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Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.
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Objective To evaluate the application of a mobile platform-based system in the management of fundus disease in outpatient settings. Methods In the outpatient departments of fundus disease,premature babies requiring eye examination under general anesthesia and adults requiring intraocular surgery were enrolled as the subjects. According to the existing clinical practices,we developed a system that met the requirements of clinical practices and optimized the clinical management. Based on the FileMaker database,the tablet computers were used as the mobile platform and the system could also be run in iPad and PC terminals.Results Since 2013,the system recorded 7500 cases of special examinations. Since July 2015,4100 cases of intravitreal drug injection were also recored in the system. Multiple-point and real-time reservation pattern increased the efficiency and opimize the clinical management. All the clinical data were digitalized. Conclusion The mobile platform-based system can increase the efficacy of examination and other clinical processes and standardize data collection;thus,it is feasible for the clinical practices in outpatient departments of ophthalmology.
Subject(s)
Adult , Humans , Infant, Newborn , Computers, Handheld , Disease Management , Infant, Premature , Outpatients , Retinal Diseases , TherapeuticsABSTRACT
<p><b>BACKGROUND</b>Polypoidal choroidal vasculopathy (PCV) is characterized by the presence of polyps with or without a branching vascular network and more prevalent among Asians. The aim of this study was to compare the outcomes of conbercept therapy between two different angiographic subtypes of PCV.</p><p><b>METHODS</b>Fifty-eight patients of PCV were classified into two phenotypes according to indocyanine green angiography (ICGA). In Type 1, both feeder and draining vessels are visible on ICGA and network vessels are numerous. In Type 2, neither feeder nor draining vessels are detectable, and the number of network vessels is small. The patients were treated with intravitreal conbercept (IVC) for 3 months. Additional IVC was given at subsequent monthly visits, if needed. The patients were followed up for 12 months, and changes in mean best-corrected visual acuity (BCVA), central retinal thickness (CRT), subretinal fluid (SRF) thickness, pigmented epithelial detachment (PED), hemorrhage, and number of polypoidal lesions were evaluated.</p><p><b>RESULTS</b>The mean BCVA in Type 2 PCV (15.92 ± 9.76 letters) achieved a significantly greater improvement than that in the Type 1 (14.10 ± 9.07 letters) at month 12 (t = 2.37, P< 0.01). Moreover, the mean CRT decrease was numerically greater in Type 2 (120.44 ± 73.81 μm) compared with Type 1 (106.48 ± 72.33 μm) at month 6 (t = 4.31, P< 0.01), and greater in Type 2 (130.21 ± 76.28 μm) compared with Type 1 (111.67 ± 79.57 μm) at month 9 (t = 1.87, P< 0.01). There was no significant difference between the two types for the decrease in SRF thickness, PED height, and regression of polyps from month 3 to 12 (t = 2.97, P > 0.05).</p><p><b>CONCLUSION</b>Classification systems for PCV will show differences in presentation, natural history, or response to anti-vascular endothelial growth factor treatment and might, therefore, provide a new key to the choice of treatment for the disease.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Choroid , General Surgery , Choroidal Neovascularization , General Surgery , Postoperative Care , Retrospective Studies , Treatment Outcome , Visual Acuity , PhysiologyABSTRACT
Angiogenidiseaseof the retinare the common reasonof several visual loss.Vasculaendothelial growth facto(VEGF) playan importanrole in pathologiangiogenesis.In recenyears,the developmenof anti-VEGF therapiehatransformed the prognosiof these conditions.The treatmenof angiogenidisease had entered an erof anti-VEGF therapy,especially in the treatmenof choroidal neovascularization (CNV) caused by age-related maculadegeneration (AMD).Abreakthrough,anti-VEGF therapy changethe photodynamitherapy (PDT) based weAMD (wAMD) treatmenmode.In thipaper,we describe thaeven though relegated to background,PDstill haclinical therapeutivalue fospecial circumstanceand certain type of CNV lesion,awell ain certain retindisease.
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Background Macular hole retinal detachment(MHRD) causes severe decrease of vision.Pars plana vitrectomy has been applied for MHRD.Silicone oil and C3F8 have been used as intraocular tamponade materials,while there are still controversity on their efficacy.Objective This trial was to evaluate the efficacy of vitreous surgery combined with silicone oil or C3F8 tamponade for patients with MHRD in highly myopic eyes.Methods A retrospective case-controlled study was designed.Fifty-one patients who underwent vitrectomy with intraocular tamponade were retrospectively analyzed.The best corrected visual acuity(BCVA) before and after surgery were examined and campared between two groups.The rate of recurrent RD and macular hole closed were analyzed.Results There was no significant difference in BCVA between silicone oil group and C3F8 tamponade group before and after surgery(U=266.000,P =0.286 ; U =205.000,P =0.029).The BCVA after surgery was elevated in both groups (Z=-2.729,P =0.006 ; Z =-3.273,P =0.001).The rates of recurrent RD and macular hole closed were no difference between two groups(P=0.894,1.000).There were no other complications but cataract.Conclusions C3F8 tamponade of MHRD in high myopic eyes show the same efficacy as silicone oil tamponade.