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Objective:To observe the efficacy and safety of vitrectomy combined with subretinal injection of alteplase (tPA) and intravitreal injection of Conbercept in the treatment of large area submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV).Methods:A retrospective clinical study. From January to September 2021, 32 eyes of 32 patients with massive SMH secondary to PCV diagnosed in the Affiliated Eye Hospital of Nanchang University were included in the study. Large SMH was defined as hemorrhage diameter ≥4 optic disc diameter (DD). There were 32 patients (32 eyes), 20 males and 12 females. The mean age was (72.36±8.62) years. All patients had unilateral disease.The duration from onset of symptoms to treatment was (7.21±3.36) days. All patients underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA examination was performed using the international standard visual acuity chart, which was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The central macular thickness (CMT) was measured by spectral domain-OCT. The average size of SMH was (6.82±1.53) DD. The logMAR BCVA 1.73±0.44; CMT was (727.96±236.40) μm. All patients were treated with 23G pars plana vitrectomy combined with subretinal injection of tPA and intravitreal injection of Conbercept. At 1, 3, 6 and 12 months after treatment, the same equipment and methods were used for relevant examinations before treatment. The changes of BCVA and CMT, the clearance rate of macular hemorrhage, and the complications during and after surgery were observed. BCVA and CMT before and after treatment were compared by repeated measures analysis of variance.Results:Compared with before treatment, BCVA gradually increased at 1, 3, 6 and 12 months after treatment, and the differences were statistically significant ( F=77.402, P<0.001). There was no significant difference in BCVA between any two groups at different time points after treatment ( P>0.05). Correlation analysis showed that BCVA at 12 months after treatment was negatively correlated with the course of disease ( r=-0.053, P=0.774). One week after treatment, macular hemorrhage was completely cleared in 30 eyes (93.75%, 30/32). The CMT was (458.56±246.21), (356.18±261.46), (345.82±212.38) and (334.64±165.54) μm at 1, 3, 6 and 12 months after treatment, respectively. Compared with before treatment, CMT decreased gradually after treatment, and the difference was statistically significant ( F=112.480, P<0.001). There were statistically significant differences in different follow-up time before and after treatment ( P<0.001). The number of treatments combined with Conbercept during and after surgery was (4.2±1.8) times. At the last follow-up, there was no recurrence of SMH, retinal interlamellar effusion and other complications. Conclusion:Subretinal injection of tPA combined with intravitreal injection of Conbercept is safe and effective in the treatment of large SMH secondary to PCV, and it can significantly improve the visual acuity of patients.
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Objective To investigate the efficacy and safety of subretinal fluid extraction combined with intravitreal conbercept and gas injection in treating polypoidal choroidal vasculopathy(PCV)complicated with serous retinal pigment epithelium detachment(sPED).Methods From July 2019 to February 2021,13 patients(13 eyes)with PCV complicated with sPED who were treated with subretinal fluid extraction combined with intravitreal injection of conbercept and gas in the Weifang Eye Hospital were selected.All affected eyes received at least 3 times(once a month)of intravitreal anti-vas-cular endothelial growth factor(VEGF)(ranibizumab)injections before the surgery,and the treatment was ineffective.The changes in best corrected visual acuity(BCVA),central retinal thickness(CRT),macular foveal PED height and width before and 1 week,1 month,3 months and 6 months after the operation were observed,and the intraoperative and postop-erative complications were recorded.Results The BCVA of the affected eyes 1 week after operation was better than that before operation,and the difference was statistically significant(Z=-3.237,P=0.001).The CRT of the affected eyes at 1 week,1 month,3 months and 6 months after the operation were thinner than that before the operation,and the differ-ence was statistically significant(Z=-3.180,-3.180,-3.110 and-3.180,P=0.001,0.001,0.002 and 0.001).The height and width of PED at 1 week,1 month,3 months and 6 months after the operation were lower than those before the operation,and the differences were statistically significant(all P＜0.05).Thirteen eyes received an average of(4.15±1.40)intravitreal injections(ranibizumab)before the surgery,and the treatment duration was(5.92±3.95)months(equivalent to one injection every 6 weeks).During the 6-month follow-up,13 eyes received an average of(2.31±1.97)intravitreal injections(conbercept)(equivalent to once every 10 weeks).Partial correlation analysis showed a weak positive correla-tion between the increase in BCVA and the decrease in CRT 6 months after operation(r=0.416,P=0.203).There was no significant correlation between the increase in BCVA and the changes in PED height and width 6 months after operation(r=0.218,0.209,P=0.520,0.538).At 1 month after the operation,9 eyes had PED recurrence or different degrees of retinal nerve subepithelial effusion,and PED improved after repeated intravitreal injection of conbercept.At 6 months after opera-tion,subfoveal PED completely disappeared in 3 eyes,and the retina was completely reattached.There was still active exu-dation in the retina of 1 eye.No systemic or severe ocular complications occurred in 13 eyes during the follow-up period.Conclusion Subretinal fluid extraction combined with intravitreal injection of conbercept and gas in the treatment of PCV complicated with sPED can safely and effectively reduce CRT,improve PED,and reduce the damage to the retina caused by long-term PED,but it has no significant effect on the improvement of BCVA at 6 months after the operation.
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@#AIM: To observe the efficacy of two conbercept regimens in the treatment of polypoid choroidal angiopathy.<p>METHODS: Twenty-one patients with polypoidal choroidal vasculopathy who met the inclusion criteria and were treated in our hospital were randomly divided into two groups. The group A(9 patients and 9 eyes)was treated with 3+Q12W scheme, namely, 0.5mg conbercept ophthalmic injection was intravitreally injected every 4wk for 3 consecutive times, and then 1 time every 12wk. In the group B(12 patients and 12 eyes), 3+TAE scheme was carried out, that is 0.5mg conbercept ophthalmic injection was intravitreally injected every 4wks for 3 consecutive times. The time of next injection was determined according to the evaluation results of each visit. The interval to the next visit/treatment was ≥ 4wk and ≤ 12wk. The best corrected visual acuity(BCVA), central retinal thickness(CRT)and the frequency of injection were compared between the two groups at 12 and 48wk after treatment, respectively.<p>RESULTS: BCVA of the group A was 74.78±11.23 letters and 74.67±13.94 letters at 12 and 48wk after treatment, which increased by 7.00±4.21 letters and 6.89±4.48 letters at the baseline before treatment, respectively. BCVA in the group B was 77.83±5.46 letters and 77.58±8.59 letters respectively at 12 and 48wk after treatment, which were 8.75±7.54 letters and 8.50±5.60 letters higher than the baseline before treatment. At the 12 and 48wk after injection, the average CRT in the group A was 276.33±44.34μm and 240.56±40.11μm, respectively, which were 43.22±42.21μm and 79.00±53.64μm lower than the baseline before treatment. At the 12 and 48wk after injection, the average CRT in the group B was 271.58±63.08μm and 241.00±43.91 μm, which were 57.42±45.33μm and 88.00±61.16μm lower than the baseline before treatment, respectively. The average times of intravitreal injection of conbercept were 6.00±0.00 and 7.75±1.14 times in the 3+Q12W group and the 3+TAE group, respectively.<p>CONCLUSION: Two different regimens of conbercept could reduce the CRT and improve the visual acuity of the patients with polypoidal choroidal vasculopathy. And the times of intravitreal injection in the 3+Q12W administration group were less than those in the3+TAE administration group.
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@#AIM: To explore the levels of interleukin-8, interleukin-8 receptor 1, 2(CXCR1, CXCR2)in aqueous humor of polypoid choroidal vasculopathy(PCV)and their clinical significance.<p>METHODS: Totally 67 patients with PCV in our hospital were selected as PCV group, and another 50 patients with cataract were selected as control group, fluorescence quantitative PCR(QPCR)was used to detect the expression of IL-8, CXCR1 and CXCR2 mRNAs in aqueous humor of two groups, the best corrected visual acuity(BCVA)of all subjects were measured by the international standard visual acuity chart, optical coherence tomography(OCT)was used to detect foveal retinal thickness(CMT), the receiver operating characteristic curve(ROC)was created to analyze the predictive values of IL-8, CXCR1 and CXCR2 in the occurrence of PCV. Multivariate Logistic regression analysis was used to assess the risk factors for PCV.<p>RESULTS: Compared with the control group, the expression of IL-8, CXCR1 and CXCR2 mRNA increased in group PCV. BCVA in PCV group decreased and CMT increased(<i>P</i><0.05). IL-8, CXCR1 and CXCR2 were significantly positively correlated with BCVA(<i>r</i>=0.438, 0.346, 0.385, all <i>P</i><0.05), IL-8, CXCR1 and CXCR2 were positively correlated with CMT(<i>r</i>=0.378, 0.606, 0.357, all <i>P</i><0.05). Logistic multivariate regression analysis showed that IL-8, CXCR1, CXCR2, BCVA and CMT were the risk factors of PCV. The AUC of IL-8, CXCR1 and CXCR2 for PCV diagnosis was 0.882, 0.860 and 0.812.<p>CONCLUSION: The expression of IL-8, CXCR1 and CXCR2 in PCV aqueous humor were all increased, which was not only related to BCVA and CMT in patients, but also related to the occurrence of PCV, and it may become a potential predictor of PCV.