Diabetic vitreopapillary traction syndrome (DVPT) is an important complication of diabetic eye disease, caused by persistent mechanical traction exerted by the vitreous on the optic disc and its surrounding tissues, It can lead to severe consequences such as visual impairment and visual field defects. The core mechanisms involve diabetic vitreous remodeling (including hyperglycemia-induced vitreous liquefaction, abnormal cross-linking, and anomalous posterior vitreous detachment) and the fibrovascular proliferation-traction vicious cycle, both contributing to the initiation and progression. Regarding diagnosis, optical coherence tomography is the cornerstone for visualizing vitreo-papillary anatomical relationships. B-scan ultrasonography is valuable in cases with opaque media. Visual field testing assesses the extent of retinal nerve fiber layer involvement. Fluorescein fundus angiography reveals disruption of the blood-retinal barrier on the optic disc surface. Optical coherence tomography angiography shows promise as a novel tool for early diagnosis and dynamic monitoring by quantifying microvascular abnormalities in the optic disc region. For treatment, conservative observation is suitable for patients with mild symptoms and stable visual function. For those experiencing progressive visual impairment, significant disc edema, or concurrent complications of diabetic retinopathy requiring intervention, active consideration of pars plana vitrectomy is warranted. Future research can focus on neuroprotection and revasrearization strategies, the quantitative relationship between traction intensity and optic nerve injury, and the optimization of individualized treatment strategies based on mechanisms, thereby further improving the diagnosis and treatment level of DVPT.
Objective To observe the morphological characteristics of high myopia (HM) paravalvular abnormalities (PVA), and the correlation between different manifestations of PVA and myopic traction maculopathy (MTM) was analyzed. MethodsA cross-sectional clinical study. A total of 42 middle-aged and elderly patients with HM and PVA diagnosed by ophthalmology examination in Department of Ophthalmology, The Second Hospital of Hebei Medical University from June to December 2021 were included in the study. There were 24 eyes in 16 males and 48 eyes in 26 females. Age was (56.71±8.10) years old. Diopter was (－13.05±3.10) D. Axial length (AL) was (28.22±1.04) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA morphology was divided into paravascular microfolds (PM), paravascular cysts (PC) and paravascular lamellar holes (PLH). MTM was divided into T0-T5 grades, of which MTM≥T3 was defined as severe MTM. The state of vitreoretinal junction was observed and the state of posterior vitreous detachment (PVD) was recorded, which divided into complete PVD and partial PVD. Partial PVD was divided into macular fovea adhesions and paravascular adhesions according to the vitreoretinal adhesions. Posterior scleral staphyloma (PS) was divided into 6 types by ultra-wide-angle fundus photography. Logistic regression model was used to analyze the factors related to MTM. ResultsIn 72 eyes, PM, PC and PLH were 72 (100.0%, 72/72), 62 (86.1%, 62/72) and 29 (40.3%, 29/72) eyes, respectively. Among them, there were 10 (13.9%, 10/72) eyes with PM alone, 33 (45.8%, 33/72) eyes with PM and PC, and 29 (40.3%, 29/72) eyes with PM, PC and PLH, respectively. There were 42 eyes with partial PVD (58.3%, 42/72), among which the macular fovea and paravascular adhesion were 22 (52.4%, 22/42) and 24 (57.1%, 24/42) eyes, respectively. PS was present in 50 eyes (69.4%, 50/72), among which 27 (54.0%, 27/50), 21 (42.0%, 21/50), 1 (2.0%, 1/50), and 1 (2.0%, 1/50) eyes were types Ⅰ to Ⅳ, respectively. Multivariate logistic regression analysis showed that AL[odds ratio (OR)=16.139, 95% confidence interval (CI) 4.062-64.120, P＜0.001], PS (OR=4.212, 95%CI 1.234-14.378, P=0.022), paravascular vitreoretinal adhesion (OR=3.478, 95%CI 11.124, P=0.036) were risk factors for PM, PC and PLH. MTM was present in 58 eyes (80.6%, 58/72), among which T1 was the most common type in 19 eyes (26.4%, 19/72). Univariate logistic regression analysis showed that the occurrence of MTM was significantly correlated to PS (OR=4.190, 95%CI 1.240-14.157, P=0.021), coexistence of PM, PC and PLH (OR=11.323, 95%CI 1.389-92.311, P=0.023), and PS were significantly correlated. There was no correlation with PVD (OR=1.889, 95%CI 0.580-6.150, P=0.291) or PS (OR=2.778, 1.786; 95%CI 0.700-11.023; 0.445-7.167; P=0.146, 0.413). There was significant difference in the incidence of severe MTM between PM alone, PM combined with PC and coexistence of PM, PC and PLH (χ2=20.943, P＜0.001). ConclusionsPM is the most common and earliest manifestation of PVA in middle-aged and elderly HM patients. AL, PS and paravascular vitreoretinal adhesion are risk factors for PM, PC and PLH. The coexistence of three PVA forms may be a marker of severe MTM.
Tissue plasminogen activator (t-PA), a serine protease capable of promoting fibrin degradation and thrombus dissolution, plays a pivotal role in the management of cardiovascular and cerebrovascular diseases. In recent years, its ophthalmic applications have expanded significantly. Intravitreal administration of t-PA demonstrates efficacy in inducing posterior vitreous detachment, thereby enhancing surgical success rates. Combined application with vitrectomy markedly improves outcomes in subretinal hemorrhage management. Systemic thrombolysis via intravenous or intra-arterial routes effectively alleviates central retinal artery occlusion, while suprachoroidal injection facilitates resolution of suprachoroidal hemorrhage. Notably, the synergistic effect of subretinal co-administration with anti-vascular endothelial growth factor agents enhances anti-angiogenic efficacy, offering novel therapeutic strategies for ocular neovascular disorders. In the future, it is necessary to further clarify the best indication of t-PA, improve the treatment scheme, and explore the combined application with other treatment methods to promote the innovation of ophthalmic treatment.