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@#AIM: To investigate the curative effect of atropine penalization therapy and occlusion therapy on children with anisometropic amblyopia, and the influence on visual function.METHODS:This prospective study included 158 children with anisometropic amblyopia who were admitted to the hospital between February 2018 and September 2020. Children enrolled were divided into penalization therapy group(78 cases)and occlusion therapy group(80 cases)by random number table method. Dominant eyes of the penalization therapy group were treated with 1% atropine gel for twice a week, while dominant eyes of the occlusion therapy group were covered for 2h or longer every day. Treatment effect, stereoscopic function and contrast sensitivity were measured after 6mo of treatment. The pattern visual evoked potentials were detected, treatment compliance,and treatment effect were evaluated.RESULTS:The overall compliance rates of the penalization therapy group and the occlusion therapy group were 96.2% and 73.8%(<i>P</i><0.05). The overall response rates of the two groups were 79.5% and 73.8%(<i>P</i>>0.05). The overall effective rates of stereoscopic visual function reconstruction in the two groups were 74.4% and 56.3%(<i>P</i><0.05). After treatment, the contrast sensitivities under 1, 4, 8, 10 and 12c/d were significantly increased in the two groups(all <i>P</i><0.001). Besides, the contrast sensitivities under 8, 10 and 12c/d in the penalization therapy group were higher than those in the occlusion therapy group(all <i>P</i><0.05). After treatment, P100 amplitude(μV)of the penalization therapy group was higher than that of the occlusion therapy group(12.96±2.10 <i>vs </i>11.42±2.53μV,<i>P</i><0.05), while P100 latency(ms)was lower than that of the occlusion therapy group(105.26±12.41 <i>vs</i> 111.40±11.74ms, <i>P</i><0.05). CONCLUSION:For patients with amblyopia, atropine penalization therapy can improve treatment compliance and stereoscopic visual function of patients with amblyopia, and have higher safety.
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Background: Adults with amblyopia are currently offered no treatment in clinical practice Recently, it has been demonstrated that patching one eye of a binocularly normal subject with a diffuser strengthens that eye's contribution to the binocular percept when the diffuser is removed. So, this study assesses effectiveness and difference of occlusion therapy while using mobile phones and while playing video games in adult patients with amblyopia.Methods: Subjects with refractive, anisometropic, sensory and strabismic amblyopia in 18 to 40 age year old included in the study. It’s a 6 months’ observational study with 2 follow-up after first visit. 66 patients were observed. The first group (n=29) give occlusion therapy while using mobile phone and second group (n=37) done occlusion therapy while playing video games. Student t-test is used to analyse vision and contrast sensitivity and analysed using statistical software SPSS (version 20.0).Results: Out of 29 patients in first group, 18 (62%) were females, and 11 (38%) were males. Out of 37 patients in second group, 20 (54.1%) were females, and 17 (45.9%) were males. First group (patching with reading in mobile phone) had more improvement than second group (patching with video gaming) in vision and contrast.Conclusion: Males are more adult amblyopes comparing to females (in both the groups). In case of comparing the improvement of visual acuity and contrast sensitivity. Better improvement is obtained more in contrast sensitivity during follow-up.
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@#AIM: To study clinical profile of amblyopia and also the outcomes of occlusion therapy among the amblyopes.<p>METHODS: This was a hospital-based longitudinal study by design. Data were collected from April 2015 to April 2016 in Ophthalmology Department of Dhulikhel Hospital. Presenting visual acuity, chief complaint at presentation, age at presentation, refractive status, binocularity and fixation patterns were assessed in all the children with amblyopia. Improvement in visual acuity was also noted in all the subjects after occlusion therapy, which is a most commonly used modality of treatment for amblyopia.<p>RESULTS: Among 1 092 children examined during the study period, 60(5.49%)were amblyopic. Among them, 35(58.30%)were females and 25(41.70%)were males. The mean age at presentation was 8.87±3.29 years. Meridional amblyopia was the most prevalent subtype seen in 43.3%(<i>n</i>=26)of children followed by anisohypermetropic amblyopia(20%, <i>n</i>=12). The most common refractive error was astigmatism accounting for 58.30% of the total cases followed by hypermetropia(22.50%)and myopia(7.50%). Compliance with spectacle wear combined with occlusion therapy and active vision therapy was 73.30%(<i>n</i>=44). There was a statistically significant improvement in visual acuity of the amblyopic eyes after the different treatment strategies after 3mo(<i>P</i>=0.002).<p>CONCLUSION: Prevalence of amblyopia and associated visual impairment is still a public health issue in developing countries like Nepal. Lack of awareness and lack of community or preschool vision screening for children lead to late presentation and significant visual impairment associated with the condition. The burden can easily be reduced with screening camps, timely referrals and proper interventions.
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Background: To determine timing of strabismus surgery, is it better to do strabismus surgery before completion of Amblyopia therapy or after completion of amblyopia therapy. Methods: 40 children were taken for this study. These children were divided into two groups of 20 each. Amblyopia was fully treated in group A and in group B children underwent surgery before full treatment of amblyopia in the form of occlusion therapy. Motor success (10 PD of orthophoria) was assessed after three months of surgery and at the child’s most recent visit. Sensory success was assessed by comparing the frequency of detectable stereoacuity. Results: There was no significant difference in motor success (65% vs 80%) and sensory success (65% vs 75%) whether amblyopia was fully treated or partially treated. Conclusion: It is not mandatory to treat ambloypia prior to surgery and amblyopia therapy can be continued post operatively.
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Purpose: To analyze macular thickness (MT), foveal thickness (FT), and retinal nerve fibre layer thickness (RNFLT) in children with unilateral anisometropic amblyopia and their changes following occlusion therapy. Methods: A prospective, longitudinal, and comparative study of 60 children aged between 5 and 18 years consisted of two groups, group 1: 30 children with unilateral anisometropic amblyopia; group 2: 30 normal children. Best corrected visual acuity (BCVA), a detailed ocular examination, spectral domain optical coherence tomography for MT, FT, and RNFLT in both eyes were done at visit one (baseline) and every 3 months for a year following occlusion therapy (initiated one month after first visit) in group 1. Results: Mean BCVA, MT, FT, and RNFLT in amblyopic eyes at first visit were 0.63 ± 0.405, 286.9 ± 6.522 ?m, 195.90 ± 8.462 ?m, and 100.87 ± 6.240 ?m, respectively and at last visit after occlusion therapy were 0.50 ± 0.318, 248.9 ± 11.681 ?m, 169.47 ± 10.941 ?m, and 99.43 ± 5.722 ?m, respectively. At first visit, mean BCVA, MT, FT, and RNFLT in nonamblyopic eyes (group 1) were 0 ± 0, 240 ± 10.447 ?m, 159.27 ± 9.285 ?m, 98.63 ± 4.723 ?m and in normal eyes (group 2: average of right and left eyes) were 0 ± 0, 239.8 ± 4.294 ?m, 143.6 ± 4.61 ?m, 100.5 ± 2.895 ?m, respectively. Conclusion: MT and FT, which were more in amblyopic eyes as compared to normal fellow eyes and group 2, decreased with improvement in BCVA after occlusion therapy. However, there was no difference in RNFLT between amblyopic eyes and normal fellow eyes and group 2 before and after occlusion therapy.
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Objective To observe the alterations ofmicrovascular structure in patients with macular edema (ME) associated with branch retinal vein occlusion (BRVO) before and after anti-VEGF drug therapy.Methods A retrospective case study.Thirty-two eyes of 32 patients with unilateral BRVO-ME at Department of Ophthalmology in Beijing Hospital during November 2016 to June 2018 were enrolled in this study.There were 14 males (14 eyes) and 18 females (18 eyes),with the mean age of 57.81 ± 10.58 years,and the mean course of the disease of 12.13 ± 7.13 d.The affected eyes was defined as the eyes with BRVO-ME.All the affected eyes received intravitreal anti-VEGF drug injections (3+PRN).BCVA and OCT angiography (OCTA) were performed on the BRVO and fellow eyes before and after intravitreal anti-VEGF drug injections.The scanning region in the macular area was 3 mm × 3 mm.Macular blood flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP),macular hemodynamics parameters [foveal avascular area (FAZ) area,perimeter (PERIM),acircularity index (AI) and vessel density within a 300um width ring surrounding the FAZ (FD-300)] and central retinal thickness (CRT) were measured in all eyes.Paired samples t-test and Univariate Linear Regression were used in this study.Results Comparing with fellow eyes,the mean macular blood flow density measured in the entire scan was lower in BRVO-ME eyes in the SCP (t=6.589,P=0.000) and DCP (~9.753,P=0.000),PERIM (t=4.054,P=0.000)),AI enlarged in BRVO-ME eyes (t=4.988,P=0.000),FD-300 was lower in BRVO-ME eyes (t=2.963,P=0.006),FAZ area enlarged in BRVO-ME eyes (t=0.928,P=-0.361).The blood flow density in the DCP was the parameter most significantly correlated with BCVA and FAZ area (r=0.462,-0.387;P＜.05).After 3 intravitreal injections of anti-VEGF drug,the CRT and FD-300 decreased,BCVA increased (t=9.865,3.256,-10.573;P＜0.05),PERIM and AI was not changed significantly (t=0.520,2.004;P＞0.05).The blood flow density in the SCP decreased (t=2.814,P＜0.05),but the blood flow density in the DCP was not changed significantly (t=0.661,P=-0.514).Contrarily,comparing with after 1 antiVEGF drug injection,the blood flow density in the DCP increased after 2 anti-VEGF drug injections (t=3.132,P＜0.05).FAZ area enlarged in BRVO-ME eyes (t=5.340,P＜0.001).Comparing with last anti-VEGF drug injection,FAZ area enlarged after every anti-VEGF drug injection (t=2.907,3.742,2.203;P＜0.05).Conclusions In BRVO-ME eyes,the blood flow density in the SCP and DCP are decreased.The blood flow density in the DCP is positively correlated with BCVA and negatively correlated with FAZ area.After antiVEGF drug therapy,the blood flow density is decreased in the SCP and increased in the DCP,FAZ area enlarged gradually,PERIM and AI are not changed significantly.
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@#Amblyopia is defined as a decrease in visual acuity that results from abnormal binocular interaction or visual deprivation during critical period of the visual cortex, which cause a variety of visual functions damage. With the development of science and technology, amblyopia treatment has new concept. The new method of amblyopia treatment is occlusion therapy based on corrected refraction, followed by visual function training and pharamacological therapy, instead of traditional treatment which contians only refraction correction and patching therapy. Correction of refractive error is no longer limited to use spectacles, also provided with contact lenses, corneal refractive surgery and intraocular refractive surgery. In addition to using patching, occlusion therapy can use Bangerter filters, contact lenses and LED liquid crystal glasses. The training of visual function aimed to improve three-level visual function and restore visual cortical plasticity, which is especially important in the adult amblyopia. Levodopa and citicoline drugs can be added to occlusion therapy in order to reach a better outcome. We should design the fittest treatment plan according to the individual situation of the patients within varied of methods, adopting diversified combination, personalized therapy.
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@#AIM: To compare the efficacy of invisible occlusion mirror and depressant membrane therapy in treatment of elderly amblyopia.<p>METHODS: Prospective study. Totally 112 cases(112 eyes)of monocular amblyopia aged 10-14 years were selected from June 2015 to December 2016 in our hospital. Among them, 55 cases(Group A)were treated with depressant membrane therapy and 57 cases(Group B)were treated with invisible concealer. The treatment compliance and efficacy of the two groups were evaluated, and the changes of corrected visual acuity before and after treatment were observed.<p>RESULTS: For 3, 6 and 12mo, there was no significant difference in treatment compliance between group A(98.2%, 96.4%, 92.7%)and group B(94.7%, 91.2%, 89.5%)(all <i>P</i>>0.05), but the effective rate of treatment(27.8%, 50.9%, 76.5%)was significantly lower than that of group B(46.3%, 71.2%, 92.2%), and the amblyopic corrected visual acuity of group B was better than that of group A(<i>P</i><0.05). After 12mo treatment, the total and actual cure rates of group A(52.7% and 56.9%)were significantly lower than those of group B(71.9% and 80.4%).<p>CONCLUSION: The treatment of monocular amblyopia over 10 years old with invisible occlusion mirror is superior to that of depressor membrane occlusion in improving visual acuity and curing rate.
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Macular edema is a common cause of visual loss in patients with retinal vascular diseases represented by diabetic retinopathy and retinal vein occlusion.Laser photocoagulation has been the main treatment for this kind of diseases for decades.With the advent of antagonist of vascular endothelial growth factor and dexamethasone implant,diabetic macular edema and macular edema secondary to retinal vein occlusion have been well controlled;the use of laser therapy is decreasing.However,considering possible risks and complications,lack of extended inspection of efficacy and safety of intravitreal pharmacotherapy,laser therapy cannot be replaced by now.Therefore,the efficacy and safety of laser therapy will improve by sober realization of role of photocoagulation and proper selection of treatment indication.
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Embolus occlusion in the retinal artery is the most common cause of central retinal artery occlusion (CRAO),while hypertension is the most common risk factor of CRAO,and ipsilateral carotid artery stenosis is the most significant risk factor in CRAO.Current clinical treatments include conservative treatments such as dilation of blood vessels and lowering the intraocular pressure (IOP),as well as aggressive treatments like intravenous thrombolysis and Nd∶YAG laser.Both thrombolysis and Nd∶YAG laser treatment can improve the visual acuity of CRAO patients,but because of its lack of randomized controlled trials,further clinical studies are needed to determine their efficacy and safety.CRAO patients may have vascular embolism at other sites in the body,and may cause different degrees of cardiovascular and cerebrovascular events.The probability of secondary ocular neovascularization following the occurrence of these events is 2.5％ to 31.6％.In addition to eye care,clinicians should also focus more on preventing cardiovascular and cerebrovascular events,and focus on the screening and active treatment of systemic risk factors to reduce the incidence and mortality of cardiovascular and cerebrovascular events.
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Objective To observe the effect of macular retinal thickness (CMT) on the long-term visual prognosis after intravitreal injection of Conbercept combined with retinal laser photocoagulation for macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Methods A retrospective non randomized controlled study.Forty-one patients (41 eyes) of ischemic BRVO secondary ME were included in the study.Among them,there were 23 males (23 eyes) and 18 females (18 eyes).The average age was (56.49±8.94) years.The best corrected visual acuity (BCVA) and optical coherence tomography were performed.The mean logMAR BCVA was 0.82±0.41,and the mean CMT was (512.61 ± 185.32) μrn.According to the CMT reduction value at 1 month after treatment,the eyes were divided into no response group and response group,each has 15 patients of 15 eyes and 26 patients of 26 eyes respectively.The age and sex composition of the two groups were not statistically significant (t=-0.298,-1.708;P=0.767,0.096),and the difference of frequency of injection was statistically significant (t=3.589,P=0.010),and there was no statistical difference between the patients with logMAR BCVA and CMT (t=2.056,-1.876;P=0.460,0.070).The average follow-up was 8 months.The logMAR BCVA on 6 months after treatment was defined as long term vision.The changes of long term vision and CMT on 1 and 6 months of two groups after treatment were observed.Pearson correlation analysis showed that the correlation between long-term vision and age,logMAR BCVA before treatment,CMT before treatment,frequency of injection,and CMT value decreased 1 month after treatment.The correlation of long-term visual acuity with age,sex,logMAR BCVA before treatment,CMT before treatment,number of drugs before treatment,CMT reduction at 1 month after treatment,integrity of ellipsoid band and integrity of external membrane (ELM) were analyzed by multiple regression analysis.Results On 1 month after treatment,the CMT of the eyes was lower than that before treatment (231.48± 177.99) μm,and the average integrity of ELM and ellipsoid were 0.56±0.50 and 0.41 ±0.50 respectively.On 6 months after treatment,the average logMAR BVCA of the eyes was 0.48 ± 0.34.The results of Pearson correlation analysis showed that the long-term vision was positively correlated with the logMAR BCVA before treatment and the number of CMT reduction and the number of drug injection at 1 month after treatment (P＜0.05);there was no correlation with age and CMT before treatment (P＞0.05).The results of multiple regression analysis showed that the long-term vision was associated with logMAR BVCA before treatment,CMT reduction,ELM integrity,and the number of times of injection (P＜0.05),and no correlation with age,sex,CMT before treatment and the integrity of the ellipsoid (P＞0.05).On the 6 months after treatment,the logMAR BCVA in the non-response group and the response group were 0.86±0.23 and 0.26±0.14,and the average CMT was respectively (398.93±104.87) and (255.15 ± 55.18) μrn,and the average injection times were respectively (2.53 ± 1.46) and (1.31 ± 0.74) times.The average logMAR BCVA,CMT and injection times of the two groups were statistically significant (t=10.293,5.773,3.589;P=0.000,0.000,0.001).No complications related to drug or intravitreal injection occurred in all patients.Conclusion The long-term vision of ME secondary to BRVO after intravitreal injection of Conbercept combined with retinal laser photocoagulation was associated with the decrease of CMT and the integrity of the ELM after 1 month of treatment,no correlation was found between CMT and ellipsoid integrity before treatment.
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Retinal vein occlusion (RVO) is the second visual threatening retinal disorders followed by diabetic retinopathy in the elderly.In the past decades,increasing knowledge of the natural history,aetiology and risk factors,medical management investigation,together with the support of high level evidence-based medical evidence and the results of real-world clinical trials play key roles in guiding the clinical practice.However,without understanding the pathogenesis and pathogeny of the disease,it is difficult to implement a comprehensive,precise and personalized treatment strategy for the RVO patients.It is of significance in the clinic to discuss the pathological process of RVO,analyze the etiological characteristics of the disease,reveal the clinical outcomes,which aim to facility the optimal treatment and follow-up procedure for the patients.
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Pharmaceutical therapy,including anti-vascular endothelial growth factor treatment and intravitreal corticosteroids,is the most common treatment for branch retinal vein occlusion (BRVO) and its complications,however there are confusing ideas about the protocol,patient selection,timing and endpoint of this treatment.The disease is easy to relapse with these drugs therapy.Collateral vessel formation was found in patients receiving intravitreal injection of ranibizumab or triamcinolone for BRVO and secondary macular edema.The mechanism of collateral vessel formation has not been carefully investigated.In the past thrombolysis,arteriovenous fasciostomy and laser choroidal retinal vascular anastomosis were used to reconstruct the retinal circulation,but their rationality,effectiveness and safety need to be further were studied.In recent years,because of the key technology is still immature,the artificial vascular bypass surgery experiment is not yet practical,but provides us a new idea worth looking forward to for the treatment of BRVO.
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Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO).Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study.Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female.The average age was (51.25 ± 12.24) years and the course was 5-17 days.All patients were given best corrected visual acuity (BCVA),intraocular pressure,slit lamp with preset lens,fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination.The patients were divided into conbercept and laser group (group Ⅰ),laser group (group Ⅱ) and conbercept group (group Ⅲ),with 30 eyes in each group.The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072,0.286;P=0.930,0.752).Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg),and macular grid pattern photocoagulation 3 days later.Group Ⅱ patients were given macular grid pattern photocoagulation.Times of injection between group Ⅰ and Ⅲ,laser energy between group Ⅰ and Ⅱ,changes of BCVA and CMT among 3 groups at 1 week,1 month,3 months and 6 months after treatment were compared.Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20 ± 0.41) and (2.23 ± 1.04) times respectively,and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections.The difference of injection times between two groups was significant (P＜0.001).Patients in group Ⅱ had received photocoagulation (1.43 ±0.63) times,9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation.The average laser energy was (96.05 ±2.34) μV in group Ⅰ and (117.41 ±6.85) μV in group Ⅱ,the difference was statistical significant (P=0.003).BCVA improved in all three groups at last follow-up.However,the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607,-4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=-0.802,P=0.429).The mean CMT reduced in all three groups after treating for 1 week and 1 month,comparing that before treatment (t=-11.855,-10.620,-10.254;P＜0.001).There was no statistical difference of CMT between group Ⅰ and Ⅲ at each follow up (t=0.404,1.723,-1.819,-1.755;P=0.689,0.096,0.079,0.900).CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=-4.621,-3.230;P＜0.001,0.003).The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month,but the difference was not statistically significant (t=1.995,P=0.056).All patients had no treatment-related complications,such as endophthalmitis,rubeosis iridis and retinal detachment.Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO.Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.
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Objective To evaluate the effectiveness of repeated intravitreal conbercept injection in patients with macular edema (ME) of retinal vein occlusion (RVO),guided by optic coherence tomography (OCT).Methods It is a retrospective case study.Forty patients (40 eyes) diagnosed as ME secondary to RVO were enrolled in this study.There were 19 males (19 eyes) and 21 females (21 eyes),with the mean age of (53.58 ± 13.19) years and the mean course of 1.5 months.The best corrected visual acuity (BCVA),indirect ophthalmoscopy,fundus fluorescein angiography (FFA) and OCT were performed.The mean baseline of BCVA,central macular thickness (CMT) were 0.25 ± 0.18 and (509.48 ± 170.13) μm respectively.All the patients were treated with 10.00 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg).Follow-up of these patients was 1 to 6 months after treatments,the BCVA,fundus manifestations,OCT were retrospectively observed by every month,the FFA was retrospectively observed by every 3 months.When there was retinal edema or CMT ≥ 50 μm by OCT during follow-up,those patients were retreated with intravitreal conbercept injection.The changes of the BCVA,CMT were evaluated before and after treatment.Meanwhile,complications in eyes related to medicine and treatment methods were evaluated too.Results At the 6 months,the BCVA was improved (increase≥2 lines) in 25 eyes (62.50％),stabilized (± 1 line) in 13 eyes (32.50％) and decreased 2 lines in 2 eyes (5.00％).Retinal hemorrhage and exudates were absorbed in most patients.FFA showed no fluorescein leakage in 1 1 eyes (27.50％),minor fluorescein leakage in 26 eyes (65.00％),and retinal capillary non-perfusion in 3 eyes (7.50％).OCT showed absorption of the subretinal fluid.The mean CMT were (235.20± 100.44) μm at 6 months.Intravitreal injection of conbercept was applied for 4 times in 8 eyes (20.00％),3 times for 18 eyes (45.00％),and 2 times for 14 eyes (35.00％).The mean number of intravitreal injection was 2.85 times.There were no ocular or systemic adverse events observed in all patients.Conclusion Intravitreal conbercept injection is an efficacy and safe treatment for the patients with ME of RVO guided by OCT.It can stabilize and improve the visual acuity.
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PURPOSE: To investigate the effect of preoperative part-time occlusion therapy on long-term surgical success in early-onset exotropia. METHODS: The medical records of patients who underwent surgery for exotropia with onset before the first year of age and who were followed for ≥3 years were reviewed. Patients were divided into two groups according to the degree of compliance with part-time occlusion therapy: the good compliance group (>50% adherence rate) and the poor compliance group (≤50% adherence rate). Surgical success was defined as orthophoria to exodeviation less than 10 prism diopters both at distance and near. The level of postoperative stereopsis was compared between the two study groups among total enrolled patients and among those with constant exotropia. RESULTS: Of the 51 patients, 26 were assigned to the good compliance group and the remaining 25 patients to the poor compliance group. The surgical success rate was significantly higher in the good compliance group than in the poor compliance group (80.8% vs. 52.0%, p = 0.040). Among 24 constant exotropia patients (12 patients for each group), the success rate was insignificantly higher in the good compliance group than in the poor compliance group (75.0% vs. 58.3%, p = 0.448). The good compliance group had a better level of stereopsis than the poor compliance group (p = 0.045 for all 44 patients, p = 0.020 for 19 patients with constant exotropia). CONCLUSIONS: Preoperative part-time occlusion therapy was useful for improving the surgical outcome of early-onset exotropia and postoperative stereopsis.
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Humans , Compliance , Depth Perception , Exotropia , Medical RecordsABSTRACT
Background Central retinal vein occlusion (CRVO) is a common retinal vascular disease.Intravitreal injection of ranibizumab, a vascular endothelial growth factor (VEGF) antibody, is being a useful approach to the treatment of macular edema secondary to CRVO.However,little literature about choroidal thickness variations following intravitreal injection of ranibizumab for CRVO is published up to now.Objective This study was to observe the dynamic changes of macular choroidal thickness after intravitreal injection of ranibizumab in CRVO eyes.Methods A self-controlled series cases study was designed.Thirty-one eyes of 31 CRVO patients were included in Tianjin Eye Hospital from June 2013 to November 2014,with the males 19 and females 12 and mean age of (51.13±16.65) years.Ranibizumab (5 mg,5 ml) was intravitreally injected in the CRVO eyes once per month for 3 times by the same operator.A enhanced depth image (EDI) mode of spectral-domain OCT system was employed to measure the choroidal thickness at subfoveal, 1 mm from fovea nasal and 1 mm from fovea temporal before and 1 month,2,3 months after first injection in both CRVO eyes and contralateral healthy eyes, respectively.The best LogMAR vision was recored.This research protocol was approved by the Ethic Committee of this hospital, and written informed consent was obtained from each individual prior to any medical examination.Results Retinal bleeding was exhibited in the CRVO eyes in color photography,and fundus fluorescein angiography showed the fluorescine leakege in the early phase and fluorescine accummulation in the late phase.The mean choroidal theckness value was (325.32±83.04) , (294.83±80.61), (315.95±90.77) and (314.81±84.98) μm before injection and 1,2,3 months after injection,respectively,showing a significantly difference among various time points (F =7.96,P =0.00) , and the choroidal theckness values were evidently reduced in various time points after injection in comparison with before injection (P =0.01,0.01,0.00).The choroidal thickness value at foveal was (314.81±84.98) μm in the CRVO eyes 3 months after injection,and that in the fellow eyes was (260.47±55.90) ,with significant difference between them (t =2.95, P =0.01).The LogMAR vision was 0.17±0.09,0.37±0.23,0.42±0.26 and 0.49±0.21 before and 1,2,3 months after injection,with the significant difference among various time points (F =21.50, P =0.00) and showed considerable improvement after intravitreal injection of ranibizumab(all at P＜0.01).The mean retinal thickness value was (244.14-±23.28) μm in the fellow eyes, and those in 1 month, 2,3 months after injection were (523.81 ± 147.61), (352.13 ± 166.71),(376.39±209.46) and (369.00±225.61) μm in the CRVO eyes, showing obvious reduce after intravitreal injection, with significant difference among different time points (F =7.09, P＜0.01).Conclusions Choroidal thickness at macular fovea is obviously increased in CRVO eyes compared with the contralateral healthy eyes.Intravitreal injection of ranibizumab can reduce choroidal thickness and therefore improve vision.EDI OCT is available in the evaluation of dynamic change of choroidal thickness.Macular choroidal thickness could be used as a predictor of CRVO prognosis following intravitreal ranibizumab.
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Background Retinal vein occlusion is a common retinal vascular diseases.Thromblysis and anticoagulation therapies are main approaches.However,systemic thrombolysis is relatively inefficient,and it often enhances the risk of hemorrhage.Objective This study was to investigate the therapeutic effects of PLM-ΔK,a kringle deficiency mutant of plasmin,on photochemically induced branch retinal vein occlusion (BRVO) after intravitreal injection.Methods BRVO models were established by the combination of caudal vein injection of Rose Bengal with argon laser radiation of periphery area of retinal veins in SD rats.Forty model rats were randomized into balance salt solution (BSS) group and 0.01 U,0.02 U,0.03 U PLM-ΔK group,and 10 μl corresponding drug was intravtreally injected 12 hours after modeling.Ophthalmoscopy and fundus fluorescein angiography (FFA) were performed to observe the change of retinal veins.The animals were sacrificed 3 days after intravitreal injection,and hematoxylin and eosin staining was used for the histopathological and ultrastructural examination of retinas.The retina of the rats was isolated for the stretched preparation of retina.The expressions of fibronectin (FN) and laminin (LN) in eyeball wall were assayed by immunofluorescence technology.The use and care of the animals complied with Statement of the Association for Research in Vision and Ophthalmology.Results The revascularization of over 2 retinal veins was found in 0,3,6 and 8 rats in the BBS group and 0.01 U,0.02 U,0.03 U PLM-ΔK group 3 days after intravitreal injection,respectively,showing a significant difference among the groups (x2=9.635,P =0.022),and the rat number with revascularization in 0.01 U PLM-ΔK group was not significantly different from that in BSS group (Z=-1.558,P =0.119),but the difference between 0.03 U PLM-ΔK group and 0.01 U PLM-ΔK group was significant (Z=-2.762,P=0.006).In the third day after intravitreal injection,retinal vein thrombus were found in the BSS group under the light microscope,and angiogenesis was seen on the retinal flatmount nuclear.In the 0.03 U PLM-ΔK group,posterior vitreal detachment was exhibited under the light microcope,and no retinal new vessel and cell damage were seen.FN was strongly expressed in the inner limiting membrane (ILM) layer,photocyte layer,outer limiting membrane (OLM) layer,choroid and scleral layer,and LN was expressed mainly in the ILM,OLM and scleral layer in the BSS group.However,the expression intensities of FN and LN were obviously weakened in the 0.03 U PLM-ΔK group.Conclusions Intravitreal injection of PLM-ΔK can enhance the reperfusion of occluded branch retinal vein and serve as a potential therapeutic drug for BRVO.Also it can permeate into choroid after intravitreal injection to degradate FN and LN.
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PURPOSE: To analyze the effect of occlusion therapy in patients with early recurrence after intermittent exotropia surgery. METHODS: The present study included 36 patients with an exodeviated angle of 10 prism diopters (PD) or more within 3 months after intermittent exotropia surgery. Eighteen patients (treatment group) performed alternating occlusion therapy for 3 hours per day for 6 months and the other 18 patients (control group) were followed up without any therapy. Age, visual acuity, deviated angle (before operation, at recurrence, and 3 and 6 months after recurrence), and binocularity were retrospectively analyzed in both groups. RESULTS: Differences between the two groups in terms of age, visual acuity, score of binocularity, association with vertical strabismus or dissociated vertical deviation, period of recurrence and exodeviated angle at recurrence were not observed. Significant differences in change of deviated angle at a far distance were found 3 months after recurrence; 0.00 ± 3.69 PD in the treatment group and +2.88 ± 2.97 PD in the control group (p = 0.014) and at a near distance -1.33 ± 5.13 PD in the treatment group and +3.22 ± 3.99 PD in the control group (p = 0.005). Significant differences in the change of deviated angle were found after 6 months from recurrence at a far distance; +0.11 ± 5.78 PD in the treatment group and +4.50 ± 4.94 PD in the control group (p = 0.020), -0.56 ± 5.71 PD in the treatment group and +3.94 ± 6.46 PD in the control group at a near distance (p = 0.034). The binocularity index was not different between the two groups. CONCLUSIONS: Although in the present study, the mean angle of deviation was not decreased, alternating occlusion therapy 3 hours per day for 6 months may be helpful in reducing the amount of exodrift in patients with early recurrence within 3 months after intermittent exotropia surgery.