects.Significant factors associated with postoperative CED included prolonged surgical duration(P=0.003),diabetes mellitus(P=0.04),postoperative ocular hypotension(P<0.001).Prolonged surgical duration was associated with intraoperative debridement.Delayed defect closure time(>2 wk)was associated with corneal scar formation at the end of the 1 y in all epithelial defect subjects(P<0.001).The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%.CONCLUSION:Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED.Delayed defect closure is associated with a greater risk of corneal scarring at one year.The overall rate of corneal scarring following vitrectomy is low at<2%.展开更多
Primary vitreoretinal lymphoma (PVRL), as a subset of primary central nervous system lymphoma (PCNSL), is a rare and fatal ocular malignancy. Most PVRL masquerades as chronic posterior uveitis, which makes the clinica...Primary vitreoretinal lymphoma (PVRL), as a subset of primary central nervous system lymphoma (PCNSL), is a rare and fatal ocular malignancy. Most PVRL masquerades as chronic posterior uveitis, which makes the clinical diagnosis challenging. Vitreous cells, subretinal lesions and imaging techniques are essential for clinical diagnosis. Importantly, cytopathology/histopathology identification of malignant cells is the gold standard for the diagnosis of PVRL. In addition, molecular detection of immunoglobulin heavy chain (IgH) or T cell receptor (TCR) gene rearrangements, immunophenotyping for cell markers, and cytokine analysis of interleukine-10 elevation are often used as adjunct procedures. Current management of PVRL involves local radiation, intravitreal chemotherapy (methotrexate and rituximab), with or without systemic chemotherapy depending on the involvement of non-ocular tissues. In cases with concomitant PCNSL, systemic high-dose methotrexate/rituximab based therapy in conjunction with local therapy, whole brain radiotherapy and/or autologous stem cell transplantation is considered. Although PVRL normally responds well to initial treatment, high rates of relapse and CNS involvement usually lead to poor prognosis and limited survival. A professional team of medical experts in ophthalmologists, ocular pathologists, neuro-oncologists and hemato-oncologists is essential for optimizing patient management.展开更多
AIM:To investigate the value of cytokine analysis in aqueous humor(AH)for discriminating vitreoretinal lymphoma(VRL)from uveitis and for evaluating the efficacy of intravitreal methotrexate(MTX)injections.METHODS:This...AIM:To investigate the value of cytokine analysis in aqueous humor(AH)for discriminating vitreoretinal lymphoma(VRL)from uveitis and for evaluating the efficacy of intravitreal methotrexate(MTX)injections.METHODS:This retrospective study was done on 28 VRL patients between 2013 and 2019.AH interleukin(IL)-10,IL-6,IL-8,vascular endothelial growth factor(VEGF),and vascular cell adhesion molecules(VCAM)were measured in 28 VRL patients and 38 uveitis patients.As to the respective examinations for distinguishing VRL from uveitis,the diagnostic accuracy was evaluated by receiver operating characteristic(ROC)curve analysis.The response to treatment was monitored by observing changes in bestcorrected visual acuity(BCVA),ocular manifestation,and AH cytokine levels in 21 patients with VRL who had undergo multiple intravitreal injections of MTX.RESULTS:Compared with uveitis patients,VRL patients had higher IL-10 level(P<0.001)and IL-10/IL-6 ratio(P<0.001),whereas patients with uveitis had significantly higher IL-6 level than those with VRL(P=0.003).An ROC analysis was used to identify the diagnostic threshold values for VRL,and it was found that optimal sensitivity and specificity improved to 94.1%and 100%,respectively,for IL-10/IL-6>1.55 and 88.2%and 81.1%,respectively,for IL-10>76.7 pg/m L.In 21 patients who had undergo repeated injections,improvements in BCVA,clinical remission of VRL and continuous decrease in cytokine levels over time were observed.In those patients,the BCVA correlated with the aqueous levels of IL-10 and IL-6 during the course of disease treatment.CONCLUSION:The combination of the aqueous cytokine profiles can be instrumental for conventional diagnostic methods and for progression monitoring and treatment response.展开更多
AIM:To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis(TKP)in patients with severe corneal opacifications.METHODS:Three patients with simultaneous corneal...AIM:To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis(TKP)in patients with severe corneal opacifications.METHODS:Three patients with simultaneous corneal and vitreoretinal pathology were treated with a soft contact lens that was used as a TKP to facilitate vitreoretinal surgery.The soft contact lens was fixated with sutures onto the globe so that no leakage was possible.RESULTS:Vitreoretinal surgery with excellent fundus view was possible in all cases.The soft contact lens allowed safe central and peripheral vitrectomy.Surgery was successful in all cases.CONCLUSION:A soft contact lens properly fixated on the globe can successfully replace a TKP.This surgical procedure has several advantages like one size fits all,low costs,and easy access to the material.展开更多
Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA ...Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was significant difference among the four groups with better outcome in group III, as in group III represented the most rapid onset of lid akinesia. As respecting to the onset of global akinesia there was significant difference among the four groups. There was better outcome in group III as it represented more rapid onset of global akinesia compared with other groups. There were significant differences among the four groups as regard postoperative pain all over 6 hours, better results were in group III (0.27 ± 0.69) compared with group I (2.23 ± 1.17), group II (2.00 ± 1.70), group IV (0.67 ± 0.71). As regarding to the first time for analgesic requirement there were significant differences among groups, there was no request for analgesia with better outcome in group III with increasing need to the analgesic medication in group I compared to group II and group IV. As regard side effects postoperatively there were few side effects in all groups with few numbers of cases in groups III only one patient. Although these differences in number of patients are not significant among the four groups. Conclusion: Addition of sodium bicarbonate to local anesthetic mixture was the best way in lowering the IOP other than other groups and addition of fentanyl to local anesthesia provided more rapid onset and duration of anesthesia, more rapid onset and duration for lid and global akinesia, less pain, less analgesic requirement and minimal side effects than the other groups.展开更多
Dear Editor,Primary vitreoretinal lymphoma（PVRL）is a rare form of ocular malignancy and it is usually considered as a subset of primary central nervous system lymphoma（PCNSL）.An insidious onset associated with del...Dear Editor,Primary vitreoretinal lymphoma（PVRL）is a rare form of ocular malignancy and it is usually considered as a subset of primary central nervous system lymphoma（PCNSL）.An insidious onset associated with delays in diagnosis iscommon.展开更多
AIM: To assess the presenting clinical features, time from presentation to diagnosis and association with central nervous system(CNS) lymphoma in patients with vitreoretinal lymphoma.METHODS: Retrospective case series...AIM: To assess the presenting clinical features, time from presentation to diagnosis and association with central nervous system(CNS) lymphoma in patients with vitreoretinal lymphoma.METHODS: Retrospective case series of patients diagnosed with vitreoretinal lymphoma between 2009 and 2011 at a single center.RESULTS: Fifteen eyes in 9 patients were included. Common presenting ocular symptoms included blurred vision(78%) and worsening floaters(44%) with an average symptom duration prior to presentation of 88.4 d(range 7-365 d). Common ophthalmic exam findings were vitreous haze(89%) and subretinal lesions(56%). The average time from presentation to diagnosis was 56.3 d(range 16-180 d). All patients were diagnosedwith large B-cell lymphoma according to pathology results. Lymphoma was restricted to the eye in 33%, while 67% of patients had CNS involvement. Of the patients with secondary vitreoretinal lymphoma, 67% initially presented with CNS lymphoma while 33% initially presented with vitreoretinal lymphoma. Of the patients with CNS involvement, memory loss(67%) was the most common presenting symptom.CONCLUSION: Vitreoretinal lymphoma most commonly presents with symptoms of blurred vision and/or worsening floaters and vitreous haze on exam. The average time from presentation to diagnosis may be decreasing with increased awareness among clinicians.展开更多
Background and Objective:Vitreoretinal surgery requires fine micro-surgical training and handling of delicate tissue.To aid in the training of residents and fellows,unique educational modalities exist to help facilita...Background and Objective:Vitreoretinal surgery requires fine micro-surgical training and handling of delicate tissue.To aid in the training of residents and fellows,unique educational modalities exist to help facilitate the development of these microsurgical skills.From virtual simulators to artificial eye models,simulation of the posterior segment has gained an increased focus in vitreoretinal surgical training programs.Development of surgical curricula for vitreoretinal training and attainment of surgical milestones has been a key component in integrating these educational training modalities.We will explore various simulators,eye models,and potential rubrics and discuss unique ways each may help and complement one another to train future vitreoretinal surgeons.Methods:We conducted a systematic PubMed search of various review studies(from publications in English ranging from January 1978 to December 2020)discussing surgical simulators,eye models,and surgical rubrics for vitreoretinal surgery and their potential impacts upon training.Key Contents and Findings:Our review assesses the benefits and applicability of various simulators,eye models,and surgical rubrics upon training.Conclusions:Utilization of vitreoretinal surgical training tools may aid in complementing the hands-on surgical training experience for vitreoretinal surgical fellows.By using simulators and rubrics,we may better be able to standardize training for reaching vitreoretinal surgical milestones and providing adequate feedback to improve surgical competency and ultimately patient outcomes.展开更多
Primary vitreoretinal lymphoma(PVRL),a rare subtype of primary central nervous system lymphoma(PCNSL),can lead to permanent vision loss and central nervous system(CNS)involvement,resulting in a poor prognosis.PVRL oft...Primary vitreoretinal lymphoma(PVRL),a rare subtype of primary central nervous system lymphoma(PCNSL),can lead to permanent vision loss and central nervous system(CNS)involvement,resulting in a poor prognosis.PVRL often masquerades as uveitis,and its partial response to topical corticosteroids further complicates the diagnosis.The gold standard for diagnosis is cytological analysis;however,owing to its low sensitivity,cytokine profiling and genetic testing may serve as supplementary diagnostic tools.There is no universally accepted consensus regarding PVRL treatment protocols.Combined systemic high-dose intravenous methotrexate(MTX)and intravitreal therapy may help manage bilateral ocular lesions,although this combination’s ability to delay CNS relapse remains controversial.For relapsed or refractory(R/R)PVRL patients aged<60 years,intensive consolidation chemotherapy followed by autologous stem cell transplantation may be considered.Novel targeted therapies such as ibrutinib and lenalidomide have demonstrated efficacy in R/R cases.Large-scale multicenter prospective studies are urgently needed to determine optimal treatment strategies.展开更多
Dear Editor,I diopathic macular telangiectasia(MacTel)type 1 is a retinal vascular disease characterized by abnormal dilation of macular capillaries,leading to metamorphopsia,progressive vision loss,and temporal scoto...Dear Editor,I diopathic macular telangiectasia(MacTel)type 1 is a retinal vascular disease characterized by abnormal dilation of macular capillaries,leading to metamorphopsia,progressive vision loss,and temporal scotoma enlargement.Currently,there is no standardized treatment protocol for MacTel type 1[1-2].Treatment outcomes can vary significantly among individuals,highlighting the ongoing need for further exploration of new and more effective treatment options.This paper presents a case of refractory macular edema associated with MacTel type 1,which showed a favorable response to pars plana vitrectomy(PPV)and internal limiting membrane(ILM)peeling.展开更多
AIM:To evaluate the efficacy of second-stage phacoemulsification(PE)of complicated initial cataract after vitreoretinal surgery(VRS)in patients with advanced proliferative diabetic retinopathy(PDR).METHODS:Totally 216...AIM:To evaluate the efficacy of second-stage phacoemulsification(PE)of complicated initial cataract after vitreoretinal surgery(VRS)in patients with advanced proliferative diabetic retinopathy(PDR).METHODS:Totally 216 patients with PDR and complicated initial cataract who underwent surgery were included.These patients were divided into four groups according to their management.In the 1st group patients were subjected to a two–step surgical procedure:VRS with silicone oil tamponade was performed as the first step,followed by the second step,PE+intraocular lens(IOL)implantation+silicone oil removal.In the 2nd group PE was performed simultaneously with VRS and silicone oil tamponade.The second step differed in the removal of silicone oil from the vitreous cavity.Patients Ia(n=17)and IIa(n=17)subgroups had their tear liquid samples being examined before surgery and on the 2nd day after the 1st phase.In subgroups Ib and IIb,an angiogenesis inhibitor was implanted 10-14d before VRS at a dose of 0.5 mg once.In the 3rd group patients were subjected to a two–step surgical procedure:VRS with gas tamponade performed as the 1st step in their treatment;followed by the 2nd step,PE and the IOL implantation.In the 4th group PE performed simultaneously with VRS with gas tamponade.RESULTS:Patients in subgroup Ia and group III had better functional results than those in subgroup IIa and group IV,respectively(P<0.001).More marked inflammatory response(2-3 points)was statistically significant in patients of the IIa subgroup(P<0.001)and group IV(P<0.001)in comparison with the patients in the Ia and group III respectively.The IIa subgroup(n=9;14.5%)showed higher incidence of neovascular glaucoma(NVG)than the Ia(n=2;3.2%),P=0.027.There also was a higher rate of NVG in group IV(n=6;19.3%)compared to group III(n=1;3.1%),P=0.04.Subgroup IIa revealed a 2 to 2.5 times higher concentration of interleukin 8(IL-8),monocyte chemoattractant protein 1(MCP-1),and inter-cellular adhesion molecule 1(ICAM-1)compared to subgroup Ia.CONCLUSION:PE of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS.In addition,it contributes to reduction of number and severity of postoperative complications.展开更多
基金Supported by National Natural Science Foundation of China(No.82160195No.82460203)Key Scientific and Technological Research Projects of China Medical Education Association(No.2024KTZ038).
文摘This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians in determining surgical indications,assessing patient conditions,and offering valuable assistance in formulating surgical strategies and predicting outcomes.Developed by a collaborative team of experts from the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,in conjunction with the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,these guidelines have been formulated through extensive research and evaluation,incorporating the latest technological advancements and studies on a global and domestic scale in vitreoretinal surgery.After extensive deliberations and incorporation of up-to-date clinical data,these guidelines have been developed to assist in standardizing preoperative examinations for vitreoretinal surgery.The overarching goals include improving medical quality,maximizing resource allocation,offering decision-making assistance,and safeguarding patient rights.This document provides a comprehensive analysis of preoperative assessments for vitreoretinal procedures,covering principles,methodologies,and precautions related to a range of diagnostic techniques including ultra-wide-angle fundus imaging,fluorescein angiography,indocyanine green angiography,ophthalmic B-ultrasound examinations,ultrasound biomicroscopy,optical coherence tomography,optical coherence tomography angiography,orbital CT scan,orbital MRI,and ophthalmic electrophysiology tests such as electroretinograms,visually evoked potentials,and visual field testing.
基金supported by the Basic Research Youth Talent Development Program of Huashan Hospital,Fudan University(2024JC030).
文摘Epstein-Barr virus(EBV)infection is well-known for its association with lymphoproliferative disorders and various lymphomas,causing significant global morbidity and mortality.EBV-positive vitreoretinal lymphoma(VRL)is exceedingly rare.As a result,the pathogenic role and genomic characteristics of EBV in VRL remain poorly understood.In this study,we employed droplet digital PCR(ddPCR)combined with EBV-specific immunofluorescence assay to detect EBV in the vitreous fluid of fifty-three VRL patients.We found that approximately 28%(15/53)of the patients were EBV positive.Analysis of clinical data showed that EBV-positive VRL patients had shorter progression-free survival(PFS)compared to EBV-negative patients(P=0.004).Additionally,through integration of EBV-targeted sequencing and PCR-based deep sequencing,we found that all five VRL-derived EBV genomes formed a distinct cluster within one phylogenetic branch.Meanwhile,several non-synonymous mutations were exclusively detected in the VRL group,including S229T in latent membrane protein 1(LMP1)and G2248R in the Epstein-Barr virus BamHI-PraL fragment 1(BPLF1).In conclusion,our findings suggest that EBV as a risk factor associated with poor prognosis in VRL,and we provide a genome-wide view of EBV sequence variations from VRL patients.This may offer insights into the pathogenic role of EBV in VRL and could potentially assist in the diagnosis and treatment of this disease.
基金Supported by the National Natural Science Foundation of China (No.81770972,No.81970843)。
文摘AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.
文摘AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and complications.RESULTS: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) eye.CONCLUSION: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.
文摘Objective To examine the hyperglycemic effects of periocular dexamethasone injection in type 2 diabetic patients after vitreoretinal surgery （VRS）. Methods This was a retrospective non-randomized controlled trial. Twenty consecutive hospitalized patients with type 2 diabetes and ocular inflammatory reaction after VRS were enrolled in this study. Ten patients received 2.5 mg dexamethasone and 10 patients received 5 mg dexamethasone. Fourteen consecutive type 2 diabetic patients without ocular inflammatory reaction after VRS were used as control group. We measured fasting blood glucose （FBG） and at 2 h after each meal （post prandial glucose, PBG; 09：00, 13：00, and 19：00 h） after periocular dexamethasone injection. Differences among three groups were determined by q tests. Results The PBG levels in both dexamethasone-treated groups started to increase within 5 h after injection （i.e., PBG at 13：00 h）, and were significantly increased at 29：00 h after injection （P〈0.05）. BG levels were almost 2-fold higher than at baseline and compared with the control group. The BG values declined gradually by 24 h to 48 h after injection. There were no differences in BG levels between the two dexamethasone-treated groups （P〉0.05）, except for PBG at 19：00 h on day 2 after injection （P〈0.05）. Conclusion Periocular dexamethasone injection can cause transient hyperglycemia in diabetic patients after VRS. BG monitoring should be performed following such injection.
文摘AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.
基金Supported by the National Natural Science Foundation of China (No.81700884,No.81900910)Zhejiang Provincial Natural Science Foundation of China (No.LGF21H120005,No.LQ19H120003)+1 种基金Key Project jointly constructed by Zhejiang Province and Ministry (No.WKJZJ-2037)Basic Scientific Research Project of Wenzhou (No.Y20210194)。
文摘AIM:To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional(3D) visualization system.METHODS:Enucleated porcine eyes were established as an animal model for removing foreign bodies.Forty medical students were recruited to remove foreign bodies to compare the traditional microscope and the 3D system.One junior resident performed the surgical task with manual and robot-assisted operations on 20 porcine eyes for each group.One senior surgeon evaluated the retinal invasion by a graded injury degree.The learning curve for minimally invasive vitreoretinal surgery was described.RESULTS:Compared with the robot-assisted group,the injury degree was higher in the manual group.For the first ten surgeries,the manual and robot-assisted groups had injuries of 2.60±1.35(4 to 0) and 1.80±1.62(4 to 0),respectively.For the last ten surgeries,the injury degrees were 1.90±1.20(3 to 0) and 0.80±0.42(1 to 0).Considering the manual and robot-assisted groups together,95%,75% and 60% of the students considered surgical manipulation with the 3D visualization system to be more comfortable,easier and clearer,respectively.CONCLUSION:The robot-assisted surgical system and 3D visualization system may have value in teaching minimally invasive vitreoretinal surgery.
基金This work was supported in part by research grants from the Zhejiang Provincial Natural Science Foundation of China(Grant No.LQ19H120003)National Nature Science Foundation of China(Grant No.81900910).
文摘The objective is to introduce the application of intraoperative optical coherence tomography(iOCT)in pars plana vitrectomy(PPV)for various vitreoretinal diseases,and to report the 4-year assessment of feasibility and utility in Chinese population.We reported a retrospective case series of patients who underwent PPV and iOCT scan at Eye Hospital of Wenzhou Medical University from January 2016 to January 2020.Clinical characteristics were documented before operation,and we intraoperatively recorded the time and results of iOCT scanning,specific surgical maneuvers performed,the consistency with the planned strategies before surgery,the type of OCT images obtained,and adverse events(AEs).The surgeon feedback was collected to evaluate the utility of iOCT during surgery.In total 339 eyes successfully completed iOCT scan,with an average scanning time of 3.54±2.3 min,including 59 cases of idiopathic macular hole(iMH),134 cases of idiopathic epiretinal membrane(iERM),33 cases of lamellar macular hole(LMH),40 cases of high myopic maculopathy,13 cases of vitreous macular traction(VMT),60 cases of dense vitreous hemorrhage(VH).The iOCT findings were not consistent with exami-nation under the operating microscope in 49 cases(14.5%),including 29 cases(8.6%)which changed the operation strategies during surgery.The Hole-door phenomenon arose in 20 cases(33.9%)of iMH and 3 cases(25%)of high myopic MH after ILMs peeling.Moreover,the residue ERM was observed in nine cases(6.7%)of iERM and two cases(14.3%)in high myopic ERM after ILMs peeling.Some new surgical methods could also be confirmed using iOCT.The ap-plication of iOCT has a significant clinical functionality in vitreoretinal surgery,providing the surgeon with a new surgical understanding,guiding the selection of a more reasonable operative procedure during surgery,predicting postoperative recovery and improving postoperative outcomes.
文摘AIM： To evaluate the outcomes of vitreoretinal surgery for four different phenotypes of X-linked retinoschisis （XLRS）. METHODS： This study included thirty-one eyes of 25 patients who developed XLRS with severe complications. Among the 31 eyes, there were 7 eyes with vitreous hemorrhage, 8 eyes with retinal detachment and vitreous hemorrhage, and 16 eyes with rhegmatogenous retinal detachment. All of the patients underwent standard three-port pars plana vitrectomy. All of the eyes were divided into 4 groups before surgery according to a modified classification scheme, with the first three groups as follows： group A, with foveal cystic schisis; group B with macular lamellar schisis; and group C with foveolamellar changes. Peripheral schisis was not present in these 3 groups; however, group D was a complex group with both macular and peripheral changes. One year after surgery, we analyzed the best corrected visual acuity and postoperative anatomical and functional outcomes of these 4 groups. RESULTS： There were 7 eyes in group A （22.6%）, 1 eye in group B （3.2%）, 15 eyes in group C （48.4%） and 8 eyes in group D （25.8%）. Postoperative anatomical and functional outcomes were satisfactory at the last visit, while the mean visual acuity was increased to 0.27±0.11, with a significant difference （t=-1.049, P=0.000） compared with the results before surgery （0.1±0.08）. Visual acuity was improved in 23 eyes （74.2%）. Complications were found in three eyes： two eyes with proliferative vitreoretinopathy and traction retinal detachment 10 and 12mo after surgery, respectively; and one eye with vitreous hemorrhage 15mo after surgery. These eyes were in groups C and D. The retinas remained attached in these 3 eyes after reoperation. CONCLUSION： We should pay greater attention to XLRS with foveolamellar changes because it is the most changeable phenotype. Once complications occur, vitreoretinal surgery can significantly improve visual acuity and restore the anatomic structure of the retina.
基金Supported by National Institutes of Health/National Eye Institute,Bethesda,Maryland,USA(K23-EY022947-01A1)。
文摘AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study.Subjects with CED 1 d after surgery without intraoperative corneal debridement was defined as the postoperative CED group.Subjects who underwent intraoperative debridement were defined as intraoperative debridement group.Eyes were matched 2:1 with controls(eyes without postoperative CED)for comparative assessment.The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement.Secondary outcomes included time to defect closure,delayed healing(>2 wk),visual acuity(VA)and presence of scarring at one year and cornea consult.RESULTS:This study included 856 eyes that underwent vitreoretinal surgery.Intraoperative corneal debridement was performed to 61(7.1%)subjects and postoperative CED developed spontaneously in 94(11.0%)subjects.Significant factors associated with postoperative CED included prolonged surgical duration(P=0.003),diabetes mellitus(P=0.04),postoperative ocular hypotension(P<0.001).Prolonged surgical duration was associated with intraoperative debridement.Delayed defect closure time(>2 wk)was associated with corneal scar formation at the end of the 1 y in all epithelial defect subjects(P<0.001).The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%.CONCLUSION:Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED.Delayed defect closure is associated with a greater risk of corneal scarring at one year.The overall rate of corneal scarring following vitrectomy is low at<2%.
基金This work was supported by State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University[2014QN09]the National Eye Institute Intramural Research Program.
文摘Primary vitreoretinal lymphoma (PVRL), as a subset of primary central nervous system lymphoma (PCNSL), is a rare and fatal ocular malignancy. Most PVRL masquerades as chronic posterior uveitis, which makes the clinical diagnosis challenging. Vitreous cells, subretinal lesions and imaging techniques are essential for clinical diagnosis. Importantly, cytopathology/histopathology identification of malignant cells is the gold standard for the diagnosis of PVRL. In addition, molecular detection of immunoglobulin heavy chain (IgH) or T cell receptor (TCR) gene rearrangements, immunophenotyping for cell markers, and cytokine analysis of interleukine-10 elevation are often used as adjunct procedures. Current management of PVRL involves local radiation, intravitreal chemotherapy (methotrexate and rituximab), with or without systemic chemotherapy depending on the involvement of non-ocular tissues. In cases with concomitant PCNSL, systemic high-dose methotrexate/rituximab based therapy in conjunction with local therapy, whole brain radiotherapy and/or autologous stem cell transplantation is considered. Although PVRL normally responds well to initial treatment, high rates of relapse and CNS involvement usually lead to poor prognosis and limited survival. A professional team of medical experts in ophthalmologists, ocular pathologists, neuro-oncologists and hemato-oncologists is essential for optimizing patient management.
基金Supported by the National Natural Science Foundation of China(No.82070948)Beijing Talent Project(No.2020027)+1 种基金Shunyi District“Beijing Science and Technology Achievements Transformation Coordination and Service Platform”Construction Fund(No.SYGX202010)Capital Health Development Scientific Research Project Grant。
文摘AIM:To investigate the value of cytokine analysis in aqueous humor(AH)for discriminating vitreoretinal lymphoma(VRL)from uveitis and for evaluating the efficacy of intravitreal methotrexate(MTX)injections.METHODS:This retrospective study was done on 28 VRL patients between 2013 and 2019.AH interleukin(IL)-10,IL-6,IL-8,vascular endothelial growth factor(VEGF),and vascular cell adhesion molecules(VCAM)were measured in 28 VRL patients and 38 uveitis patients.As to the respective examinations for distinguishing VRL from uveitis,the diagnostic accuracy was evaluated by receiver operating characteristic(ROC)curve analysis.The response to treatment was monitored by observing changes in bestcorrected visual acuity(BCVA),ocular manifestation,and AH cytokine levels in 21 patients with VRL who had undergo multiple intravitreal injections of MTX.RESULTS:Compared with uveitis patients,VRL patients had higher IL-10 level(P<0.001)and IL-10/IL-6 ratio(P<0.001),whereas patients with uveitis had significantly higher IL-6 level than those with VRL(P=0.003).An ROC analysis was used to identify the diagnostic threshold values for VRL,and it was found that optimal sensitivity and specificity improved to 94.1%and 100%,respectively,for IL-10/IL-6>1.55 and 88.2%and 81.1%,respectively,for IL-10>76.7 pg/m L.In 21 patients who had undergo repeated injections,improvements in BCVA,clinical remission of VRL and continuous decrease in cytokine levels over time were observed.In those patients,the BCVA correlated with the aqueous levels of IL-10 and IL-6 during the course of disease treatment.CONCLUSION:The combination of the aqueous cytokine profiles can be instrumental for conventional diagnostic methods and for progression monitoring and treatment response.
文摘AIM:To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis(TKP)in patients with severe corneal opacifications.METHODS:Three patients with simultaneous corneal and vitreoretinal pathology were treated with a soft contact lens that was used as a TKP to facilitate vitreoretinal surgery.The soft contact lens was fixated with sutures onto the globe so that no leakage was possible.RESULTS:Vitreoretinal surgery with excellent fundus view was possible in all cases.The soft contact lens allowed safe central and peripheral vitrectomy.Surgery was successful in all cases.CONCLUSION:A soft contact lens properly fixated on the globe can successfully replace a TKP.This surgical procedure has several advantages like one size fits all,low costs,and easy access to the material.
文摘Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was significant difference among the four groups with better outcome in group III, as in group III represented the most rapid onset of lid akinesia. As respecting to the onset of global akinesia there was significant difference among the four groups. There was better outcome in group III as it represented more rapid onset of global akinesia compared with other groups. There were significant differences among the four groups as regard postoperative pain all over 6 hours, better results were in group III (0.27 ± 0.69) compared with group I (2.23 ± 1.17), group II (2.00 ± 1.70), group IV (0.67 ± 0.71). As regarding to the first time for analgesic requirement there were significant differences among groups, there was no request for analgesia with better outcome in group III with increasing need to the analgesic medication in group I compared to group II and group IV. As regard side effects postoperatively there were few side effects in all groups with few numbers of cases in groups III only one patient. Although these differences in number of patients are not significant among the four groups. Conclusion: Addition of sodium bicarbonate to local anesthetic mixture was the best way in lowering the IOP other than other groups and addition of fentanyl to local anesthesia provided more rapid onset and duration of anesthesia, more rapid onset and duration for lid and global akinesia, less pain, less analgesic requirement and minimal side effects than the other groups.
文摘Dear Editor,Primary vitreoretinal lymphoma（PVRL）is a rare form of ocular malignancy and it is usually considered as a subset of primary central nervous system lymphoma（PCNSL）.An insidious onset associated with delays in diagnosis iscommon.
基金Supported by Unrestricted departmental funding from Research to Prevent Blindness(New York,NY)
文摘AIM: To assess the presenting clinical features, time from presentation to diagnosis and association with central nervous system(CNS) lymphoma in patients with vitreoretinal lymphoma.METHODS: Retrospective case series of patients diagnosed with vitreoretinal lymphoma between 2009 and 2011 at a single center.RESULTS: Fifteen eyes in 9 patients were included. Common presenting ocular symptoms included blurred vision(78%) and worsening floaters(44%) with an average symptom duration prior to presentation of 88.4 d(range 7-365 d). Common ophthalmic exam findings were vitreous haze(89%) and subretinal lesions(56%). The average time from presentation to diagnosis was 56.3 d(range 16-180 d). All patients were diagnosedwith large B-cell lymphoma according to pathology results. Lymphoma was restricted to the eye in 33%, while 67% of patients had CNS involvement. Of the patients with secondary vitreoretinal lymphoma, 67% initially presented with CNS lymphoma while 33% initially presented with vitreoretinal lymphoma. Of the patients with CNS involvement, memory loss(67%) was the most common presenting symptom.CONCLUSION: Vitreoretinal lymphoma most commonly presents with symptoms of blurred vision and/or worsening floaters and vitreous haze on exam. The average time from presentation to diagnosis may be decreasing with increased awareness among clinicians.
文摘Background and Objective:Vitreoretinal surgery requires fine micro-surgical training and handling of delicate tissue.To aid in the training of residents and fellows,unique educational modalities exist to help facilitate the development of these microsurgical skills.From virtual simulators to artificial eye models,simulation of the posterior segment has gained an increased focus in vitreoretinal surgical training programs.Development of surgical curricula for vitreoretinal training and attainment of surgical milestones has been a key component in integrating these educational training modalities.We will explore various simulators,eye models,and potential rubrics and discuss unique ways each may help and complement one another to train future vitreoretinal surgeons.Methods:We conducted a systematic PubMed search of various review studies(from publications in English ranging from January 1978 to December 2020)discussing surgical simulators,eye models,and surgical rubrics for vitreoretinal surgery and their potential impacts upon training.Key Contents and Findings:Our review assesses the benefits and applicability of various simulators,eye models,and surgical rubrics upon training.Conclusions:Utilization of vitreoretinal surgical training tools may aid in complementing the hands-on surgical training experience for vitreoretinal surgical fellows.By using simulators and rubrics,we may better be able to standardize training for reaching vitreoretinal surgical milestones and providing adequate feedback to improve surgical competency and ultimately patient outcomes.
基金supported by grants from the National Natural Science Foundation of China(Nos.82170181,82370188)Beijing Physician Scientist Training Project(BJPSTP-2024-01)to Liang Wang.
文摘Primary vitreoretinal lymphoma(PVRL),a rare subtype of primary central nervous system lymphoma(PCNSL),can lead to permanent vision loss and central nervous system(CNS)involvement,resulting in a poor prognosis.PVRL often masquerades as uveitis,and its partial response to topical corticosteroids further complicates the diagnosis.The gold standard for diagnosis is cytological analysis;however,owing to its low sensitivity,cytokine profiling and genetic testing may serve as supplementary diagnostic tools.There is no universally accepted consensus regarding PVRL treatment protocols.Combined systemic high-dose intravenous methotrexate(MTX)and intravitreal therapy may help manage bilateral ocular lesions,although this combination’s ability to delay CNS relapse remains controversial.For relapsed or refractory(R/R)PVRL patients aged<60 years,intensive consolidation chemotherapy followed by autologous stem cell transplantation may be considered.Novel targeted therapies such as ibrutinib and lenalidomide have demonstrated efficacy in R/R cases.Large-scale multicenter prospective studies are urgently needed to determine optimal treatment strategies.
基金Supported by Science and Technology Project of Sichuan Provincial Health Commission(No.24WXXT13)North Sichuan Medical College Doctor Start-up Fund Project(No.CBY24-QDA01).
文摘Dear Editor,I diopathic macular telangiectasia(MacTel)type 1 is a retinal vascular disease characterized by abnormal dilation of macular capillaries,leading to metamorphopsia,progressive vision loss,and temporal scotoma enlargement.Currently,there is no standardized treatment protocol for MacTel type 1[1-2].Treatment outcomes can vary significantly among individuals,highlighting the ongoing need for further exploration of new and more effective treatment options.This paper presents a case of refractory macular edema associated with MacTel type 1,which showed a favorable response to pars plana vitrectomy(PPV)and internal limiting membrane(ILM)peeling.
文摘AIM:To evaluate the efficacy of second-stage phacoemulsification(PE)of complicated initial cataract after vitreoretinal surgery(VRS)in patients with advanced proliferative diabetic retinopathy(PDR).METHODS:Totally 216 patients with PDR and complicated initial cataract who underwent surgery were included.These patients were divided into four groups according to their management.In the 1st group patients were subjected to a two–step surgical procedure:VRS with silicone oil tamponade was performed as the first step,followed by the second step,PE+intraocular lens(IOL)implantation+silicone oil removal.In the 2nd group PE was performed simultaneously with VRS and silicone oil tamponade.The second step differed in the removal of silicone oil from the vitreous cavity.Patients Ia(n=17)and IIa(n=17)subgroups had their tear liquid samples being examined before surgery and on the 2nd day after the 1st phase.In subgroups Ib and IIb,an angiogenesis inhibitor was implanted 10-14d before VRS at a dose of 0.5 mg once.In the 3rd group patients were subjected to a two–step surgical procedure:VRS with gas tamponade performed as the 1st step in their treatment;followed by the 2nd step,PE and the IOL implantation.In the 4th group PE performed simultaneously with VRS with gas tamponade.RESULTS:Patients in subgroup Ia and group III had better functional results than those in subgroup IIa and group IV,respectively(P<0.001).More marked inflammatory response(2-3 points)was statistically significant in patients of the IIa subgroup(P<0.001)and group IV(P<0.001)in comparison with the patients in the Ia and group III respectively.The IIa subgroup(n=9;14.5%)showed higher incidence of neovascular glaucoma(NVG)than the Ia(n=2;3.2%),P=0.027.There also was a higher rate of NVG in group IV(n=6;19.3%)compared to group III(n=1;3.1%),P=0.04.Subgroup IIa revealed a 2 to 2.5 times higher concentration of interleukin 8(IL-8),monocyte chemoattractant protein 1(MCP-1),and inter-cellular adhesion molecule 1(ICAM-1)compared to subgroup Ia.CONCLUSION:PE of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS.In addition,it contributes to reduction of number and severity of postoperative complications.
