Purpose To compare the anatomic and functional outcomes of treating thick submacular haemorrhage with intravitreal gas injection with and without tissue plasminogen activator (t-PA) in patients with age-related macular degeneration. Methods A review of age-related macular degeneration patients with submacular haemorrhage who underwent intravitreal gas injection with and without t-PA at a tertiary referral centre was conducted. Main outcome measures were best and final postoperative visual acuity. Results A total of 53 eyes of 53 patients were included, 28 eyes received intravitreal t-PA and gas injection (t-PA and gas group) and 25 eyes received intravitreal gas injection alone (gas-alone group). Incidence of best visual acuity improvement was significantly higher in the t-PA and gas group than in the gas-alone group (60.7 vs 32.0%; P ¼ 0.037). However, subgroup analysis demonstrated that the difference was significant only in eyes with haemorrhage duration of more than 14 days (46.2 vs 8.3%; P ¼ 0.035). Incidence of final visual acuity improvement was not significantly different between the two groups (42.9 vs 28.0%; P ¼ 0.39). The complications of vitreous haemorrhage and endophthalmitis were similar between the two groups. Multiple logistic regression analysis demonstrated that shorter haemorrhage duration (o14 days) was the main factor predictive of best visual acuity improvement (OR ¼ 9.02, P ¼ 0.015). Whether t-PA was used was of borderline significance (OR ¼ 4.96, P ¼ 0.046). AbstractConclusions Intravitreal t-PA was valuable for submacular haemorrhage only in eyes with relatively old haemorrhage. For eyes with recent onset of haemorrhage, t-PA is suggested only if initial gas injection failed to displace submacular haemorrhage.
Purpose To analyse the anatomical and functional outcome of surgery for primary rhegmatogenous retinal detachment (RRD) in highly myopic eyes. Methods We retrospectively reviewed the medical records of 111 high myopic patients (111 eyes) with primary RRD treated by scleral buckling or pars plana vitrectomy in a tertiary referral university hospital. The postoperative retinal status and best-corrected visual acuity were recorded. Risk factors including age, refractive error, duration of retinal detachment, preoperative visual acuity, extent of detachment, and intraoperative and postoperative complications were evaluated. Multiple logistic regression analysis was used to determine the independent correlation of each variable on anatomical and functional outcome. Results Primary surgery resulting in retinal reattachment was achieved in 96 (86.5%) eyes with more than 6 months follow-up (range, 6-60 months). Sixty-eight (61.3%) eyes had postoperative corrected visual acuity 20/50 or more. Postoperative complications in high myopic eyes were variable, and the most common was cataract progression (19.8%). Upon multiple logistic regression analysis, young patients had significantly better anatomical outcome, although the variables including less refraction error, better preoperative visual acuity, scleral buckling procedure, and less surgical intervention showed better functional outcome in our series. Conclusions The anatomical outcome of surgery for primary RRD in highly myopic eyes was favourable, and young patients tended to have a higher success rate. Functional outcome was significantly correlated with refractive error, preoperative visual acuity, surgical procedure, and number of vitreoretinal surgery.
Purpose To evaluate the therapeutic effect of photodynamic therapy (PDT) combined with posterior subtenon injection of triamcinolone acetonide (PSTA) in the treatment of choroidal neovascularization (CNV). Methods In this retrospective case-control study, treatment outcomes at 12 months of patients with CNV were reviewed. One hundred and two consecutive patients (102 eyes) with subfoveal CNV of various causes were included. Patients in the study group (n ¼ 46) received PDT followed within 2 days by 40 mg of PSTA. Patients in the control group (n ¼ 56) received PDT alone. Patients were retreated 3 months later or more if fluorescein angiography showed residual membrane leakage. Treatment outcomes were compared between the two groups and among different CNV subgroups. Results Gain in mean best-corrected visual acuity (BCVA) was significantly higher in the study group ( þ 0.78 lines) than in the control group (À1.86 lines) (Po0.0001). The number of treatments within 1 year was significantly less in the study group (1.26 vs 1.63, P ¼ 0.008). The mean BCVA change for myopic CNV and age-related predominantly classic CNV subgroups was significantly higher in the study group ( þ 2.82 vs À0.91 lines, P ¼ 0.0005 for myopic CNV; þ 0.6 vs À1.79 lines, P ¼ 0.01 for age-related predominantly classic CNV). The main side effect in the study group was increased intraocular pressure (8.7%). ConclusionCompared with PDT alone, PDT combined with PSTA has a better therapeutic effect for both myopic and age-related predominantly classic CNV; the myopic CNV subgroup shows the best response.
Purpose To examine the evolution and complications of preretinal hemorrhage under silicone oil after diabetic vitrectomy. Methods A total of 44 cases of primary diabetic vitrectomy with silicone oil infusion were reviewed in a 3-year period. Intravitreal bevacizumab was used preoperatively for cases with active proliferation, and in all cases at the end of surgery. Intraoperative bleeding, postoperative extent of preretinal hemorrhage, blood reabsorption time, and reproliferation and treatment results were assessed. Results Maximal blood distributed in thin and scattered patterns (23 cases), thick and localized patterns (10 cases), or thick and scattered patterns (10 cases) developed within 1 week after surgery, and was largely reabsorbed within a month with improved postoperative vision. Confluent blood extending to the midperiphery (one case) resulted in severe fibrosis and detachment. Complications included fibrotic plaque (two cases), and fibrous band and thick membrane (seven cases). Six cases underwent preretinal tissue removal. Vision improvementZ3 lines was noted in three cases. Conclusion Most of the rebleeding occurred within the first post-op week, with gradual reabsorption in the posterior pole within 4 weeks; widespread confluent bleeding might result in severe reproliferation and detachment. A major complication of preretinal bleeding was the formation of preretinal fibrosis. Re-operation achieved a mild VA improvement.
Purpose To evaluate the therapeutic outcome and the recurrence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) after transpupillary thermotherapy (TTT) in light-brown retinas. Methods A retrospective, non-randomized study of 58 eyes in 55 patients with subfoveal CNV treated with TTT was conducted. Power settings were set about half the value for Caucasian eyes. The outcome was assessed with best-corrected visual acuity, fluorescein angiography, indocyanine green angiography, and fundoscopic examination. Results Forty-four membranes were occult, six classic, and eight mixed. Mean follow-up was 16.6710.7 months (range: 6-48 months). Membranes closed in 46 eyes. Iatrogenic complications included three subretinal haemorrhage, two retinal pigment epithelium tears, and two macular area cystic changes. In eyes with occult CNV, visual acuity improved in six (13.6%), 14 (31.8%) remained unchanged, and 24 (54.6%) deteriorated. For various CNV, average logMAR changes from baseline at last follow-up were 0.30 in occult, À0.08 in classic, and 0.59 in mixed (Po0.01). Thirty eyes experienced recurrence within 9.276.2 months (range: 2-22 months). Cumulative recurrence rate was 45% at 12 months and 71% at 22 months, with no significant difference between occult and non-occult type CNV. Conclusions Transpupillary thermotherapy does not cure CNV secondary to AMD. High recurrence was found independent of CNV type. Most improved vision was found mostly in classic CNV. Complications associated with high energy level should be considered in light-brown retinas.
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