Corticosteroids, anti-vascular endothelial growth factor, antibiotics and antiviral were the main 4 classes of drugs for intravitreal injection. Depending on the class and volume of medication, age and gender of patients, ocular axial lengths or vitreous humour reflux, intraocular pressure (IOP) can be elevated transiently or persistently after intravitreal injection. Transient IOP elevation occurred in 2 weeks after intravitreal injection, and can be reduced to normal level for most patients. Only a small portion of such patients have very high IOP and need intervention measures such as anterior chamber puncture or lowering intraocular pressure by drugs. Long term IOP elevation is refers to persistent IOP increase after 2 weeks after intravitreal injection, and cause optic nerve irreversible damage and decline in the visual function of patients. Thus drug or surgical intervention need to be considered for those patients with high and long period of elevated IOP. Large-scale multicenter clinical trials need to be performed to evaluate the roles of the drug and patients factors for IOP of post-intravitreal injection, and to determine if it is necessary and how to use methods reducing IOP before intravitreal injection.
ObjectiveTo observe the short-term efficacy and safety of a new strategy of dexamethasone intravitreal implant (DEX) combined with ranibizumab in the treatment of retinal vein occlusion (RVO) secondary to macular edema (ME) (RVO-ME). MethodsA prospective clinical interventional study. From May 2020 to September 2021, 78 RVO-ME patients with 78 eyes diagnosed in the eye examination of Department of Ophthalmology of The First Affiliated Hospital of Anhui University of Science&Technology were included in the study. Among them, there were 35 males and 43 females, all with monocular disease. Branch retinal vein occlusion (BRVO) was found in 40 patients with 40 eyes; central retinal vein occlusion (CRVO) was found in 38 patients with 38 eyes. According to the treatment strategies, patients were randomly divided into DEX and ranibizumab combination therapy group (initial combination therapy group), DEX monotherapy group and ranibizumab monotherapy group, with 29 eyes, 26 eyes and 23 eyes respectively. Different types of RVO were divided into different treatment groups of BRVO and CRVO. Best corrected visual acuity (BCVA) and frequency domain optical coherence tomography were performed. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. There were no significant differences in logMAR BCVA (χ2=2.376) and central retinal thickness (CRT) (F=0.052) among the three groups (P＞0.05). After treatment, the patients were followed up every month for 6 months. The changes of BCVA, CRT and the incidence of adverse reactions were observed during follow-up. One-way ANOVA and Kruskal-Wallis H test were used to compare the differences. ResultsDuring the follow-up period, compared with the baseline, the BCVA of the eyes in the initial combination treatment group, DEX treatment group and ranibizumab treatment group were significantly improved (Z=110.970, 90.359, 207.303), and CRT was significantly decreased (F=107.172, 88.418, 61.040), the difference was statistically significant (P＜0.01). At 1, 2, 3, 4, 5, and 6 months after treatment, there were significant differences in the mean changes in BCVA between the initial combined treatment group, DEX treatment group, and ranibizumab treatment group (χ2=34.522, 29.570, 14.199, 7.000, 6.434, 6.880; P＜0.05); 1, 2, 3, and 6 months after treatment, the differences were statistically significant (F=4.313, 7.520, 3.699, 3.152; P＜0.05). The time required to improve BCVA by 0.1 logMAR units in the initial combination treatment group, DEX treatment group, and ranibizumab treatment group was 5.73 (3.21, 8.48), 9.97 (6.29, 18.78), and 20.00 (9.41, 37.89) d, respectively; The time required for CRT to drop to 300 μm was 24.31 (21.32, 26.15), 29.42 (25.65, 31.37), and 29.17 (25.28, 36.94) d, respectively. The BCVA improvement of 0.1 logMAR unit and the time required for CRT to decrease to 300 μm in the eyes of initial combined treatment group were shorter than those in the eyes of DEX treatment group and the ranibizumab treatment group, and the differences were statistically significant (Z=－3.533, －4.445, －3.670, －4.030; P＜0.01). Different BRVO treatment groups: 1, 2, 3, 5, and 6 months after treatment, the mean BCVA changes were significantly different (χ2=24.989, 21.652, 11.627, 7.054, 9.698; P＜0.05); CRVO was different treatment group: 1 and 2 months after treatment, there were significant differences in mean BCVA changes (χ2=11.137, 9.746; P＜0.05). Two months after treatment, there were significant differences in CRT changes between BRVO and CRVO groups with different treatment regimens (F=3.960, 3.722; P＜0.01). The time required to improve BCVA by 0.1 logMAR unit in the eyes of BRVO and CRVO combined treatment group was shorter than that in the eyes of BRVO, CRVO DEX treatment group and the BRVO, CRVO ranibizumab treatment group, and the differences were statistically significant (BRVO: Z=－2.687, －3.877; P＜0.05; CRVO: Z=－2.437, －3.575; P＜0.05). The time required for CRT to drop to 300 μm in the CRVO combined treatment group was significantly shorter than that in the CRVO DEX treatment group and the CRVO ranibizumab treatment group, and the difference was statistically significant (F=6.910, P＜0.010); there was no statistically significant difference between the different BRVO treatment groups (F=1.786, P＞0.05). The number of re-treated eyes in the initial combined treatment group and DEX treatment group was less than that in the ranibizumab treatment group, and the difference was statistically significant (χ2=18.330, 7.224; P＜0.05). The retreatment interval of the eyes in the initial combined treatment group was significantly longer than that in the DEX treatment group and the ranibizumab treatment group, and the difference was statistically significant (P＜0.01). There was no significant difference in the incidence of intraocular hypertension among the initial combined treatment group, DEX treatment group and ranibizumab treatment group (χ2=0.058, P＞0.05). ConclusionsThe new strategy of initial combination therapy with DEX and ranibizumab in the treatment of RVO-ME has a better short-term effect. Compared with the monotherapy group, the retreatment interval is shorter, the visual and anatomical benefits are faster, the efficacy lasts longer, and the safety is better.
Gene therapy is designed to introduce genetic material into the cells of a patient via virus to enhance, inhibit, edit or add a genetic sequence, results in a therapeutic or prophylactic effect. Gene therapy has brought positive influence and great potential for the treatment of retinal diseases including genetic retinal diseases and acquired retinal diseases. In addition to the constant optimization of gene vectors, the exploration of different drug delivery techniques has brought different therapeutic effects for gene therapy of retinal diseases. The main delivery methods include subretinal injection, intravitreal injection, suprachoroidal injection. Considering the transfection efficiency and safety of delivery methods, emerging sub-inner limiting membrane injection and noninvasive gene delivery are under investigation. The selection of gene delivery method is very important for the safety and effectiveness of gene therapy for retinal diseases. It is not only related to the development of equipment and technology, but also related to the modification of adeno-associated virus, the selection of promoter and the specific retinal cells that the target gene wants to be transfected. Therefore, the most appropriate method of gene delivery should be selected according to the final gene therapy agent and the specific transfected cells after taking all these factors into consideration.
ObjectiveTo investigate the clinical effects and influence factors of intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs in the treatment of idiopathic choroidal neovascularization (ICNV). MethodsThis retrospective study involved 27 patients (27 eyes) with ICNV from July 2012 to July 2015. Patients received intravitreal bevacizumab (1.25 mg), ranibizumab (0.05 mg), additional injection was provided if it was needed. The average follow-up time was 168 weeks. The recovery of best corrected visual acuity (BCVA) and central foveal retinal thickness (CRT) of the affected eye was observed. Follow up once a month after the initial treatment until the lesion was completely absorbed or scarred (the first follow-up period). Follow up every 12 weeks was performed to observe the recurrence of the lesions (the second stage of long-term follow-up). One month after the last injection of the first follow-up period, according to the regression of choroidal neovascularization (CNV), the affected eyes were divided into a significant improvement group (significant improvement group) and an insignificant improvement group (non-significant improvement group)), to analyze the effects of age, course of disease, type of drugs, number of injections, baseline BCVA and CRT on the regression of CNV lesions. According to the results of long-term follow-up, the eyes were divided into recurrence group and non-recurrence group, and the factors affecting the recurrence of CNV lesions were analyzed. Measurement data between groups was compared by using independent sample t test or non-parametric test; count data was compared by using χ2 test. Logistic regression analysis was used to analyze the factors affecting the regression and recurrence of the lesion. ResultsAt baseline and 1 month after the last injection in the first stage, the average BCVA of the eyes were 55.70±15.21 and 73.59±12.08 letters; CRT was 338.3±89.32 and 264.5±47.47 μm, respectively. The BCVA and CRT of the affected eyes were compared at the two time points, and the differences were statistically significant (Z= －3.886, －4.061; P＜0.001). The BCVA of the eyes in the significant improvement group and the insignificant improvement group were 65.38±17.27 and 51.63±12.61 letters, respectively; the difference between the two groups of BCVA was statistically significant (t=－2.316, P=0.029). The results of long-term follow-up showed that of the 27 eyes, 6 eyes had recurrence; the average recurrence time was 90.83±49.02 weeks. After another intravitreal injection of anti-VEGF drugs, the CNV lesions was resolved. The average injection times of the relapsed group and the non-relapsed group were 3.67±0.816 and 2.24±0.768, respectively. The average injection times of the relapsed group was significantly higher than that of the non-relapsed group, and the difference was statistically significant (Z=－3.253, P＜0.001). There was no statistically significant difference between the two groups of eyes at baseline and CRT at the last follow-up (Z=－1.342,－1.313; P=0.195, 0.195). ConclusionIntravitreal injection of anti-VEGF drugs can effectively increase the regression rate of BCVA and CNV lesions in ICNV eyes; high baseline visual acuity indicates better CNV lesion regression after treatment. Relapsed patients can be effectively improved after re-treatment with anti-VEGF drugs, and CNV recurrence has no significant effect on the final prognosis.
Noninfectious uveitic macular edema (NIU-ME) is a major cause of visual impairment in patients with uveitis. Intravitreal route can control inflammation rapidly, reduce macular edema, and improve vision with relatively lower doses of the drug. Currently, several intravitreal injection drugs have been used for the treatment of NIU-ME. Cataract and elevated intraocular pressure are the major complications. Due to its efficacy and safety, intravitreal drugs have gradually become an effective alternative to systemic treatment, especially in patients with unilateral disease. However, more studies are needed on drug selection, timing of injection and combination therapy in clinical practice. There are various treatments for NIU-ME, and the ultimate treatment should be individualized based on the severity of the disease, the risk/benefit ratio of each therapy, and the patient's tolerance.
Objective To observe and analyze the risk factors of positive conjunctival capsule microbial culture in patients with intravitreal injection treatment (IVT) before treatment. MethodsA prospective study. A total of 1 092 patients who received IVT at the Vitreous Injection Center of Tianjin Medical University Eye Hospital from February 2021 to February 2024 were included in the study. Among them, 539 were males and 553 were females. The age was (62.29±13.61) years. Hypertension and diabetes were 661 and 576 cases, respectively. There were 742 cases of urban residence and 350 cases of rural residence. Three and one days before IVT, 364 patients received antibiotics and 364 patients did not receive antibiotics. Patients' gender, age, history of hypertension and diabetes, pre-IVT antibiotic eye drops use history, and differences in residence (town/country) were collected in detail. Samples were collected after the conjunctival sac was rinsed, and microbial culture was performed. The differences in conjunctival microbial culture positivity rates was compared between those who did not use antibiotic eye drops before IVT, those who used them 1 day before IVT, and those who used them 3 days before IVT. The positive rate of conjunctival sac microbial culture were compared among individuals of different ages, genders, with/without hypertension, with/without diabetes, with different IVT times, and from different living areas (urban/rural). The clinical baseline of positive conjunctival capsule bacterial culture was compared and observed. χ2 test was used to compare the positive rate of conjunctival capsule microbial culture among different clinical baselines. Logistic binary regression analysis was used to analyze the influencing factors. ResultsAmong the 1 092 patients, 54 cases (4.95%, 54/1 092) were positive for microbial culture of conjunctival sac. There was no significant difference (P＞0.05) in the positive rate of conjunctival sac microbial culture among patients of different ages (χ2=5.599), gender (χ2=0.549), residence (χ2=0.153), with or without hypertension and diabetes (χ2=3.545, 0.044), and with or without diabetic macular edema (χ2=0.180). There was no significant difference (P＞0.05) in the positive rate of conjunctival sac microbial culture between patients with different numbers of IVT (χ2=0.961) or between those who received antibiotic eye drops before IVT and those who did not (χ2=5.600). Logistic binary regression analysis showed that none of the above factors were risk factors for positive conjunctival capsule microbial culture (P＞0.05). No infective endophthalmitis occurred in all patients during the observation period. ConclusionThe use of antibiotics before IVT is not the decisive factor for positive microbial culture in conjunctival sac.
ObjectiveTo observe the clinical features of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration (nAMD) and its response to anti-vascular endothelial growth factor (VEGF) therapy. MethodsA retrospective clinical study. From July 2019 to July 2024, 188 patients (188 eyes) with nAMD who were continuously admitted to Tianjin University Aier Eye Hospital and received anti-VEGF drug treatment were included in the study. All eyes underwent best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. Treatment consisted of intravitreal anti-VEGF injections monthly for 3 months, followed by a pro re nata regimen. Based on the presence of BALAD on baseline OCT, eyes were divided into a BALAD group and a control group. BCVA was measured using a standard logarithmic visual acuity chart and converted to the logarithm of the minimum angle of resolution; central retinal thickness (CRT) was measured by OCT. Patients were followed for ≥12 months. Differences in CRT, BCVA, macular neovascularization (MNV) subtypes, and treatment outcomes at 12 months were compared between the two groups. The Scheirer-Ray-Hare test was used for non-normally distributed repeated measures data to compare interactions between time and group for BCVA and CRT; Spearman's rank correlation was used for correlation analysis of continuous variables between groups. ResultsThe number of eyes in the BALAD group and the control group was 33 (17.55%, 33/188) and 155 (82.45%, 155/188) respectively. Among the 33 eyes in the BALAD group, 21 eyes (63.64%, 21/33) had type 1 MNV, among which 18 eyes had polypoid choroidal vascular disease (PCV). There was no statistically significant difference in the gender composition ratio and MNV classification between the two groups of patients (χ2=2.09, 1.87, P＞0.05). There were statistically significant differences in age (t=-2.63), the proportion of PCV (χ2=13.73), and CRT (Z=-3.03) (P＜0.05). Twelve months after treatment, the cystic cavities of 84.85% (28/33) of the affected eyes in the BALAD group subsided. The BCVA of both groups of affected eyes improved over time (H=17.93, P＜0.05), but the overall BCVA of the BALAD group was still worse than that of the control group (H=17.80, P＜0.05). There was a significant difference in the improvement degree of CRT between the two groups (H=43.87, P＜0.05), and only in the control group was a significant positive correlation between BCVA and CRT (r=0.24, P＜0.05). ConclusionsIn nAMD, BALAD is associated with type 1 MNV, particularly the PCV subtype, and may serve as a biomarker for predicting anti-VEGF response. Although the BALAD structure is sensitive to anti-VEGF therapy and readily resolves, the limited functional improvement suggests it may be an imaging indicator of poor prognosis.
Nowadays, one of the most challenging aspects of retinoblastoma (RB) therapy is how to control the resistant or recurrent viable vitreous seeds, for which intravenous chemotherapy appears to be ineffective. Recently, intravitreal chemotherapy offers another option to control advanced stage and vitreous seeds of RB, and may be a promising new approach to RB therapy. However, intravitreal injection for RB patients raises considerable controversy due to concerns of possible extraocular extension along the injection route, and should not replace the primary standard of care for bilateral RB or group E eyes of RB. Close follow-up and further studies are needed to determine appropriate indications, to determine the effective drugs and concentrations, to optimize RB therapy protocols and to investigate the relationship between long-term efficacy and toxicities.
ObjectiveTo compare and analyze the application of anti-vascular endothelial growth factor (VEGF) drugs for intravitreal injection in the real world before and after the establishment of one-stop intravitreal injection center, as well as the advantages and disadvantages of different management modes. MethodsA retrospective clinical study. A total of 4 015 patients (4 659 eyes) who received anti-VEGF drugs for ocular fundus diseases at the Tianjin Medical University Eye Hospital from July, 2018 to June, 2022 were included in the study. There were 2 146 males and 1 869 females. The ocular fundus diseases in this study were as follows: 1 090 eyes of 968 patients with wet age-related macular degeneration (wAMD); 855 eyes of 654 patients with diabetic macular edema (DME); 1 158 eyes of 980 patients with diabetic retinopathy (DR); 930 eyes of 916 patients with macular edema secondary to retinal vein occlusion (RVO-ME). A total of 294 eyes of 275 patients with choroidal neovascularization secondary to pathological myopia (PM-CNV); 332 eyes of 222 patients with other fundus diseases. A total of 13 796 anti-VEGF needles were injected. A total of 1 252 patients (1 403 eyes) from July 2018 to June 2020 were regarded as the control group. From July 2020 to June 2022, 2 763 patients (3 256 eyes) who received anti-VEGF treatment in the intravitreal injection center were regarded as the observation group. The total number of intravitreal injection needles, the distribution of anti-VEGF therapy in each disease according to disease classification, the proportion of patients who chose the 3+ on-demand treatment (PRN) regimen and the distribution of clinical application of different anti-VEGF drugs were compared between the control group and the observation group. The waiting time and medical experience of patients were investigated by questionnaire. χ2 test was used to compare the count data between the two groups, and t test was used to compare the measurement data. ResultsAmong the 13 796 anti-VEGF injections in 4 659 eyes, the total number of anti-VEGF drugs used in the control and observation groups were 4 762 and 9 034, respectively, with an average of (3.39±3.78) and (2.78±2.27) injections per eye (t=6.900, P＜0.001), respectively. In the control and observation groups, a total of 1 728 and 2 705 injections of anti-VEGF drugs were used for wAMD with an average of (5.14±4.56) and (3.59±2.45) injections per eye, respectively; a total of 982 and 2 038 injections of anti-VEGF drugs were used for DME with an average of (4.36±4.91) and (3.24±2.77) needles per eye, respectively. Additionally, a total of 942 and 2 179 injections of anti-VEGF drugs were injected for RVO-ME with an average of (3.98±3.71) and (3.14±2.15) injections per eye, respectively; a total of 291 and 615 injections of anti-VEGF drugs were injected for PM-CNV with an average of (3.31±2.63) and (2.99±1.69) injections per eye, respectively. A total of 683 and 1 029 injections of anti-VEGF drugs were injected for DR with an average of (1.60±1.26) and (1.41±1.05) injections per eye, respectively. The clinical application and implementation of "3+PRN" treatment were as follows: 223 (66.4%, 223/336) and 431 eyes (57.2%, 431/754) in the wAMD (χ2=8.210, P=0.004), 75 (33.3%, 75/225) and 236 (37.5%, 236/630) eyes in the DME (χ2=1.220, P＞0.05), and 97 (40.9%, 97/237) and 355 eyes (51.2%, 355/693) in the RVO-ME (χ2=7.498, P=0.006), 39 (44.3%, 39/88) and 111 eyes (53.9%, 111/206) in the PM-CNV ( χ2=2.258, P＞0.05), respectively. In addition, the results of the questionnaire survey showed that there were significant differences between the control and observation groups regarding the time of appointment waiting for surgery (t=1.340), time from admission to entering the operating room on the day of injection (t=2.780), time from completing preoperative treatment preparation to waiting for entering the operating room (t=8.390), and time from admission to discharge (t=6.060) (P＜0.05). ConclusionsThe establishment of a one-stop intravitreal injection mode greatly improved work efficiency and increased the number of injections. At the same time, the compliance, waiting time, and overall medical experience of patients significantly improved under centralized management.
Primary vitreoretinal lymphoma (PVRL) is a rare type of non-Hodgkin's lymphoma with poor prognosis and the optimal treatment has yet to be determined. Its treatment has evolved from enucleation to ocular radiotherapy, systemic chemotherapy and intravitreal chemotherapy. Radiotherapy can effectively eradicate tumor cells but ocular recurrences are common. Systemic chemotherapy has become the mainstream option but there are problems with only-partial response of PVRL and high rate of recurrence. Intravitreal chemotherapy, primarily used as adjunctive to systemic chemotherapy, has achieved high remission rate and low rate of recurrence as well as with limited ocular complications. The tumor cells were cleared and the visual function preserved. However, issues about the drug applied, treatment protocols and goals of intravitreal chemotherapy, whether for visual preservation or survival improvement, are worthy for further study.