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vitrectomy with residual internal limiting membrane covering and autologous blood for a secondary macular hole:A case report

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World Journal of Clinical Cases 2022年第2期10卷 671-676页

作者： Huang-Fang Ying Shuang-Qing Wu Wei-Ping Hu Li-Yang Ni Zi-Long Zhang Yong-Gen Xu Department of Ophthalmology Affiliated Hospital of Shaoxing UniversityShaoxing 312000Zhejiang ProvinceChina Department of Ophthalmology Zhejiang Provincial Integrated Chinese and Western Medicine HospitalHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Myopic foveoschisis(MF)is a common complication of pathological myopia.A macular hole(MH)usually results from the natural progression of MF and is a common complication of vitrectomy.vitrectomy combined with residual internal limiting membrane(ILM)covering and autologous blood was effective for closing a secondary MH.CASE SUMMARY A 52-year-old woman presented to our clinic with a complaint of blurred vision in the right eye for 7 years.Her best corrected visual acuity(BCVA)was 20/100,axial length was 25.79 mm and standard equivalent refractive error was-10.5 dioptres.Preoperative optical coherence tomography revealed foveoschisis in the right eye.vitrectomy with fovea-sparing ILM peeling was performed.An MH developed and gradually expanded 5 mo after the initial vitrectomy.vitrectomy with residual ILM covering and autologous blood was performed.The MH closed 3 wk after the second vitrectomy.CONCLUSION Fovea-sparing ILM peeling can provide residual ILM for the treatment of MH secondary to vitrectomy for MF.vitrectomy combined with residual ILM covering and autologous blood is effective for closing secondary MH and improving BCVA.

关键词： vitrectomy Internal limiting membrane Autologous blood Macular hole Myopic foveoschisis Case report

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy

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International Journal of Ophthalmology(English edition) 2022年第8期15卷 1279-1289页

作者： Kenan Sonmez Hilal Kilinc Hekimsoy University of Health Sciences Ulucanlar Eye Education and Research HospitalAnkara 06240Turkey

AIM:To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil(SO)endotamponade for the management of rhegmatogenous retinal detachment(RRD)complicated by advanced proliferative vitreoretinopathy(PVR).METHODS:This is a retrospective,interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade.Eyes with a minimum follow-up of 6mo after SO extraction were included.Eyes were classified into three PVR subgroups according to severity and extension of proliferation.The influence of several preoperative,intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis.RESULTS:A hundred and one eyes of 101 patients that met the inclusion criteria were studied.Seventy-five of 101 eyes(74.3%)had successful retinal reattachment after one operation.Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment,recurrent membrane proliferation and keratopathy.Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values,primary vitrectomy and PVR outside of the posterior pole.CONCLUSION:Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR,an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications.Primary vitrectomy,PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.

关键词： proliferative vitreoretinopathy aqueous inflammation silicone oil tamponade vitrectomy predictors

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia

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International Journal of Ophthalmology(English edition) 2022年第10期15卷 1650-1656页

作者： Xiao-Tian Zhang Jing-Xian Wang Song Chen Clinical College of Ophthalmology Tianjin Medical UniversityTianjin 300020China Tianjin Eye Hospital Tianjin 300020China Tianjin Key Laboratory of Ophthalmology and Visual Science Tianjin300020China Tianjin Medical University Tianjin 300070China

AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group we

关键词： macular hole retinal detachment high myopia posterior scleral staphyloma retinal photocoagulation vitrectomy

Staged lensectomy and vitrectomy in the management of stage 5C retinopathy of prematurity with corneal opacification:long-term follow up

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International Journal of Ophthalmology(English edition) 2022年第9期15卷 1437-1443页

作者： Ping Fei Ting-Yi Liang Jie Peng Yu Xu Jia Luo Qi Zhang Jia-Kai Li Jiao Lyu Pei-Quan Zhao Department of Ophthalmology Xinhua HospitalAffiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092China

·AIM:To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5 C retinopathy of prematurity(ROP)with corneal opacification.·METHODS:This was a retrospective,interventional,consecutive case series.Twenty-two eyes of 18 stage 5 C ROP patients with corneal opacification were included.Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus.Staged lensectomy and posterior vitrectomy were performed.The anatomical and visual outcomes were reviewed at the final follow-up visit.·RESULTS:The mean gestational age of ROP patients was29.3±1.6 wk(range:27-32 wk),comprising 8 males and 10 females.The average birth weight was 1363.0±300.0 g.All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively.Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia.Six eyes had posterior pupillary synechiae or membranes.Seven(31.8%)eyes had vascularly active retinas.The average interval between two procedures was 6.8±4.6 mo(2.5-18.5 mo).After surgeries,all the patients had normal anterior chambers.Fourteen eyes had clear corneas.The intraocular pressure of 3 eyes with glaucoma was controlled by medication.Two eyes had ocular phthisis.The retina was reattached in 3 eyes and partially attached in 11 eyes.Visual acuity ranged from no light perception to hand motion.·CONCLUSION:Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage5 C ROP patients with corneal opacification.The earlier the lensectomy is performed,the better the prognosis is.

关键词： lensectomy vitrectomy staged surgery retinopathy of prematurity corneal opacification retinal detachment

Preoperative laser reduces silicone oil use in primary diabetic vitrectomy

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International Journal of Ophthalmology(English edition) 2022年第4期15卷 591-597页

作者： Wen-Bin Zheng Xiao-Hu Ding Kun-Bei Lai Ji-Zhu Li Yu-Qing Wu Yuan Ma Zi-Ye Chen Shi-Da Chen Sai-Nan Xiao Bing-Qian Liu Ying Lin Tao Li State Key Laboratory of Ophthalmology Zhongshan Ophthalmic CenterSun Yat-sen UniversityGuangdong Provincial Key Laboratory of Ophthalmology and Visual ScienceGuangdong Provincial Clinical Research Center for Ocular DiseasesGuangzhou 510060Guangdong ProvinceChina

AIM: To identify the predictive factors and laser photocoagulation associated with the use of silicone oil as endotamponade during primary diabetic vitrectomy. METHODS: The medical and surgical records of 690 patients(798 eyes) who underwent primary diabetic vitrectomy at a tertiary eye hospital in China from January 2018 to December 2018 were reviewed in this retrospective cohort study. The patients’ baseline characteristics and preoperative treatments were recorded. The binary Logistic regression model was used to evaluate the risk factors for the use of silicone oil as endotamponade agent during primary vitrectomy for proliferative diabetic retinopathy(PDR)-related complications.RESULTS: Among 690 patients with mean age of 52.1±10.5 y(range: 18-85 y), 299/690(43.3%) were female. The 31.6% of the eyes received preoperative laser treatment, and 72.4% of the eyes received preoperative anti-VEGF adjuvant therapy. Non-clearing vitreous haemorrhage(VH) alone or combined with retinal detachment was the main surgical indication(89.5%) for primary vitrectomy. Silicone oil was used as endotamponade in 313(39.2%) eyes. Lack of preoperative laser treatment [odds ratio(OR) 0.66, 95% confidence interval(CI): 0.48-0.92;P=0.015] and older age(OR 0.96, 95%CI: 0.95-0.98;Pvitrectomy for PDR. CONCLUSION: The lack of preoperative laser treatment is a significant predictor of silicone oil tamponade during primary vitrectomy for PDR. However, the severity of PDR relevant to silicone oil use should be further evaluated.

关键词： proliferative diabetic retinopathy vitrectomy laser photocoagulation silicone oil tamponade predictive factors

Vitreous function and intervention of it with vitrectomy and other modalities

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International Journal of Ophthalmology(English edition) 2022年第6期15卷 857-867页

作者： Yao Zong Qian-Ying Gao Yan-Nian Hui Department of Ophthalmology the Affiliated Hospital of Qingdao UniversityQingdao 266003Shandong ProvinceChina Vesber Vitreous Institute Guanghzou 510000Guangdong ProvinceChina Department of Ophthalmology Eye Institute of PL AXijing HospitalFourth Military Medical UniversityXi5an 710032Shaanxi ProvinceChina

The vitreous body, the largest intraocular component, plays a key role in eye development, refraction, cell barrier function, oxygen metabolism and the pathogenesis of assorted diseases. Age, refraction and systemic diseases can cause vitreous metabolic abnormalities. With the continuous development of vitrectomy techniques and equipment, vitreous injections and vitrectomies have increased over the recent decades. However, the normal oxygen tension gradient in the vitreous helps to protect the lens and anterior chamber angle from oxidative stress damage, whereas the increased vitreous oxygen tension around lens and the trabecular meshwork after vitrectomy. It may lead to postoperative nuclear cataract and increase the risk for glaucoma. As a conventional procedure, scleral buckling holds several advantages over vitrectomy in selected cases. This review raises concerns regarding the function of the vitreous and encourages conducting vitreous interventions prudently if it is possible.

关键词： vitreous function oxygen metabolism vitrectomy scleral buckling

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy

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International Journal of Ophthalmology(English edition) 2022年第6期15卷 975-982页

作者： Yao Huang Yue Qi Wen-Bin Wei An-Li Duan Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical UniversityBeijing 100730China

AIM: To report the long-term outcome of posterior scleral reinforcement(PSR) followed by vitrectomy for pathologic myopic foveoschisis(MF).METHODS: The records of 27 patients(44 eyes) treated with posterior scleral reinforcement(PSR) followed by vitrectomy for pathologic MF were retrospectively reviewed.The best-corrected visual acuity(BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings and complications were analyzed.RESULTS: Forty-four eyes of 27 patients were included in this study. The follow-up period was 47.98±18.23mo(24-83mo). The mean preoperative BCVA(logMAR) was 1.13±0.63, and the mean postoperative BCVA was 0.30±0.33at the last visit. There showed a significant improvement in BCVA postoperatively(Pvitrectomy is an effective procedure to improve the visual acuity and the anatomical structure of macula. It can also stabilize the axial length for a long time.

关键词： myopic foveoschisis posterior scleral reinforcement vitrectomy

Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

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International Journal of Ophthalmology(English edition) 2022年第6期15卷 1011-1014页

作者： Hai-Xia Guo Ruo-Tian Xie Yun Wang Cai-Yun You Yuan-Yuan Liu Xiang-Da Meng Jin-Guo Yu Hua Yan Department of Ophthalmology Tianjin Medical University General HospitalTianjin 300052China Laboratory of Molecular Ophthalmology School of Basic Medical SciencesTianjin Medical UniversityTianjin 300070China Department of Ophthalmology the First People's Hospital of XiningXining 810099Qinghai ProvinceChina

AIM:To investigate the clinical features,causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens(IOL)removal in the treatment of acute-onset endophthalmitis after cataract surgery(APCE).METHODS:We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018.Data on the clinical features,causative organisms,visual acuity,intraocular pressure(IOP)and complications were collected.The mean follow-up period was 25.5 mo.RESULTS:The mean age of the patients was 71.4 y.The mean time between cataract surgery and the onset of endophthalmitis was 2.0 d.Preoperative visual acuity ranged from no light perception to hand motion.After vitrectomy,the visual acuity increased in nine eyes(90%),and was unchanged in one eye(10%).A significant difference was observed between the mean preoperative(36.3±7.1 mm Hg)and postoperative IOP(14.9±4.3 mm Hg,Pvitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.

关键词： vitrectomy silicone oil endophthalmitis cataract intraocular lens

Intraocular lens removal or not during vitrectomy for acute infectious endophthalmitis after cataract surgery

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International Journal of Ophthalmology(English edition) 2022年第6期15卷 855-856页

作者： Yan-Nian Hui Department of Ophthalmology Xijing HospitalEye Institute of Chinese PL AFourth Military Medical UniversityXi'an 710032Shaanxi ProvinceChina

At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens(IOL) during vitrectomy in cases with a moderate or severe inflammation is controversial. In order to call upon more discussion, we publish the article entitled “Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery” written by Guo et al in this issue. With recent advanced vitrectomy techniques, and critical measures for management of risk factors related to occurrence of infection, IOL remaining during timely vitrectomy for acute endophthalmitis can possibly be safe and effective in selected cases.

关键词： intraocular lens removal endophthalmitis vitrectomy cataract surgery