ObjectiveTo evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy (PPV). MethodsA retrospective clinical study. 17 528 surgeries in 10 895 eyes of 10 895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study. Among them, 5 346 eyes in 5 346 cases were male; 5 549 eyes in 5 549 cases were female. The age ranged from 0 to 95 years, with the mean age of (57.74±13.15) years. 6 381 surgeries in 3 615 eyes from August 2015 to December 2018 (the initial period of day surgery) were used as the control group; 11 147 surgeries in 7 280 eyes from January 2019 to June 2023 (the expanded period of day surgery) were used as the observation group. According to the management mode of ambulatory surgery, the observation group was subdivided into the decentralized management group (January 2019 to December 2020) and the centralized management group (January 2021 to June 2023), with 2 905 and 4 375 eyes and 4 646 and 6 501 surgeries, respectively. Changes in the percentage of day surgery, average hospitalization days, and average unplanned reoperation rate were compared. The Mann-Whitney U test was used to compare numerical variables between groups; the chi-square test or Fisher's exact test was used to compare categorical variables. ResultsThe number of cases of daytime PPV performed in the observation group and control group was 7 852 (70.44%, 7 852/11 147) and 24 (0.38%, 24/6 381) cases, respectively, and the average hospitalization days were 1 (1) and 5 (3) d. Compared with the control group, the observation group had a significantly higher percentage of day surgery (χ2=8 051.01) and a considerably lower mean hospitalization day (Z=4 536 844.50), and the differences were statistically significant (P＜0.000 1). The mean hospitalization days in the decentralized and centralized management groups were 2 (3) and 1 (0) d, respectively, and unplanned reoperations were 34 (0.73%, 34/4 646) and 171 (2.63%, 171/6 501) eyes, respectively. Compared with the decentralized management group, average hospitalization days was significantly lower (Z=1 436.94) and unplanned reoperation rate was significantly higher (χ2=54.10) were significantly lower in the centralized management group, both of which were statistically significant (P＜0.000 1). ConclusionPPV ambulatory management model can significantly reduce the average hospitalization day, but also results in higher rates of unplanned reoperations.
Hereditary thyroxine protein amyloidosis (ATTRv) is one of the most common forms of systemic and ocular amyloidosis, characterized by autosomal dominant inheritance, incomplete penetrance, and diverse manifestations. ATTRv deposition leads to visual impairment and even irreversible visual loss, which has a negative impact on the quality of life of patients. The diagnostic rate of pathological examination and genetic testing in ATTRv patients is low, and the detection rate of systemic amyloid lesions is low. We need to increase our awareness of this disease and gain a deeper understanding of its systemic manifestations and corresponding examination methods; genetic testing is conducted on the proband's family to investigate the relationship between different gene mutations and eye manifestations. In the future, multidisciplinary consultations can be conducted to jointly diagnose and treat patients with ATTRv eye involvement, conducting large-scale and long-term follow-up studies on the early clinical characteristics, treatment plans, efficacy, possible complications, and early prevention, in order to improve clinical diagnosis rate, reduce misdiagnosis rate, and improve patient prognosis.
ObjectiveTo systematically review the efficacy of preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD). MethodsA evidence-based medicine study. The National Library of Medicine's PubMed, Web of Science, CNKI, and WanFang database were searched. Clinical controlled studies were selected the study object was RRDCD patients and the interventions were preoperative corticosteroids used as an adjunctive treatment. The search was conducted from January 2000 to January 2022. Duplicated, incomplete, or irrelevant articles were excluded. The conventional meta-analysis was used to evaluate the efficacy of corticosteroids used before surgery. The network meta-analysis was used to directly or indirectly compare the efficacy of oral corticosteroids or intravenous dexamethasone, peribulbar injection of glucocorticoids, prednisolone acetate eye-drops, intravitreal injection of triamcinolone acetonide (TA) and posterior sub-tenon injection of triamcinolone acetonide. Publication bias was evaluated by funnel plot. ResultsAccording to the search strategy, 43 articles were initially retrieved, and 929 eyes of 13 articles were finally included for analysis; 6 and 10 articles were included in the traditional meta-analysis and the network meta-analysis. Among the 6 studies included in the conventional meta-analysis, 5 studies were retrospective and 1 study was a randomized controlled trial, involving a total of 575 eyes. The analysis results showed that there was no significant difference in the primary retinal reattachment rate between the corticosteroids group and the control group [odds ratio (OR)= 1.53, 95% confidence interval (CI) 0.67-3.53, P=0.314]. Among the 10 studies included in the network meta-analysis, 7 studies were retrospective trials, 2 studies were randomized controlled trials, and 1 study was prospective trial, involving a total of 575 eyes. The analysis results showed that there were significant differences in the primary retinal reattachment rate between the triamcinolone acetonide intravitreal injection group and the no corticosteroid treatment group (OR=4.09, 95%CI 1.06-15.79). Sub-tenon injection triamcinolone acetonide had a higher incidence rate of ocular hypertension than oral glucocorticoid or intravenous dexamethasone (OR= 4.47, 95%CI 1.42-14.13). ConclusionsTriamcinolone acetonide intravitreal injection before surgery can improve the primary retinal reattachment rate in RRDCD patients. Patients with the posterior sub-tenon injection of triamcinolone acetonide should be alert to elevated intraocular pressure.
Diabetic retinopathy (DR) has become an important cause of irreversible vision loss worldwide. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs is an important method to the treatment of DR. However, the current anti-VEGF treatment regimen is not uniform. Anti-VEGF injection was preferred and then delayed combined with laser had better prognostic effect. The best time for operation was 5-7 days after injection of anti-VEGF drugs. Pars plana vitrectomy, intraoperative and postoperative on-demand anti-VEGF drugs injection can significantly improve patient prognosis and reduce complications, but further research is needed to strike a balance between the economic burden and the number of injections. Various anti-VEGF drugs have their own advantages for different diseases and should be selected according to the characteristics of the diseases and drugs. Anti-VEGF drugs combined with antioxidants may further improve DR outcomes. Future studies should pay more attention to the optimization and personalization of anti-VEGF drugs application programs to meet the therapeutic needs of different patients.
ObjectiveTo observe the effect of mild anemia on prognosis of hyperplastic diabetic retinopathy (PDR) treated by pars plana vitrectomy (PPV). MethodsA retrospective case-control study. From January 2021 to December 2022, 147 PDR patients with 147 eyes who received PPV treatment at Shenyang He Eye Hospital were included in the study. There were 147 eyes in 147 cases, 82 eyes in 82 males and 65 eyes in 65 females. Age was 25-79 (53.54±12.74) years old. A hemoglobin (Hb) of 90 to 120 g/L in men and 90 to 110 g/L in women was defined as mild anemia. According to Hb results, the patients were divided into mild anemia group and non-anemia group, with 39 cases (39 eyes) and 108 cases (108 eyes), respectively. The best corrected visual acuity (BCVA) test was performed using the international standard logarithmic visual acuity scale before and after the surgery, which was statistically converted to minimum resolved logarithmic (logMAR) visual acuity. The logMAR BCVA of the affected eye was 0.2-2.5 (1.60±0.62) before surgery. According to whether the BCVA improved by more than 3 lines 6 months after surgery, the affected eyes were divided into BCVA improved by more than 3 lines and BCVA improved by less than 3 lines, 117 eyes and 30 eyes, respectively. The patient's body mass index (BMI), BCVA at 6 months after surgery, and the occurrence of neovascular glaucoma (NVG) and recurrence of vitreous hemorrhage (RVH) were recorded. Independent sample t test was used for comparison between groups. Multivariate logistic regression analysis was performed to analyze the influencing factors of increased BCVA ≥3 rows after surgery. ResultsSix months after surgery, the logMAR BCVA of patients in mild anemia group and non-anemia group were 0.97±0.87 and 0.68±0.63, respectively. BCVA increased ≥3 in 26 (66.7%, 26/39) and 91 (84.3%, 91/108) eyes, respectively. logMAR BCVA (t=2.234) and BCVA increased by ≥3 rows of eyes (χ2=5.460) between the two groups, the differences were statistically significant (P=0.027, 0.019). Logistic regression analysis showed that baseline logMAR BCVA [odds ratio (OR) =4.291, 95% confidence interval (CI) 1.918-9.600, P＜0.001)], BMI (OR=1.248, 95%CI 1.057-1.472, P=0.009), the number of retinal laser photocoagulation during surgery (OR=1.001, 95%CI 1.000-1.002, P=0.038), mild anemia (OR=0.360, 95%CI 0.131-0.993, P=0.048), postoperative NVG (OR=0.156, 95%CI 0.033-0.726, P=0.018) and RVH (OR=0.264, 95%CI 0.086-0.808, P=0.020) were independent factors for BCVA improvement ≥3 lines after PPV. ConclusionsMild anemia has a certain effect on BCVA improvement after PPV of PDR. Mild anemia, post-operative NVG and RVH were independent risk factors for increasing BCVA ≥3 lines after PPV in PDR patients.
Proliferative diabetic retinopathy is a serious complication of diabetes in the eye that can lead to severe vision loss or even complete vision loss. In recent years, with the rapid development of surgical equipment and fundus examination technology, the indications for pars plana vitrectomy based surgical treatment have been expanded, surgical improvement and application, combined application of drugs, such as anti-vascular endothelial growth factor drugs, glucocorticoids, and surgical evaluation have made new progress. Surgical evaluation based on imaging can continuously monitor patients' eye conditions before, during and after surgery, and clinicians can choose different surgical plans and timing for different patients, which can help reduce patients' pain and achieve better visual outcomes.
Cataract combined with retinopathy can seriously affect the vision of patients. Vitrectomy combined with one-stage implantation of multi-focal intraocular lens (MIOL) has been paid more and more attention. The application of MIOL shows potential in improving the visual quality of patients, but its effect is affected by many factors, and refractive drift is a key problem to be solved. At present, the research mainly focuses on cataract patients with high myopia, and further research on other types of retinopathy is needed. In the future, multi-center, large-sample, long-term clinical studies and interdisciplinary cooperation are needed to optimize surgical and management programs to enhance the application effect of MIOL in the treatment of retinopathy and improve the quality of life of patients.
Objective To observe and analyze the correlation between ectopic foveal inner layer (EIFL) and the EIFL-based idiopathic epiretinal membrane (ERM) staging system and the anatomic and functional prognosis of ERM eyes post pars plana vitrectomy (PPV). MethodsA retrospective study. From January 1, 2020 to October 30, 2023, 345 eyes of 330 patients diagnosed with idiopathic ERM in Department of Ophthalmology of Peking University People's Hospital and treated with standard transciliary flat three-channel 25G PPV combined with ERM and internal limiting membrane exfoliation were included in the study. Among them, 96 were males (111 eyes) and 234 were females (234 eyes). The mean age was (66.8±7.7) years. All study eyes received standard three-port 25G PPV combined with ERM and internal limiting membrane peeling. All study eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. BCVA was performed using a standard logarithmic visual acuity chart and converted to logarithm of the minimum angle of resolution visual acuity for statistical analysis. EIFL thickness and central foveal thickness (CFT) on OCT were measured. ERM eyes were grouped into stage Ⅰ, Ⅱ, Ⅲ and Ⅳ according to ERM staging scheme based on EIFL; disorganization of the retinal inner layers (DRIL) of study eyes were assessed and grouped into no, mild and severe groups. The correlation between ERM staging as well as EIFL thickness and the anatomical and functional prognosis 6 months post-PPV were analyzed. ResultsAmong 345 study eyes, 12, 87, 174 and 72 eyes were stage Ⅰ-Ⅳ ERM respectively, 63 with no DRIL, 216 with mild DRIL and 66 with severe DRIL. Among the 153 eyes with macular edema, the edema subsided in 66 eyes (43.1%, 66/153) 6 months after the operation. Eighty-seven eyes (56.9%, 87/153) did not regress. The edema subsided 6 months after the operation was not significantly correlated with the ERM stage before the operation (χ2=3.331, R=−0.145, P=0.304) or the degree of DRIL (χ2=0.655, R=−0.108, P=0.445). The results of the correlation analysis showed that logMAR BCVA 6 months after the surgery was positively correlated with the degree of DRIL before the surgery (Tau-b=0.236), ERM stage (Tau-b=0.194), CFT (r=0.383), and EIFL thickness (r=0.317) (P＜0.05). There was no significant correlation with the thickness of the outer nuclear layer before the operation (r=0.004, P＞0.05). Preoperative ERM stage (Tau-b=0.303, P＜0.001) and DRIL severity (Tau-b=0.238, P=0.001) were positively correlated with CFT at 6 months after surgery. ConclusionThe ERM stage and EIFL thickness before the operation are positively correlated with logMAR BCVA and CFT 6 months after the operation.
Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C3F8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. MethodsA retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference (P＞0.05). PPV combined with ILM peeling and C3F8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. ResultsAfter initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation (P＞0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month (P=0.783, 0.358), but the difference was statistically significant at 3 months (P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation (P=0.687, 0.950). ConclusionPPV combined with ILM peeling and C3F8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
Objective To compare the outcomes of ranibizumab and conbercept adjunct for pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized case-control study. From June 2022 to December 2023, 90 cases (90 eyes) of PDR patients diagnosed through ophthalmic examination at Department of Ophthalmology of Gansu Provincial Hospital were included in the study. All patients underwent the best corrected visual acuity (BCVA), intraocular pressure, B-mode ultrasound, and optical coherence tomography (OCT) examinations. The central macular thickness (CMT) was measured using an OCT instrument. The patients were randomly divided into a intravitreal injection of ranibizumab group (monoclonal-antibody group) and a intravitreal injection of conbercept group (fusion-protein group) using a random number table method, with 45 cases (45 eyes) in each group. Two groups of patients were intravitreal injected with 10 mg/ml ranibizumab or conbercept 0.05 ml, respectively. A standard 23G PPV was performed through the flat part of the ciliary body 3-7 days after intravitreal injection. Relevant examinations were performed using the same equipments and methods as before surgery at postoperative 1 week, 1, 3, 6, and 12 months. The PPV time, intraoperative use of intraocular electrocoagulation, incidence of iatrogenic retinal breaks, and sterile air or silicone oil tamponade rate in the vitreous cavity, the postoperative changes of BCVA and CMT, and incidence of complications were compared between two groups. Independent sample t test was used for inter group comparison. ResultsThe intraoperative utilization rate of intraocular electrocoagulation in the monoclonal-antibody group was higher than that in the fusion-protein group, and the difference was statistically significant (χ2=3.876, P＜0.05). There were no statistically significant differences in the PPV time (t=0.152), intraoperative bleeding rate (χ2=0.800), incidence of iatrogenic retinal breaks (χ2=1.975), and sterile air and silicone oil tamponade rate in the vitreous cavity (χ2=1.607, 1.553) between the two groups (P＞0.05). There were no statistically significant differences in early and late postoperative vitreous hemorrhage (χ2=1.235, 2.355), and re-PPV (χ2=2.355) between two groups (P＞0.05). The BCVA of the fusion-protein group was significantly better than that of the monoclonal-antibody group at postoperative 3 months, and the difference was statistically significant (t=2.428, P＜0.05). The CMT of the fusion-protein group was lower than that in the monoclonal-antibody group at postoperative 1 week, and the difference was statistically significant (t=2.739, P＜0.05). None of the patients experienced endophthalmitis, retinal artery occlusion, or severe cardiovascular events after surgery. ConclusionCompared with intravitreal injection of ranibizumab before PPV, intravitreal injection of conbercept before PPV in PDR patients can shorten the surgical time, reduce intraoperative bleeding rate, lower the rate of electrocoagulation and intraocular tamponade, and incidence of iatrogenic retinal breaks, and improve the visual acuity.