This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various ...This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications.Herein,we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques,minimizing intraoperative challenges,and enhancing postoperative recovery.We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field.Overall,this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’quality of life.展开更多
BACKGROUND Silicone oil(SiO)migration to the central nervous system(CNS)is a rare complication of SiO tamponade after vitreo-retinal surgeries,it could masquerade hemorrhage on computed tomography neuro-imaging.Only l...BACKGROUND Silicone oil(SiO)migration to the central nervous system(CNS)is a rare complication of SiO tamponade after vitreo-retinal surgeries,it could masquerade hemorrhage on computed tomography neuro-imaging.Only limited cases were reported in the literature,certain intra-operative and post-operative ocular risk factors might contribute to the different extend of SiO migration in the CNS.AIM To study the risk factors for cerebral ventricular migration(CVM)on top of visual pathway migration(VPM).METHODS Conforming to the preferred reporting items for systematic reviews and metaanalyses guidelines,literature searches on PubMed,MEDLINE,EMBASE were performed on June 1,2024.Publications on SiO migration to CNS were included in this review.Non-English articles,and studies without neuro-imaging of the CNS were excluded.Patient demographics,SiO filled eyes'ocular characteristics and vitrectomy surgical details were extracted from included studies in this review.VPM and CVM were assigned as group 1 and group 2 respectively.Fisher's exact tests,Mann-Whitney U tests and binary logistic regression were performed.RESULTS Total 68 articles were obtained after searches,48 publications were included for analysis.Total 54 SiO filled eyes were analyzed.Post-vitrectomy intraocular pressure(IOP)was found to be significant in both Mann-Whitney U test(P=0.047)and binary logistic regression(P=0.012).Diabetic was found to be significant in binary logistic regression(P=0.037),but at borderline risk for CVM in Fisher's exact test(P=0.05).Other significant factors include longer SiO tamponade time(P=0.002 in Fisher's exact test)and visual acuity(P=0.011 in binary logistic regression).Optic nerve atrophy or disc cupping(P=1.00,P=0.790)and congenital optic disc anomalies(P=0.424)were all with P>0.05.CONCLUSION SiO migration to CNS is rare with limited case reports only.Our analysis of the existing literature demonstrated higher post-vitrectomy IOP was associated with CVM,followed by patients’diabetic status,longer SiO tamponade time and visual acuity.Optic nerve atrophy,disc cupping and congenital optic disc anomalies were not associated.Modifiable risk factors of post-vitrectomy IOP and SiO tamponade time should be closely monitored by vitreoretinal surgeons.Lower IOP target post-vitrectomy and earlier SiO removal surgeries should be arranged.展开更多
AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case seri...AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case series of patients with pseudophakia who underwent retinal detachment(RD)surgery was enrolled.The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases,according to preoperative findings.Eyes with anterior chamber intraocular lens,proliferative vitreoretinopathy anterior to equator,previous invasive glaucoma surgery,severe degenerative myopia or macular hole,and<6mo follow-up were excluded from outcomes analysis.The primary clinical outcome measures were the single surgery anatomic success(SSAS)and final surgery anatomic success(FSAS)rates.Secondary outcome measures were postoperative visual acuity and refractive error.RESULTS:A total of 81 consecutive patients(81 eyes)were enrolled for analysis,comprising 66(81%)men and 15(19%)women with a mean age of 58y(range,33-86y)and the mean final follow-up period was 21.0±19.6mo.A total of 62 PRRDs(n=62;76.5%)were repaired with an initial SB,and 19 PRRDs(n=19;23.5%)were repaired with a combined SB-PPV.The SSAS and FSAS rates were 92.6%(75/81)and 100%(81/81),respectively.All initial failures had retinal reattachment after the secondary PPV.The mean final postoperative best-corrected visual acuity(BCVA)was 0.42±0.33 logMAR(visual acuity 20/55)and final mean refractive error was-1.48±1.40 diopters.The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate(P<0.05)preoperatively.SSAS was 56/62(90.3%)and 19/19(100%),and the mean postoperative refractive error was-1.30±1.32 D and-1.53±1.38 D for the patients in the SB and SB-PPV groups,respectively.There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups.The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group(median,20/40)than in the SB-PPV group(median 20/50).In the SB group,patients with macula-on had better visual acuity postoperatively than patients with macula-off(P=0.000).CONCLUSION:The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.展开更多
AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary ...AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected.Twenty-four potential influencing factors,including patient characteristics and surgical factors,were selected for analysis.Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis.A risk prediction model was constructed and evaluated using receiver operating characteristic(ROC)curves,area under the ROC curve(AUC),calibration plots,and decision curve analysis(DCA)curves.RESULTS:The 386 cases(389 eyes)of patients who underwent PPV and had complete surgical records were ultimately included.Within a 2-year longitudinal observation,41.39%of patients developed cataract secondary to PPV.Logistic regression results identified a history of hypertension[odds ratio(OR)=1.78,95%CI:1.002–3.163,P=0.049],silicone oil tamponade(OR=3.667,95%CI:2.373–5.667,P=0.000),and lens thickness(OR=1.978,95%CI:1.129–3.464,P=0.017)as independent risk factors for cataract secondary to PPV.The constructed nomogram achieved AUC=0.6974.Calibration plots indicated good agreement between predicted and observed outcomes,while DCA curves demonstrated the model’s clinical utility.CONCLUSION:By incorporating a history of hypertension,vitreous substitute type,and lens thickness,this study constructs a prediction model with moderate discriminative ability.This model offers a valuable tool for clinicians to identify high-risk patients early,potentially allowing for more timely interventions and improved patient outcomes.展开更多
AIM:To investigate the outcomes and prognosis of macular epiretinal membrane(ERM)after pars plana vitrectomy(PPV)in patients with high myopia(HM),focusing on the optimal timing of surgery and its impact on prognosis.M...AIM:To investigate the outcomes and prognosis of macular epiretinal membrane(ERM)after pars plana vitrectomy(PPV)in patients with high myopia(HM),focusing on the optimal timing of surgery and its impact on prognosis.METHODS:The clinical data of 50 eyes from 49 patients diagnosed with ERM,who were highly myopic and underwent PPV were retrospectively analyzed.The patients with ERM were classified into five groups based on the characteristics associated with different levels of myopic traction maculopathy.Group 1:Simple ERM without complex vertical and tangential direction traction on retina on optical coherence tomography(OCT)image;Group 2:ERM with obvious macular foveal schisis,without macular hole(MH);Group 3:ERM with inner lamellar MH,with or without macular foveal schisis;Group 4:ERM with outer lamellar MH,with or without foveal retinal detachment(RD);Group 5:ERM with full-thickness MH.Baseline characteristics,changes in best corrected visual acuity(BCVA)before and after surgery,and anatomical characteristics through spectral domain OCT were compared.RESULTS:The 50 eyes were followed for 6mo,with an average age of 58.66y and an average axial length(AL)of 28.69 mm.Among the five groups,postoperative logMAR BCVA improved(P<0.05).Group 1 had better mean BCVA at baseline(0.59±0.36)and at 6mo postoperatively(0.16±0.22)compared to the other groups,while Group 5 had worse mean BCVA at baseline(1.68±0.45)and at 6mo postoperatively(1.27±0.64).There were no statistically significant differences in sex,age or AL between the groups(P>0.05).OCT showed that Groups 4 and 5 exhibited poorer macular anatomy compared to the other three groups,as evidenced by lower rates of central retinal reattachment(64.3%in Group 4,86.7%in Group 5)and integrity of the inner segment/outer segment of photoreceptor junction(28.6%in Group 4,26.7%in Group 5).CONCLUSION:PPV is an effective treatment for ERM in patients with HM.All groups showed postoperative improvement in BCVA compared to preoperative levels,demonstrating the necessity of surgical intervention.Early intervention,particularly before the fourth stage of the disease,may lead to better visual outcomes.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 present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)com...AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)combined with Ahmed glaucoma valve(AGV)implantation.METHODS:This is a retrospective,single-center,consecutive case series.All patients underwent 23-gauge PPV with AGV implantation 2–3d after intravitreal ranibizumab injection(IVR).The minimum postoperative follow-up period lasted 12mo.The primary outcome measures included bestcorrected visual acuity(BCVA),intraocular pressure(IOP),and topical hypotensive medications.RESULTS:Fifteen diabetic patients(age,46–81y)with rapid-onset NVG and VH following uncomplicated phacoemulsification were included.The median time to the initial NVG diagnosis following cataract surgery was within 4wk.After PPV combined with AGV implantation,the mean BCVA(logMAR)improved from 1.9(range:1.0 to 2.6)preoperatively to 1.2(range:0.2 to 2.6)at the final follow-up.Baseline BCVA and the presence of diabetic nephropathy(DN)were significantly associated with the final BCVA in the multiple regression model.The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline.At the final follow-up,9 patients required one or two topical ocular hypotensive medications,while the other 6 needed not.Success was achieved in 87%,and the reoperation rate was 20%.The majority of NVG cases(9/15)were primarily attributed to the rapid progression of proliferative diabetic retinopathy.However,a notable subset(6 eyes)was complicated retinal vein occlusion or carotid artery occlusion.CONCLUSION:PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments.Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.展开更多
AIM:To evaluate whether fluid-air exchange is an effective treatment for unclosed macular hole(MH)after primary vitrectomy.METHODS:This retrospective study included patients with an unclosed MH within 1–2wk after vit...AIM:To evaluate whether fluid-air exchange is an effective treatment for unclosed macular hole(MH)after primary vitrectomy.METHODS:This retrospective study included patients with an unclosed MH within 1–2wk after vitrectomy.Patients were divided into the vitrectomy,fluid-air exchange,and observation groups according to the secondary treatment.The anatomical outcomes and postoperative visual acuity were recorded.RESULTS:The analysis included 25 eyes in 25 patients(16 females)aged 37–74y(vitrectomy group,n=10;fluid-air exchange group,n=9;observation group,n=6).Closure rate after secondary treatment was 100%in the vitrectomy group,88.9%in the fluid-air exchange group and 33.3%in the observation group.Optical coherence tomography images obtained at the last follow-up revealed that continuity of the external limiting membrane(ELM)was significantly more common(P=0.004)in the fluid-air group(8/9 eyes,88.9%)than in the vitrectomy group(2/10 eyes,20.0%)and that macular morphology was better in the fluid-air group than in the vitrectomy group.No serious complications were observed after secondary treatment.CONCLUSION:Fluid-air exchange is an alternative option to repeat vitrectomy for patients with an unclosed MH after initial vitrectomy with elevated macular edge.展开更多
AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic r...AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy(PDR)with gradable optical coherence tomography(OCT)imaging from January 2018 to March 2022.The incidence of post vitrectomy DME(PV-DME)was defined as patients with a central retinal thickness(CRT)>300µm by OCT among patients without preoperative DME.RESULTS:The cumulative incidence of PV-DME at 3mo was 40.1%(89/222),with its majority subtype of single diffused retinal thickening(66.2%)followed by single cystoid macular edema(27.0%).Multivariate Cox regression analysis indicated that a thicker preoperative CRT[hazard ratio(HR)=1.01,95%confidence interval(CI)1.00-1.02]and intraoperative internal limiting membrane peeling(HR=3.18,95%CI 1.85-5.47)were associated with the presence of PV-DME,while intraoperative intravitreal injection of triamcinolone acetonide(HR=0.28,95%CI 0.13-0.57)was protective against PV-DME.In eyes with preoperative DME(n=143),the CRT decreased gradually from 468.3±177.7μm preoperatively to 409.5±151.0μm(P=0.027),377.4±141.9μm(P<0.001),and 368.0±157.6μm(P<0.001)at 7d,1 and 3mo postoperatively,respectively.Multivariate linear regression analysis indicated that only a thicker preoperative CRT(β=0.77,95%CI 0.63-0.92)was associated with a decreasing postoperative CRT.CONCLUSION:PV-DME is a very common postoperative complication in patients with PDR.Triamcinolone acetonide could prevent its formation.Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.展开更多
AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repai...AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.展开更多
●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:T...●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.展开更多
AIM:To assess the utility and efficiency of endoscopyassisted vitrectomy(EAV)for the treatment of corneal opacity in severe ocular trauma.METHODS:Patients who underwent fundus examination using a preoperative slit lam...AIM:To assess the utility and efficiency of endoscopyassisted vitrectomy(EAV)for the treatment of corneal opacity in severe ocular trauma.METHODS:Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy,followed by EAV and additional surgery were retrospectively recruited.Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups.Outcome measurements included the best corrected visual acuity(BCVA),intraocular pressure(IOP),findings of endoscopic fundus examination,and postoperative complications.RESULTS:Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo.Retinal detachment(RD)and vitreous haemorrhage(VH)were identified in 16 eyes(76.2%),RD only in four eyes(19.0%),and VH combined with intraocular foreign body in one eye(4.8%).All eyes underwent at least three surgeries.Stage-Ⅰ surgeries involved wound closure(100%),lens extraction(76.2%),and anterior vitrectomy(14.3%).Stage-Ⅱ surgeries involved scleral buckling(28.6%),membrane peeling(47.6%),retinal laser photocoagulation(100%)and silicone oil tamponade(100%)using EAV.Stage-Ⅲ surgeries were conducted using endoscopy including silicone oil removal(52.4%),retinal laser photocoagulation(52.4%)and penetrating keratoplasty(28.6%).Nearly all eyes showed improvements in BCVA and IOP.Although there were no severe complications,glaucoma was noted in one eye,chronic hypotony in another eye,and band keratopathy in three eyes.CONCLUSION:EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.展开更多
AIM:To analyze the distribution of fibrovascular proliferative membranes(FVPMs)in proliferative diabetic retinopathy(PDR)patients that treated with pars plana vitrectomy(PPV),and to evaluate the outcomes separately.ME...AIM:To analyze the distribution of fibrovascular proliferative membranes(FVPMs)in proliferative diabetic retinopathy(PDR)patients that treated with pars plana vitrectomy(PPV),and to evaluate the outcomes separately.METHODS:This was a retrospective and cross-sectional study.Consecutive 25-gauge(25-G)PPV cases operated for PDR from May 2018 to April 2020.According to the FVPMs images outlined after operations,subjects were assigned into three groups:arcade type group,juxtapapillary type group,and central type group.All patients were followed up for over one year.General characteristics,operation-related variables,postoperative parameters and complications were recorded.RESULTS:Among 103 eyes recruited,the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different(both P<0.01),with 95(92.23%)FVPMs located in the nasal quadrants,and 74(71.84%)in the inferior.The eyes with a central FVPM required the longest operation time,with silicon oil used in most patients,generally combined with tractional retinal detachment(RD)and rhegmatogenous RD,the worst postoperative bestcorrected visual acuity(BCVA)and the highest rates of recurrent RD(all P<0.05).FVPM type,age of onset diabetes mellitus,preoperative BCVA,and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement(all P<0.05).Compared with the central type group,the arcade type group had higher rates of BCVA improvement.CONCLUSION:FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels.Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.展开更多
BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and redu...BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.展开更多
BACKGROUND As the incidence of diabetes continues to increase,the number of patients with diabetic retinopathy(DR)also increases each year.After undergoing vitrectomy for DR,patients often experience negative emotiona...BACKGROUND As the incidence of diabetes continues to increase,the number of patients with diabetic retinopathy(DR)also increases each year.After undergoing vitrectomy for DR,patients often experience negative emotional problems that negatively affect their recovery.AIM To investigate negative feelings in patients with DR after vitrectomy and to explore related influencing factors.METHODS A total of 146 individuals with DR who were accepted for treatment at The Third People’s Hospital of Changzhou from May 2021 to April 2023 were recruited to participate in this study.All patients underwent vitrectomy.The self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to assess the degree of anxiety and depression 2-3 days after the operation.The participants were divided into a healthy control group and a negative emotion group.The patients’general demographic characteristics and blood glucose levels were collected.Logistic regression analysis was used to analyze the factors influencing negative feelings post-operation.Pearson’s correlation coefficient was used to analyze the association between SAS scores,SDS scores,and blood glucose levels.RESULTS The control group included 85 participants.The negative emotion group comprised 40 participants with anxiety,13 with depression,and eight with both.Logistic regression showed that being female(OR=3.090,95%CI:1.217-7.847),a family per capita monthly income of<5000 yuan(OR=0.337,95%CI:0.165-0.668),and a longer duration of diabetes(OR=2.068,95%CI:1.817-3.744)were risk factors for negative emotions in patients with DR after vitrectomy(P<0.05).The concentrations of fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),and glycated hemoglobin(HbA1c)in the negative emotion group exceeded those in the control group(P<0.05).SAS scores were positively associated with FPG(r=0.422),2hPG(r=0.334),and HbA1c(r=0.362;P<0.05).SDS scores were positively correlated with FPG(r=0.218)and 2hPG(r=0.218;P<0.05).CONCLUSION Sex,income level,and duration of diabetes were factors that influenced negative emotions post-vitrectomy.Negative emotions were positively correlated with blood glucose levels,which can be used to develop intervention strategies.展开更多
Diabetic vitrectomy is a highly intricate surgical procedure performed during the advanced stages of diabetic retinopathy(DR).It is used to treat conditions such as tractional or combined retinal detachment,vitreous h...Diabetic vitrectomy is a highly intricate surgical procedure performed during the advanced stages of diabetic retinopathy(DR).It is used to treat conditions such as tractional or combined retinal detachment,vitreous hemorrhage,and subhyaloid hemorrhage,which are all severe manifestations of proliferative DR.The results of the surgery are uncertain and variable.Vitreoretinal surgery has made significant progress since the early stages of vitrectomy.In the past ten years,advancements in intravitreal pharmacotherapy have emerged,offering new possibilities to improve the surgical results for our patients.Within the realm of medical terminology,an"adjunct"refers to a pharmaceutical or substance employed to aid or expedite the primary therapeutic intervention for a particular ailment.Their introduction has broadened the range of therapeutic choices that are accessible prior to,during,and following surgical procedures.This review article will specifically analyze the pharmacological adjuncts used in diabetic vitrectomy surgery,with a focus on their role in facilitating or aiding specific steps of the procedure.The implementation of this system of categorization offers benefits to the surgeon by allowing them to foresee potential difficulties that may occur during the surgical procedure and to choose the appropriate pharmacological agent to effectively tackle these challenges,thus enhancing surgical success rates.展开更多
Aim:The objective of this study was to investigate the prognosis of massive vitreous hemorrhage(VH)secondary to polypoidal choroidal vasculopathy(PCV)after vitrectomy.Methods:Forty-nine eyes in 48 patients with PCV an...Aim:The objective of this study was to investigate the prognosis of massive vitreous hemorrhage(VH)secondary to polypoidal choroidal vasculopathy(PCV)after vitrectomy.Methods:Forty-nine eyes in 48 patients with PCV and breakthrough VH who underwent 23-gauge pars plana vitrectomy between January 2015 and December 2020 were enrolled.The main outcome parameters were best-corrected visual acuity,postoperative adverse events,and reoperation.Results:The average follow-up time was 20.0±15.82 months.The average preoperative best-corrected visual acuity(BCVA)was 2.12±0.65 logarithm of the minimum angle of resolution(logMAR),the BCVA at six monthswas 1.65±0.64 logMAR,and the six-month follow-up BCVA was 1.67±0.76 logMAR.Compared to the average preoperative BCVA,the six-months and last follow-up BCVA after vitrectomy improved(P<0.05).The BCVA at the final follow-up was better than 1.3 logMAR only in 14 eyes(28.6%).Postoperative complications were observed in 10 eyes(20.4%),including recurrent retinal detachment,recurrent vitreous hemorrhage,macular hole,hyphema and lens dislocation.Fourteen eyes(28.6%)underwent cataract surgery procedure an average of 10.16±5.14 months after vitrectomy.BCVA one week and three monthsafter cataract surgery improved compared toBCVA before cataract surgery(P<0.05).Hypertension was associated with BCVA six months after vitrectomy(P=0.017).The BCVA at baseline and three months after PPV were worse in patients who underwent vitrectomy combined with silicone oil filling(P<0.05).Eyes with postoperative complications had worse BCVA at six months,12 months,and at the final follow-up after PPV(P<0.05).The duration of VH is related to the BCVA 12 months after PPV visual acuity after surgery.Patients who underwent vitrectomy within one month of the onset of vitreous hemorrhage had better BCVA 12 months after vitrectomy than those who underwent vitrectomy surgery one month later(P=0.015).Conclusions:Although the prognosis of vitrectomy varies greatly,cataract surgery could be considered to improve BCVA if polypoidal lesions are inactive six months after vitrectomy.展开更多
AIMTo compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with vari...AIMTo compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases.METHODSA total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA).RESULTSThe most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1<sup>st</sup> day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP≤8 mm Hg) was not different between groups in the postoperative 1<sup>st</sup> day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05).CONCLUSIONTwenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.展开更多
AIM:To report the cytology results of 25-gauge transconjunctival(25G-TSV)diagnostic vitrectomy in cases suspicious for intraocular lymphoma(IOL),and compare the results to those reported in the literature.METHODS:Clin...AIM:To report the cytology results of 25-gauge transconjunctival(25G-TSV)diagnostic vitrectomy in cases suspicious for intraocular lymphoma(IOL),and compare the results to those reported in the literature.METHODS:Clinical and cytopathological records of 18vitreous biopsy specimens obtained via 25G-TSV diagnostic vitrectomy in 12 patients suspicious for IOL were reviewed retrospectively.A review of the literature in regards to the diagnostic yields of vitreous specimens obtained via 25-gauge and 20-gauge diagnostic vitrectomy in suspected cases of IOL was performed.RESULTS:Eighteen eyes from 12 patients with clinical suspicion of IOL underwent diagnostic 25G-TSV.The cytopathological investigations demonstrated IOL in 15eyes(83.3%).Vitreous analysis was non-diagnostic in 3eyes(16.7%).CONCLUSION:Twenty-five-gauge diagnostic vitrectomy yields adequate sample for cytological evaluation of the vitreous in cases suspicious for IOL.The diagnostic results of the 25G-TSV in the current study are superior to those reported for 20-gauge vitrectomy but equivalent to those reported for 25G-TSV in the published literature.展开更多
Ocular endoscopes enable ophthalmologists to observe any part of the retina without any limitations, including those caused by corneal opacities, the rim of the intraocular lens, cortical remnants, capsular opacities,...Ocular endoscopes enable ophthalmologists to observe any part of the retina without any limitations, including those caused by corneal opacities, the rim of the intraocular lens, cortical remnants, capsular opacities, a small pupil, and vitreous opacities. Moreover, ocular endoscopes enable the management of peripheral lesions without scleral indentation and are compatible with microincision vitrectomy surgery. The enlarged view under the endoscope, as obtained by drawing towards the lesion, appears to be another advantage. Rhegmatogenous retinal detachment with undetectable retinal breaks, trauma, endophthalmitis, scleral wounds with incarceration of the vitreous, and microcornea are indications for endoscopic vitrectomy. The combination of endoscopy and a wide-angle viewing system could compensate for the deficiencies of each technique and achieve more effective and safer surgical maneuvers. Endoscopy skills appear to be a great advantage for vitreoretinal surgeons;however, because endoscopies require a learning curve, becoming familiar with the handling of the endoscope through stepby-step learning is necessary.展开更多
文摘This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications.Herein,we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques,minimizing intraoperative challenges,and enhancing postoperative recovery.We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field.Overall,this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’quality of life.
文摘BACKGROUND Silicone oil(SiO)migration to the central nervous system(CNS)is a rare complication of SiO tamponade after vitreo-retinal surgeries,it could masquerade hemorrhage on computed tomography neuro-imaging.Only limited cases were reported in the literature,certain intra-operative and post-operative ocular risk factors might contribute to the different extend of SiO migration in the CNS.AIM To study the risk factors for cerebral ventricular migration(CVM)on top of visual pathway migration(VPM).METHODS Conforming to the preferred reporting items for systematic reviews and metaanalyses guidelines,literature searches on PubMed,MEDLINE,EMBASE were performed on June 1,2024.Publications on SiO migration to CNS were included in this review.Non-English articles,and studies without neuro-imaging of the CNS were excluded.Patient demographics,SiO filled eyes'ocular characteristics and vitrectomy surgical details were extracted from included studies in this review.VPM and CVM were assigned as group 1 and group 2 respectively.Fisher's exact tests,Mann-Whitney U tests and binary logistic regression were performed.RESULTS Total 68 articles were obtained after searches,48 publications were included for analysis.Total 54 SiO filled eyes were analyzed.Post-vitrectomy intraocular pressure(IOP)was found to be significant in both Mann-Whitney U test(P=0.047)and binary logistic regression(P=0.012).Diabetic was found to be significant in binary logistic regression(P=0.037),but at borderline risk for CVM in Fisher's exact test(P=0.05).Other significant factors include longer SiO tamponade time(P=0.002 in Fisher's exact test)and visual acuity(P=0.011 in binary logistic regression).Optic nerve atrophy or disc cupping(P=1.00,P=0.790)and congenital optic disc anomalies(P=0.424)were all with P>0.05.CONCLUSION SiO migration to CNS is rare with limited case reports only.Our analysis of the existing literature demonstrated higher post-vitrectomy IOP was associated with CVM,followed by patients’diabetic status,longer SiO tamponade time and visual acuity.Optic nerve atrophy,disc cupping and congenital optic disc anomalies were not associated.Modifiable risk factors of post-vitrectomy IOP and SiO tamponade time should be closely monitored by vitreoretinal surgeons.Lower IOP target post-vitrectomy and earlier SiO removal surgeries should be arranged.
文摘AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case series of patients with pseudophakia who underwent retinal detachment(RD)surgery was enrolled.The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases,according to preoperative findings.Eyes with anterior chamber intraocular lens,proliferative vitreoretinopathy anterior to equator,previous invasive glaucoma surgery,severe degenerative myopia or macular hole,and<6mo follow-up were excluded from outcomes analysis.The primary clinical outcome measures were the single surgery anatomic success(SSAS)and final surgery anatomic success(FSAS)rates.Secondary outcome measures were postoperative visual acuity and refractive error.RESULTS:A total of 81 consecutive patients(81 eyes)were enrolled for analysis,comprising 66(81%)men and 15(19%)women with a mean age of 58y(range,33-86y)and the mean final follow-up period was 21.0±19.6mo.A total of 62 PRRDs(n=62;76.5%)were repaired with an initial SB,and 19 PRRDs(n=19;23.5%)were repaired with a combined SB-PPV.The SSAS and FSAS rates were 92.6%(75/81)and 100%(81/81),respectively.All initial failures had retinal reattachment after the secondary PPV.The mean final postoperative best-corrected visual acuity(BCVA)was 0.42±0.33 logMAR(visual acuity 20/55)and final mean refractive error was-1.48±1.40 diopters.The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate(P<0.05)preoperatively.SSAS was 56/62(90.3%)and 19/19(100%),and the mean postoperative refractive error was-1.30±1.32 D and-1.53±1.38 D for the patients in the SB and SB-PPV groups,respectively.There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups.The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group(median,20/40)than in the SB-PPV group(median 20/50).In the SB group,patients with macula-on had better visual acuity postoperatively than patients with macula-off(P=0.000).CONCLUSION:The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.
基金Supported by the Shenzhen Science and Technology Program(No.JCYJ20220818103207015)the SanMing Project of Medicine in Shenzhen(No.SZSM202311012).
文摘AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected.Twenty-four potential influencing factors,including patient characteristics and surgical factors,were selected for analysis.Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis.A risk prediction model was constructed and evaluated using receiver operating characteristic(ROC)curves,area under the ROC curve(AUC),calibration plots,and decision curve analysis(DCA)curves.RESULTS:The 386 cases(389 eyes)of patients who underwent PPV and had complete surgical records were ultimately included.Within a 2-year longitudinal observation,41.39%of patients developed cataract secondary to PPV.Logistic regression results identified a history of hypertension[odds ratio(OR)=1.78,95%CI:1.002–3.163,P=0.049],silicone oil tamponade(OR=3.667,95%CI:2.373–5.667,P=0.000),and lens thickness(OR=1.978,95%CI:1.129–3.464,P=0.017)as independent risk factors for cataract secondary to PPV.The constructed nomogram achieved AUC=0.6974.Calibration plots indicated good agreement between predicted and observed outcomes,while DCA curves demonstrated the model’s clinical utility.CONCLUSION:By incorporating a history of hypertension,vitreous substitute type,and lens thickness,this study constructs a prediction model with moderate discriminative ability.This model offers a valuable tool for clinicians to identify high-risk patients early,potentially allowing for more timely interventions and improved patient outcomes.
基金Supported by the National Natural Science Foundation of China(No.82371084).
文摘AIM:To investigate the outcomes and prognosis of macular epiretinal membrane(ERM)after pars plana vitrectomy(PPV)in patients with high myopia(HM),focusing on the optimal timing of surgery and its impact on prognosis.METHODS:The clinical data of 50 eyes from 49 patients diagnosed with ERM,who were highly myopic and underwent PPV were retrospectively analyzed.The patients with ERM were classified into five groups based on the characteristics associated with different levels of myopic traction maculopathy.Group 1:Simple ERM without complex vertical and tangential direction traction on retina on optical coherence tomography(OCT)image;Group 2:ERM with obvious macular foveal schisis,without macular hole(MH);Group 3:ERM with inner lamellar MH,with or without macular foveal schisis;Group 4:ERM with outer lamellar MH,with or without foveal retinal detachment(RD);Group 5:ERM with full-thickness MH.Baseline characteristics,changes in best corrected visual acuity(BCVA)before and after surgery,and anatomical characteristics through spectral domain OCT were compared.RESULTS:The 50 eyes were followed for 6mo,with an average age of 58.66y and an average axial length(AL)of 28.69 mm.Among the five groups,postoperative logMAR BCVA improved(P<0.05).Group 1 had better mean BCVA at baseline(0.59±0.36)and at 6mo postoperatively(0.16±0.22)compared to the other groups,while Group 5 had worse mean BCVA at baseline(1.68±0.45)and at 6mo postoperatively(1.27±0.64).There were no statistically significant differences in sex,age or AL between the groups(P>0.05).OCT showed that Groups 4 and 5 exhibited poorer macular anatomy compared to the other three groups,as evidenced by lower rates of central retinal reattachment(64.3%in Group 4,86.7%in Group 5)and integrity of the inner segment/outer segment of photoreceptor junction(28.6%in Group 4,26.7%in Group 5).CONCLUSION:PPV is an effective treatment for ERM in patients with HM.All groups showed postoperative improvement in BCVA compared to preoperative levels,demonstrating the necessity of surgical intervention.Early intervention,particularly before the fourth stage of the disease,may lead to better visual outcomes.
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.
基金Supported by Shanghai Municipal Health Commission(No.202140183).
文摘AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)combined with Ahmed glaucoma valve(AGV)implantation.METHODS:This is a retrospective,single-center,consecutive case series.All patients underwent 23-gauge PPV with AGV implantation 2–3d after intravitreal ranibizumab injection(IVR).The minimum postoperative follow-up period lasted 12mo.The primary outcome measures included bestcorrected visual acuity(BCVA),intraocular pressure(IOP),and topical hypotensive medications.RESULTS:Fifteen diabetic patients(age,46–81y)with rapid-onset NVG and VH following uncomplicated phacoemulsification were included.The median time to the initial NVG diagnosis following cataract surgery was within 4wk.After PPV combined with AGV implantation,the mean BCVA(logMAR)improved from 1.9(range:1.0 to 2.6)preoperatively to 1.2(range:0.2 to 2.6)at the final follow-up.Baseline BCVA and the presence of diabetic nephropathy(DN)were significantly associated with the final BCVA in the multiple regression model.The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline.At the final follow-up,9 patients required one or two topical ocular hypotensive medications,while the other 6 needed not.Success was achieved in 87%,and the reoperation rate was 20%.The majority of NVG cases(9/15)were primarily attributed to the rapid progression of proliferative diabetic retinopathy.However,a notable subset(6 eyes)was complicated retinal vein occlusion or carotid artery occlusion.CONCLUSION:PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments.Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.
文摘AIM:To evaluate whether fluid-air exchange is an effective treatment for unclosed macular hole(MH)after primary vitrectomy.METHODS:This retrospective study included patients with an unclosed MH within 1–2wk after vitrectomy.Patients were divided into the vitrectomy,fluid-air exchange,and observation groups according to the secondary treatment.The anatomical outcomes and postoperative visual acuity were recorded.RESULTS:The analysis included 25 eyes in 25 patients(16 females)aged 37–74y(vitrectomy group,n=10;fluid-air exchange group,n=9;observation group,n=6).Closure rate after secondary treatment was 100%in the vitrectomy group,88.9%in the fluid-air exchange group and 33.3%in the observation group.Optical coherence tomography images obtained at the last follow-up revealed that continuity of the external limiting membrane(ELM)was significantly more common(P=0.004)in the fluid-air group(8/9 eyes,88.9%)than in the vitrectomy group(2/10 eyes,20.0%)and that macular morphology was better in the fluid-air group than in the vitrectomy group.No serious complications were observed after secondary treatment.CONCLUSION:Fluid-air exchange is an alternative option to repeat vitrectomy for patients with an unclosed MH after initial vitrectomy with elevated macular edge.
基金Supported by Zhejiang Provincial Highlevel Health Talents Training Project(No.CZ-RC2022010)Wenzhou Basic Medical and Health Technology Project(No.Y2023173)Innovation Project of School of Ophthalmology and Optometry,Eye Hospital of Wenzhou Medical University(No.YNCX3201905).
文摘AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy(PDR)with gradable optical coherence tomography(OCT)imaging from January 2018 to March 2022.The incidence of post vitrectomy DME(PV-DME)was defined as patients with a central retinal thickness(CRT)>300µm by OCT among patients without preoperative DME.RESULTS:The cumulative incidence of PV-DME at 3mo was 40.1%(89/222),with its majority subtype of single diffused retinal thickening(66.2%)followed by single cystoid macular edema(27.0%).Multivariate Cox regression analysis indicated that a thicker preoperative CRT[hazard ratio(HR)=1.01,95%confidence interval(CI)1.00-1.02]and intraoperative internal limiting membrane peeling(HR=3.18,95%CI 1.85-5.47)were associated with the presence of PV-DME,while intraoperative intravitreal injection of triamcinolone acetonide(HR=0.28,95%CI 0.13-0.57)was protective against PV-DME.In eyes with preoperative DME(n=143),the CRT decreased gradually from 468.3±177.7μm preoperatively to 409.5±151.0μm(P=0.027),377.4±141.9μm(P<0.001),and 368.0±157.6μm(P<0.001)at 7d,1 and 3mo postoperatively,respectively.Multivariate linear regression analysis indicated that only a thicker preoperative CRT(β=0.77,95%CI 0.63-0.92)was associated with a decreasing postoperative CRT.CONCLUSION:PV-DME is a very common postoperative complication in patients with PDR.Triamcinolone acetonide could prevent its formation.Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.
基金Supported by the Joint Construction Project of Henan Medical Science and Technology(No.LHGJ20220370)the Natural Science Foundation of Henan Province(No.232300420237).
文摘AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.
文摘●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.
基金Supported by the Guangdong Province Natural Science Foundation(No.2019A1515011732)Guangzhou Science and Technology Foundation of Guangdong Province(No.202002030413)Science and Technology Project of General Hospital of Southern Theater Command of PLA(No.2023NZB010).
文摘AIM:To assess the utility and efficiency of endoscopyassisted vitrectomy(EAV)for the treatment of corneal opacity in severe ocular trauma.METHODS:Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy,followed by EAV and additional surgery were retrospectively recruited.Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups.Outcome measurements included the best corrected visual acuity(BCVA),intraocular pressure(IOP),findings of endoscopic fundus examination,and postoperative complications.RESULTS:Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo.Retinal detachment(RD)and vitreous haemorrhage(VH)were identified in 16 eyes(76.2%),RD only in four eyes(19.0%),and VH combined with intraocular foreign body in one eye(4.8%).All eyes underwent at least three surgeries.Stage-Ⅰ surgeries involved wound closure(100%),lens extraction(76.2%),and anterior vitrectomy(14.3%).Stage-Ⅱ surgeries involved scleral buckling(28.6%),membrane peeling(47.6%),retinal laser photocoagulation(100%)and silicone oil tamponade(100%)using EAV.Stage-Ⅲ surgeries were conducted using endoscopy including silicone oil removal(52.4%),retinal laser photocoagulation(52.4%)and penetrating keratoplasty(28.6%).Nearly all eyes showed improvements in BCVA and IOP.Although there were no severe complications,glaucoma was noted in one eye,chronic hypotony in another eye,and band keratopathy in three eyes.CONCLUSION:EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.
基金Supported by the Program for Qinhuangdao Self-financing Science and Technology Plan of 2008 (No.201805A143).
文摘AIM:To analyze the distribution of fibrovascular proliferative membranes(FVPMs)in proliferative diabetic retinopathy(PDR)patients that treated with pars plana vitrectomy(PPV),and to evaluate the outcomes separately.METHODS:This was a retrospective and cross-sectional study.Consecutive 25-gauge(25-G)PPV cases operated for PDR from May 2018 to April 2020.According to the FVPMs images outlined after operations,subjects were assigned into three groups:arcade type group,juxtapapillary type group,and central type group.All patients were followed up for over one year.General characteristics,operation-related variables,postoperative parameters and complications were recorded.RESULTS:Among 103 eyes recruited,the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different(both P<0.01),with 95(92.23%)FVPMs located in the nasal quadrants,and 74(71.84%)in the inferior.The eyes with a central FVPM required the longest operation time,with silicon oil used in most patients,generally combined with tractional retinal detachment(RD)and rhegmatogenous RD,the worst postoperative bestcorrected visual acuity(BCVA)and the highest rates of recurrent RD(all P<0.05).FVPM type,age of onset diabetes mellitus,preoperative BCVA,and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement(all P<0.05).Compared with the central type group,the arcade type group had higher rates of BCVA improvement.CONCLUSION:FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels.Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.
基金Youth Project of Liangxiang Hospital Fangshan District Beijing,No.2022-11.
文摘BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.
文摘BACKGROUND As the incidence of diabetes continues to increase,the number of patients with diabetic retinopathy(DR)also increases each year.After undergoing vitrectomy for DR,patients often experience negative emotional problems that negatively affect their recovery.AIM To investigate negative feelings in patients with DR after vitrectomy and to explore related influencing factors.METHODS A total of 146 individuals with DR who were accepted for treatment at The Third People’s Hospital of Changzhou from May 2021 to April 2023 were recruited to participate in this study.All patients underwent vitrectomy.The self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to assess the degree of anxiety and depression 2-3 days after the operation.The participants were divided into a healthy control group and a negative emotion group.The patients’general demographic characteristics and blood glucose levels were collected.Logistic regression analysis was used to analyze the factors influencing negative feelings post-operation.Pearson’s correlation coefficient was used to analyze the association between SAS scores,SDS scores,and blood glucose levels.RESULTS The control group included 85 participants.The negative emotion group comprised 40 participants with anxiety,13 with depression,and eight with both.Logistic regression showed that being female(OR=3.090,95%CI:1.217-7.847),a family per capita monthly income of<5000 yuan(OR=0.337,95%CI:0.165-0.668),and a longer duration of diabetes(OR=2.068,95%CI:1.817-3.744)were risk factors for negative emotions in patients with DR after vitrectomy(P<0.05).The concentrations of fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),and glycated hemoglobin(HbA1c)in the negative emotion group exceeded those in the control group(P<0.05).SAS scores were positively associated with FPG(r=0.422),2hPG(r=0.334),and HbA1c(r=0.362;P<0.05).SDS scores were positively correlated with FPG(r=0.218)and 2hPG(r=0.218;P<0.05).CONCLUSION Sex,income level,and duration of diabetes were factors that influenced negative emotions post-vitrectomy.Negative emotions were positively correlated with blood glucose levels,which can be used to develop intervention strategies.
文摘Diabetic vitrectomy is a highly intricate surgical procedure performed during the advanced stages of diabetic retinopathy(DR).It is used to treat conditions such as tractional or combined retinal detachment,vitreous hemorrhage,and subhyaloid hemorrhage,which are all severe manifestations of proliferative DR.The results of the surgery are uncertain and variable.Vitreoretinal surgery has made significant progress since the early stages of vitrectomy.In the past ten years,advancements in intravitreal pharmacotherapy have emerged,offering new possibilities to improve the surgical results for our patients.Within the realm of medical terminology,an"adjunct"refers to a pharmaceutical or substance employed to aid or expedite the primary therapeutic intervention for a particular ailment.Their introduction has broadened the range of therapeutic choices that are accessible prior to,during,and following surgical procedures.This review article will specifically analyze the pharmacological adjuncts used in diabetic vitrectomy surgery,with a focus on their role in facilitating or aiding specific steps of the procedure.The implementation of this system of categorization offers benefits to the surgeon by allowing them to foresee potential difficulties that may occur during the surgical procedure and to choose the appropriate pharmacological agent to effectively tackle these challenges,thus enhancing surgical success rates.
基金supported by the Bethun·Lumitin Research Funding for the young and middle-aged Ophthalmologists(grant no.BJ-LM2021014J)the Science and Technology Program of Guangzhou,China(SL2022A03J00452).
文摘Aim:The objective of this study was to investigate the prognosis of massive vitreous hemorrhage(VH)secondary to polypoidal choroidal vasculopathy(PCV)after vitrectomy.Methods:Forty-nine eyes in 48 patients with PCV and breakthrough VH who underwent 23-gauge pars plana vitrectomy between January 2015 and December 2020 were enrolled.The main outcome parameters were best-corrected visual acuity,postoperative adverse events,and reoperation.Results:The average follow-up time was 20.0±15.82 months.The average preoperative best-corrected visual acuity(BCVA)was 2.12±0.65 logarithm of the minimum angle of resolution(logMAR),the BCVA at six monthswas 1.65±0.64 logMAR,and the six-month follow-up BCVA was 1.67±0.76 logMAR.Compared to the average preoperative BCVA,the six-months and last follow-up BCVA after vitrectomy improved(P<0.05).The BCVA at the final follow-up was better than 1.3 logMAR only in 14 eyes(28.6%).Postoperative complications were observed in 10 eyes(20.4%),including recurrent retinal detachment,recurrent vitreous hemorrhage,macular hole,hyphema and lens dislocation.Fourteen eyes(28.6%)underwent cataract surgery procedure an average of 10.16±5.14 months after vitrectomy.BCVA one week and three monthsafter cataract surgery improved compared toBCVA before cataract surgery(P<0.05).Hypertension was associated with BCVA six months after vitrectomy(P=0.017).The BCVA at baseline and three months after PPV were worse in patients who underwent vitrectomy combined with silicone oil filling(P<0.05).Eyes with postoperative complications had worse BCVA at six months,12 months,and at the final follow-up after PPV(P<0.05).The duration of VH is related to the BCVA 12 months after PPV visual acuity after surgery.Patients who underwent vitrectomy within one month of the onset of vitreous hemorrhage had better BCVA 12 months after vitrectomy than those who underwent vitrectomy surgery one month later(P=0.015).Conclusions:Although the prognosis of vitrectomy varies greatly,cataract surgery could be considered to improve BCVA if polypoidal lesions are inactive six months after vitrectomy.
文摘AIMTo compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases.METHODSA total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA).RESULTSThe most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1<sup>st</sup> day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP≤8 mm Hg) was not different between groups in the postoperative 1<sup>st</sup> day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05).CONCLUSIONTwenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.
文摘AIM:To report the cytology results of 25-gauge transconjunctival(25G-TSV)diagnostic vitrectomy in cases suspicious for intraocular lymphoma(IOL),and compare the results to those reported in the literature.METHODS:Clinical and cytopathological records of 18vitreous biopsy specimens obtained via 25G-TSV diagnostic vitrectomy in 12 patients suspicious for IOL were reviewed retrospectively.A review of the literature in regards to the diagnostic yields of vitreous specimens obtained via 25-gauge and 20-gauge diagnostic vitrectomy in suspected cases of IOL was performed.RESULTS:Eighteen eyes from 12 patients with clinical suspicion of IOL underwent diagnostic 25G-TSV.The cytopathological investigations demonstrated IOL in 15eyes(83.3%).Vitreous analysis was non-diagnostic in 3eyes(16.7%).CONCLUSION:Twenty-five-gauge diagnostic vitrectomy yields adequate sample for cytological evaluation of the vitreous in cases suspicious for IOL.The diagnostic results of the 25G-TSV in the current study are superior to those reported for 20-gauge vitrectomy but equivalent to those reported for 25G-TSV in the published literature.
文摘Ocular endoscopes enable ophthalmologists to observe any part of the retina without any limitations, including those caused by corneal opacities, the rim of the intraocular lens, cortical remnants, capsular opacities, a small pupil, and vitreous opacities. Moreover, ocular endoscopes enable the management of peripheral lesions without scleral indentation and are compatible with microincision vitrectomy surgery. The enlarged view under the endoscope, as obtained by drawing towards the lesion, appears to be another advantage. Rhegmatogenous retinal detachment with undetectable retinal breaks, trauma, endophthalmitis, scleral wounds with incarceration of the vitreous, and microcornea are indications for endoscopic vitrectomy. The combination of endoscopy and a wide-angle viewing system could compensate for the deficiencies of each technique and achieve more effective and safer surgical maneuvers. Endoscopy skills appear to be a great advantage for vitreoretinal surgeons;however, because endoscopies require a learning curve, becoming familiar with the handling of the endoscope through stepby-step learning is necessary.
