●AIM:To evaluate the effect of background diseases and number of previous intravitreal aflibercept injections(IVAIs)on immediate intraocular pressure(IOP)increase and vitreous reflux(VR)rate and to evaluate the corre...●AIM:To evaluate the effect of background diseases and number of previous intravitreal aflibercept injections(IVAIs)on immediate intraocular pressure(IOP)increase and vitreous reflux(VR)rate and to evaluate the correlation of both age and axial length with immediate IOP increase and VR rate.●METHODS:This study included 105 patients with cystoid macular edema secondary to retinal vein occlusion,35 patients with diabetic macular edema,69 patients with neovascular age-related macular degeneration(nAMD),and 12 patients with myopic choroidal neovascularization,which underwent first-time IVAI.The correlation of immediate IOP increase and VR rates with the four background diseases was investigated.Moreover,the correlation of age with immediate IOP increase and VR rate as well as correlation of axial length with immediate IOP increase and VR rate were evaluated.Further,54 patients with nAMD were treated with IVAI>10 times(multiple IVAIs).Moreover,the correlation of immediate IOP increase and VR rates with first-time and multiple IVAIs in nAMD was determined.●RESULTS:The immediate IOP increase(P=0.16)and VR rates(P=0.50)were almost similar among the four background diseases.The immediate postinjection IOP and age,VR rate and age,immediate postinjection IOP and axial length,or VR rate and axial length were not correlated in the four background diseases.The immediate IOP increase(P=0.66)and VR rates(P=0.28)did not significantly differ between first-time and multiple IVAIs in nAMD.●CONCLUSION:Background diseases and number of previous IVAIs have no effect on immediate IOP increase and VR rate.Further,age and axial length have no correlation on immediate IOP increase and VR rate.展开更多
We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had met...We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had metastases to the iris and ciliary body, resulting in progressive vision loss in her left eye. Treatment was successful by intravitreal injections of anti-vascular endothelial growth factor.展开更多
AIM:To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone(DEX)intravitreal implant(Ozurdex).METHOD...AIM:To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone(DEX)intravitreal implant(Ozurdex).METHODS:The study included 32 eyes of 26 patients treated with DEX implant due to chronic uveitis-induced cataract and followed up for at least a year.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),anterior chamber reaction,central macular thickness(CMT),intraoperative and postoperative complications and uveitis recurrence were analyzed retrospectively.RESULTS:A successful surgery was performed in all patients.The average follow-up period was 12mo.The female/male ratio was 13/13.Mean age was 45.65±3.83y(range 26 to 65y).Etiologically,rheumatic arthritis occurred in 6 patients(18.75%),ankylosing spondylitis in 4(12.50%),HLA-B27 associated uveitis in 3(9.38%),Vogt-KoyanagiHarada-associated uveitis in 4(12.50%),Behcet’s disease in 2(6.25%),and 7(21.88%)suffered from unknown diseases.All 32 eyes had varying degrees of improvement at 12mo after surgery,with 2 eyes showing BCVA of 0.1 or below(6.25%),6 having 0.1-0.5(18.75%),18 of 0.5-1.0(56.25%),and 6 of 1.0 or above(18.75%).No cases with increased IOP were observed.The values of mean CMT was increased at day 1,decreased at 1,3mo after surgery and increased at 6,12mo after surgery.No severe uveitis reactions,such as fibrinous exudates in the anterior chamber and exudative membrane formation on the anterior surface of the IOL,were observed after surgery.CONCLUSION:The present studies show that intravitreal injection of Ozudex during cataract operation can provide a new option for the clinical treatment of uveitis-induced cataract.展开更多
AIM: To compare the effectiveness of intravitreal bevacizumab and subthreshold macular photocoagulation(SMP), for the treatment of non-center involved diabetic macular edema(non-CI DME).METHODS: Prospective, randomize...AIM: To compare the effectiveness of intravitreal bevacizumab and subthreshold macular photocoagulation(SMP), for the treatment of non-center involved diabetic macular edema(non-CI DME).METHODS: Prospective, randomized, controlled clinical study included patients with type 2 diabetes, non-CI DME and best-corrected visual acuity(BCVA) of 0.30 logMAR or better. Each eye was randomized into three groups:group 1, monthly intravitreal bevacizumab; group 2, single SMP; group 3, single SMP and monthly bevacizumab. Main outcome measures were BCVA, and macular thickness measured with optical coherence tomography as macular central subfield thickness(CST), macular area of greater thickness(MAGT) and total macular volume(TMV). Results were analyzed after 3 mo.RESULTS: A total of 32 eyes were included. Group 3 improved in BCVA(0.19±0.16 to 0.12±0.14 logMAR; P=0.041) and in TMV(7.90±0.57 to 7.65±0.73 mm3; P=0.025). Group 1 improved in MAGT(325±26.26 to 298.20±44.85 μm; P=0.022) and TMV(7.79±0.57 to 7.50±0.56 mm3, P=0.047). Group 2 didn't show significant improvement of any variable.CONCLUSION: The loading phase of bevacizumab as monotherapy or combined with SMP is superior to SMP as monotherapy in providing short-term visual and anatomical improvement in non-CI DME.展开更多
Retinal vein occlusion (RVO) is the most common visually disabling disease affecting the retina after diabetic retinopathy. Although the disease entity has long been known, its management is still controversial. Macul...Retinal vein occlusion (RVO) is the most common visually disabling disease affecting the retina after diabetic retinopathy. Although the disease entity has long been known, its management is still controversial. Macular edema is the main reason for decreased visual acuity (VA) in this retinal vascular disorder. Recently the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of macular edema through intravitreal injection route. The most widely injected drugs so far have been triamcinolone acetonide (TA) and bevacizumab. The objective of this review is to evaluate the evidence and discuss the rationale behind the recent suggestions that intravitreal pharmacotherapy by corticosteroids and anti-vascular endothelial growth factors may be useful in the treatment of retinal vein occlusion.展开更多
AIM:To explore the efficacy of preoperative intravitreal bevacizumab(IVB) injection combined with Ahmed glaucoma valve(AGV) implantation in the treatment of neovascular glaucoma(NVG).METHODS:This retrospective study i...AIM:To explore the efficacy of preoperative intravitreal bevacizumab(IVB) injection combined with Ahmed glaucoma valve(AGV) implantation in the treatment of neovascular glaucoma(NVG).METHODS:This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure(IOP) number of anti-glaucoma medications, visual acuity(VA), surgical success rates,and complications were recorded.RESULTS:AfterAGVimplantation,IOPwas18.2±4.0mmHg,15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36 mo,significantly decreased compared with pre-IOP(P <0.01).The number of anti-glaucoma medications was 0.9 ±0.5,0.8 ±0.9 and 0.8 ±0.6 at 6, 12 and 36 mo, significantly decreased compared to pre-treatment(P <0.01). At last visit, there were 19 eyes with stable VA, 4 with VA improvement, 12 with diminished VA and 3 with complete loss light perception. There were 7 cases that failed during 3-year fellow up period. Cumulative probabilities of valve survival by Kaplan-Meier analysis were 82.9%,74.1% and 71.0% at 12, 24 and 36 mo, respectively. Cox stepwise regression analysis found that the survival time was significant associated with the pre-visual acuity <2/400(P <0.05). Post-operative complications occurred in 8eyes, of which hyphema presented in 2 eyes, choroidal effusion in 2 eyes.CONCLUSION:The procedure of preoperative IVB andAGV implantation should be one of treatments for NVG because of its safety and effectiveness.展开更多
AIM:To compare the effectiveness between multiple intravitreal injections of ganciclovir alone and combined with foscarnet as initial treatment for patients with newlyonset cytomegalovirus retinitis (CMVR).METHODS:The...AIM:To compare the effectiveness between multiple intravitreal injections of ganciclovir alone and combined with foscarnet as initial treatment for patients with newlyonset cytomegalovirus retinitis (CMVR).METHODS:The retrospective study observed 37 patients(58 eyes) who suffered from CMVR onset between 2013 and 2015. Among them, 35 eyes underwent 4 weekly intravitreal injections of 3.0 mg ganciclovir, and 23 eyes underwent 4 weekly injections of 3.0 mg ganciclovir combined with 2.4 mg foscarnet. Visual acuity, intraocular pressure and viral load of cytomegalovirus (CMV) in aqueous humor measured by real-time polymerase chain reaction were compared before and after each injection.RESULTS:CMV-DNA copies in aqueous humor decreased remarkably in both groups. The average of CMV-DNA copies in patients’ aqueous decreased from 38.3×10~4 copies/mL at baseline to 2.2×10~4 copies/mL after the 4^(th) injection in patients who were treated with ganciclovir monotherapy,and decreased from 76.9×10~4 copies/mL to 11.3×10~4 copies/mL after 4 continuous injections of ganciclovir combined with foscarnet. No significant difference was found in reduction of viral load, change of visual acuities or intraocular pressures between monotherapy or combined therapy.CONCLUSION:Results of this study show that the initial effectiveness of treating CMVR after 4 weekly intravitreal injections is not significantly different from ganciclovir alone or combined with foscarnet. Continuous injection of ganciclovir alone is sufficient in treating immunosuppressive patients with newly-onset CMVR.展开更多
AIM: To investigate the complications of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema, and to determine the risk factors for intraocular pressure (IOP) elevation. METHODS: Charts of p...AIM: To investigate the complications of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema, and to determine the risk factors for intraocular pressure (IOP) elevation. METHODS: Charts of patients with macular edema secondary to branch retinal vein occlusion (BRVO), diabetic retinopathy and uveitis who had received IVTA injections were reviewed to document its complications. IOP elevation was defined as a pressure of ≥24mmHg at some point during follow-up. Multivariate logistic regression analysis was performed to characterize baseline risk factors for this elevation. RESULTS: The study included 111 eyes of 65 female and 46 male patients with a mean follow-up of (11.6±5.1) months. Of the 111 eyes, 52 (46.8%) had macular edema secondary to BRVO, 44 (39.6%) had clinically significant diabetic macular edema (CSDME) and 15 (13.5%) had non-infectious uveitis with macular edema. IOP was recorded ≥24mmHg in 38 eyes (34.2%) during the follow-up. Higher baseline IOP (P =0.022), younger age (P =0.003), and male gender (P = 0.014) were significant risk factors for IOP elevation after IVTA injection. Eyes with prior vitrectomy were less likely to have IOP elevation (P =0.054). Two eyes (5.2% of eyes with increased IOP) underwent trabeculectomy, and 9 eyes (16.3% of the phakic eyes) necessitated cataract surgery. Other complications included branch vein occlusion (1.8%), sterile endophthalmitis (0.9%) and pseudohypopyon (0.9%). CONCLUSION: IVTA has side effects with IOP elevation and cataract formation being the two most common. A subset of patients is more prone to developing increased IOP following IVTA, namely, younger male patients with higher baseline IOP.展开更多
AIM: To evaluate the effects of panretinal photocoagulation(PRP) compared with PRP plus intravitreal bevacizumab(IVB) in patients with high-risk proliferative diabetic retinopathy(PDR) according to the Early Treatment...AIM: To evaluate the effects of panretinal photocoagulation(PRP) compared with PRP plus intravitreal bevacizumab(IVB) in patients with high-risk proliferative diabetic retinopathy(PDR) according to the Early Treatment Diabetic Retinopathy Study criteria.· METHODS: The data were collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. After treated with standard PRP,the eyes were randomly assigned to receive only PRP(PRP group) or PRP plus intravitreal injection of 1.25 mg of bevacizumab(PRP-Plus group). Patients underwent complete ophthalmic evaluation, including best corrected visual acuity(BCVA), intraocular pressure(IOP), and new vessel size in fluorescein angiography(FA) and optical coherence tomography for the assessment of central subfield macular thickness(CSMT) at baseline and at weeks 12(±2), 16(±2), 24(±2) and 48(±2). Main outcome measures also included vitreous clear-up time and neovascularization on the disc(NVD) regression time.Adverse events associated with intravitreal injection were investigated.·RESULTS: Thirty consecutive patients(n =36 eyes)completed the 48-week follow-up. There was no significant difference between the PRP and PRP-Plus groups with respect to age, gender, type or duration of diabetes, area of fluorescein leakage from active neovascularizations(NVs), BCVA or CSMT at baseline.The mean vitreous clear-up time was 12.1 ±3.4wk after PRP and 8.4 ±3.5wk after PRP combined with IVB. The mean time interval from treatment to complete NVD regression on FA examination was 15.2 ±3.5wk in PRP group and 12.5±3.1wk in PRP-Plus group. No significant difference in CSMT was observed between the groups throughout the study period. However, the total area of actively leaking NVs was significantly reduced in the PRP-Plus group compared with the PRP group(P <0.05).Patients received an average of 1.3 injections(range:1-2).Ten eyes(27.8%) underwent 2 injections. Two eyes had ocular complication of PDR progression to dense vitreous hemorrhage(VH). No major adverse events were identified.·CONCLUSION: The adjunctive use of IVB with PRP is associated with a greater reduction in the area of active leaking NVs than PRP alone in patients with high-risk PDR. Short-term results suggest combined IVB and PRP achieved rapid clearance of VH and regression of retinal NV in the treatment of high-risk PDR. Further studies are needed to determine the effect of repeated intravitreal bevacizumab injections and the proper number of bevacizumab injections as an adjuvant.展开更多
AIM: To evaluate prospectively immediate intraocular pressure (IOP) changes after the intravitreal injection of ranibizumab, 2 and 4mg triamcinolone acetonide. METHODS: Patients who underwent intravitreal injection of...AIM: To evaluate prospectively immediate intraocular pressure (IOP) changes after the intravitreal injection of ranibizumab, 2 and 4mg triamcinolone acetonide. METHODS: Patients who underwent intravitreal injection of 0.1mL (4mg) triamcinolone acetonide (TA, Group T4), 0.05mL (2mg) TA (Group T2) and 0.05mL (0.5mg) ranibizumab (Group R) comprised the study population. Overall, 229 eyes of 205 patients were injected. Fifty-four eyes (23.6%) were in Group T4, 69 eyes (30.1%) in Group T2 and 106 eyes (46.3%) in Group R. If IOP was less than 26mmHg immediately after the injection no further measurement was performed. If IOP was ≥26mmHg, IOP was remeasured till the reading was below 26mmHg at 5, 15 and 30 minutes. RESULTS: Immediately after the injection, the IOP of 28 eyes (51.9%) in Group T4, 22 eyes (31.9%) in Group T2 and 51 eyes (48.1%) in Group R were over 25mmHg. At 30 minutes, IOP of one eye (1.9%) in group T4, two eyes (2.9%) in group T2 and two eyes (1.9 %) in Group R were over 25mmHg. Immediate post-injection IOP was significantly higher in Group T4 and Group R when compared to Group T2 (P <0.001 and P <0.001, respectively). IOP was significantly higher in eyes without vitreous reflux when compared to those with vitreous reflux in all groups (P <0.001). CONCLUSION: IOP may remarkably increase immediately after the intravitreal injection of 2 or 4mg triamcinolone acetonide, and 0.5mg ranibizumab. Absence of vitreous reflux is the most important predicting factor for immediate IOP rise after the injection.展开更多
AIM:To assess possible benefits of intravitreal triamcinolone acetonide(IVTA)injection as pretreatment for macular laser photocoagulation(MLP)in patients with diabetic macular edema(DME).·METHODS:Published random...AIM:To assess possible benefits of intravitreal triamcinolone acetonide(IVTA)injection as pretreatment for macular laser photocoagulation(MLP)in patients with diabetic macular edema(DME).·METHODS:Published randomized controlled trials(RCTs)concerning MLP with or without IVTA pretreatment for DME were retrieved from databases CNKI,Medline,EMbase,Web of Science,and the Cochrane Library.A Meta-analysis on eligible studies was conducted using Rev Man 5.0 software.Two investigators independently assessed the quality of the trials and extracted data.Main outcome measures included the change in best-corrected visual acuity(BCVA),difference in central macular thickness(CMT)and adverse events reporting in particular elevated intraocular pressure within the follow-up period.The results were pooled using weight mean difference(WMD)or odds risk(OR)with their corresponding 95%confidence intervals(CI).A fixed-or random-effect model was employed depending on the heterogeneity of the inclusion trials.·RESULTS:Finally,five independent RCTs were identified and used for comparing MLP with IVTA pretreatment(131 eyes)with MLP alone(133 eyes,control group).The overall study quality was relatively higher according to the modified Jadad scale.The Metaanalysis showed that MLP with IVTA pretreatment significantly reduced CMT at one,three and six months(P=0.002,0.0003 and 0.04,respectively),compared with MLP alone.The IVTA pretreatment group showed statistically significant improvements in BCVA at the one-month follow up as compared with the control group(P=0.03).At three-and six-month follow up,there was a beneficial trend towards improving visual acuity in the IVTA pretreatment group without statistical significance between groups(P=0.06 and 0.20,respectively).The incidence of elevation of intraocular pressure was significantly higher in the IVTA pretreatment group than in the control group(P<0.0001).No evidence of publication bias was present according to Begg's test and Egger's test.There was a low level of heterogeneity in the included studies.·CONCLUSION:This Meta-analysis indicates that MLP with IVTA pretreatment has a better therapeutic effect in terms of CMT reduction and earlier(1mo)visual improvement for patients with DME as compared with MLP alone.Further confirmation with rigorously welldesigned multi-center trials is needed.展开更多
AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interven...AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections(0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity(VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy(PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity(BCVA), central foveal thickness(CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS: A total of 56 eyes(56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters(P<0.001) at 12 mo, while CFT decreased significantly from 457.41±207.86 μm to 247.98±127.08 μm(P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12 mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION: Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.展开更多
AIM: To investigate the effect of albuminuria on diabetic macular edema(DME) and the possible association between baseline urinary albumin excretion(UAE) and intravitreal conbercept(IVC) treatment frequency in DME pat...AIM: To investigate the effect of albuminuria on diabetic macular edema(DME) and the possible association between baseline urinary albumin excretion(UAE) and intravitreal conbercept(IVC) treatment frequency in DME patients. METHODS: In this hospital-based retrospective study, a total of 350 in-patients with type 2 diabetes mellitus were recruited and their clinical records were reviewed. Thereafter, 52 patients identified with severe non-proliferative diabetic retinopathy(NPDR) combined with albuminuria were divided into the microalbuminuria(UAE 30-300 mg/24 h) and macroalbuminuria(UAE>300 mg/24 h) groups, which were compared and analyzed by both independent sample t-test and Chi-square test. Correlations between the systemic variables and the central foveal thickness(CFT) were evaluated using Spearman’s correlation and linear regression analyses. Of the 52 patients with centerinvolved DME, 43 received an initial combined injection of conbercept(0.5 mg/0.05 mL) and triamcinolone acetonide(1 mg/0.05 mL), followed by an IVC injection, as needed. The relationship between baseline UAE and number of IVCinjections during the first year of treatment was analyzed using Spearman’s partial correlation.RESULTS: Of 350 patients, a higher incidence of DME was observed in severe non-proliferative retinopathy(NPDR) patients than that observed in other groups. By dividing the 52 patients with severe NPDR into the micro-and macro-albuminuria subgroups, significant differences in CFT, systolic blood pressure, total cholesterol and serum creatinine levels, and UAE were revealed. Furthermore, a positive liner correlation between the UAE and CFT was found. Finally, the partial correlation coefficient adjusted for either the CFT or UAE indicated that both parameters directly correlated with the number of IVC injections administered during the 12 mo of follow-up. CONCLUSION: Generally, macular edema occurred in patients with severe NPDR, for whom the UAE is an independent risk predictor of DME. The baseline UAE and CFT predicted the treatment frequency of IVC injections administered in the first year for eyes with DME.展开更多
AIM: To evaluate the efficacy and safety of intravitreal injection of conbercept in patients with neovascular agerelated macular degeneration(AMD). METHODS: Retrospective review of 66 eyes of 63 patients with neovasc...AIM: To evaluate the efficacy and safety of intravitreal injection of conbercept in patients with neovascular agerelated macular degeneration(AMD). METHODS: Retrospective review of 66 eyes of 63 patients with neovascular AMD. All patients received 0.5 mg intravitreal injections of conbercept monthly for 3 consecutive months, and then pro re nata treatment was performed. The changes of best-corrected visual acuity(BCVA) and central macular thickness(CMT) were observed before and after treatments. Minimum follow-up time was 12 mo. SPSS 22.0 statistical software was used for statistical analysis.展开更多
AIM:To investigate the effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness(SFChT) and retinal vessel diameter in patients with branch retinal vein occlusion. METHODS:An interven...AIM:To investigate the effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness(SFChT) and retinal vessel diameter in patients with branch retinal vein occlusion. METHODS:An interventional,restrospective study of 41 eyes of 41 patients who had completed 12 mo of follow-up,divided into group 1(1.25 mg of bevacizumab,21 eyes of 21 patients) and group 2(2.5 mg of bevacizumab,20 eyes of 21 patients).Complete ophthalmic examination,fluorescein angiography,enhanced depth imaging optical coherence tomography and measurement of retinal vessel diameter with IVAN software were performed at baseline and follow-up.RESULTS:The SFChT changed from 279.1(165-431) urn at baseline to 277.0(149-413) μm at 12 mo in group 1(P=0.086),and from 301.4(212-483) μm to 300.3(199-514) μm in group 2(P=0.076).The central retinal arteriolar equivalent(CRAE) changed from 128.8±11.2 μm at baseline to 134.5±8.4 μm at 12 mo in group 1,and from134.6±9.0 μm to 131.4±12.7 μm in group 2(P=0.767).The central retinal venular equivalent(CRVE) changed from 204.1±24.4 μm at baseline to 196.3±28.2 μm at 12 mo in group 1,and from 205.8±16.3 μm to 194.8±18.2 μm in group 2(P=0.019).The mean central macular thickness(P<0.05) and average best-corrected visual acuity(BCVA;P<0.05) improved in both groups.CONCLUSION:Changes in the SFChT are not statistically significant and not different according to the doses of bevacizumab.The CRAE did not show significant change,however,the CRVE showed significant decrease regardless of the dose.展开更多
AIM:To evaluate the changes in ocular blood flow with color Doppler ultrasonography(CDU) after intravitreal triamcinolone acetonide(IVTA) injection.METHODS:A total of 46 patients who underwent IVTA(4 mg/0.1 mL) inject...AIM:To evaluate the changes in ocular blood flow with color Doppler ultrasonography(CDU) after intravitreal triamcinolone acetonide(IVTA) injection.METHODS:A total of 46 patients who underwent IVTA(4 mg/0.1 mL) injection for diabetic macular edema(DME)(n =22), central retinal vein occlusion(CRVO)(n =12) and choroidal neovascular membrane(CNVM)(n =12) were included in the study. Peak systolic velocity(PSV), end diastolic velocity(EDV) and resistivity index(RI) were measured from the ophthalmic artery(OA), the central retinal artery(CRA) and the posterior ciliary artery(PCA)of each patient with CDU before, at the end of the first week and at the end of the first month following IVTA injection.RESULTS:In the DME group, PSV of OA at the first of the first month(mean ±SD)(37.48 ±10.87 cm/s) increased compared to pre-injection value(31.39 ±10.84 cm/s)(P =0.048). There was a statistically significant decrease(P =0.049) in PSV of CRA at the end of the first month(7.97±2.67 cm/s) compared to the pre-injection(9.47±3.37 cm/s).There was not any statistically significant difference onthe other parameters in the DME group. Also, there was not any statistically significant difference on the ocular blood flow values in the CRVO and CNVM groups.CONCLUSION:We observed that 4 mg/0.1 mL IVTA increased PSV of OA and decreased PSV of CRA in DME patients and did not have any effect on ocular blood flow values of CRVO and CNVM patients.展开更多
AIM:To report on intraocular pressure(IOP)after intravitreal injections of triamcinolone acetonide.·METHODS:Systematic literature review of studies that investigated the effects of an injection of triamcinolone I...AIM:To report on intraocular pressure(IOP)after intravitreal injections of triamcinolone acetonide.·METHODS:Systematic literature review of studies that investigated the effects of an injection of triamcinolone Intravitreal triamcinolone acetonide on IOP was conducted according to the Cochrane Collaboration methodology and the reported effects have been analyzed with Meta-analysis.·RESULTS:We found that the IOP follows an inverted-U shape pattern over time starting with an average value of14.81±1.22 mm Hg before the injection,rising to a maximum of 19.48±2.15 mm Hg after one month of injection and falling down to 16.16±1.92 mm Hg after6mo.Moreover,country of study,age,previous history of glaucoma and gender compositions matter for crossstudy were different in reported IOP changes.·CONCLUSION:Our findings may be helpful in determining pressure elevation risk of intravitreal triamcinolone acetonide therapy as well as comparing it with those of more recent therapies such as the antivascular endothelial growth factor agents.展开更多
AIM:To report the visual outcome based on various patterns of optical coherence tomography(OCT)morphology in diabetic macular edema(DME),following treatment with anti-VEGF intravitreal bevacizumab(IVB)injection.METHOD...AIM:To report the visual outcome based on various patterns of optical coherence tomography(OCT)morphology in diabetic macular edema(DME),following treatment with anti-VEGF intravitreal bevacizumab(IVB)injection.METHODS:Sixty-seven consecutive subjects with centre involving DME underwent intravitreal injection of bevacizumab(1.25 mg/0.05 mL)in this retrospective,comparative,non randomized study.The DME was classified into one of four categories:focal,diffuse,focal cystoid and neurosensory detachment based on OCT.Best corrected visual acuity(BCVA),macular appearance,and OCT findings were used to decide whether the subject should have a repeat injection of intravitreal bevacizumab.Outcome measures were a change in mean BCVA(Snellen converted to logMAR)and central macular thickness(CMT)in each group during the six month follow-up period.RESULTS:The mean BCVA improved to logMAR 0.23at final follow-up from a baseline of 0.32 logMAR(P=0.040)in the focal group,logMAR 0.80 at final follow-up from a baseline of 0.82 logMAR(P=0.838)in the diffuse group,worsened to logMAR 0.53 at final follow-up from a baseline of 0.43 logMAR(P=0.276)in the focal cystoid group,and improved to logMAR 0.79 at final follow-up from a baseline of 0.93 logMAR(P=0.490)in the neurosensory detachment group.The mean CMT before treatment were 298.8±25.03μm in the focal group,310.8±40.6μm in the diffuse group,397.15±31.05μm in the focalcystoid group and 401.03±75.1μm in the neurosensory detachment group.A mean of 2.05(range:1-5)injections in the focal group,1.32(range:1-2)in the diffuse group,2.6(range:1-6)in the focal cystoid group and 2.6(range:1-6)in the neurosensory detachment group were performed during the six month follow-up period.Following intravitreal bevacizumab treatment,vision improved,remained unchanged or worsened in 11,7 and2 subjects in focal group;11,9 and 8 in diffuse group;0,2 and 4 in focal cystoid group and 5,5 and 3 subjects respectively in neurosensory detachment group.CONCLUSION:OCT morpholgy patterns in DME may predict the effects of intravitreal bevacizumab treatment,and patients with focal DME are most likely to benefit from the improvent of visual acuity from this treatment.展开更多
Retinal degenerations are the leading causes of irreversible visual loss worldwide. Many pathologies included under this umbrella involve progressive degeneration and ultimate loss of the photoreceptor cells, with age...Retinal degenerations are the leading causes of irreversible visual loss worldwide. Many pathologies included under this umbrella involve progressive degeneration and ultimate loss of the photoreceptor cells, with age-related macular degeneration and inherited and ischemic retinal diseases the most relevant. These diseases greatly impact patients' daily lives, with accompanying marked social and economic consequences. However, the currently available treatments only delay the onset or slow progression of visual impairment, and there are no cures for these photoreceptor diseases. Therefore, new therapeutic strategies are being investigated, such as gene therapy, optogenetics, cell replacement, or cell-based neuroprotection. Specifically, stem cells can secrete neurotrophic, immunomodulatory, and anti-angiogenic factors that potentially protect and preserve retinal cells from neurodegeneration. Further, neuroprotection can be used in different types of retinal degenerative diseases and at different disease stages, unlike other potential therapies. This review summarizes stem cell-based paracrine neuroprotective strategies for photoreceptor degeneration, which are under study in clinical trials, and the latest preclinical studies. Effective retinal neuroprotection could be the next frontier in photoreceptor diseases, and the development of novel neuroprotective strategies will address the unmet therapeutic needs.展开更多
The effect of intravitreal ganciclovir injection combined with intravenous infusion on acquired immune deficiency syndrome(AIDS) patients with cytomegalovirus retinitis(CMVR) was investigated. A total of 32 eyes in 23...The effect of intravitreal ganciclovir injection combined with intravenous infusion on acquired immune deficiency syndrome(AIDS) patients with cytomegalovirus retinitis(CMVR) was investigated. A total of 32 eyes in 23 AIDS patients diagnosed as CMVR from 2017 to 2018 were included in the retrospective study. All patients underwent induction therapy by using intravenous drip of the anticytomegalovirus(CMV) agent ganciclovir(5 mg/kg q12 h) combined with intravitreal ganciclovir injection(3 mg/time, 2 times/wk). The visual acuity, fundus photographs, lesion location, and number of intravitreal injections were observed preoperatively and postoperatively. Totally 14 eyes were cured during induction therapy. The number of injections [4.13(2 to 6)] in CMVR patients with peripherally fundus lesions were significantly lower than those with central lesions (4.89(2 to 6))The individualized therapy of intravitreal ganciclovir injections for AIDS patients with CMVR can effectively reduce the numbers of intravitreal injections.展开更多
文摘●AIM:To evaluate the effect of background diseases and number of previous intravitreal aflibercept injections(IVAIs)on immediate intraocular pressure(IOP)increase and vitreous reflux(VR)rate and to evaluate the correlation of both age and axial length with immediate IOP increase and VR rate.●METHODS:This study included 105 patients with cystoid macular edema secondary to retinal vein occlusion,35 patients with diabetic macular edema,69 patients with neovascular age-related macular degeneration(nAMD),and 12 patients with myopic choroidal neovascularization,which underwent first-time IVAI.The correlation of immediate IOP increase and VR rates with the four background diseases was investigated.Moreover,the correlation of age with immediate IOP increase and VR rate as well as correlation of axial length with immediate IOP increase and VR rate were evaluated.Further,54 patients with nAMD were treated with IVAI>10 times(multiple IVAIs).Moreover,the correlation of immediate IOP increase and VR rates with first-time and multiple IVAIs in nAMD was determined.●RESULTS:The immediate IOP increase(P=0.16)and VR rates(P=0.50)were almost similar among the four background diseases.The immediate postinjection IOP and age,VR rate and age,immediate postinjection IOP and axial length,or VR rate and axial length were not correlated in the four background diseases.The immediate IOP increase(P=0.66)and VR rates(P=0.28)did not significantly differ between first-time and multiple IVAIs in nAMD.●CONCLUSION:Background diseases and number of previous IVAIs have no effect on immediate IOP increase and VR rate.Further,age and axial length have no correlation on immediate IOP increase and VR rate.
文摘We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had metastases to the iris and ciliary body, resulting in progressive vision loss in her left eye. Treatment was successful by intravitreal injections of anti-vascular endothelial growth factor.
基金Supported by the Natural Science Basic Research Program in Shaanxi Province(No.2020JM-683)2020 Scientific Research Incubation Fund of Xi’an People’s Hospital(No.FZ-63)。
文摘AIM:To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone(DEX)intravitreal implant(Ozurdex).METHODS:The study included 32 eyes of 26 patients treated with DEX implant due to chronic uveitis-induced cataract and followed up for at least a year.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),anterior chamber reaction,central macular thickness(CMT),intraoperative and postoperative complications and uveitis recurrence were analyzed retrospectively.RESULTS:A successful surgery was performed in all patients.The average follow-up period was 12mo.The female/male ratio was 13/13.Mean age was 45.65±3.83y(range 26 to 65y).Etiologically,rheumatic arthritis occurred in 6 patients(18.75%),ankylosing spondylitis in 4(12.50%),HLA-B27 associated uveitis in 3(9.38%),Vogt-KoyanagiHarada-associated uveitis in 4(12.50%),Behcet’s disease in 2(6.25%),and 7(21.88%)suffered from unknown diseases.All 32 eyes had varying degrees of improvement at 12mo after surgery,with 2 eyes showing BCVA of 0.1 or below(6.25%),6 having 0.1-0.5(18.75%),18 of 0.5-1.0(56.25%),and 6 of 1.0 or above(18.75%).No cases with increased IOP were observed.The values of mean CMT was increased at day 1,decreased at 1,3mo after surgery and increased at 6,12mo after surgery.No severe uveitis reactions,such as fibrinous exudates in the anterior chamber and exudative membrane formation on the anterior surface of the IOL,were observed after surgery.CONCLUSION:The present studies show that intravitreal injection of Ozudex during cataract operation can provide a new option for the clinical treatment of uveitis-induced cataract.
文摘AIM: To compare the effectiveness of intravitreal bevacizumab and subthreshold macular photocoagulation(SMP), for the treatment of non-center involved diabetic macular edema(non-CI DME).METHODS: Prospective, randomized, controlled clinical study included patients with type 2 diabetes, non-CI DME and best-corrected visual acuity(BCVA) of 0.30 logMAR or better. Each eye was randomized into three groups:group 1, monthly intravitreal bevacizumab; group 2, single SMP; group 3, single SMP and monthly bevacizumab. Main outcome measures were BCVA, and macular thickness measured with optical coherence tomography as macular central subfield thickness(CST), macular area of greater thickness(MAGT) and total macular volume(TMV). Results were analyzed after 3 mo.RESULTS: A total of 32 eyes were included. Group 3 improved in BCVA(0.19±0.16 to 0.12±0.14 logMAR; P=0.041) and in TMV(7.90±0.57 to 7.65±0.73 mm3; P=0.025). Group 1 improved in MAGT(325±26.26 to 298.20±44.85 μm; P=0.022) and TMV(7.79±0.57 to 7.50±0.56 mm3, P=0.047). Group 2 didn't show significant improvement of any variable.CONCLUSION: The loading phase of bevacizumab as monotherapy or combined with SMP is superior to SMP as monotherapy in providing short-term visual and anatomical improvement in non-CI DME.
文摘Retinal vein occlusion (RVO) is the most common visually disabling disease affecting the retina after diabetic retinopathy. Although the disease entity has long been known, its management is still controversial. Macular edema is the main reason for decreased visual acuity (VA) in this retinal vascular disorder. Recently the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of macular edema through intravitreal injection route. The most widely injected drugs so far have been triamcinolone acetonide (TA) and bevacizumab. The objective of this review is to evaluate the evidence and discuss the rationale behind the recent suggestions that intravitreal pharmacotherapy by corticosteroids and anti-vascular endothelial growth factors may be useful in the treatment of retinal vein occlusion.
文摘AIM:To explore the efficacy of preoperative intravitreal bevacizumab(IVB) injection combined with Ahmed glaucoma valve(AGV) implantation in the treatment of neovascular glaucoma(NVG).METHODS:This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure(IOP) number of anti-glaucoma medications, visual acuity(VA), surgical success rates,and complications were recorded.RESULTS:AfterAGVimplantation,IOPwas18.2±4.0mmHg,15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36 mo,significantly decreased compared with pre-IOP(P <0.01).The number of anti-glaucoma medications was 0.9 ±0.5,0.8 ±0.9 and 0.8 ±0.6 at 6, 12 and 36 mo, significantly decreased compared to pre-treatment(P <0.01). At last visit, there were 19 eyes with stable VA, 4 with VA improvement, 12 with diminished VA and 3 with complete loss light perception. There were 7 cases that failed during 3-year fellow up period. Cumulative probabilities of valve survival by Kaplan-Meier analysis were 82.9%,74.1% and 71.0% at 12, 24 and 36 mo, respectively. Cox stepwise regression analysis found that the survival time was significant associated with the pre-visual acuity <2/400(P <0.05). Post-operative complications occurred in 8eyes, of which hyphema presented in 2 eyes, choroidal effusion in 2 eyes.CONCLUSION:The procedure of preoperative IVB andAGV implantation should be one of treatments for NVG because of its safety and effectiveness.
基金Supported by the 1351 Beijing Chaoyang Talent Training Program(No.CYXX-2017-21)
文摘AIM:To compare the effectiveness between multiple intravitreal injections of ganciclovir alone and combined with foscarnet as initial treatment for patients with newlyonset cytomegalovirus retinitis (CMVR).METHODS:The retrospective study observed 37 patients(58 eyes) who suffered from CMVR onset between 2013 and 2015. Among them, 35 eyes underwent 4 weekly intravitreal injections of 3.0 mg ganciclovir, and 23 eyes underwent 4 weekly injections of 3.0 mg ganciclovir combined with 2.4 mg foscarnet. Visual acuity, intraocular pressure and viral load of cytomegalovirus (CMV) in aqueous humor measured by real-time polymerase chain reaction were compared before and after each injection.RESULTS:CMV-DNA copies in aqueous humor decreased remarkably in both groups. The average of CMV-DNA copies in patients’ aqueous decreased from 38.3×10~4 copies/mL at baseline to 2.2×10~4 copies/mL after the 4^(th) injection in patients who were treated with ganciclovir monotherapy,and decreased from 76.9×10~4 copies/mL to 11.3×10~4 copies/mL after 4 continuous injections of ganciclovir combined with foscarnet. No significant difference was found in reduction of viral load, change of visual acuities or intraocular pressures between monotherapy or combined therapy.CONCLUSION:Results of this study show that the initial effectiveness of treating CMVR after 4 weekly intravitreal injections is not significantly different from ganciclovir alone or combined with foscarnet. Continuous injection of ganciclovir alone is sufficient in treating immunosuppressive patients with newly-onset CMVR.
文摘AIM: To investigate the complications of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema, and to determine the risk factors for intraocular pressure (IOP) elevation. METHODS: Charts of patients with macular edema secondary to branch retinal vein occlusion (BRVO), diabetic retinopathy and uveitis who had received IVTA injections were reviewed to document its complications. IOP elevation was defined as a pressure of ≥24mmHg at some point during follow-up. Multivariate logistic regression analysis was performed to characterize baseline risk factors for this elevation. RESULTS: The study included 111 eyes of 65 female and 46 male patients with a mean follow-up of (11.6±5.1) months. Of the 111 eyes, 52 (46.8%) had macular edema secondary to BRVO, 44 (39.6%) had clinically significant diabetic macular edema (CSDME) and 15 (13.5%) had non-infectious uveitis with macular edema. IOP was recorded ≥24mmHg in 38 eyes (34.2%) during the follow-up. Higher baseline IOP (P =0.022), younger age (P =0.003), and male gender (P = 0.014) were significant risk factors for IOP elevation after IVTA injection. Eyes with prior vitrectomy were less likely to have IOP elevation (P =0.054). Two eyes (5.2% of eyes with increased IOP) underwent trabeculectomy, and 9 eyes (16.3% of the phakic eyes) necessitated cataract surgery. Other complications included branch vein occlusion (1.8%), sterile endophthalmitis (0.9%) and pseudohypopyon (0.9%). CONCLUSION: IVTA has side effects with IOP elevation and cataract formation being the two most common. A subset of patients is more prone to developing increased IOP following IVTA, namely, younger male patients with higher baseline IOP.
文摘AIM: To evaluate the effects of panretinal photocoagulation(PRP) compared with PRP plus intravitreal bevacizumab(IVB) in patients with high-risk proliferative diabetic retinopathy(PDR) according to the Early Treatment Diabetic Retinopathy Study criteria.· METHODS: The data were collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. After treated with standard PRP,the eyes were randomly assigned to receive only PRP(PRP group) or PRP plus intravitreal injection of 1.25 mg of bevacizumab(PRP-Plus group). Patients underwent complete ophthalmic evaluation, including best corrected visual acuity(BCVA), intraocular pressure(IOP), and new vessel size in fluorescein angiography(FA) and optical coherence tomography for the assessment of central subfield macular thickness(CSMT) at baseline and at weeks 12(±2), 16(±2), 24(±2) and 48(±2). Main outcome measures also included vitreous clear-up time and neovascularization on the disc(NVD) regression time.Adverse events associated with intravitreal injection were investigated.·RESULTS: Thirty consecutive patients(n =36 eyes)completed the 48-week follow-up. There was no significant difference between the PRP and PRP-Plus groups with respect to age, gender, type or duration of diabetes, area of fluorescein leakage from active neovascularizations(NVs), BCVA or CSMT at baseline.The mean vitreous clear-up time was 12.1 ±3.4wk after PRP and 8.4 ±3.5wk after PRP combined with IVB. The mean time interval from treatment to complete NVD regression on FA examination was 15.2 ±3.5wk in PRP group and 12.5±3.1wk in PRP-Plus group. No significant difference in CSMT was observed between the groups throughout the study period. However, the total area of actively leaking NVs was significantly reduced in the PRP-Plus group compared with the PRP group(P <0.05).Patients received an average of 1.3 injections(range:1-2).Ten eyes(27.8%) underwent 2 injections. Two eyes had ocular complication of PDR progression to dense vitreous hemorrhage(VH). No major adverse events were identified.·CONCLUSION: The adjunctive use of IVB with PRP is associated with a greater reduction in the area of active leaking NVs than PRP alone in patients with high-risk PDR. Short-term results suggest combined IVB and PRP achieved rapid clearance of VH and regression of retinal NV in the treatment of high-risk PDR. Further studies are needed to determine the effect of repeated intravitreal bevacizumab injections and the proper number of bevacizumab injections as an adjuvant.
文摘AIM: To evaluate prospectively immediate intraocular pressure (IOP) changes after the intravitreal injection of ranibizumab, 2 and 4mg triamcinolone acetonide. METHODS: Patients who underwent intravitreal injection of 0.1mL (4mg) triamcinolone acetonide (TA, Group T4), 0.05mL (2mg) TA (Group T2) and 0.05mL (0.5mg) ranibizumab (Group R) comprised the study population. Overall, 229 eyes of 205 patients were injected. Fifty-four eyes (23.6%) were in Group T4, 69 eyes (30.1%) in Group T2 and 106 eyes (46.3%) in Group R. If IOP was less than 26mmHg immediately after the injection no further measurement was performed. If IOP was ≥26mmHg, IOP was remeasured till the reading was below 26mmHg at 5, 15 and 30 minutes. RESULTS: Immediately after the injection, the IOP of 28 eyes (51.9%) in Group T4, 22 eyes (31.9%) in Group T2 and 51 eyes (48.1%) in Group R were over 25mmHg. At 30 minutes, IOP of one eye (1.9%) in group T4, two eyes (2.9%) in group T2 and two eyes (1.9 %) in Group R were over 25mmHg. Immediate post-injection IOP was significantly higher in Group T4 and Group R when compared to Group T2 (P <0.001 and P <0.001, respectively). IOP was significantly higher in eyes without vitreous reflux when compared to those with vitreous reflux in all groups (P <0.001). CONCLUSION: IOP may remarkably increase immediately after the intravitreal injection of 2 or 4mg triamcinolone acetonide, and 0.5mg ranibizumab. Absence of vitreous reflux is the most important predicting factor for immediate IOP rise after the injection.
文摘AIM:To assess possible benefits of intravitreal triamcinolone acetonide(IVTA)injection as pretreatment for macular laser photocoagulation(MLP)in patients with diabetic macular edema(DME).·METHODS:Published randomized controlled trials(RCTs)concerning MLP with or without IVTA pretreatment for DME were retrieved from databases CNKI,Medline,EMbase,Web of Science,and the Cochrane Library.A Meta-analysis on eligible studies was conducted using Rev Man 5.0 software.Two investigators independently assessed the quality of the trials and extracted data.Main outcome measures included the change in best-corrected visual acuity(BCVA),difference in central macular thickness(CMT)and adverse events reporting in particular elevated intraocular pressure within the follow-up period.The results were pooled using weight mean difference(WMD)or odds risk(OR)with their corresponding 95%confidence intervals(CI).A fixed-or random-effect model was employed depending on the heterogeneity of the inclusion trials.·RESULTS:Finally,five independent RCTs were identified and used for comparing MLP with IVTA pretreatment(131 eyes)with MLP alone(133 eyes,control group).The overall study quality was relatively higher according to the modified Jadad scale.The Metaanalysis showed that MLP with IVTA pretreatment significantly reduced CMT at one,three and six months(P=0.002,0.0003 and 0.04,respectively),compared with MLP alone.The IVTA pretreatment group showed statistically significant improvements in BCVA at the one-month follow up as compared with the control group(P=0.03).At three-and six-month follow up,there was a beneficial trend towards improving visual acuity in the IVTA pretreatment group without statistical significance between groups(P=0.06 and 0.20,respectively).The incidence of elevation of intraocular pressure was significantly higher in the IVTA pretreatment group than in the control group(P<0.0001).No evidence of publication bias was present according to Begg's test and Egger's test.There was a low level of heterogeneity in the included studies.·CONCLUSION:This Meta-analysis indicates that MLP with IVTA pretreatment has a better therapeutic effect in terms of CMT reduction and earlier(1mo)visual improvement for patients with DME as compared with MLP alone.Further confirmation with rigorously welldesigned multi-center trials is needed.
文摘AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections(0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity(VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy(PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity(BCVA), central foveal thickness(CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS: A total of 56 eyes(56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters(P<0.001) at 12 mo, while CFT decreased significantly from 457.41±207.86 μm to 247.98±127.08 μm(P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12 mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION: Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.
基金Supported by Nature Science Foundation of Shaanxi Province of China (No.2017JM8074)
文摘AIM: To investigate the effect of albuminuria on diabetic macular edema(DME) and the possible association between baseline urinary albumin excretion(UAE) and intravitreal conbercept(IVC) treatment frequency in DME patients. METHODS: In this hospital-based retrospective study, a total of 350 in-patients with type 2 diabetes mellitus were recruited and their clinical records were reviewed. Thereafter, 52 patients identified with severe non-proliferative diabetic retinopathy(NPDR) combined with albuminuria were divided into the microalbuminuria(UAE 30-300 mg/24 h) and macroalbuminuria(UAE>300 mg/24 h) groups, which were compared and analyzed by both independent sample t-test and Chi-square test. Correlations between the systemic variables and the central foveal thickness(CFT) were evaluated using Spearman’s correlation and linear regression analyses. Of the 52 patients with centerinvolved DME, 43 received an initial combined injection of conbercept(0.5 mg/0.05 mL) and triamcinolone acetonide(1 mg/0.05 mL), followed by an IVC injection, as needed. The relationship between baseline UAE and number of IVCinjections during the first year of treatment was analyzed using Spearman’s partial correlation.RESULTS: Of 350 patients, a higher incidence of DME was observed in severe non-proliferative retinopathy(NPDR) patients than that observed in other groups. By dividing the 52 patients with severe NPDR into the micro-and macro-albuminuria subgroups, significant differences in CFT, systolic blood pressure, total cholesterol and serum creatinine levels, and UAE were revealed. Furthermore, a positive liner correlation between the UAE and CFT was found. Finally, the partial correlation coefficient adjusted for either the CFT or UAE indicated that both parameters directly correlated with the number of IVC injections administered during the 12 mo of follow-up. CONCLUSION: Generally, macular edema occurred in patients with severe NPDR, for whom the UAE is an independent risk predictor of DME. The baseline UAE and CFT predicted the treatment frequency of IVC injections administered in the first year for eyes with DME.
文摘AIM: To evaluate the efficacy and safety of intravitreal injection of conbercept in patients with neovascular agerelated macular degeneration(AMD). METHODS: Retrospective review of 66 eyes of 63 patients with neovascular AMD. All patients received 0.5 mg intravitreal injections of conbercept monthly for 3 consecutive months, and then pro re nata treatment was performed. The changes of best-corrected visual acuity(BCVA) and central macular thickness(CMT) were observed before and after treatments. Minimum follow-up time was 12 mo. SPSS 22.0 statistical software was used for statistical analysis.
文摘AIM:To investigate the effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness(SFChT) and retinal vessel diameter in patients with branch retinal vein occlusion. METHODS:An interventional,restrospective study of 41 eyes of 41 patients who had completed 12 mo of follow-up,divided into group 1(1.25 mg of bevacizumab,21 eyes of 21 patients) and group 2(2.5 mg of bevacizumab,20 eyes of 21 patients).Complete ophthalmic examination,fluorescein angiography,enhanced depth imaging optical coherence tomography and measurement of retinal vessel diameter with IVAN software were performed at baseline and follow-up.RESULTS:The SFChT changed from 279.1(165-431) urn at baseline to 277.0(149-413) μm at 12 mo in group 1(P=0.086),and from 301.4(212-483) μm to 300.3(199-514) μm in group 2(P=0.076).The central retinal arteriolar equivalent(CRAE) changed from 128.8±11.2 μm at baseline to 134.5±8.4 μm at 12 mo in group 1,and from134.6±9.0 μm to 131.4±12.7 μm in group 2(P=0.767).The central retinal venular equivalent(CRVE) changed from 204.1±24.4 μm at baseline to 196.3±28.2 μm at 12 mo in group 1,and from 205.8±16.3 μm to 194.8±18.2 μm in group 2(P=0.019).The mean central macular thickness(P<0.05) and average best-corrected visual acuity(BCVA;P<0.05) improved in both groups.CONCLUSION:Changes in the SFChT are not statistically significant and not different according to the doses of bevacizumab.The CRAE did not show significant change,however,the CRVE showed significant decrease regardless of the dose.
文摘AIM:To evaluate the changes in ocular blood flow with color Doppler ultrasonography(CDU) after intravitreal triamcinolone acetonide(IVTA) injection.METHODS:A total of 46 patients who underwent IVTA(4 mg/0.1 mL) injection for diabetic macular edema(DME)(n =22), central retinal vein occlusion(CRVO)(n =12) and choroidal neovascular membrane(CNVM)(n =12) were included in the study. Peak systolic velocity(PSV), end diastolic velocity(EDV) and resistivity index(RI) were measured from the ophthalmic artery(OA), the central retinal artery(CRA) and the posterior ciliary artery(PCA)of each patient with CDU before, at the end of the first week and at the end of the first month following IVTA injection.RESULTS:In the DME group, PSV of OA at the first of the first month(mean ±SD)(37.48 ±10.87 cm/s) increased compared to pre-injection value(31.39 ±10.84 cm/s)(P =0.048). There was a statistically significant decrease(P =0.049) in PSV of CRA at the end of the first month(7.97±2.67 cm/s) compared to the pre-injection(9.47±3.37 cm/s).There was not any statistically significant difference onthe other parameters in the DME group. Also, there was not any statistically significant difference on the ocular blood flow values in the CRVO and CNVM groups.CONCLUSION:We observed that 4 mg/0.1 mL IVTA increased PSV of OA and decreased PSV of CRA in DME patients and did not have any effect on ocular blood flow values of CRVO and CNVM patients.
文摘AIM:To report on intraocular pressure(IOP)after intravitreal injections of triamcinolone acetonide.·METHODS:Systematic literature review of studies that investigated the effects of an injection of triamcinolone Intravitreal triamcinolone acetonide on IOP was conducted according to the Cochrane Collaboration methodology and the reported effects have been analyzed with Meta-analysis.·RESULTS:We found that the IOP follows an inverted-U shape pattern over time starting with an average value of14.81±1.22 mm Hg before the injection,rising to a maximum of 19.48±2.15 mm Hg after one month of injection and falling down to 16.16±1.92 mm Hg after6mo.Moreover,country of study,age,previous history of glaucoma and gender compositions matter for crossstudy were different in reported IOP changes.·CONCLUSION:Our findings may be helpful in determining pressure elevation risk of intravitreal triamcinolone acetonide therapy as well as comparing it with those of more recent therapies such as the antivascular endothelial growth factor agents.
文摘AIM:To report the visual outcome based on various patterns of optical coherence tomography(OCT)morphology in diabetic macular edema(DME),following treatment with anti-VEGF intravitreal bevacizumab(IVB)injection.METHODS:Sixty-seven consecutive subjects with centre involving DME underwent intravitreal injection of bevacizumab(1.25 mg/0.05 mL)in this retrospective,comparative,non randomized study.The DME was classified into one of four categories:focal,diffuse,focal cystoid and neurosensory detachment based on OCT.Best corrected visual acuity(BCVA),macular appearance,and OCT findings were used to decide whether the subject should have a repeat injection of intravitreal bevacizumab.Outcome measures were a change in mean BCVA(Snellen converted to logMAR)and central macular thickness(CMT)in each group during the six month follow-up period.RESULTS:The mean BCVA improved to logMAR 0.23at final follow-up from a baseline of 0.32 logMAR(P=0.040)in the focal group,logMAR 0.80 at final follow-up from a baseline of 0.82 logMAR(P=0.838)in the diffuse group,worsened to logMAR 0.53 at final follow-up from a baseline of 0.43 logMAR(P=0.276)in the focal cystoid group,and improved to logMAR 0.79 at final follow-up from a baseline of 0.93 logMAR(P=0.490)in the neurosensory detachment group.The mean CMT before treatment were 298.8±25.03μm in the focal group,310.8±40.6μm in the diffuse group,397.15±31.05μm in the focalcystoid group and 401.03±75.1μm in the neurosensory detachment group.A mean of 2.05(range:1-5)injections in the focal group,1.32(range:1-2)in the diffuse group,2.6(range:1-6)in the focal cystoid group and 2.6(range:1-6)in the neurosensory detachment group were performed during the six month follow-up period.Following intravitreal bevacizumab treatment,vision improved,remained unchanged or worsened in 11,7 and2 subjects in focal group;11,9 and 8 in diffuse group;0,2 and 4 in focal cystoid group and 5,5 and 3 subjects respectively in neurosensory detachment group.CONCLUSION:OCT morpholgy patterns in DME may predict the effects of intravitreal bevacizumab treatment,and patients with focal DME are most likely to benefit from the improvent of visual acuity from this treatment.
基金supported by Fundación Carolina,Madrid,SpainFondo Europeo de Desarrollo Regional,Fondo Social Europeo and Consejería de Educación(Grant VA077P17),Junta de Castilla y León,SpainCentro en Red de Medicina Regenerativa y Terapia Celular,Junta de Castilla y León,Spain,respectively
文摘Retinal degenerations are the leading causes of irreversible visual loss worldwide. Many pathologies included under this umbrella involve progressive degeneration and ultimate loss of the photoreceptor cells, with age-related macular degeneration and inherited and ischemic retinal diseases the most relevant. These diseases greatly impact patients' daily lives, with accompanying marked social and economic consequences. However, the currently available treatments only delay the onset or slow progression of visual impairment, and there are no cures for these photoreceptor diseases. Therefore, new therapeutic strategies are being investigated, such as gene therapy, optogenetics, cell replacement, or cell-based neuroprotection. Specifically, stem cells can secrete neurotrophic, immunomodulatory, and anti-angiogenic factors that potentially protect and preserve retinal cells from neurodegeneration. Further, neuroprotection can be used in different types of retinal degenerative diseases and at different disease stages, unlike other potential therapies. This review summarizes stem cell-based paracrine neuroprotective strategies for photoreceptor degeneration, which are under study in clinical trials, and the latest preclinical studies. Effective retinal neuroprotection could be the next frontier in photoreceptor diseases, and the development of novel neuroprotective strategies will address the unmet therapeutic needs.
基金Supported by the Open Research Project of Key Laboratory of Capital Medical University (No.2017YKSJ04)Capital Medical University Fundamental Clinical Research Cooperation Fund (No.16JL73)
文摘The effect of intravitreal ganciclovir injection combined with intravenous infusion on acquired immune deficiency syndrome(AIDS) patients with cytomegalovirus retinitis(CMVR) was investigated. A total of 32 eyes in 23 AIDS patients diagnosed as CMVR from 2017 to 2018 were included in the retrospective study. All patients underwent induction therapy by using intravenous drip of the anticytomegalovirus(CMV) agent ganciclovir(5 mg/kg q12 h) combined with intravitreal ganciclovir injection(3 mg/time, 2 times/wk). The visual acuity, fundus photographs, lesion location, and number of intravitreal injections were observed preoperatively and postoperatively. Totally 14 eyes were cured during induction therapy. The number of injections [4.13(2 to 6)] in CMVR patients with peripherally fundus lesions were significantly lower than those with central lesions (4.89(2 to 6))The individualized therapy of intravitreal ganciclovir injections for AIDS patients with CMVR can effectively reduce the numbers of intravitreal injections.
