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Objective:To compare the efficacy and safety of intravitreal injection of anti-vascular endothelial growth factor drug conbercept and intravitreal dexamethasone implant Ozurdex in the treatment of diabetic macular edema (DME).Methods:A randomized controlled clinical study was performed.Thirty-six DME patients (36 eyes) were enrolled in Weifang Eye Hospital from March 2018 to June 2019.The patients were randomized into Ozurdex group and conbercept group via a random number table, with 18 eyes in each group.Patients received Ozurdex injection once, which was maintained for 6 months, or conbercept injection once a month for 3 times according to grouping.Before and after treatment, the best corrected visual acuity (BCVA) was examined with the International Standard Visual acuity chart and converted to logarithm of minimal angle resolution unit.The intraocular pressure (IOP) was measured using a non-contact tonometer.The central retinal thickness (CRT) was detected by optical coherence tomography (OCT).This study followed the Declaration of Helsinki and was approved by the Ethics Committee of Weifang Eye Hospital.Results:All patients were followed up for 6 months.In Ozurdex group, the BCVA pre-injection and at 1 month, 3, 4, 6 months after the first injection was 0.59±0.22, 0.53±0.20, 0.41±0.16, 0.38±0.19 and 0.56±0.19, respectively.The BCVA at 1 month, 3 and 4 months after the first injection were better than that before injection, and the differences were statistically significant (all at P<0.05).In conbercept group, the BCVA pre-injection and at 1 month, 3, 4, 6 months after the first injection were 0.60±0.23, 0.51±0.17, 0.29±0.13, 0.56±0.18 and 0.60±0.18, respectively.The BCVA at 1 month and 3 months after the first injection were better than that before injection, showing statistically significant differences (all at P<0.05).The CRT at 1 month, 3 and 4 months after the first injection were significantly lower than that before treatment in both the two groups (all at P<0.05).The CRT pre-injection was (498.61±77.14)μm in Ozurdex group, which was significantly higher than (462.17±48.74)μm at 6 months after the first injection ( P<0.05).No significant difference in CRT was found between pre-injection and 6 months after the first injection in conbercept group ( P>0.05).The incidence of high IOP in Ozurdex group was 33.3%(6/18), which was higher than 5.56%(1/18) in conbercept group, with a significant difference ( χ2=4.433, P=0.035).No adverse effects such as aggravation of cataract, lens injury, endophthalmitis, vitreous hemorrhage and retinal detachment was found during the follow-up. Conclusions:For DME, both conbercept and Ozurdex can improve BCVA and reduce CRT.Ozurdex shows durable efficacy and needs fewer injections than conbercept, but conbercept has less effect on IOP and is safer than Ozurdex.
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Objective:To observe the effect of non-vitrectomy in the treatment of idiopathic macular epiretinal membranes (IMEM).Methods:This study is a randomized controlled trial. From December 2017 to December 2018, 60 IMEM patients (60 eyes) diagnosed in Weifang Eye Hospital were included in the study. BCVA, intraocular pressure (IOP) and OCT were performed in all patients. The BCVA examination was performed using the international standard visual acuity chart, which was converted to logMAR. The CMT was measured by OCT. According to the surgical methods, the patients were divided into non-vitrectomy group and control group, 30 patients (30 eyes) in each group. The age ( t=1.723), logMAR BCVA ( t=1.703), CMT ( t=-0.956), IOP ( t=-1.434) were not significantly different between the two groups ( P=0.090, 0.094, 0.343, 0.157). 23G vitreous cutting system was used in all eyes. The macular epiretinal membranes was removed by non-vitrectomy in the non-vitrectomy group and by vitrectomy in the control group. The relevant examination with the same equipment and methods before the operation at 1 week and 1, 3, 6 months after operation. The time of surgery, the changes of BCVA, CMT and postoperative complications in the two groups were observed comparatively. Variance analysis of repeated measurements was performed for the comparison of BCVA, CMT and IOP after surgery in the two groups. Wilcoxon rank sum test of two independent samples was performed for the degree of vision improvement. The incidence of postoperative complications was compared by χ2 test. Results:At 6 months after operation, BCVA increased in 24 eyes (80%) and unchanged in 6 eyes (20%) in the non-vitrectomy group. Compared with preoperative BCVA, the difference was statistically significant ( P<0.05). BCVA increased in 25 eyes (83.4%), unchanged in 4 eyes (13.3%) and decreased in 1 eye (3.3%) in the control group. Compared with preoperative BCVA, the difference was statistically significant ( P<0.05). There was no significant difference between the two groups in BCVA improvement degree after operation ( Z=-0.26, P>0.05). At 6 months after operation, the average logMAR BCVA was statistically significant compared with the preoperative in the non-vitrectomy group ( P=0.002, 0.005) and control group ( P=0.004, <0.001). Visual stability occurred 1 month after operation in the non-vitrectomy group and 3 months after operation in the control group. The effective operative time of the non-vitrectomy group and control group was 4.50±1.41 and 15.50±2.33 min, respectively. The difference of effective operation time between the two groups was statistically significant ( t=-22.12, P <0.05). After surgery, no significant complications were found in the non-vitrectomy group. In the control group, there were 3 eyes with low IOP and 1 eye with macular hole during operation. Conclusions:Non-vitrectomy and vitrectomy have similar effects on IMEM. Non-vitrectomy has short effective operation time, faster recovery after surgery and no obvious complications.
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Objective To investigate the clinical efficacy of intravitreal injection of conbercept on different types of macular edema (ME) induced by branch retinal vein occlusion (BRVO).Methods A prospective casecontrol study was designed.Fifty-six eyes of 56 patients diagnosed with ME secondary to BRVO in Weifang Eye Hospital between May 2016 and May 2017 were chosen for this study.According to the morphologies of ME through optical coherence tomography (OCT),patients were divided into 3 groups:15 cases 15 eyes with serous retinal detachment (SRD),19 cases 19 eyes with cystoid macular edema (CME),and 22 cases 22 eyes with mixed edema.All of the patients received intravitreal injection of conbercept using "1 +PRN" method and followed up for 6 months.When the change of central macular thickness (CMT) exceed 100 μm,repeat the injection.The best corrected visual acuity (BCVA) and CMT before and after treatment for 1 week,1 month and 6 months and the average injection times were compared among different groups and time points.This study was approved by the Ethic Committee of Weifang Ophthalmic Hospital.Informed consent was signed from each patient before any treatments were proceeded.Results The differences of BCVA (LogMAR vision) at different time points before and after treatment among the 3 groups were statistically significant (Fgroup =105.834,P =0.000;Ftime =68.070,P =0.000).One month after treatment,BCVA in SRD group was the best,the next was CME group,and BCVA in mixed edema group was the poorest,and the difference between SRD group and mixed edema group was statistically significant (P＜ 0.05).Six months after treatment,BCVA in SRD group was the best,the next was CME group,and BCVA in mixed edema group was the poorest,the differences compared with each other were statistically significant (all at P＜0.05).The BCVA after treatment were improved than those before treatment in all the three groups,BCVA in 6 months after treatment was improved than that in 1 week and 1 month after treatment in each group,the differences were statistically significant (all at P＜0.05).The differences of CMT at different time points among the 3 groups were statistically significant (Fgroup =68.640,P =0.000;Ftime =29.783,P =0.000).CMT in mixed edema group before treatment was thicker than that in the SRD group and CME group,with significant differences between them (all at P＜0.05).The CMT after treatment were thinner than those before treatment in 3 groups,with significant differences between them (all at P＜0.05).With the extension of time,CMT was thinner gradually in each group,the differences of CMT in 1 week,1 month,6 months after treatment were statistically significant (all at P＜0.05).The number of injections in 6 months was statistically different among the three groups (F =12.479,P =0.000).The number of injections in SRD group was less than that in the CME group and mixed edema group,and the differences were statistically significant (P =0.001,0.000).Among the patients who still need to be injected or laser treatment after 6 months of treatment,1 patient was SRD type ME (6.7％),3 patients were CME type ME (15.8％),and 5 patients were mixed type ME (22.7％).Conclusions The efficacy of intravitreal injection with conbercept on different types of ME induced by BRVO was definitive,which can effectively improve BCVA and reduce ME;of which,the number of average injection times in SRD group is the least and its prognosis is best,just followed by CME group,while the number of injection times in mixed edema group is the largest and its prognosis is the poorest.
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Objective To observe the clinical effect ofintravitreal injection of tissue plasminogen activator (t-PA),ranibizumab and C3F8 in the treatment of early submacular hemorrhage (SMH) induce to polypoid choroidal vasculopathy (PCV).Methods The clinical data of 20 eyes of 20 patients with early SMH induce to PCV were enrolled in this study.The duration of bleeding in the eye was 7 to 28 days,and the mean duration of bleeding was 14.8± 5.6 days.All eyes are measured using the Snellen chart best corrected visual acuity (BCVA),logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity.Measure central retinal thickness (CRT) and central retinal pigment epithelial detachment (PED) thickness using frequency-domain optical coherence tomography.The average logMAR BCVA of eyes was 1.73 ±0.91;the mean CRT was 620.0±275.8 μm;the average central PED thickness was 720.3±261.9 μm.All eyes receive intravitreal injection of t-PA,ranibizumab and C3F8.The intravitreal injection of ranibizumab was administered once a month for 3 consecutive months,followed by an on-demand treatment plan.Mean follow-up time was 9.9 ± 3.6 months.The changes in BCVA,CRT,central PED thickness and clearance degree of SMH at 6 months after treatment were observed.Results On the 6 months after treatment,the average logMAR BCVA,CRT and central PED thickness of the eyes were respectively 0.42 ± 0.37,290.2 ± 97.4 μmn and 41.6 ± 78.1 μm.Compared with baseline,the after treatment BCVA was significantly increased (F=38.14,P=0.000),but the CRT and central PED were significantly decreased (F=7.48,75.94;P=0.000,0.000).Among the 20 eyes,16 eyes of SMH was completely cleared,accounting for 80％;4 eyes was partially cleared,accounting for 20％.No recurrence and systemic or local complications occurred during follow-up of all eyes.Conclusion Intravitreal injection oftPA,ranibizumab,and C3F8 in the treatment of early SMH induce to PCV can effectively remove SMH,improve vision,reduce CRT and central thickness of PED.