[Research on the surgery treatment and etiology of fungal endophthalmitis].

Objective: To evaluate the efficacy of vitrectomy and etiological diagnosis in the treatment of fungal endophthalmitis. Methods: A retrospective survey was done on the clinical manifestation, etiological diagnosis and treatment efficacy of 15 patients (15 eyes) who had been diagnosed with fungal endophthalmitis at the inpatient department of Peking Union Medical College Hospital during 2002-2015. A total of 15 eyes of 15 patients, 3 male and 12 female patients, were included in this study. The mean age of the patients was (45.8±15.3) years. Among the 15 eyes, 12 (12 patients) were diagnosed with endogenous fungal endophthalmitis and 3 (3 patients) were diagnosed with exogenous fungal endophthalmitis. Fourteen eyes have been misdiagnosed with uveitis, systematic or local application of glucocorticoid and/or immunosuppressor have been conducted on the patients which resulted in exacerbation. Baseline visual acuity: light perception in 2 eyes, hand movement for 12 eyes, and 1 eye of 0.1. Six eyes showed slight inflammatory reaction in anterior chamber, four eyes showed moderate inflammatory reaction in anterior chamber, while five eyes showed severe inflammatory reaction with hypopyon in anterior chamber. B-Scan ultrasound examination showed inflammatory vitreous opacity in all 15 eyes, combined proliferative vitreoretinopathy (PVR) were found in 11 eyes, retinal detachment were found in 10 eyes, which include 6 cases of tractional retinal detachment, 1 case of exudative retinal detachment, and 3 cases of retinal and choroid detachment. Forty eyes underwent vitrectomy, 1 eye underwent intravitreal injection. Nine eyes were processed with silicone oil tamponade, one eye was processed with C(3)F(8) tamponade. At the beginning of the operation, vitreous fluids were collected for preparing smears which were later used for fungus culture and drug susceptibility testing. Results: According to the smear results of vitreous fluid, fungal hyphae and spores were found in 10 eyes. The fungus culture indicated positive results in 12 eyes, including candida albicans in 6 eyes, fusarium, candida parapsilosis, paecilomyces lilacinus, asoergullus terreus, mulan candida and aspergillus in 1 eye respectively. Based on etiological diagnosis, 14 eyes received amphotericin B intraocular injection during operation, and 9 patients received fluconazole (venous transfusion or oral administration), 2 patients received voriconazole through venous transfusion or oral administration, one patient received itraconazole through oral administration. All 15 eyes received local application of amphotericin B eyedrop or fluconazole eyedrop. The intraocular inflammations in all 15 eyes were mitigated. The visual acuity improved in 6 eyes, remained unchanged in 4 eyes, and reduced in 5 eyes. Postoperative visual acuity achieved 0.1 to 0.15 in 2 eyes, 0.01 to 0.04 in 2 eyes, CF in 2 eyes, HM in 4 eyes, LP in 2 eyes, and NLP in 3 eyes. The retina of 5 eyes remained in position, the retina of 2 eyes reattached, the retina of 2 eyes failed to reattach. Recurrent retinal detachment happened in the other 6 eyes, 5 of which received reoperation. Eventually, the retina of 10 eyes reattached, and the retina of the 5 eyes failed to reattach. Conclusions: Vitrectomy is an effective method for treatment of fungal endophthalmitis. The positive rates of vitreous smear and fungus culture were really high. Application of sensitive anti-fungal drugs based on etiological diagnose can improve therapeutic level. (Chin J Ophthalmol, 2018, 54: 270-276).

[Comparative study of the effects of sterilized air and perfluoropropane gas tamponades on recovery after idiopathic full-thickness macular hole surgery].

Objective: To compare the effects of sterilized air and perfluoropropane (C(3)F(8)) tamponades on recovery after vitrectomy for the treatment of idiopathic full-thickness macular hole (IFTMH). Methods: Case control study. Seventy-three eyes of 69 consecutive cases underwent vitrectomy with air (53 eyes) or 10% C(3)F(8) gas (20 eyes) tamponade. Surgical outcomes were retrospectively analyzed between the two groups, including logarithm of the minimal angle of resolution (logMAR) and optical coherence tomography findings like the size of the macular hole and the photoreceptor layer defect. Results: Preoperatively, the mean best corrected visual acuity (BCVA) was (0.10±0.49), the mean hole diameter was (777.9±320.7) µm, and the mean diameter of the photoreceptor layer defect was (1 709.3±516.0) µm in the sterilized air group, while in the C(3)F(8) group, the mean BCVA was (0.07±0.50), the mean hole diameter was (853.9±355.0) µm, and the mean defect diameter was (1 480.5±429.9) µm. The primary closure rate was 90.6% in the sterilized air group and 95.0% in the C(3)F(8) group. One month after surgery, the mean BCVA was (0.17±0.41), and the mean diameter of the photoreceptor layer defect was (820.5±598.0) µm in the sterilized air group, while in the C(3)F(8) group, the mean BCVA was 0.12±0.49, and the mean defect diameter was (762.5±658.0) µm. There was no statistically significant difference in the closure rate (χ(2)=0.019), BCVA (t=-1.689), hole diameter (t=0.837) and diameter of the photoreceptor layer defect (t=0.338) between the two groups(P>0.05). Conclusions: Vitrectomy with sterilized air tamponade is safe and effective for the treatment of IFTMH and even cases with relatively large diameters. (Chin J Ophthalmol, 2017, 53: 327-331).

One "8"-shaped scleral suture to treat rhegmatogenous retinal detachment: a refined procedure of minimal scleral buckling.

The aim of this study was to investigate the outcomes of one "8"-shaped scleral suture of minimal scleral buckling (MSB) surgery without sub-retinal drainage for rhegmatogenous retinal detachment (RRD) treatment. Thirty patients (30 eyes) with RRD were recruited. Thirty eyes with RRD were repaired by one "8"-shaped scleral suture of minimal buckling without subretinal drainage by one surgeon. The refined MSB procedure is described. Reattachment time and best-corrected visual acuity (BCVA) were observed. The age of the 30 patients ranged from 17 to 65 years (mean, 43.1 ± 8.6 years). The retinas of 19 eyes (63.3%) reattached within 12 h of the operations, and those of 11 eyes (67%) reattached within 72 h. The average time of follow-up was 10.4 ± 2.8 months. BCVAs were increased in 27 eyes (90%), whereas those of 3 eyes did not change. The mean preoperative BCVA was 0.738 ± 0.368 log minimal angle of resolution (MAR), and mean postoperative BCVA was 0.422 ± 0.278 logMAR, and the difference was statistically significant (P < 0.05). The sponge for buckling in only one eye exposed from the conjunctiva was taken out, and the retina remained attached. In conclusion, an "8"-shaped scleral suture of MSB without sub-retinal drainage is an efficient procedure to treat selected RRD cases.

[Surgical removal of macular epiretinal membrane].

Vitreous surgery was used to remove macular epiretinal membranes in 15 eyes of 15 cases of which 7 were idiopathic and 8 secondary. In the period of postoperative follow-up, the visual acuity improved in 14 eyes (93%), in which 57% improved 3 or more than 3 lines. The visual recovery is related to the time of operation chosen. No complication was noted, except development of a paracentral scotoma in 1 eye.

Endolaser photocoagulation after vitrectomy on rabbit's eyes.

Ophthalmoscopic and histopathologic studies of endolaser photocoagulation after vitrectomy were carried out on rabbit's eyes. The endoprobe was connected to the Coherent "Novus 2,000" argon laser system. Under appropriate application the grayish white retinal lesions produced by argon green and argon all wavelength endolaser photocoagulation were similar ophthalmoscopically at a treatment power of 80-100 mw and exposure duration of 0.2s. Histopathologically, the characteristic changes of the retinal lesions produced by argon all wave-length were more significant than that produced by argon green endolaser photocoagulation. Scattered retinal photocoagulation can be done when the opaque medium is cleared on the operating table.

A clinical study on diabetic retinopathy.

A clinical research on the diabetic retinopathy(DR) is reported. In the 662 cases of diabetes mellitus examined, the prevalence of DR was 51.3%, of which 7.6% were preproliferative and 7% proliferative. The study showed that when the disease progressed to the preproliferative and proliferative DR, laser photocoagulation could be the best treatment of choice, and panretinal photocoagulation was also quite effective in the treatment of pregnant patients with proliferative diabetic retinopathy.

Choroidal osteoma. Clinical characteristics and long-term follow-up of five cases.

We studied the clinical characteristics and long-term follow-up of 5 patients with choroidal osteoma. All the patients but one were female. The choroidal lesions were unilateral in 3 patients and bilateral in 2. During the follow-up, the lesions enlarged somewhat, but the progression was very slow and inconspicuous. Clinical diagnosis and treatment are briefly discussed.