ABSTRACT
Diabetic retinopathy(DR)is the most prevalent and severe ocular complication in people with diabetes, and it is one of the leading causes of blindness in adults. In recent years, drug therapy represented by anti-vascular endothelial growth factor(VEGF)agents has become the first-line therapy in DR treatment, but it cannot reverse retinal non-perfusion areas, microaneurysms and abnormal teleangiectatic capillaries, those who cannot be treated on time are at risk of disease progression. Laser photocoagulation has been widely applied for more than 40 years, it can effectively reduce the rate of blindness by eliminating the non-perfusion areas of capillaries, and panretinal photocoagulation(PRP)has been the primary treatment for DR. With the continuing innovations in laser technology, on the basis of maintaining the curative effect, the aim of minimizing retinal damage and adverse side effects has been realized. A combination of laser photocoagulation and anti-VEGF agents can achieve complementary advantages and better efficacy. Deepening the clinical research on laser therapy and laser therapy combined with anti-VEGF agents in the treatment of DR may help to establish the personalized treatment corresponds with our national conditions. This article briefly reviews the latest application progress of laser therapy in DR treatment in the era of anti-VEGF agents.
ABSTRACT
Diabetic macular edema(DME)and age-related macular degeneration(ARMD)are the leading causes of visual impairment and blindness worldwide, and their common pathological features are increased vascular permeability and abnormal neovascularization, in which cytokines such as vascular endothelial growth factor(VEGF)and angiopoietin-2(Ang-2)play an important role. Intravitreal injection of anti-VEGF agents significantly changed the clinical management of DME and ARMD, but limitations such as the non-responsive cases, the treatment burden and risks caused by frequent injections need to be overcome. Faricimab, a novel bispecific monoclonal antibody that simultaneously targets VEGF-A and Ang-2, can effectively reduce vascular permeability, decrease the number of neovascularization and alleviate retinal edema. Registered clinical studies have shown that Faricimab is effective in improving vision and reducing retinal edema, which is non-inferior to Aflibercept and Ranibizumab, maintains a long dosing interval, and has a high safety profile. This article reviews the latest advances in the treatment of DME and ARMD with Faricimab.
ABSTRACT
Diabetic macular edema(DME)has become the leading cause of vision loss in patients with diabetes. Currently, intravitreal injection of anti-vascular endothelial growth factor(VEGF)therapy is the first-line treatment for DME. However, the economic burden and related complications brought by frequent injections should not be ignored. Therefore, the drugs with longer-lasting effects and longer injection intervals must be explored. Brolucizumab is a single-chain antibody fragment(scFv)with a high affinity for VEGF. Compared with other available anti-VEGFs, it has the characteristics of smaller molecular weight, higher tissue permeability and durable therapeutic effect. Clinical studies and real-world evidences showed that Brolucizumab is non-inferior to aflibercept in improving visual acuity in patients with DME. And Brolucizumab is more effective in regressing intra-retinal fluid and reducing central foveal thickness(CSFT)with longer injection interval. At the same time, Brolucizumab has a low incidence of adverse events and favourable safety after intraocular injection. This article reviews the latest progress of Brolucizumab in the treatment of DME.
ABSTRACT
@#AIM: To evaluate the accuracy of B-mode ultrasonography in the measurement of different kinds of posterior segment intraocular foreign body(IOFB).<p>METHODS: IOFBs from a total of 13 eyes collected in our hospital from January 2016 to December 2016 were analyzed retrospectively. Immediately after IOFBs being taken out, their actual sizes were measured with a ruler. The difference between the pre-operative B-ultrasound measurements and the actual size were compared, and the correlation coefficient was calculated(B-ultrasound measurement/actual size). In order to exclude the possibility that any damage to the IOFB during an operation may interfere with the actual size measurement, different kinds of 5mm long objects(metal, glass and wood)were put into a water sac which was about 20mm-30mm in diameter to mimic IOFB in the eyes respectively. Same measurements for each kind of objects were then preformed and repeated for 4 times. <p>RESULTS:All the 13 cases of IOFBs, including 12 cases of magnetic metal and one case of glass were removed intact <i>via</i> vitrectomy. Of all metal IOFBs, the average axle length by B-mode ultrasound and the average actual axle length were 3.65±1.30mm and 2.45±0.94mm respectively. All measurements were larger than actual sizes(<i>P</i>=0.016). The average correlation coefficient was 1.49. For the water sac experiment, the average measured values of metal, glass and wood objects were 6.76±0.15mm, 6.55±0.04mm and 6.02±0.07mm, and the average correlation coefficient were 1.35, 1.31 and 1.20 respectively. <p>CONCLUSION:The measured size is larger than the actual size when B-mode ultrasonographic scan is used to evaluate the posterior segment IOFB, especially for metal and glass objects. Therefore, it is necessary to take into consideration when making incisions for operational IOFB removal.
ABSTRACT
@#AIM: To evaluate the accuracy of B-mode ultrasonography in the measurement of different kinds of posterior segment intraocular foreign body(IOFB).<p>METHODS: IOFBs from a total of 13 eyes collected in our hospital from January 2016 to December 2016 were analyzed retrospectively. Immediately after IOFBs being taken out, their actual sizes were measured with a ruler. The difference between the pre-operative B-ultrasound measurements and the actual size were compared, and the correlation coefficient was calculated(B-ultrasound measurement/actual size). In order to exclude the possibility that any damage to the IOFB during an operation may interfere with the actual size measurement, different kinds of 5mm long objects(metal, glass and wood)were put into a water sac which was about 20mm-30mm in diameter to mimic IOFB in the eyes respectively. Same measurements for each kind of objects were then preformed and repeated for 4 times. <p>RESULTS:All the 13 cases of IOFBs, including 12 cases of magnetic metal and one case of glass were removed intact <i>via</i> vitrectomy. Of all metal IOFBs, the average axle length by B-mode ultrasound and the average actual axle length were 3.65±1.30mm and 2.45±0.94mm respectively. All measurements were larger than actual sizes(<i>P</i>=0.016). The average correlation coefficient was 1.49. For the water sac experiment, the average measured values of metal, glass and wood objects were 6.76±0.15mm, 6.55±0.04mm and 6.02±0.07mm, and the average correlation coefficient were 1.35, 1.31 and 1.20 respectively. <p>CONCLUSION:The measured size is larger than the actual size when B-mode ultrasonographic scan is used to evaluate the posterior segment IOFB, especially for metal and glass objects. Therefore, it is necessary to take into consideration when making incisions for operational IOFB removal.
ABSTRACT
·AIM:To present a case of late onset bilateral keratectasis after laser in situ keratomileusis (LASIK) for myopia with rigid gas-permeable contact lenses with a brief review of literature on this subject.·METHODS:A 27-year-old woman underwent bilateral uneventful LASIK for moderate myopia. Preoperative cycloplegic refractions were -5.50/-0.50×50° right eye (OD) and - 4.50/-1.00×15° left eye (OS).Corneal pachymetry was 526μm OD and 541μm OS, Preoperative corneal topography was normal and did not reveal any keratoconus or forme fruste keratoconus.Following the creation of flaps with 160μm plates,ablations of 102μm OD and 86μm OS were performed,estimated to leave residual stromal beds of 264μm OD and 295μm OS.·RESULTS:Twenty-nine months postoperatively,the patient developed bilateral inferior keratectasia of -12.50/-4.00×160° OD and -6.00/- 4.25×125° OS.Visual acuity was reduced in both eyes;the central cornea had steepened; and pachymetry showed central corneal thinning.Keratectasia was diagnosed,and rigid contact lenses were fitted.Three years later,the patient achieved satisfactory visual acuity and all-day lens wear with minimal complications.·CONCLUSION:Late keratectasia may follow LASIK for low to moderate myopia despite a thorough preoperative work-up.Rigid contact lenses can offer a safe,reversible option for improving visual acuity in such patients by delaying or avoiding the need for intracorneal ring segments implanting or penetrating keratoplasty.