Objective:To observe the changes of macular visual function after myopic foveoschisis (MF) and pars plana vitrectomy (PPV) combined with internal limiting membrane peeling and air filling.Methods:A single-center, retrospective study. From October 2018 to October 2019, 29 MF inpatients (32 eyes) in Tianjin Eye Hospital were included in this study. There were 3 males (4 eyes) and 26 females (28 eyes). The age was 63.00±3.45 years old. Equivalent spherical lens degree was -14.16±2.54 D, and axial length was 29.14±1.04 mm. Among them, 3 patients (3 eyes) had lamellar macular holes. All eyes underwent standard pars plana three-channel 25G PPV combined with internal limiting membrane peeling and air filling. Before surgery and at 1, 3, and 6 months after surgery, macular microperimetry was performed with a macular integrity assessment instrument, and the mean retinal sensitivitie (MS) within 10° of the macula, fovea 2° and 4° fixation rates (P1, P2), 63% and 95% bivariate contour ellipse area (BCEA) were recorded. The comparison of MS, P1, P2, 63%BCEA and 95%BCEA at different times before and after surgery was performed by paired t test; the comparison of fixation stability rate was performed by χ 2 test. Results:Compared with before surgery, there were significant differences in the improvement of MS in affected eyes at 1, 3 and 6 months after surgery ( t=-2.208, -3.435,-4.919; P=0.038, 0.002, 0.000). In the pairwise comparison at different times after surgery, only 6 months after surgery and 1 month after surgery were significantly different ( P=0.036). Compared with the preoperative P1, P2, 63%BCEA and 95%BCEA, the P1 and P2 of the eyes gradually increased after surgery, while the 63%BCEA and 95%BCEA gradually decreased, however, the difference was not statistically significant (P1: t=-1.595,-1.698,-1.966; P=0.125, 0.104, 0.062. P2: t=-1.622,-1.654,-1.707; P=0.119, 0.112, 0.102. 63%BCEA: t=1.410, 1.409, 1.553; P=0.172, 0.173, 0.135. 95%BCEA: t=1.412, 1.408, 1.564; P=0.172, 0.173, 0.132). Six months after surgery, all the eyes underwent anatomical repositioning of the macular area, and no serious complications such as full-thickness macular hole and macular hole retinal detachment were found. Conclusions:PPV with internal limiting membrane peeling and air filling is an effective and safe method for MF, and the macular function improved significantly within 6 months postoperatively.

Objective To observe the dynamic characteristics of visual acuity after vitrectomy in different sizes of idiopathic macular hole,and analyze the influencing factors.Methods A retrospective study.From August 2016 to June 2018,302 patients (302 eyes) with monocular idiopathic macular hole who underwent 25G vitrectomy combined with the internal limiting membrane peeling in Tianjin Eye Hospital were included in the study.There were 130 males and 172 females,with the mean age of 63.36 ± 6.91 years.There were 158 left eyes and 144 right eyes.The logMAR BCVA was 1.13 ± 0.45.The minimum diameter (422.92± 211.73 μm) and basal diameter (835.47± 366.42 μm) of macular hole and choroid thickness under fovea (244.84± 60.68 μm)were measured by OCT.According to the minimum diameter,the holes were divided into small hole group (≤ 250 μm),middle hole group (＞250 μm and ≤400 μm) and large hole group (＞400 μm).The logMAR BCVA at 1,3 and 6 months after surgery in 3 groups were observed.Two-factor repeated measure ANOVA was used to compare the visual acuity of the 3 groups.The generalized estimation equation (GEE) was used to analyze the influencing factors of postoperative visual recovery.Results One month after surgery,all the holes were closed.One,3 and 6 months after surgery,the logMAR BCVA were 0.33 ± 0.25,0.23 ± 0.18,0.16± 0.17 in the small hole group;the logMAR BCVA were 0.46±0.25,0.35±0.26,0.27±0.28 in the middle hole group;the logMAR BCVA were 0.81 ±0.51,0.61 ±0.48,0.53±0.37 in the large hole group.Through repeated measurement variance analysis of two factors,it was found that there was an interaction between different groups and different time nodes (F=23.133,P＜0.01).All data were segmented and one-way repeated measure ANOVA was performed.The results showed that there was a statistically significant difference in visual acuity between the small hole group and the middle hole group among preoperative and 1 month after surgery (P＜0.05),while there was no statistically significant difference in visual acuity between 1,3 and 6 months after surgery (P＞0.05).In the large hole group,among preoperative,1 months after surgery,3 months after surgery,the visual acuity difference was statistically significant (P＜0.05),while the visual acuity difference between 3 months after surgery and 6 months after surgery was not statistically significant (P＞0.05).The results of GEE analysis showed that hole size (X2=4.17,P=0.04),basal diameter (X2=7.25,P=0.01),disease course (X2=19.26,P=0.00),and choroid thickness (X2=4.19,P=0.04) were the influencing factors of postoperative visual acuity.Conclusions After vitrectomy of macular holes of different sizes,the visual recovery trend is different.The visual recovery of small holes and middle holes is faster and basically restored at 1 month.The large holes requires a slow recovery process and stabilizes vision at 3 months.Hole size,basal diameter,course of disease and choroid thickness are the influencing factors of visual acuity recovery.

Objective:To observe the healing morphology, macular microstructure and visual function of idiopathic macular hole (IMH) after pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) flap.Methods:Retrospective case study. From 2016 to 2018, 39 eyes of 39 patients with IMH diagnosed in Tianjin Eye Hospital were included in the study. Among them, there were 4 eyes in 4 males and 35 eyes in 35 females, with an average age of 64.56±7.2 years. BCVA, OCT, OCT angiography (OCTA) and MAIA microperimetry examination were performed in all patients. BCVA examination was performed with the international standard visual acuity chart, which was converted to logMAR visual acuity when recording. All patients underwent PPV combined with ILM flap covering and air tamponade. According to the characteristics of OCT images postoperatively, the eyes were divided into U-shaped closed group, V-shaped closed group, irregular closed group and flat closed group, with 26, 5, 7 and 1 eyes respectively. There was a significant difference in the minimum hole diameter ( F=5.118, P=0.005) and macular hole classification ( F=3.608, P=0.024). The shallow capillary layer (SCP) blood flow density in the U-shaped closure group was significantly higher than that in the V-shaped closure group, the irregular closure group and the flat closure group (t=2.079, 2.368; P=0.047, 0.025). At 1, 3, 6 months after the operation, the same equipment and methods were used for relevant examination. The blood flow density of BCVA, SCP, perimeter of foveal avascular zone (PERIM) and mean sensitivity (MS) were compared before and after operation. Independent sample t-test was used for quantitative data comparison between different groups, and χ2 test was used for counting data comparison. Results:Six months after operation, the logMAR of the eyes in the U-shaped closure group was -0.75±0.29 higher than that before operation, and was better than that in the V-shaped closure group, the irregular closure group and the flat closure group ( t=-2.974, -2.518; P=0.006, 0.018). The integrity of external limiting membrane (ELM) and ellipsoid in U-shaped closed group was significantly higher than that in V-shaped closed group, irregular closed group and flat closed group ( χ2=15.229, 10.809; P=0.020, 0.013). The percentage of macular central fovea reflex mass in the U-shaped closed group was significantly lower than that in the V-shaped closed group, irregular closed group and flat closed group ( χ2=20.107, P=0.000). PERIM in U-shaped closure group was smaller than that in V-shaped closure group, irregular closure group and flat closure group, and the difference was statistically significant ( t=-3.391, -2.427; P=0.002, 0.022). The total MS of macular area 10° in the U-shaped closure group was significantly higher than that in the other V-shaped closure group, irregular closure group and flat closure group ( t=2.939, 2.811; P=0.001, 0.001). Conclusion:After IMH operation, the U-shaped closure showed better BCVA and macular light sensitivity, the proportion of ELM and ellipsoid to restore structural integrity are higher, PERIM is smaller, and there are fewer macular fovea strong reflex masses.

Objective:To observe the changes of microperimeter and OCT angiography (OCTA) in idiopathic macular hole (IMH) before and after operation, and to explore the correlation between the changes and visual acuity.Methods:From January 2018 to January 2019, 41 patients (41 eyes) with IMH who underwent pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) flap surgery in Tianjin Eye Hospital were included in this study. Among them, 8 patients (8 eyes) were male and 33 patients (33 eyes) were female. The average age was 64.02±6.46 years. The average course of disease was 7.00±8.85 months. BCVA, microperimeter and OCTA were performed. The retinal mean sensitivity (RMS) at 10 ° and fovea 2 ° fixation rate (P1) and binary contour ellipse area (63% BCEA) were measured by macular integrity assessment instrument. The central retinal thickness (CRT), choroidal blood flow area (CFA), superficial and deep retinal blood flow density (FAVD, FDVD), foveal avascular zone (FAZ) and blood flow densitywithin the width of FAZ 300 μm (FD-300) were measured by OCTA. Twenty one and 19 eyes with or without ILM flap operation were treated with 25G standard three incision PPV. The follow-up time was more than 6 months. Paired t-test was used to compare the indexes before and after operation. Pearson correlation analysis was performed for the correlation between logMAR visual acuity and microperimeter variables and OCTA variables. Nonparametric test was performed for paired comparison between affected eyes and contralateral eyes before and after operation.Results:At 6 months after operation, logMAR visual acuity ( t=-12.33), RMS ( t=7.94), P1 ( t=3.21), 63% BCEA ( t=-3.98), CRT ( t=-9.17), CFA ( t=8.14), FSVD ( t=3.75), FDVD ( t=3.88) were significantly improved compared with those before operation ( P<0.001). The difference of FAZ area ( t=-1.40) and FD-300 ( t=1.95) before and after operation were not statistically significant ( P>0.05). The results of correlation analysis showed that logMAR visual acuity 6 months after surgery was correlated with preoperative logMAR visual acuity, MIN, RMS, P1, 63% BCEA, FSVD, FDVD and FAZ ( r=0.432、0.527、-0.410、-0.383、0.349、-0.406、-0.373、0.407; P<0.05). At 6 months after operation, the indexes of the affected eyes were significantly improved compared with those before operation, but worse than those of the contralateral eyes ( P<0.05). Conclusions:PPV for IMH can effectively improve the visual acuity, retinal function and foveal microvascular circulation. Retinal function and blood circulation changes have a significant impact on postoperative visual acuity.

When macular diseases involves the fovea, patients' central vision is significantly reduced. A central dark spot appears in the visual field, and their visual function indicators, such as reading speed and fixation stability, are significantly impaired, which seriously affects the patients' quality of life. The human body's response to the damage of the fovea region is a spontaneous adaptation strategy adopted by the brain. The brain will select the paracentral region as the pseudo fovea to serve as the fixation site of the eye, however, the development of patient's own residual vision is not maximized by this adaptation behavior. In recent years, through continuous research, it has been discovered that the automatic eye position recognition and automatic eye tracking system in the microperimeter can accurately detect specific retinal sites, combined with the biofeedback training mode, and can combine fundus examination with biofeedback training. It can help patients with age-related macular degeneration, pathological myopia macular degeneration, Stargardt's disease, macular hole and other macular diseases to choose the best retinal site as an eye movement benchmark, maximize the patient's residual vision and improve the patient's visual function.

Objective: To observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C₃F₈) tamponade in the treatment of idiopathic macular hole (IMH). Methods: A retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C₃F₈ tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD<400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C₃F₈, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C₃F₈. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed. Results: The postoperative BCVA of group A, B and C was improved obviously,the differences were statistically significant (t=−11.66, −7.52, −4.99; P<0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, −0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation, Conclusions The macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.

Objective To evaluate the enhancing effects of scleral biomechanics and safety of collagen crosslinking by using minimally invasive riboflavin and ultraviolet A.Methods Fifty-six healthy New Zealand white rabbits were randomized into non-cosslinking group,post-crosslinking 1-day group,post-crosslinking 7-day group,postcrosslinking 15-day group,post-crosslinking 1-month group,post-crosslinking 2-month group and post-crosslinking 3-month group,eight for each group.Riboflavin solution at the concentration of 0.1％ was dropped once per 2 minutes for 20 minutes,and then minimally invasive riboflavin and ultraviolet A was carried out in the right eyes by putting the lighting emitting diode (LED) probe end of microinvasive ultraviolet scleral crosslinking device to irradiate the posterior sclera for 30 minutes with the wavelength of 370 nm and radiation energy of 3 mW/cm2,and the left eyes served as the normal controls.The scleral temperature was measured using clinical thermometer during the crosslinking period.The rabbits were sacrificed according to the grouping and the eyeballs were obtained.The scleral thickness was measured by callipers,the pretension and tensile failure tests of sclera strips were tested by micromaterial mechanics performance test system to measure the extreme stress,extreme strain and 8％ elastic modulus.Hematoxylin-eosin staining was employed to examine the morphology of eye tissues.Retinal cell apoptosis was detected by TUNEL assay.Results The scleral thickness was insignificantly different among the non-crosslinking group,post-crosslinking 1-day group,post-crosslinking 7-day group,post-crosslinking 15-day group,post-crosslinking 1-month group,post-crosslinking 2-month group and post-crosslinking 3-month group and between right eyes and left controls (F,es =0.02,P＞0.05;Fgroup =1.71,P＞0.05).Compared with the non-crossliking group,the extreme stress and 8％ elastic modulus of the scleras were significantly increased,and the extreme strain of the scleras was significantly decreased in post-crosslinking 1-day group,post-crosslinking 7-day group,post-crosslinking 15-day group,post-crosslinking 1-month group,postcrosslinking 2-month group and post-crosslinking 3-month group (all at P＜0.05).Not any morphological abnormalities were found in corneas,scleras,irises,ciliary bodies and choroids in various groups.The apoptosis rates of retinal cells were (11.00±0.33)％,(12.33±1.58)％,(12.02±0.45)％,(11.81±0.85)％,(12.15± 0.61)％,(12.14±0.25)％and (11.74±0.63) ％ in the non-crosslinking group,post-crosslinking 1-day group,post-crosslinking 7-day group,postcrosslinking 15-day group,post-crosslinking 1-month group,post-crosslinking 2-month group and post-crosslinking 3-month group,respectively,with no significant difference among the three groups (F =1.78,P =0.14).Conclusions Rabbit sclera collagen crosslinking by using the minimally invasive riboflavin and ultraviolet A can effectively enhance the biomechanical strength of the sclera,and this procedure is safe.

Objective To observe and analyze the causes and prognosis of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods A total of 160 PDR patients (171 eyes) were enrolled in this retrospective study.There were 85 males and 75 females.The patients aged from 33 to 73 years,with the mean age of (56.40±8.97) years.All the patients were performed 25G pars plana vitrectomy by the same doctor.Fibrovascular membrane peeling and panretinal photocoagulation were performed during the operation.Combined phacoemulsification was performed in one hundred and five patients.Vitreous tamponade was used at the end of surgery,including silicone oil (43 eyes),C3F8 (63 eyes),air or fluid (65 eyes).The follow-up ranged from 6 to 22 months,with the mean follow-up of (9.34±6.97) months.The features of PVH were observed.The difference of age,HbA1 c,creatinine level,the severity of the fundus lesions,whether received treatment of anti-vascular endothelial growth factor (VEGF),whether received combined cataract phacoemulsification were analyzed to find out the cause and prognosis of PVH.Results The corrected vision of all the patients after the primary PPV at the latest follow up was finger counting/1 meter.PVH occurred in 15 eyes of 15 patients,the incidence was 8.77％.The PVH occurred 2 weeks to 6 months after surgery.There were significant difference in age (t=2.551),proportion with tractional retinal detachment (x2=7.431),progressive fibrovascular proliferation (x2=4.987) and using anti-VEGF (x2=9.742) between the patients with and without PVH (P＜0.05).There was no significant difference in HbAlc (t=0.501),creatinine level (t=1.529),and the proportion of cataract phacoemulsification (x2=0.452) between the patients with and without PVH (P＞0.05).During follow-up,neovascularization of iris (NVI) occurred in 1 eye and neovascular glaucoma (NVG) occurred in 4 eyes.Seven eyes underwent reoperation,7 eyes were spontaneous recovered,1 eye with NVG give up treatment.Fibrovascular membrane was the major cause of recurrent hemorrhage.At the end of follow-up,hemorrhage was absorbed in all the 14 eyes which were treated,12 eyes had same visual acuity compared to that before postoperative hemorrhage,2 eyes with NVG had decreased vision.There was significant difference in the corrected vision between the patients with and without NVI or NVG (P=0.022).Conclusions PVH after PPV for PDR is closely related to the severity of diabetic retinopathy,fibrovascular membrane is the major cause of recurrent hemorrhage.NVG is an important factor related to vision acuity prognosis.

Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH),but the visual acuity and MH closure rate remains to be further improved.After removal of posterior vitreous cortex,the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH.During the circumferential peeling,the ILM is not removed completely from the retina but is left attached to the edges of the MH.The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades.Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy,especially for MH with large diameter and unhealed MH after ILM peeling.Compared with conventional vitrectomy combined with ILM peeling,inverted ILM flap technique can enhance MH closure and improve visual acuity.Due to lack of large sample observation in clinical trials of inverted ILM flap technique,we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique.

Objective To observe the effects on rabbit corneas and retinas after single intravitreal injection of voriconazole at different doses.Methods According to the randomization table,25 healthy rabbits were randomly divided into control group,and voriconazole 50,100,200,and 400 μg groups.Therefore,there were 5 rabbits in each group.The eyes of control group received intravitreal injection of 0.1 ml balanced saline solution,and those treatment groups received 0.1 ml voriconazole injection of corresponding dose.Before the injection and 1,7,and 14 days after the injection,endothelial cell counts and corneal thicknesses were measured;full-field electroretinogram were performed and b-wave amplitudes in maximal combined reaction (Max-R) were recorded.On 14 days after the injection,histologic structures were observed by light microscope and transmission electron microscope.Results There was no significant difference in endothelial cell counts (F=0.320,0.291,0.467,0.649) and corneal thicknesses (F=0.214,0.284,0.360,0.225) with those of control group at any time points (P＞0.05).Before and 1 day after the injection,b-wave amplitudes of each voriconazole group had no significant difference compared with those of control group (F=0.220,0.106;P＞0.05).On 7 days after the injection,b-wave amplitudes decreased significantly at doses of 200 μg and 400 μg (P＜0.05).On 14 days after the injection,there was no significant difference between the the amplitude of 200 μg group and that of control group (P＞ 0.05).However,the amplitude of the 400 μg group decreased continuously and there was still significant difference (P＜0.05).Light microscopy did not reveal any corneal abnormality in both control group and voriconazole groups.The retinas were normal except that of the 400 μg group,which had a thinner and degenerated inner nuclear layer and disordered photoreceptor layer.Under transmission electron microscope,there were no ultrastructure damages of corneas in both control group and voriconazole groups,either.The rabbit retinas of the 50 μg and 200 μg group have normal inner nuclear layer and photoreceptor layer,but degrees of changes in both layers were observed in the eyes of 200 μg and 400 μg group.Conclusions There is no obvious effects on rabbit corneas and retinas after single intravitreal injection of voriconazole at he dose less than or equal 100 μg.There are no obvious effects on rabbit corneas at the dose of 200 μg and 400 μg,while there are damages to the retinas in both functions and histological structures.