Reply to: 'comments on 'effects of refractive accommodation on subfoveal choroidal thickness in silicone oil-filled eyes".

In this article, we answered the questions in Lei Gao et al.'s comments on the "effects of refractive accommodation on subfoveal choroidal thickness in silicone oil-filled eyes" one by one.

COMBINATION OF VITRECTOMY AND INTENTIONAL MACULAR DETACHMENT IS ASSOCIATED WITH A FASTER EDEMATOUS REGRESSION THAN VITRECTOMY ALONE IN THE TREATMENT OF REFRACTORY DIABETIC MACULAR EDEMA.

PURPOSE: To compare clinical outcomes in eyes with refractory diabetic macular edema managed by vitrectomy combined with and without intentional macular detachment (IMD). METHODS: This is a retrospective cohort study. Forty-one eyes with diabetic macular edema that were previously poorly responsive to at least 5 monthly anti-vascular endothelial growth factor and at least twice switch therapy previously were included in this study. All eyes underwent pars plana vitrectomy with internal limiting membrane peeling, 21 of which were combined with an IMD procedure (assigned to an IMD group) and 20 of which did not have IMD performed (nMD group). Macular morphologic and visual acuity changes were analyzed from baseline through the endpoint (24 weeks) postprocedure, and were compared between groups. RESULTS: All patients completed at least six months of follow-up, with a mean of 29.7 weeks (24-56 weeks). The mean central retinal thickness reduction was greater in the IMD group than that in the nMD group at 1 week (P = 0.001), 2 weeks (P = 0.008), and 4 weeks (P = 0.004), but there was no statistically significant difference at 12 weeks (P = 0.051) or 24 weeks (P = 0.056). There were no significant differences in the mean changes of best-corrected visual acuity from baseline to the 24 weeks endpoint in either group (P = 0.83). CONCLUSION: Vitrectomy can release macular edema in the eyes with refractory diabetic macular edema. Combined with IMD technical, patients seemed to achieve a faster central retinal thickness decrease but neither the final morphologic outcome nor the visual acuity was affected.

Effects of refractive accommodation on subfoveal choroidal thickness in silicone oil-filled eyes.

PURPOSE: To investigate the effects of refractive accommodation on subfoveal choroidal thickness (SFCT) in silicone oil (SO)-filled eyes. METHODS: This retrospective, self-comparative study was conducted on 40 patients with unilateral macula-on rhegmatogenous retinal detachment, who underwent vitrectomy and SO tamponade. The SFCT of SO-filled eyes and the fellow control eyes were measured using optical coherence tomography at their one-month visit after surgery. The patients wore soft contact positive lenses for 24 h in the SO-filled eyes, to correct their refractive error. SFCT and choroidal vascularity index (CVI) were measured before and after wearing the contact lenses. Mean SFCT was compared between SO-filled eyes and the fellow control eyes, and SFCT and CVI were compared before and after refractive error correction in the SO-filled eyes. RESULTS: Mean SFCT of SO-filled eyes (221.52 ± 38.41 um) was less than that of the fellow eyes (273.41 ± 31.30 um) (P < 0.001). After refractive error correction, the mean SFCT increased to 269.28 ± 36.90 um(P < 0.001). However, CVI decreased from 57.01 ± 2.41 to 55.39 ± 2.39 (P < 0.05). CONCLUSIONS: SFCT reduction in SO-filled eyes was primarily due to the hyperopia status. The non-uniform change in CVI suggests that changes in CT are mainly attributed to a greater expansion of the stromal area instead of the choroidal vascular area. TRIAL REGISTRATION: This study protocol was reviewed and approved by the Ethics Committee of the Central Theater General Hospital, approval number No. [2020]058-1, retrospectively registered.