Visual Acuity Improvement Rate Research Articles

Early Surgery and High Dose Steroids in Treating Patients with Indirect Traumatic Optic Neuropathy: A Meta-Analysis and Systematic Review

Introduction: Optic nerve injury is a devastating cause of permanent visual loss after blunt or penetrating injury occurring in up to 7% of head trauma cases. No single treatment strategy and timing of intervention has proved optimal. Timely and appropriate management is key to improving visual outcomes. We compared whether immediate surgical decompression or steroids would lead to improvement of visual outcomes in individuals with indirect traumatic optic neuropathy. Methods: We searched from several online databases and included studies of patients with direct Optic nerve injury, those who received combined treatment with surgery and steroids, and those with delayed initiation of treatment were excluded. Results: The final search yielded eleven eligible studies. Both interventions showed similar results in improvement of visual function (RR 2.35, 95% CI 0.87 to 6.34, p=0.09, I2 0%). Both early and late intervention also showed similar results in improvement of visual function (RR 1.72, 95% CI 0.89 to 3.35, p=0.11, I2 61%). Among patients who underwent early surgical decompression, the rate of visual acuity improvement was 73% with those who underwent transcranial surgery and 69% with those who underwent endoscopic surgery. Conclusion: This study shows that immediate surgical decompression and early high dose steroid administration are equally effective in improving visual function. Patients with no light perception (NLP) and light perception (LP) pre treatment resulted to better visual improvement with steroids while those with counting fingers (CF) and more than CF pre treatment, resulted to better visual improvement with surgical decompression.

Central Bouquet Hemorrhages in Pathologic Myopia: Clinical Characteristics and Prognostic Relevance

To compare the clinical implications of central bouquet hemorrhages (CBH) to primarily subretinal hemorrhages, both occurring in the setting of pathologic myopia with lacquer crack formation. Multi-center retrospective cohort study PARTICIPANTS: 25 eyes (11 primarily subretinal hemorrhages, 14 CBH) were monitored over a median of 35 months (interquartile range [IQR] 9.50-54). Comprehensive ophthalmological examinations and optical coherence tomography (OCT) were reviewed. The study employed linear mixed-effects models to compare the impact of CBH versus primarily subretinal hemorrhages on baseline visual acuity (VA), rate of VA improvement, and final VA, adjusting for the follow-up period. Times of hemorrhages reabsorbtion and rate of ellipsoid zone (EZ) layer disruption on OCT were recorded. Eyes with CBH exhibited significantly worse baseline VA (0.93±0.45[20/160 Snellen] vs. 0.36±0.26[20/50 Snellen] LogMAR, p<0.001), a slower rate of VA improvement (p=0.04), and a trend towards worse final VA (0.48±0.47[20/60 Snellen] vs. 0.16±0.16[20/30 Snellen] LogMAR, p=0.06) compared to eyes with primarily subretinal hemorrhages. The CBH group experienced prolonged reabsorption times (median 10 months [IQR 4.6-23.3] vs. 2.3 months [IQR 2-3.2]) and a high prevalence of EZ layer disruption (86% vs. 0%) than primarily subretinal hemorrhages. CBH reabsorption was followed by the appearance of vertical hyperreflective lines in the central fovea in 67% of eyes, persisting for up to 6 years of follow-up. CBH signifies a distinct condition in pathologic myopia, characterized by worse visual outcomes, prolonged structural impact, and possible irreversible damage, compared to primarily subretinal hemorrhages. CBH regression should be taken into account in the differential diagnosis of vertical hyperreflective lesions in the central fovea on OCT in eyes with pathologic myopia.

Effect of Optic Canal Opening on Postoperative Visual Acuity in Patients with Tuberculum Sellae Meningiomas.

Tuberculum sellae meningiomas (TSMs) account for 5 to 10% of all intracranial meningiomas. They typically invade the optic canal and displace the optic nerve upward and laterally. The transcranial approach has been the standard surgical approach, while the transsphenoidal approach has been proposed for its minimally invasive nature; however, some reservations concerning this approach remain. From January 2000 to December 2018, a total of 97 patients who were diagnosed with TSM with invasion of the optic canal were enrolled and underwent microsurgery for tumor removal with optic canal opening. A retrospective analysis was performed on the effect of optic canal opening on postoperative visual acuity improvement. The median follow-up was 17.4 months (range: 3-86 months). Among the 97 patients with TSM involving the optic canal, optic canal invasion was seen on preoperative imaging in 73 patients and during intraoperative exploration in all patients. In total, 87/97 patients (89.7%) underwent optic canal opening to remove tumors involving the optic canal, and the rate of total macroscopic resection of tumors invading the optic canal was 100%. Among the 10 patients who did not undergo optic canal opening, the rate of total resection of tumors involving the optic canal was 80% (8/10, p < 0.001). There were no deaths or serious complications. The postoperative visual acuity improvement rate was 64.4%, 23.7% maintained the preoperative level, and the visual acuity deteriorated 11.9%. Intraoperative optic canal opening is the key to total resection of TSMs involving the optic canal and improving postoperative visual acuity.

Efficacy and prognostic factors of endoscopic optic canal decompression in children with traumatic optic neuropathy

Objective: To explore the efficacy and prognostic factors of endoscopic optic canal decompression in children with traumatic optic neuropathy (TON). Methods: The clinical data of 47 children with TON treated with endoscopic optic nerve decompression in the Department of Neurosurgery of Beijing Tongren Hospital from November 2010 to October 2021 were retrospectively analyzed, and the visual acuity before and after treatment was compared. The clinical factors were taken as independent variables, and visual improvement was taken as dependent variable for multivariate Cox regression analysis to observe the factors that may affect the efficacy. Results: There were 47 patients in this study, including 35 males and 12 females, and the age ranged from 3.0 to 12.0 (7.2±2.3) years. After surgery and hormone treatment, 28 (59.6%) cases obtained visual improvement. Univariate analysis showed that the improvement rate of visual acuity in patients with residual vision after injury was higher than that in patients without vision [85.0% (17/20) vs 40.7% (11/27), P=0.002], while the improvement rate of visual acuity in patients with dislocated optic canal fracture was lower than that in those without fracture [42.1% (8/19) vs 71.4% (20/28), P=0.044]. The improvement rate of visual acuity in patients with operation time interval ≤7 d was higher than that in patients with operation time interval>7 d [80.8% (21/26) vs 33.3% (7/21), P=0.001]. Multivariate Cox regression analysis showed that post-traumatic residual visual acuity (HR=3.805, 95%CI: 1.087-13.318, P=0.037) and operation time interval≤7 d (HR=2.883, 95%CI: 1.084-7.662, P=0.034) were protective factors for post-surgical visual acuity. Conclusions: Endoscopic optic nerve decompression can effectively improve the visual acuity of children with TON. Post-traumatic residual visual acuity and operation time interval ≤7 d are independent protective factors for post-surgical visual acuity.

CLINICAL CHARACTERISTICS OF EALES DISEASE AND THE EFFICACY OF DIFFERENT INTERVENTIONS FOR NEOVASCULAR COMPLICATIONS.

To evaluate clinical features and manifestations of Eales disease and the efficacy of different interventions. The databases PubMed, EMBASE, and Ovid from inception until February 2021 were searched. Pooled analyses included 1) presenting features, 2) symptoms and signs, and 3) postoperative vision outcomes and complications. Statistical analyses were conducted with R software version 3.6.3. Forty-seven studies involving 3,557 patients and 4,959 eyes were included. The pooling results showed that Eales disease was male dominated (94%), bilateral involvement (64%), and mainly occurred in adolescents. Approximately 83% of patients were positive in Mantoux test, and 31% of patients have vitreous tap polymerase chain reaction positive for tuberculosis genome. More than half of the patients had decreased vision at the first clinic visit. The common signs of Eales disease included sclerotic vessels (83%), neovascularization of retina elsewhere (64%) and periphlebitis (51%). Macular changes could be detected in 24% of patients. The most common complication was vitreous hemorrhage, followed by cataracts and retinal detachment. Photocoagulation was directed at nonperfusion or neovascularization areas, with a decrease in the incidence of later pars plana vitrectomy (19%). Anti-vascular endothelial growth factor treatment was suggested for vitreous hemorrhage, which could achieve high visual acuity improvement rate (82%) while increasing the possibility of retinal detachment (18%). Pars plana vitrectomy was indicated in cases with persistent vitreous hemorrhage or retinal detachment, with 56% of patients obtaining visual improvement. Still, 17% of patients needed a second pars plana vitrectomy, mainly because of recurrent vitreous hemorrhage or retinal detachment. Eales disease most commonly affects young men. It has diverse clinical features, and management should be based on the progression of the disease.

Clinical observation of microsurgical removal of the hemilateral tuberculum sellae meningiomas through contralateral eyebrow arch approach

The current study aimed to investigate the clinical feasibility of microscopic resection of hemilateral tuberculum sellae meningiomas (TSM) via the contralateral eye brow arch approach. The clinical data of 34 patients with TSM who underwent microsurgery from January 2016 to June 2021 in the Neurosurgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and the First Affiliated Hospital of Henan University were collected and reviewed. The postoperative visual acuity improvement rate was 88.5% (23/26), and the total tumor resection rate was 88.2% (30/34); the postoperative visual acuity improvement in patients with total tumor resection was better than that of patients with partial resection [90.9% (20/22) vs 3/4]. Meanwhile, the postoperative visual acuity improvement in patients with the superior optic nerve and laterl-superior optic nerve was better than that of patients with the lateral optic nerve type (12/14, 8/8 vs 3/4). Supraorbital skin numbness occurred in 3 cases after operation, and the symptoms disappeared during follow-up; 2 cases had mild disturbance of hormone level, and urine output of 2 cases increased after operation, which returned to normal level after symptomatic treatment; 1 case had subcutaneous effusion which was absorbed after treatment. There were no complications such as olfactory disturbance and intracranial infection. During follow-up for 3-60 (33±6) months, recurrence occurred in 2 cases and reoperation was performed. For the hemilateral TSM, according to the preoperative evaluation of the origin of the TSM and the side with visual impairment, the contralateral eyebrow approach is selected to fully expose the tumor base below the optic nerve. It is beneficial to fully resect the tumor under direct vision, and the symptoms of postoperative visual impairment are significantly improved, indicating that the current surgical method can be used in the clinical setting.

Efficacy and safety of intra-arterial thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis.

To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) in patients with central retinal artery occlusion (CRAO). PubMed and EMBASE were searched for potentially eligible studies that reported IAT in CRAO patients from inception to Nov 8, 2021. Standard mean difference (SMD) was pooled to compare visual acuity (VA) at baseline with final in IAT patients. The rates and odds ratios (OR) were meta-analyzed to compare VA improvement in IAT with non-IAT patients, stratified to different times from onset to procedure, different definitions of VA improvement, and three CRAO stages. Adverse effects were recorded. Fifteen studies were included, enrolling 507 CRAO patients who received IAT and 296 CRAO patients who did not. VA was significantly improved from baseline to final VA in IAT patients (SMD [LogMAR] 0.70, 95% CI [0.51, 0.90]). VA improvement rate was higher in IAT patients than that in non-IAT (56% vs 32%, OR 3.55, 95%CI [1.74, 7.24]), with greater OR in IAT within 6h from onset to procedure (OR 4.60, 95%CI [1.24, 16.99]) than that beyond 6h (OR 3.36, 95%CI [1.43, 7.85]). The benefit remained consistent when VA improvement was defined as ≥ 3 lines on the Snellen chart (OR 4.68, 95%CI [2.10, 10.41]) and was even greater when CRAO was incomplete. Five patients had a symptomatic intracranial hemorrhage and 21 patients had ischemic stroke or transient ischemic attack after IAT. IAT treatment has certain potential in ameliorating VA in CRAO patients, which should be balanced against cerebral complications.

Comparison of the Efficacy and Safety of Neuroendoscopic Endonasal Transsphenoidal Surgeries and Intracranial Endoscopic Pterional Approach in Resection of Tuberculum Sellae Meningiomas.

Objective To compare of the efficacy and safety of neuroendoscopic endonasal transsphenoidal surgeries and intracranial endoscopic pterional approach in resection of tuberculum sellae meningioma. Methods From January 2014 to June 2021, 60 patients with tuberculum sellae meningioma diagnosed and treated in our hospital were enrolled and randomly divided into study group and control group. The tuberculum sellae meningioma was removed by neuroendoscopic endonasal transsphenoidal surgeries in the study group, while the intracranial endoscopic pterional approach was used in the control group. The chi-square test was used to compare the differences of tumor complete resection rate, visual acuity improvement rate, total effective rate at 3 months after operation, and adverse reactions between the two groups. Results The clinical characteristics of the two groups were comparable (P > 0.05). After surgical treatment, the complete resection rate in the study group was higher than that in the control group (93.3% vs 70.0%), and the difference was statistically significant (P=0.020). After treatment, the visual acuity improvement rate of the study group was 83.3% (25/30), which was significantly higher than that of the control group (60.0%, 18/30), and the difference was statistically significant (χ2 = 4.022, P=0.045). After surgical treatment, the total effective rate at 3 months after operation was higher in the study group than in the control group (96.7% vs 83.3%), with statistical significance (P=0.041). There was no significant difference in postoperative adverse reactions between the study group and control group (33.3% vs 30.0%, P=0.781). Conclusion The neuroendoscopic endonasal transsphenoidal surgeries has significant efficacy and can significantly improve the visual acuity of patients without increasing adverse reactions, which is worthy of clinical promotion.

The outcome of surgical and non-surgical treatments for traumatic optic neuropathy: a comparative study of 685 cases.

BackgroundThe choice and efficacy of surgical or/and surgical treatments for traumatic optic neuropathy (TON) remained controversial by now. This study aims to present the outcomes of surgical and nonsurgical treatments for TON in our center.MethodsA total of 685 consecutive patients were retrospectively included in the study. And divided into surgical and non-surgical groups. All cases were treated with corticosteroids for 3 days after admission. Endoscopic optic decompression was applied to 479 patients of surgical group; The other 206 patients of nonsurgical were administered with corticosteroids alone. The visual outcomes before and after treatment were compared with Wilcoxon rank and tests. The improvement rate between two groups were compared with chi-square test.ResultsThe visual acuity (VA) after treatment was significantly better than that before treatment (P=0.000). Overall VA improvement rate in the surgical group was better than that in non-surgical group (42.8% vs. 35.4%) with no significant difference (P=0.072). The VA improvement rate was significant greater in the surgical group than that in the non-surgical group in the patients with NLP before treatment (P=0.028). The VA improvement rate was better in the surgical group than that in the non-surgical group (71.9% vs. 57.8%) but with no significant difference. The final overall VA was 0.1 or better in 43 cases; 104 cases were able to count fingers; hand motion (HM) became perceivable in 132 cases; light perception (LP) was achieved in 53 cases; and no light perception (NLP) remained in 353 cases.ConclusionsEndoscopic optic nerve decompression (EOND) combined with corticosteroids or corticosteroids alone could reach the improvement for patients with TON. The EOND combined with corticosteroids could achieve better VA improvement in patients with NLP.

Face-Down Posture versus Non-Face-Down Posture following Large Idiopathic Macular Hole Surgery: A Systemic Review and Meta-Analysis.

Evidence regarding the effect of a face-down posture (FDP) for large idiopathic macular hole (IMH) is inconsistent. We conducted a systematic review and meta-analysis to determine whether a postoperative FDP is required for the treatment of large IMH. Eligible randomized controlled trials published before September 2021 were retrieved from the Medline, Embase, and Cochrane Library databases. The efficacy outcome was the IMH closure rate and the visual acuity improvement rate. A meta-analysis was performed using a random effects model. The “Grading of Recommendations Assessment, Development, and Evaluation” approach was implemented, and the numbers needed-to-treat (NNTs) were calculated. Seven studies comprising 640 patients were included. We performed a predefined subgroup analysis of IMH size using a cut-off point of 400 µm. Compared with non-FDP, a significant effect of FDP was found in the IMH > 400 µm group (OR = 3.34; 95% CI = 1.57–7.14; trial sequential analysis-adjusted CI = 1.20–11.58; NNTs = 7.9). After stratifying by the posturing periods, the beneficial effect of FDP lasting at least five days, but not three days was observed for large IMH. Maintaining a FDP for at least five days postoperatively is an effective strategy (certainty of evidence: “moderate”) for treating large IMH.

Involvement of the optic pathway and outcome of visual function in patients with neurohypophyseal germ cell tumor.

Patients with neurohypophyseal germ cell tumors (GCTs) typically present with visual problems. Hence, this study aimed to assess optic pathway involvement based on clinical and radiological findings and to validate the outcome of visual function. A total of 16 patients with newly diagnosed neurohypophyseal GCTs who were treated at the University of Tsukuba Hospital between 2000 and 2020 were included in this study. The median interval from symptom onset to diagnosis was 173.5days (range, 33-1588days). Patients with visual disturbance at diagnosis had a longer time to diagnosis compared with those without. Ophthalmologic abnormalities were frequently observed, with an incidence rate of 69%. Fifty percent of patients exhibited optic pathway involvement detected via magnetic resonance imaging (MRI). Visual impairment was more severe in the patients with optic pathway involvement (p = 0.002). Post-treatment visual impairment was improved but was still significantly severe in patients with optic pathway involvement than in those without involvement (p = 0.010). Visual field deficit more likely remained with an improvement rate of 50%, whereas the improvement rate of visual acuity was 78%. Further, none developed late-onset visual deterioration during the follow-up period. Visual disturbance and optic pathway involvement are common in neurohypophyseal GCTs. Visual impairment particularly in patients with optic pathway involvement on MRI is more likely to remain at follow-up, although the outcome of visual function is acceptable in most cases.

The Effectiveness of the Supine Position in Managing Inferior Breaks in Rhegmatogenous Retinal Detachment After Vitrectomy with Gas Tamponade.

ObjectiveThis study aims to determine whether the supine position is effective for the management of inferior peripheral breaks after pars plana vitrectomy with gas tamponade.MethodsA total of 29 patients (29 eyes) with acute rhegmatogenous retinal detachment and causative peripheral inferior breaks, located between the four o’clock and eight o’clock positions, underwent pars plana vitrectomy with gas tamponade. These patients maintained a face-up supine position for at least six hours each day for 14 days postoperatively. The alternate lateral position was used for the remaining hours, depending on the distribution of the retinal breaks.ResultsThe final retinal reattachment rate was 100%, and the visual acuity improvement rate was 100% postoperatively, with no recurrence during the one-year follow up. No patients suffered from any sight-threatening complications. Of the 16 patients with preoperatively clear lenses, 3 were documented to have a cataract during their three-month postoperative follow up. Four patients were documented to have increased intraocular pressure, which was controllable during the early postoperative days.ConclusionPostoperative pars plana vitrectomy and gas tamponade in the supine position is effective for managing primary rhegmatogenous retinal detachment with causative breaks between the four o’clock and eight o’clock positions.

Outcomes of Limbal Stem Cell Transplant

Limbal stem cell transplant (LSCT) can be categorized as direct autologous limbal transplant (AULT), direct allogenic limbal transplant (ALLT), cultivated autologous limbal stem cells transplant (cAULT), and cultivated allogenic limbal stem cells transplant (cALLT). To our knowledge, there is no study directly comparing the outcomes and complications of these procedures. To evaluate the outcomes of different LSCT procedures. We searched PubMed, EMBASE, Web of Science, and Cochrane without language filter for peer-reviewed articles about LSCT. The latest search was performed on June 30, 2019. Clinical studies with the outcome of at least 20 eyes after LSCT were included. Animal studies and studies of other surgical interventions were excluded. Two reviewers independently abstracted the data from each study. Heterogeneity was evaluated with the I2 statistic, and a meta-analysis was performed using the random-effects model. Outcome measures included the improvement of ocular surface, visual acuity (VA), and adverse events of recipient eyes and donor eyes. Forty studies (2202 eyes) with a mean (SD) follow-up of 31.3 (20.9) months met the inclusion criteria. The mean (SD) age of study participants was 38.4 (13.1) years, and men accounted for 74%. The number of eyes that underwent AULT, ALLT, cAULT, and cALLT were 505, 742, 771, and 184, respectively. Improvement of the ocular surface was achieved in 74.5% of all eyes, 85.7% of eyes after AULT (95% CI, 79.5%-90.3%), 84.7% after cAULT (95% CI, 77.2%-90.0%), 57.8% after ALLT (95% CI, 49.0%-66.1%), and 63.2% after cALLT (95% CI, 49.3%-75.2%). Autologous limbal transplantation resulted in a greater VA improvement rate (76%) than did the other 3 procedures (cAULT: 56.4%; ALLT: 52.3%; cALLT: 43.3%; all P < .001). The most common adverse events in all recipient eyes were recurrent/persistent epithelial erosion (10.5%; 95% CI, 7.2%-23.3%) and elevated intraocular pressure (intraocular pressure, 1.7%; 95% CI, 0.5%-7.8%). Patients who underwent ALLT had the highest rate of recurrent epithelial erosion (27.8%; 95% CI, 17.1%-41.9%) and intraocular pressure elevation (6.3%; 95% CI, 1.8%-19.4%). These findings suggest LSCT can improve or stabilize the corneal surface with a low rate of severe ocular complications and that autologous LSCT may have a higher success rate and fewer complications than allogenic LSCT.

Combination analysis on the impact of the initial vision and surgical time for the prognosis of indirect traumatic optic neuropathy after endoscopic transnasal optic canal decompression.

To analyze the impact of the initial vision and surgical time for endoscopic transnasal/transethmosphenoid optic canal decompression (ETOCD) in the treatment of indirect traumatic optic neuropathy (TON). This retrospective case series analysis included 72 patients with indirect TON who underwent ETOCD from August 2017 to May 2019. Visual acuity (VA) was compared before and after surgery to estimate the improvement rate. The overall VA improvement rate of ETOCD was 54.2%. There were 83.3% and 33.3% improvement rate ofpatients with residual vision and blindness, respectively. VA was improved in 60.9% of patients treated within 3days, 61.5% treated within 7days, and 35.0% treated later than 7days. Of the blindness patients, 50.0%, 37.5%, and 0.0% were treated within 3days, 3-7days, and later than 7days, respectively. Of patients with residual vision, 85.7%, 92.3%, and 70.0% were treated within 3days, 3-7days, and later than 7days, respectively. A statistically significant difference was found between patients with residual vision and those with blindness (P < 0.01), as well as between patients who received ETOCD within 7days and those who received ETOCD later than 7days (P = 0.043). The improvement rate of blindness patients managed within 3days (P = 0.008) and 3-7days (P = 0.035) was significantly higher than that for patients managed beyond 7days. Indirect TON patients can directly benefit from ETOCD, and patients with residual vision have better improvement rates. ETOCD should be performed as soon as possible to salvage the patient's VA, especially within the first 7days. For blindness patients, it is necessary to carry out the surgery within 7days with increased benefit seen before 3days.

Internal limiting membrane peeling with different dyes in the surgery of idiopathic macular hole: a systematic review of literature and network Meta-analysis.

To evaluate the effect of internal limiting membrane (ILM) peeling with indocyanine green (ICG), brilliant blue G (BBG), triamcinolone acetonide (TA), trypan blue (TB), or without dye for the treatment of idiopathic macular hole (IMH). A search was conducted using PubMed, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) for related studies published before October 2018. A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.

Comparison of the efficacy of two methods to extract intraocular magnetic foreign bodies

Objective To compare the efficacy of two different methods of intraocular magnetic foreign body extraction. Methods From Jan.2016 to Dec.2017, the data of 165 cases who received intraocular magnetic foreign bodies extraction in our hospital were analyzed retrospectively. All cases were randomly divided into two groups. Group A, 89 cases, received extraction of magnetic foreign bodies through the original wound, and group B, 76 cases, received extraction of intraocular magnetic foreign bodies through the vitreous. Postoperative the follow-up time was 12-15 months. Results The visual acuity of group A improved in 64 eyes (71.91%), remained unchanged in 6 eyes(6.74%). Visual acuity was improved in 66 eyes (86.89%) of group B, unchanged in 7 eyes(9.21%). The difference in visual acuity improvement rate was not statistically significant between the two groups (χ2=0.055, P=0.801). The rates of complication of the two groups were similar. Conclusion The efficacies of two methods of extraction of intraocular magnetic foreign bodies are similar. Key words: Foreign body, intraocular, magnetic; Extraction, magnetic attration, original wound; Extraction, through the vitreous

Comparison the clinical efficacy between FP7 and FP8 Ahmed glaucoma valve implantation in the treatment of refractory glaucoma

Objective To compare the clinical efficacy between FP7 and FP8 Ahmed glaucoma valve (AGV) implantation in the treatment of adult refractory glaucoma. Methods The data of 40 cases of adult refractory glaucoma from May 2015 to Feb. 2019 were retrospectively analysed. All cases were divided into two groups randomly. Group A, 25 eyes of 25 patients, underwent FP7 AGV implantation, and group B, 15 eye of 15 patients, underwent FP8 AGV implantations. The fallow-up time was 12 months. The intraocular pressure, visual acuity, success rate, complications and postoperative medication before and after surgery were compared between the two groups. Results The average intraocular pressure at each time point after surgery were significantly lower in the two groups than those before surgery (P 0.05). The number of anti-glaucoma drugs in both groups was significantly reduced after surgery compared with that before surgery, and the difference was statistically significant (P 0.05). There were no statistically significant difference between the two groups in the success rate, visual acuity improvement rate and complication rate at 12 months after surgery (P>0.05). Conclusion There is no significant difference in reducing intraocular pressure, protecting vision, complications, drug dependence of glaucoma, and the success rate between FP7 and FP8 AGV implantation. Application of FP8 AGV in adult eyes with insufficient subconjunctival space is a safe and effective choice. Key words: Glaucoma, refractory, adult; Valve, glaucoma, Ahmed; Efficacy

Clinical study of razumab combined with 25G transconjunctival sutureless vitrectomy in the treatment of 29 patients with idiopathic macular anterior membrane

Objective To investigate the effect of razumab combined with 25 G transconjunctival sutureless vitrectomy in patients with idiopathic macular epiretinal membrane (IMEM). Methods 57 cases (57 eyes) of IMEM patients in our hospital were divided into two groups according to random number table. 28 cases in the control group were treated with 25G transconjunctival sutureless vitrectomy, and 29 cases in the observation group were treated with rezumab on the basis of the control group.The improvement of visual acuity, changes of macular fovea thickness (central foveal thickness, CFT), serum levels of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) in the two groups were observed and compared. The changes of intraocular pressure before treatment and at different time points (1 weeks, 1 months, 3 months) after treatment and incidence of complications in two groups were statistically analyzed. Results 3 months after treatment, the improvement rate of visual acuity in the observation group was 75.86% (22/29), higher than that in the control group 50% (14/28) (P 0.05). The incidence of complications in the observation group was 10.34% (3/29), while that in the control group was 7.14% (2/28), with no significant difference between the two groups (P>0.05). Conclusions The combination of rezumab and 25G transconjunctival sutureless vitrectomy can reduce the CFT of IMEM patients, improve their levels of serum ICAM-1 and VEGF, and improve their vision. Besides, it has little influence on intraocular pressure and fewer complications. Key words: Ranibizumab; Conjunctiva; Vitrectomy; Macula lutea; Retina

Outcome of endoscopic trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy in children

BackgroundTo evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON).MethodsFrom July 1st, 2008 to July 1st, 2015, 62 children diagnosed with ITON who underwent ETOCD were reviewed. Main outcome measure was improvement in visual acuity after treatment.ResultsAltogether 62 children (62 eyes) with a mean age of 11.26 ± 4.14 years were included. Thirty-three (53.2%) of them had residual vision before surgery while 29 (46.8%) had no light perception (NLP). The overall visual acuity improvement rate after surgery was 54.84%. The improvement rate of patients with residual vision (69.70%) was significant higher than that of patients with no light perception (NLP) (37.9%) (P = 0.012). However, no significant difference was shown among patients with different residual vision (P = 0.630). Presence of orbital and/ or optic canal fracture and hemorrhage within the post-ethmoid and/or sphenoid sinus resulted in poor postoperative visual acuity, duration of presenting complaints did not affect final visual acuity or did not effect outcomes. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome. Three patients developed cerebrospinal fluid rhinorrhea and one encountered cavernous sinus hemorrhage during surgery. No other severe complications were observed.ConclusionChildren with residual vision had better postoperative visual prognosis and benefited more from ETOCD than children with NLP. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome, however, this needs to be reassessed in children presenting long after the injury.Treatment should still be recommended even for cases of delayed presentation to hospital.

The efficacy of intravitreal injection of Ranibizumab before vitrectomy in the treatment of proliferative diabetic retinopathy

Objective To evaluate the efficacy of intravitreal Ranibizumab injection before vitrectomy in the treatment of proliferative diabetic retinopathy (PDR) . Methods The data of 128 eyes of 92 patients of PDR from Jan. 2016 to Dec. 2016 were enrolled and analyzed retrospectively. All patients were randomly divided into observation group, 66 eyes of 46 patients, and control group, 62 eyes of 46 patients. The control group was treated with vitrectomy only. The observation group received intravitreal Ranibizumab injection before vitrectomy. The efficacy of two groups were compared. Results The operation time and hospital stay time in observation group were shorter than those in control group (P=0.000). At 3 months after operation, the visual acuity improvement rate was 92.42% in the observation group and 80.65% in the control group (P=0.034). The average postoperative visual acuity in the observation group was higher than that in the control group (P=0.009) . The intraocular pressure in the observation group was lower than that in the control group (P=0.001), the central macular retinal thickness in the observation group was thinner than that of the control group (P=0.000). The complication rate in the observation group was 3.03%, which was lower than 14.25% in the control group (P=0.020). The postoperative vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) in the observation group were lower than those in the control group (P=0.001, 0.000). Conclusion Intravitreal injection of Ranibizumab before vitrectomy for the treatment of PDR can promote visual acuity and improve the high level of VEGF and PEDF after operation. Key words: Retinopathy, diabetic, proliferative; Ranibizumab, intravitreal injection; Vitrectomy; Efficacy