ABSTRACT
AIM: To compare the differences in the efficacy and safety of combination of intravitreal dexamethasone(Ozurdex)and ranibizumab or monotherapy of ranibizumab in eyes with macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: Patients diagnosed with non-ischemic RVO-ME by fluorescein fundus angiography in our hospital from June 2020 to December 2022 were selected. All patients were initially treated with intravitreal injection of ranibizumab(0.5 mg), and 42 patients(42 eyes)who had central retinal thickness(CRT)≥300 μm after 2 wk were included. They were randomly divided into combined treatment group and monotherapy group. The combined treatment group(21 eyes)received Ozurdex intravitreal injection immediately, while the monotherapy group(21 eyes)was treated with ranibizumab intravitreal injection by 3+pro re nata(PRN). The changes of best corrected visual acuity(BCVA), CRT, and intraocular pressure before and at 2 wk, 1, 2, 3, 4, 5, and 6 mo after treatment were recorded, and the ocular or systemic complications were observed.RESULTS:The BCVA and CRT of all patients at 2 wk, 1, 2, 3, 4, 5, and 6 mo after treatment were significantly better than those before treatment(all P<0.01). There were statistical significance in the BCVA and CRT between two groups at 2 and 3 mo after treatment(all P<0.05). The most significant increase of BCVA in the combined treatment group occurred at 2 mo after treatment. The mean recurrence time of macular edema in the monotherapy group was 1.45±0.53 mo, with 4.21±0.78 injection times of ranibizumab. None of the patients showed serious complications after treatment. The most common complications in the combined treatment group were subconjunctival hemorrhage and elevated intraocular pressure, which were manageable with topical ocular hypotensive agents, and no patient required antiglaucoma or cataract surgery.CONCLUSION: Compared with monotherapy of ranibizumab, intravitreal injection of dexamethasone combined with ranibizumab can significantly improve the visual acuity and effectively reduce the macular edema in the treatment of RVO-ME, with a long duration of efficacy and less intravitreal injection of drugs.
ABSTRACT
Background The classical theory from Gass holds that idiopathic macular hole (IMH) is due to the dragging of vitreous cortex in the tangent direction on the macular region,while spectral domain OCT (SD-OCT)studies found that the diameters of inner segment/outer segment (IS/OS) absence (DIOA) region was closely associated with vision ability of IMH patients.Enhanced depth imaging (EDI) is thought to be a new method to study the relation between DIOA and subfoveal choroidal thickness (SFCT) ,but there are few relevant reports.Objective This study aimed to observe the correlation between photoreceptor IS/OS junction and SFCT before and after vitrectomy in IMH by EDI SD-OCT.Methods Forty unilateral IMH patients were enrolled in Affiliated Foshan Hospital of Southern Medical University from June 2011 to June 2013.Vitrectomy (23G) was performed on the patients by the same operator.EDI mode of SD-OCT was used to measure DIOA and SFCT in horizontal direction before and 6 months after surgery.The relationship between DIOA and SFCT was evaluated using Pearson linear correlation analysis.Written informed consent was obtained from each patient before medical assessment.Results IMH was anatomically closed after vitrectomy in 34 eyes with the closure rate 85％.The mean DIOA was (1 280±753) μm in preoperation, which was significantly higher than (656 ± 322) μm in postoperation (t =4.989, P =0.000).The mean SFCT was (130±43)μm in preoperation,showing a slight reduce in comparison with (140±38)μrn in postoperation, but there was not statistical significance between them (t =-1.407, P =0.175).Negative correlations were found between DIOA and SFCT in both preoperation and postoperation (preoperation:r=-0.748 ,P=0.000;postoperation: r=-0.686,P =0.001).Conclusions The alteration of DIOA shows a negative correlation with SFCT in IMH eyes,suggesting a contributing role of the choroid in the change of photoreceptors of IMH.