Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study. Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female. The average age was (51.25±12.24) years and the course was 5–17 days. All patients were given best corrected visual acuity (BCVA), intraocular pressure, slit lamp with preset lens, fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination. The patients were divided into conbercept and laser group (group Ⅰ), laser group (group Ⅱ) and conbercept group (group Ⅲ), with 30 eyes in each group. The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072, 0.286;P=0.930, 0.752). Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg), and macular grid pattern photocoagulation 3 days later. Group Ⅱ patients were given macular grid pattern photocoagulation. Times of injection between group Ⅰ and Ⅲ, laser energy between group Ⅰ and Ⅱ, changes of BCVA and CMT among 3 groups at 1 week, 1 month, 3 months and 6 months after treatment were compared. Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20±0.41) and (2.23±1.04) times respectively, and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections. The difference of injection times between two groups was significant (P＜0.001). Patients in group Ⅱ had received photocoagulation (1.43±0.63) times, 9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation. The average laser energy was (96.05±2.34) μV in group Ⅰ and (117.41±6.85) μV in group Ⅱ, the difference was statistical significant (P=0.003). BCVA improved in all three groups at last follow-up. However, the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607, –4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=–0.802,P=0.429). The mean CMT reduced in all three groups after treating for 1 week and 1 month, comparing that before treatment (t=–11.855, –10.620, –10.254;P＜0.001). There was no statistical difference of CMT between group Ⅰand Ⅲ at each follow up (t=0.404, 1.723, –1.819, –1.755;P=0.689, 0.096, 0.079, 0.900). CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=–4.621, –3.230;P＜0.001, 0.003). The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month, but the difference was not statistically significant (t=1.995,P=0.056). All patients had no treatment-related complications, such as endophthalmitis, rubeosis iridis and retinal detachment. Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO. Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.
Objective To investigate the effects of Hep-A and Hep-B on vascular endothelial growth factor (VEGF)-induced breakdown of blood-retinal barrier. Methods The mice were subcutaneously injected vehicle, Hep-A or Hep-B 10 mg/kg twice a day for 5 days. Then, 1 μl of 10-6mol/L VEGF were intravitreous injected. After 6 hours, 13.7×104Bq/g3H-mannital were injected intraperitoneally. The mice were sacrificed and the retinas, lungs, kidneys were removed and examined for radioactivity. The result were analyzed using SPSS software to calculate and compare retina/lung and etina/kidney leakage ratio among groups of different treatment. Result The retina/lung and retina/kidney leakage ratio were 0.38±0.04 and 0.21±0.03 respectively in normal mice; increased significantly to 1.05±0.11 and 0.46±0.04 respectively in model mice, both Plt;0.01 compared to those in normal mice; decreased to 0.59±0.06 and 0.32±0.03 respectively in mice treated with Hep-A, both Plt;0.01 compared to those in model mice; decreased 0.54±0.04 and 0.35±0.03 in mice treated with Hep-B,both Plt;0.01 compared to those in model mice. Conclusion Hep-A and Hep-B can significantly reduce VEGF-induced breakdown of blood-retinal barrier in mice. Chin J Ocul Fundus Dis，2004，20：352-354)
Diabetic macular edema (DME) is one of the main reasons causing blindness in patients with diabetic retinopathy. In recent years, with the recognition of the pathogenic role of vascular endothelial growth factor (VEGF) in DME, many clinical trials of intravitreal injection of anti-VEGF drugs have been carried out at home and abroad, proving that it has significant effects in improving visual acuity and reducing macular edema, and has become the first-line treatment of DME. However, there are still many challenges in routine clinical application of anti-VEGF drugs, such as frequent injections, insensitivity to treatment, and it is unclear whether repeated injections will cause damage to retina. The pathophysiological process of DME is very complicated, in addition to VEGF, there are many inflammatory factors and growth factors involved. Clinical trials of long-acting anti-VEGF agents, drugs of other targets and gene therapy are also being carried out. It is believed that with the in-depth research and progress of clinical trials, the gradual application of anti-VEGF drugs, other drugs and therapy in clinical practice are just around the corner, which is expected to provide more convenient and effective treatments for DME patients in the future.
Retinal vein occlusion (RVO) is one of the most common retinal vascular diseases causing blindness, macular edema (ME) is often secondary to it, which causes serious visual impairment to patients. Imaging biomarkers in the changes of retina and choroid of ME secondary to RVO (RVO-ME) have important clinical value in the evaluation of condition, curative effect and visual acuity prediction of patients with RVO-ME. Among them, the disorganization of the retinal inner layers, the integrity of external limiting membrane and ellipsoid zone, and the change of central macular thickness are reliable indexes to evaluate the prognosis of visual acuity; hyperreflective foci, subretinal fluid and intraretinal fluid can be used as important parameters to reflect the level of inflammation; prominent middle limiting membrane and paracentral acute middle maculopathy are the objective basis for judging the degree of retinal ischemia; the changes of choroidal vascular index and choroidal thickness also have potential advantages in evaluating the progress of the disease. Accurately grasp the characteristics of biological markers of RVO-ME related optical coherence tomography is conducive to its reasonable and accurate use in the clinical diagnosis and treatment of RVO-ME, and helpful to further explore the pathogenesis of the disease.
Objective To observe the short-term effect of changing the sequence of PRP and MLP on the pre-proliferative or proliferative diabetic retinopathy patients with clinical significant macular edema (CSEM). Methods Sixty-three consecutive pre-proliferative or proliferative diabetic retinopathy outpatients (103 eyes) with clinical significant macular edema were selected and divided into two groups: 54 eyes in patients of group A accepted MLP one month prior to PRP and 49 eyes in patients of group B accepted the photocoagulative therapies in a contrary sequence. All the patients were followed up for 3 to 13 months and visual acuity. Light sensitivity of 5deg;macular threshold, and FFA were performed pre- and post-photocoagution. Results The improvement of visual acuity was found to be better in group A than that of group B (Plt;0.01) 2 months after the therapy, since then, there was no significant defference (Pgt;0.05) in both groups. Three and 4 months after the treatment, there was no significant difference in change of light sensitivity of 5deg;macular threshold in both groups. The macular leakages of 59 eyes, 32 ingroup A and 27 in group B, were well controlled. Conclusion Among the pre-proliferative or proliferative diabetic retinopathy patients with CSEM, visual acuity of those who accept MLP prior to PRP more rapidly than those who accept contrary sequence of photocoagulation, but the changing of therapeutic sequence might have no dramatic influence on light sensilivity of 5deg;macular threshold. (Chin J Ocul Fundus Dis,2000,16:150-152)
ObjectiveTo investigate the efficacy and safety of intravitreous injection with triamcinolone acetonide (TA) for cystoid macular edema (CME) due to central retinal vein occlusion (CRVO).MethodsFourteen eyes of 14 patients with CME due to CRVO underwent intravitreous injection with 0.1 ml TA (40 mg/ml). Best-corrected visual acuity, intraocular pressure (IOP), slitlamp examinaion, fundus fluorescein angiography, and optical coherence tomography (OCT) were performed on the patients before and after the injection. The follow-up period was 10-22.4 months, with the mean of 15.9 months.ResultsThe average visual acuity was 0.1 before the treatment; while 1 month and 3 months after the injection, the visual acuity of all of the patients improved, including ≥0.2 in 71.43% and 63.6% of the patients, respectively, and ≥0.5 in 429% and 27.3%, respectively. After then, the visual acuity of some patients decreased, and in the final visit, 4 eyes (28.6%) had a visual acuity of ≥0.2, and 1 eye (7.1%) of ≥0.5. Compared with that before the treatment, the visual acuity of 10 (71.4%) eyes improved and 4 (28.6%) eyes declined. One month after the treatment, the macular edema disappeared in 10 eyes (71.4%) and alleviated in 4 (28.6%). In the final visit, macular edema disappeared in 4 eyes, alleviated in 9, and aggravated in 1. In the follow-up duration, high IOP［22.3-40.1 mm Hg (1 mm Hg=0.133 kPa)］. In the final visit, posterior subcapsular cataract was found in 7 eyes.ConclusionIntravitreous injection with TA may be effective in reducing CME and enhancing the visual acuity in a short term with high IOP in some eyes. In the long-term follow-up period, the rate of recurrence of CME and incidence of posterior subcapsular cataract is high. (Chin J Ocul Fundus Dis, 2005,21:213-216)
Diabetic macular edema is the major cause of vision impairment in patients with non-proliferative diabetic retinopathy. Thickness and pathological alterations in each retina layer of diabetic macular edema (DME) patients can be performed by optical coherence tomography (OCT) device. And retinal light sensitivity at specific retinal point and fixation state can be detected by microperimetry qualitatively and quantitatively. Moreover, OCT can discover pathological anatomical changes in the retina of DME patients, thus facilitating the interpretation of the structure-function relationship in DME with combination of microperimetry results. At present, there are various therapies for DME patients, and the primary method in evaluating therapeutic efficacy is to compare the pathological changes in the retina before and after treatment by OCT. Besides, microperimetry can provide information in visual function restoration. The combined application of OCT and microperimetry has broad prospects in the diagnosis and treatment of DME patients.
ObjectiveTo analyze the influencing factors on clinical response to conbercept for diabetic macular edema (DME).MethodsA total of 51 patients (51 eyes) with DME who underwent intravitreal injection of conbercept were included in this retrospective study. The general information (age, sex, body mass index, smoking history, drinking history), blood glucose indicators (duration of diabetes, fasting blood glucose, HbA1c), blood pressure indicators (history of hypertension, systolic blood pressure, diastolic blood pressure), lipid indicators [total cholesterol (TC), high-density lipoprotein (HDL), apolipoprotein A (APOA)], biochemical indicators [neutrophil concentration, hemoglobin (HB), serum creatinine (Scr)] were collected. The best corrected visual acuity (BCVA) and macular central macular thickness (CMT) before and after treatment were comparatively analyzed. CMT reduced not less than 20% and BCVA increased by 2 lines as effective standards. Univariate analysis and multivariate logistic regression analysis were used to determine the factors affecting the efficacy of intravitreal injection of conbercept in patients with DME.ResultsUnivariate analysis showed that diastolic blood pressure, HDL, serum neutrophil concentration, baseline CMT and baseline BCVA were associated with edema regression (P＜0.05); HbA1c was associated with vision improvement (P＜0.05). Multivariate logistic regression analysis showed that there was a history of smoking (OR=0.122, 95% CI 0.017 − 0.887), low diastolic blood pressure (OR=0.850, 95%CI0.748 − 0.966), low HDL (OR=0.007, 95%CI 0.000 1 − 0.440), thin baseline CMT (OR=0.986, 95%CI0.977 − 0.995) were independent risk factors for failure outcome of edema regression (P＜0.05); long duration of diabetes (OR=1.191, 95%CI 1.011 − 1.404), high APOA (OR=1.007, 95% CI 1.000 − 1.013) were independent risk factors for failure outcome of vision improvement. Age, fasting blood glucose, systolic blood pressure, TC, HB, Scr and other indicators had no effect on the efficacy of edema regression and vision improvement after treatment (P＞0.05).ConclusionsSmoking history, long duration of diabetes, low diastolic blood pressure, low HDL level, high APOA level and thin baseline CMT are independent risk factors for the treatment of DME with intravitreal injection of conbercept.
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients. It mainly includes focal DME and diffuse DME, while DME of clinical significance needs timely intervention treatment. Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME. Currently, the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation. Among them, anti-VEGF injection is becoming the first-line therapeutic, and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients. During the diagnosis and treatment of DME, attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME. With the appearance of heterogeneity in the efficacy of anti-VEGF drugs, it remains to be further studied how to choose alternative therapeutics and when to replace them.