ABSTRACT
Background Intravitreal injection of ranibizumab is a primary approach to the treatment of wet age-related macular degeneration (wAMD),but whether it is necessary for wAMD with subfoveal scarring and active lesion to receive the intravitreal injection of ranibizumab is in dispute.Objective This study was to evaluate the possible therapeutic effect of intravitreal injection of ranibizumab on wAMD with subfoveal scarring and active lesion.Methods The clinical data of the patients with wAMD with subfoveal scarring and active lesion were retrospectively analyzed,including 89 eyes of 89 cases who received diagnoses and treatments in Second Hospital of Yunnan Province from February 2013 to May 2015.Sixty-eight patients who received intravitreal injections of ranibizumab were treated group,and 21 patients who received clinical observations only served as the untreated group.Intravitreal injection of ranibizumab was carried out following the 3+prn principle,and all of the patients were followed-up for 6-24 months.Best corrected visual acuity (BCVA) of the patients were examined with ETDRS chart.The fundus findings was examined by fundus color photography and fundus fluoresceinangiography (FFA).The subjective assessment of visual improvements was obtained from each patient,and the recession of retinal active lesions was assessed by OCT,including the absorbing state of subretinal fluid,the change of central retinal thickness (CRT) and subfoveal scarring.Results The mean injection times were (4.1 ± 1.2) for each eye.The BCVA at the end of following-up was evidently improved in both groups,and no significant difference was found among various time points (P＞0.05).However,the patient rate of BCVA improvement was 69.12％ in the treated group,which was signnificantly higher than 28.58％ of the untreated group (P =0.016).In the treated group,subretinal fluid was gradually absorbed in all eyes in the treating duration,however,in the untreated group,the fluid was completely absorbed in 7 eyes,unchanged in 8 eyes and increased in 6 eyes.The CRT reduced by (220.16±34.76) μm in treated group,and that in the untreated group was (101.56±31.59) μm,showing significant difference between them (P =0.004).The patient rate of perceived improvement of vision was 91.12％ and 42.85％ in the treated group and untreated group respectively,with significant difference between the two groups (P=0.008).Conclusions Intravitreal injection of ranibizumab can make active lesion recess in end-stage wAMD with subfoveal scarring and active lesion and improve the life quality of the patients.
ABSTRACT
Introdução: O quelóide é uma alteração cicatricial de alta prevalência e difícil tratamento. Essa pesquisa é baseada em uma modalidade conjunta de efeito comprovado na literatura, a aplicação de corticosteróide intralesional associada à cirurgia. Algumas referências citam a importância da excisão intralesional do quelóide, baseando-se na experiência clínica dos cirurgiões. O objetivo desta pesquisa é avaliar se no tratamento do quelóide com corticosteróide intralesional mais excisão cirúrgica a manutenção ou não de tecido queloidiano nas bordas da ferida operatória influencia no índice de recidiva. Método: Estudo prospectivo que avaliou 42 pacientes em um total de 60 lesões queloidianas, no período de agosto de 2005 a janeiro de 2008, comparando três grupos cada qual com 20 lesões alocadas de forma aleatória. Foi realizada excisão intralesional no grupo 1; justalesional (sem margem macroscópica) no grupo 2 e extralesional (com margem de 2 mm) no grupo 3. O tratamento com corticosteróide intralesional foi realizado da mesma forma em todos os pacientes. A variável de desfecho foi clínica: índice de recidiva. Resultados: Após o acompanhamento de dois anos, a taxa de recidiva do quelóide foi de 20% no grupo 1, 45% no grupo 2 e 77,5% no grupo 3 (p=0,024). Conclusão: Quanto ao tratamento cirúrgico, justifica-se a excisão intralesional, mantendo as bordas do tecido queloidiano, por estar associada a menor índice de recidiva quando comparado à excisão justa ou extralesional.
Introduction: Keloid is a scar tissue abnormality of high prevalence and difficult treatment. This research is based on a scientific literature proved combined tactical, the intralesional corticosteroid injection associated with surgery. Some references cite the importance of intralesional excision of keloid, based upon clinical experience of a few surgeons. The objective is to assess the influence of maintaining or not keloid tissue in the surgical wound edges in the intralesional corticosteroid injection plus surgical excision method, in the recurrency of keloid. Methods: Prospective study with 42 patients in a total of 60 keloid lesions, from August 2005 to January 2008, comparing three groups, each one with 20 lesions randomly distributed. Intralesional excision was performed in group 1; with no macroscopic borders in group 2; and extralesional (2 mm borders) in group 3. The intralesional corticosteroid injection was performed the same way in all patients. The analyzed outcome was clinical: keloid recrudescency taxes. Results: After the two year follow-up, the keloid recrudescency taxes was about 20% in group 1, 45% in group 2 and 77.5% in group 3 (p=0.024). Conclusions: The intralesional excision is justified, for being associated with lower recrudescency taxes, when compared with excisions with none or 2 mm borders.