Li-Jun Shen

Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis.

Purpose: The purpose of the study was to evaluate visual and anatomical outcomes in patients with myopic foveoschisis who underwent vitrectomy and internal limiting membrane (ILM) peeling with perfluoropropane (C3F8) tamponade or balanced saline solution in the vitreous cavity. Methods: Retrospective comparison of a consecutive surgical series. Eighteen eyes of 17 patients scheduled for myopic foveoschisis surgery were recruited at the affiliated Eye Hospital of Wenzhou Medical College, Zhejiang, China. Pars plana vitrectomy and ILM peeling with indocyanine green staining were performed in all patients. Refractive lens exchange was simultaneously performed in 12 phakic eyes. Finally, the vitreous cavity was filled with balanced saline solution in seven eyes of seven patients (Group A). Fluid-air exchange was performed in another 11 eyes of 11 patients (Group B), followed by injection of 18% C3F8. Patients were evaluated using best-corrected visual acuity (BCVA) testing and optical coherence tomography scans. Results: All patients completed more than 6 months of follow-up. In two groups, preoperative factors were not significantly different. In Group B, the postoperative BCVA was significantly greater than the preoperative BCVA (t = 4.401, P = 0.001) but not significantly different in Group A (t = 1.970, P = 0.096). The BCVA change in Group B was significantly greater than Group A at the last visit (Z = 2.23, P = 0.025). In both groups, the BCVA change was significantly correlated with the preoperative BCVA, respectively. The BCVA was improved by 0.2 logarithm of the minimum angle of resolution or more in 10 eyes (91%) in Group B and 4 eyes (56%) in Group A. All eyes in both groups did not have decreases in the postoperative BCVA. In 3 months after vitrectomy, 6 eyes in Group A did not have anatomical resolutions. However, it was interesting to see that the height of retinoschisis at the central macular region gradually decreased until anatomical resolution was achieved. In Group B, all eyes had anatomical resolutions in 3 months after vitrectomy. None of the eyes developed macular hole during the surgery and the period of routine follow-up period. Conclusion: Vitrectomy with ILM peeling does not increase the risk of iatrogenic macular hole formation. The poor elasticity of the ILM and the traction of membranous structure on the surface of the ILM play important roles in the development of myopic foveoschisis. In eyes undergoing vitrectomy and ILM peeling for myopic foveoschisis, C3F8 tamponade results in more rapid anatomical resolution and greater improvement in BCVA than balanced saline solution.

Injection and suturing technique for scleral fixation foldable lens in the vitrectomized eye.

Injection and Suturing Technique for Scleral Fixation Foldable Lens in the Vitrectomized Eye The transscleral suture fixation intraocular lens (IOL) technique has been widely used in the management of IOL implantation with loss of capsular support or capsule rupture since its initial report in 1986 by Malbran et al.1 There have been many modifications of the technique for scleral fixation. Today, the foldable lens forceps is the most commonly used method for implantation of scleral fixation foldable IOL. In this method, the haptics are tied by the sutures, and the IOL was implanted through a 3.5-mm clear corneal incision. However, implantation by forceps has a number of disadvantages. 1) Intraocular pressure (IOP) is harder to maintain because the corneal incision leads to mass aqueous outflow while inserting the IOL by forceps. Especially, the resulting drop in IOP has potentially severe complications such as eyeball collapse and subchoroidal expulsive hemorrhages2 because of loss of vitreous body support in the vitrectomized eye. 2) The forceps may damage the IOL optical surface, which will influence the vision outcome. Forceps folding provoked more surface irregularities, which probably makes the IOL more susceptible to bacterial adhesion.3 3) Difficulty in tying the haptics can cause the IOL optic to touch the external eye. This is because the IOL is usually placed on the corneal surface and frequently slips and contacts the cornea or conjunctiva and even blood from the incisions when the haptics are tied. In this article, we reported a modified implantation technique for scleral suture fixation of foldable IOL by injection system in the vitrectomized eye.

Erythropoietin as a novel therapeutic agent for atrophic age-related macular degeneration

The purpose of this article is to propose a novel therapeutic approach to the treatment of age-related macular degeneration (ARMD), the leading cause of blindness in the elderly population (over 60 years of age) in developed countries. Although recent advances have been made in the treatment of the neovascular form of ARMD, there is still no effective treatment for the most prevalent atrophic form of ARMD. Although the exact etiology and molecular pathogenesis of the atrophic ARMD are not fully understood, it is believed that oxidative stress and local inflammation play a major role in the pathologic processes and that the disease is triggered by dysfunction in the retinal pigment epithelia, leading to the degeneration of macular photoreceptor cells, followed by irreversible loss of vision. Considering that erythropoietin (EPO) has antioxidant, anti-inflammatory, and neuroprotective properties, we hypothesize that it can be developed as a novel therapeutic agent for the treatment of the atrophic form of ARMD. Future studies are needed to confirm or rule out this hypothesis. If successful, such studies may also help shield the lights on molecular mechanisms of atrophic ARMD.

Elevated Erythropoietin in Vitreous of Patients with Rhegmatogenous Retinal Detachment and Proliferative Vitreoretinopathy

Aim: Our purpose was to determine the vitreous erythropoietin (EPO) level in patients with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR). Methods: The levels of EPO in vitreous were measured using a sandwich enzyme-linked immunosorbent assay kit from 64 patients, of whom 40 had RRD, 13 had PVR and 11 had idiopathic macular hole as control. Results: The mean levels of EPO in the RRD group (54.6 ± 7.3 mU/ml) and PVR group (104.1 ± 20.8 mU/ml) were significantly higher than that in the idiopathic macular hole control group (14.4 ± 3.6 mU/ml; p < 0.001, p = 0.003, respectively). The mean EPO level in PVR was higher than that in RRD, but the difference was not significant (p = 0.112). Conclusion: The vitreous EPO level was upregulated in eyes with RRD and PVR.

Congenital membranous cataract associated with persistent fetal vasculature

A 15-year-old boy underwent phacoemulsification for a membranous cataract during which the presence of anterior persistent hyaloid artery and elongated ciliary processes were discovered. A posterior capsulorhexis was performed and the anterior part of the persistent hyaloid artery stalk was resected together with the posterior capsule. A foldable intraocular lens was implanted and the optic was captured in the posterior capsulorhexis margin. This is an unusual case of congenital membranous cataract associated with malformations of persistent fetal vasculature and elongated ciliary processes.

Bimanual technique in proliferative diabetic retinopathy using an optical fiber-free intravitreal surgery system: a case control study.

Purpose To evaluate the results of bimanual membrane peeling technique with an optical fiber-free intravitreal surgery system (OFFISS) in eyes with fibrovascular proliferation due to diabetic retinopathy. Methods Fifteen eyes of 14 consecutive patients with severe fibrovascular proliferation due to diabetic retinopathy who underwent bimanual vitrectomy using the OFFISS and 15 eyes of 15 nonconsecutive patients with similar fundus condition who underwent vitrectomy using a conventional microscope system were compared in a retrospective, consecutive case-control series. Results Reattachment rates at 3 months following surgery for the cases and controls were 93% and 100%, respectively, and final reattachment rates for both were 100%. The best-corrected visual acuity improved by two lines or more in 100% of the cases as compared to 87% of the controls (p=0.48). The mean VA (logMAR) improved 1.08 in the cases and 0.93 in the controls at final examination (p=0.46). Surgical complications were rare in both groups (p>0.05). The mean duration of membrane peeling of the cases was significantly lower than the controls (p=0.01). Conclusions For complicated surgical manipulations such as membrane peeling in diabetic vitrectomy for severe fibrovascular proliferation, bimanual vitrectomy using the OFFISS is a more effective and safer alternative to the conventional vitrectomy method.

Surgical management of silicone oil migrated into suprachoroidal space after vitrectomy.

AIM To report a successful surgical management of silicone oil migrated into suprachoroidal space after the repair of the retinal detachment with hemorrhagic choroidal detachment. METHODS Retrospective observational case report. A 30-year-old man with retinal detachment and hemorrhagic choroidal detachment due to severe corneal penetrating injury, underwent a pars plana lensectomy and vitrectomy, endolaser, and silicone oil tamponade followed by transscleral suprachoroidal hemorrhage drainage in the right eye. One week later, a localised temporal choroid elevation was noted. This persistent elevation was confirmed by operation research to be silicone oil migration into suprachoroidal space. RESULTS The migrated silicone oil was drained via trans-scleral cut down, and the intravitreal silicone oil was removed and replaced by 16% C2F6. Over the next 2 weeks, the elevation vanished and the choroid became completely flat. CONCLUSION The migration of silicone oil into suprachoroidal space is a rare complication of vitrectomy. The pathway of the migration is most likely through internal orifice of sclerotomy sites. Trans-scleral drainage surgery is an effective method to remove the migrated silicone oil from suprachoroidal space.

Clinical evaluation of rigid gas permeable contact lenses and visual outcome after repaired corneal laceration.

Objective: To evaluate the clinical value of rigid gas permeable contact lenses (RGPCLs) in patients with traumatic corneal scarring and address implications of primary corneal repair. Methods: Eighteen subjects with a history of corneal laceration were fit with RGPCLs. Scar locations were divided into two zones; each patient was examined using Pentacam. Entering data included uncorrected visual acuity (UCVA), spectacle-corrected visual acuity (SVA), time between injury and RGPCL fitting, location and size of scar, and amount of corneal astigmatism. Follow-up data included RGPCL visual acuity (RGPCLVA), RGPCL-related complications, and dropout characteristics. Visual acuity values were converted to logMAR for analysis. Results: No serious complications occurred. The average time between suture removal and RGPCL fitting was 5.7±5.5 months. Average corneal astigmatism was −3.44±2.09 diopters. One subject had developed corneal ectasia. RGPCLVA was more than 0.1 in three subjects: one experienced primary corneal repair complications, and two subjects (<10 years) developed amblyopia. In both zones, the difference in RGPCLVA outcome between zone I and zone II was not statistically significant (F=0.060, P=0.809). The difference between SVA in zones I and II was found to be statistically significant (F=6.131, P=0.026), as were the differences between SVA and RGPCLVA (F=8.598, P=0.010). The scar size had no significant influence on RGPCLVA, SVA, or UCVA. Four participants (22.2%) were successfully fit. Dropout characteristics included ocular discomfort, inconvenience, parental apprehension, and low motivation. Conclusions: Rigid gas permeable contact lens is an ideal method for evaluating visual potential in patients with traumatic corneal astigmatism. Pentacam examinations of those patients with poor RGPCLVA can help an ophthalmologist find and understand existing problems in suture techniques.

A new scleral plug with shouldered-stop for use during vitrectomy.

A new scleral plug has been developed that has advantages over those previously described or currently available. The scleral plug has been used for temporarily sealing pars plana incisions during vitrectomy since 1977. It prevents tissue prolapse, prevents liquid, gas, or silicone oil loss, and makes it possible for the surgeon to control the intraocular pressure. However, being small, hard, and irregular, the plug used previously requires a plug forceps to grasp. The special forceps has hockey-stick shaped tips imprinted with a pair of matching grooves.1 Due to the impediment by the lips of the grooves, the forceps had difficulty grasping the expanded head of the plug and the plug easily falls off during transfer from the plug holder or from the scleral incision. Moreover, the plug shaft cannot completely be inserted into the incision and readily placed at one manipulation step unless one presses the plug head again. These problems interfere with smooth operation and waste time. To solve these problems, we have devised a new scleral plug with a shouldered-stop. The principal feature is that a shouldered-stop and neck are added between the shaft and the expanded head of the original plug. This plug is made of high-grade stainless steel with a smooth finish. The head is an approximate low profile hemispheric expansion 1.8 mm in diameter. The diameter of the neck (length 0.5 mm) and the shaft (length 3 mm) is 0.9 mm. The shouldered-stop is a cylinder 0.2 mm in thickness and 2.0 mm in diameter, which remains outside of the eyeball and covers the incision to strengthen the sealing function. The