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@#AIM:To evaluate the long-term efficacy and safety of retinal photocoagulation combined with intravitreal injection of Ranibizumab(IVR)and simple Ranibizumab in the treatment of branch retinal vein occlusion secondary macular edema(BRVO-ME).<p>METHODS: The literatures related to randomized controlled clinical studies on the treatment of BRVO-ME with laser and Ranibizumab in Embase, The Cochrane Library, PubMed, China National Knowledge Infrastructure(CNKI), Wanfang Database and China Science and Technology Journal Database(VIP)were systematically retrieved, and the risk assessment was carried out and data indicators were extracted for the included studies. RevMan 5.3 software was used for data analysis and funnel plot was used to evaluate publication bias.<p>RESULTS: Totally 7 studies were included, with 641 eyes. There was no significant difference in the best corrected visual acuity(BCVA)between the laser combined with Ranibizumab group and the simple Ranibizumab group at 12mo \ and 24mo \ after treatment. There was no significant difference in central foveal thickness between the two groups at 12mo \ and 24mo \. There were no statistically significant differences in the injection times of Ranibizumab and the incidence of final adverse events between the two groups at 12mo and 24mo after treatment.<p>CONCLUSION: Compared with the treatment of BRVO-ME with simple Ranibizumab, there was no significant difference in the long-term efficacy of vision and central foveal thickness for the laser combined with Ranibizumab, and there was no significant difference in the injection times and safety of Ranibizumab.
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@#AIM:To evaluate the functional and structural changes of foveal macula after intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion(BRVO-ME)and screen the factors that can predict the final visual acuity of the patients. <p>METHODS: Prospective, clinical study. In this prospective single-arm study, we observed 25 patients(25 eyes)diagnosed with BRVO-ME who were enrolled from 2018.6-2019.5 in the first central hospital of Baoding. All patients received monthly ranibizumab 0.5mg injections for 3 consecutive months. The best-corrected visual acuity(BCVA),the central macular thickness(CMT)and the vessel perfusion density(VPD), vessel length density(VLD)and fovea avascular zone(FAZ)of superficial capillary plexus(SCP)were evaluated detected by optical coherence tomography(OCT and OCTA)before and 1mo after the third injection. Mf-ERG was used to analyze the amplitude density of P1 wave and latency of P1, N1 wave from ring 1 and ring 2. <p>RESULTS: After treatment, BCVA(LogMAR)was improved significantly compared with that before(0.323±0.086 <i>vs</i> 0.773±0.304, <i>P</i><0.05). CMT was lower than before(239.385±33.175μm <i>vs</i> 489.346±137.453μm, <i>P</i><0.05), but there was no significant change in FAZ, VPD and VLD of SCP within 6mm×6mm of macular area before and after treatment(<i>P</i>>0.05). The latency of P1, N1 wave of ring 1 and ring 2 were significantly decresed from baseline, while the amplitude density of P1 wave was increased(<i>P</i><0.05). Pearson correlation analysis shows that age, baseline BCVA, VLD, VPD, FAZ were significantly correlated with changes in visual acuity before and after treatment(<i>P</i><0.05).<p>CONCLUSION: In patients with BRVO-ME, ranibizumab therapy can reduce CMT, improve BCVA and improve the structure and function of macular area. Age, BCVA before treatment and microstructure parameters of macular area can be used as predictors of vision improvement.
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Polypoidal choroidal vasculopathy (PCV) is a retinal disorder commonly found in Asians presenting as neovascular age-related macular degeneration and is characterized by serous macular detachment, serous or hemorrhagic pigment epithelial detachment, subretinal hemorrhage, and occasionally visible orange-red subretinal nodular lesions. PCV is diagnosed using indocyanine green angiography (ICGA), and the lesions appear as polypoidal aneurysmal vascular lesions with or without abnormal branching vascular network. Although ICGA remains the gold standard for the diagnosis of PCV, various imaging modalities have also facilitated the diagnosis and monitoring of PCV. Recent advances in imaging technology including the use of high resolution spectral domain optical coherence tomography (OCT) and OCT angiography have provided new insights on the pathogenesis of PCV, suggesting a link between PCV and pachychoroid spectrum of macular disorders. With the evolving understanding on the pathogenesis and clinical characteristics of PCV, different therapeutic options have been proposed. These include intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy, combination therapy with anti-VEGF and verteporfin photodynamic therapy, and thermal laser photocoagulation. In recent years, major multi-center randomized clinical trials such as EVEREST, EVEREST II, and PLANET studies have been conducted to compare the efficacy and safety of various treatment options for PCV. This review aims to summarize the results of recent literature, clinical trials and studies to provide an update on the management options of PCV. An overall management strategy for PCV will also be proposed.
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@#AIM: To observe the interaction of Ranibizumab and laser in the treatment of proliferative diabetic retinopathy(PDR). <p>METHODS: From December 2014 to August 2015, synchronous PDR patients with macular edema were divided into two groups. Thirty patients(48 eyes)were treated with Ranibizumab and laser, and 28 patients(45 eyes)were treated with laser alone. In the combined treatment group, FFA was reexamined 1wk after intravitreal injection of Ranibizumab. The patient then received panretinal photocoagulation(PRP). PRP was performed in the laser group alone. The best corrected visual acuity(BCVA)at 1, 4 and 8wk after treatment was observed and recorded. Macular thickness was measured by OCT. <p>RESULTS: The BCVA and macular thickness were significantly different between the two groups at 1, 4 and 8wk after treatment(<i>P</i><0.05). In the laser alone group, the visual acuity decreased and the thickness of the macular thickness increased after 1wk. After treated 4 and 8wk, visual acuity improved, macular thickness decreased. After 1wk of intravitreal injection, FFA showed retinal leakage improvement in all eyes in the combined treatment group, with neovascularization retracted in varying degrees. <p>CONCLUSION:Ranibizumab combined with photocoagulation, can improve early vision, and reduce macular edema. Anti-VEGF therapy and photocoagulation may play a synergistic role to some extent. Drugs antagonized VEGF, improved macular edema and microvascular function. It can enhance the laser effect.Effective photocoagulation can further improve retinal ischemia and hypoxia, inhibit the excessive expression of VEGF.
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Neovascular glaucoma (NVG) is a dreadful pathology and it will be rapid spontaneous evolution responsible for eventual visual loss in many cases,with poor therapeutic efficiency.The main challenges in clinical practice for the management of NVG are as follows:(1) What is the goal of NVG treatment,to decrease intraocular pressure (IOP) or to reserve visual function? (2) How to create an optimal condition or timing for the treatment of primary disease? (3)What is exactly the key of NVG treatment? Anti-vascular endothelial growth factor (VEGF) medication,anti-glaucoma surgery or pan-retinal photocoagulation (PRP) for strict control of clinical situations potentially responsible for retinal ischemia ? (4)How to set up a comprehensive management strategy for NVG? In this paper,we established a comprehensive treatment strategy for NVG,including a core aim for preserving visual function,a goal of completing PRP and the main methods of anti-VEGF injection and anti-glaucoma surgery in order to preserve visual status of NVG patients as much as possible.
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Wet age-related macular degeneration is the leading cause of the severe, irreversible vision loss in individuals over the age of 65 years. Anti-VEGF therapy has been shown to play a key role in the pathogenesis of wAMD, which is the front-line therapy admittedly. lt has no clear steady curative effect for some patients even if they accepted repeating Anti-VEGF therapy. For the purpose of visual acuity improved more, a steady flow of new therapy has emerged, such as function towards the same or different targets of antiangiogenesis, consolidating the effect by combination therapy, improving or simplifying the mode of administration, etc. This paper gives a brief review of the progress of anti-VEGF for the therapy in wet age-related macular degeneration.
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Choroidal neovascularization (CNV) is a rare complication associated with coloboma of the choroid. We describe three cases of coloboma choroid where there was loss of vision due to CNV development at the edge of the coloboma. One was managed by photodynamic therapy alone and two were managed by a combination of reduced fluence PDT and intravitreal bevacizumab. Significantly we noted that one treatment session was sufficient to achieve regression of the CNV and improvement in visual acuity.
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Choroidal neovascularization is one of the common causes resulting in vision loss in patients with pathologic myopia, and the irreversible central vision lose is often found. This article reviews the epidemiology of pathologic myopia, pathogenesis, clinical manifestation and anti-VEGF therapy of choroidal neovascularization secondary to pathologic myopia.