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Anti-VEGF therapies have been widely used in the treatment of age-related macular degeneration, diabetic macular edema, retinal vein occlusion with macular edema and other retinal diseases. It have achieved remarkable treatment effect with relatively high safety, but there are still reports of adverse reactions in cardio-cerebral vessels and eyes. There are many methods to measure retinal blood flow. Although the principles of these methods are different, the results are different, and there is no uniform standard, it has been observed that anti-VEGF drugs may cause some changes in retinal vessel diameter, arterial blood flow velocity and blood flow parameters. Especially after multiple injections, the effect may be more obvious.
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Acute zonal occult outer retinopathy (AZOOR) is an acquired retinal diseases.The majority of patients who develop AZOOR are women characterized by an acute onset of visual blurred and scotoma with photopsias.The fundus examination is often normal or appeared mild abnormal.The RPE atrophy of fundus is similar with white syndrome.Although FFA and ICGA features are either unremarkable or unrelated to AZOOR,there are still important in differential diagnosis.The characteristic abnormalities appearance of FAF (complicated and varied),OCT (regional anomaly of ellipsoid zone),visual field (visual field defect) and ERG (decreased amplitude and prolonged latency of rod reaction,maximum reaction,cone reaction and scintillation reaction) are considered critical examinations to the diagnosis of AZOOR.Although there is no effective therapy for AZOOR,it has some self-limitation.
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Macular edema (ME) secondary to central retinal vein occlusion (CRVO) often cause severe visual impairment.Intravitreal anti-vascular endothelial growth factor agents and steroids can effectively eliminate ME and improve visual function,but the visual outcome is affected by multiple factors.Retinal blood flow,especially the macular microcirculation,has significant correlation with visual outcome.Ischemic CRVO,especially patients with severe damage in the deep and superficial vascular layer of the macular zone,usually have poor visual outcome.In addition,the integrity of the multi-layer retinal structure closely correlates with the visual outcome.Patients with intact ellipsoid zone,external limit membrane beneath the fovea have good visual recovery.Additionally,good baseline visual acuity,positive response to treatment in early phase,young age and timely treatment usually brings about better visual outcome.
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Objective To analyze the etiologies of severe vitreous hemorrhage in venerable age patients.Methods A retrospective series case study was adopted.Medical records of 30 cases 30 eyes severe vitreous hemorrhage venerable age patients were analyzed in Xuanwu Hospital Capital Medical University,Peking University Third Hospital and Beijing Tsinghua Chang Gung Hospital from July in 1999 to June in 2015.Visual acuity,intraocular pressure,anterior segment slit lamp microscopy,mydriasis funduscopy and ophthalmic B type ultrasound examination were used to evaluate 30 cases 30 eyes.Thirty eyes were all treated with pars plans vitrectomy (PPV).Results Mydriasis funduscopy examination showed that vitreous hemorrhage was so dense in 30 eyes that the fundus cannot be observed.The initial visual acuity examination showed that 8 eyes were count finger,5 eyes were hand move,16 eyes were light perception,and 1 eye was no light perception.There were dense light spots or clusters of high echoes in vitreous cavities,complete/incomplete posterior vitreous detachment (PVD) of all eyes;retinal detachment with different degrees in 5 eyes;proliferating cord adhesion to the wall of eyeball in 3 eyes.The etiologies included retinal vein occlusion (RVO) in 10 eyes (33.33％),retinal tear or retinal detachment in 7 eyes (23.33％),polypoidal choroidal vasculopathy (PCV) in 7 eyes (23.33％),proliferative diabetic retinopathy (PDR) in 4 eyes (13.33％).The above 4 etiologies were in 28 eyes,accounting for 93.33％.The others were ocular trauma in 2 eyes (6.67％).Conclusions The main cause to severe vitreous hemorrhage venerable age patients is RVO,followed by retinal tear or retinal detachment,PCV and PDR.Ocular trauma is rare.Vitrectomy is a diagnostic treatment,which can remove vitreous hemorrhage,improve the visual acuity of the patients,and determine the etiologies of the vitreous hemorrhage.
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Objective To observe the curative effects of anti-vascular endothelial growth factor (anti-VEGF) intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope for neovascular glaucoma (NVG).Methods NVG patients with uncontrolled intraocular pressure (IOP) and retinopathy was enrolled from May,2014 to May,2016.Eighteen patients were enrolled with 15 males(15 eyes) and 3 females(3 eyes) with age at (61.7 ± 13.9) years old.Anti-VEGF intracameral and intravitreal injection with anterior chamber puncture was performed in the first day of sequential treatment.Trebeculectomy was performed 3-5 days after injection and finally the pan-retinal photocoagulation was started 5-7 days after anti-glaucoma surgery.The best corrected visual acuity (BCVA),IOP,cornea,neovascularization of iris and retinal disease were observed and recorded.Results The diagnosis included 1 eye with central retinal artery occlusion (CRAO),6 eyes with central retinal vein occlusion (CRVO),5 eyes with branch retinal vein occlusion,5 eyes with proliferative diabetic retinopathy and 2 eyes with combined CRAO and CRVO.IOP before and after treatment were (43.5 ±5.1) mmHg (1 kPa =7.5 mmHg) and (15.2 ± 2.2) mmHg,there was significantly statistical difference (t =21.68,P ＜0.001).The categories of antiglaucoma medicines were 5.1 ± 0.5 and 0.5 ± 1.0 before and after treatment respectively,and the difference was statistical significant (t =12.30,P ＜ 0.001).BCVA was improved in 4 eyes,maintained in 13 eyes and decreased in only 1 eye.Conclusion The sequential treatment including anti-VEGF intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope is safe and effective.
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Background The incidence and progression of glaucomatous optic neuropathy is related to a disturbance of the retrobulbar hemodynamics.Compound anisodine is clinically applied for the treatment of ischemic ocular diseases.Objective To evaluate the effects of compound anisodine injection on the ocular blood flow of glaucoma patients.Methods Twenty-one patients with primary glaucoma were divided into the treatment group and the control group.The eyes of each patient in the treatment group were selected further into the treatment eye group (11 eyes with greater mean deviation [MD]) or the opposite eye group(11 eyes with lesser MD).One of the eyes of each patient in the control group with MD value were selected as control eyes (10 eyes).The treatment eye group received compound anisodine on the para-superficial temporal artery via subcutaneous injection once a day for 2 treatment periods (each period equals 14 days,with 7 days intermittent between periods,totally 35 days) in addition to routine treatment.The retrobulbar blood flow,optic disc data,refraction error,visual field and intraocular pressure were measured in 3 time points:Before treatment period (baseline test),one day after treatment period (the 1st postreatment test) and 35 days after treatment period (the 2nd posttreatment test).Results Compared with the control group,the peak systolic velocity (PSV) and end diastolic velocity (EDV) of short posterior ciliary artery (SPCA) of the treatment eye group were relatively increased significantly in the 1st posttreatment test (P =0.017,0.028),the PSV of SPCA of the opposite eye group was relatively increased significantly in the 1 st posttreatment test (P =0.049),the EDV of central retinal artery (CRA) of the opposite eye group was relatively increased significantly in the 2nd posttreatment test (P =0.035).In contrast to the treatment eye group,the inferior quadrant RNFL thickness of the optic disc decreased significantly in the 2nd posttreatment test in the control group (P =0.009),the 6 o'clock RNFL thicknesses of the optic disc decreased significantly in the 1 st posttreatment test in the control group (P =0.014),and the 6 o'clock and 7 o'clock RNFL thicknesses of the optic disc decreased significantly in the 2nd posttreatment test in the control group (P =0.029,0.011).Conclusions The application of compound anisodine for the treatment of primary glaucoma relatively increases the PSV and EDV of SPCA.
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Objective To understand the prevalence and cause of eye diseases in the middle and old aged population in community was of important significance for the prevention and treatment of relevant diseases.The present study attempts to survey the prevalence of common eye diseases and conditions of blindness and low vision in 50 years and older population in community of Beijing.MethodsThis was an ophthalmologic epidemiology survey.The 2 833 target population was included and registered in Western Chang'an street community in door-to-door and questionnaire manner between October,2006-October,2007.Multiple factors,such as demography,general conditions,lifestyles,education degree,economical status,medical status and the awareness of relevant ophthalmic knowledge of participants were recorded and evaluated.Relevant eye examinations including uncorrected visual acuity,pinhole visual acuity,non-contact intraocular pressure test,slit-lamp,funduscopy and optometry examinations were performed in Beijing No.2 Hospital by trained ophthalmologists.Blindness and low vision were evaluated based on WHO criteria.The causes of leading-blindness and low vision were analyzed.Oral informed consent was obtained from all of the subjects.Results2 410 individuals of 2 833≥50-year-old participants received complete surveys according to the designed process in this study with an examined rate of 85.07%.The incidence of blindness and low vision in examinees was 0.79% and 5.64% respectively.The positive factors related to blindness and low vision appeared to be age,education and an awareness of relevant ophthalmic knowledge (χ~2=26.62,18.28,21.32,P＜0.001).The primary causes of blindness in examined population,in order,were cataract,glaucoma and retinopathy,and those of low vision were cataracts,refractive error and diabetic retinopathy.ConclusionIt is emphasized that early prevention and treatment for cataract,glaucoma,diabetic retinopathy and refractive errors can reduce the prevalence of blindness and low vision in people over 50 years in the Western Chang'an street community of Beijing.
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@# ObjectiveTo study the effect of negative pressure suction during laser in situ keratomileusis (LASIK) on rabbit retinal structure.Methods32 New Zealand white rabbits were randomly divided into normal control, experimental control, negative suction 45 seconds and negative suction 3 minutes groups. Experimental control groups were treated only using eximer laser. In negative suction groups, rabbit eyes were suction for 45 seconds or 3 minutes by negative pressure generator. The tissues of optic nerve and retina both after negative pressure suction and of normal rabbit eyes were examined with electron and light microscope 0, 7, 14, 28 days after operation. ResultsThere was no change in the tissues of optic nerve and retina between normal control and experimental control. After the negative pressure suction for 45 s, the optic nerve and retinal cells changed lightly at different time point. After the negative pressure suction for 3 min, the optic nerve fibers and retinal cells changed sharply during postoperative instant to 14th days, which can be recovered until 28 days after operation.ConclusionUltrastructural changes of retina and optic nerve may be induced by acute intraocular pressure elevation caused by negative pressure suction during LASIK.
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Purpose To evaluate differences in the pattern of optic disc and retinal nerve fiber layer (RNFL) damage in normal tension glaucoma (NTG) and high tension glaucoma (HTG) patients. Methods We enrolled 49 eyes of 49 patients:30 NTG (IOP≤21 mm Hg,1 mm Hg=0.133 kPa), 19 HTG(IOP≥25 mm Hg). Mean age was 59.2?12.3 (range, 36-75) for HTG patients, and 59.6?8.6(range, 39-71) for NTG patients. All patients underwent complete ophthalmic examination, achromatic automated perimetry (AAP), scanning laser ophthalmoscopy (SLO), scanning laser polarimetry (SLP), optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT). All patients had glaucomatous optic nerve damage and abnormal AAP. Results There were no differences in mean deviation on AAP between NTG and HTG eyes ( P =0.37), while the corrected pattern standard deviation was larger in NTG than in HTG eyes ( P =0.014). Cup∶disc area ratios in global ( P =0.03) and three sectors ( P