Case of acute vision loss after injectable remdesivir with anticoagulants and overdose of antibiotics: A late report

A woman reported decreased vision in the right eye since hospitalization for COVID-19. Vision in the right eye was 6/18 and in the left eye was counting fingers. Her left eye had cataract and right eye was pseudophakic with earlier documented good recovery. In the right eye, she had branch retinal vein occlusion (BRVO) with macular edema documented on optical coherence tomography (OCT). It was suspected that it might be an ocular manifestation of COVID-19 which had not been reported and had worsened. An overdose of antibiotics or remdesivir might also be responsible for the same. She was advised anti-VEGF injections and was kept under treatment.

Evaluation of the predictive effect of parafoveal blood flow density of macula on the number of intravitreal Conbercept injections in patients with branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate blood flow density within 300μm(FD-300)around the foveal avascular zone(FAZ)in optical coherence tomography angiography(OCTA)of patients with macular edema(ME)complicated with non-ischemic branch retinal vein occlusion(BRVO), and to explore and evaluate the predictive effect of this parameter on the number of intraocular drug injections.METHODS: A retrospective case study. A total of 50 patients(50 eyes)who were diagnosed as non-ischemic BRVO combined with ME and received intravitreal conbercept(IVC)in the Affiliated Eye Hospital of Nanjing Medical University from January 2021 to March 2022 were selected, and they were treated with 3+PRN regimen. The 25 cases(25 eyes)treated with intraocular injection ≤5 times were classified as group B, and 25 cases(25 eyes)treated with intraocular injection >5 times were classified as group C, and 25 fellow eyes were randomly selected as control group A. OCTA was used to scan the macular area in 3mm×3mm to collect images of retinal blood flow, the central macular thickness(CMT)and FD-300. The CMT, best-corrected visual acuity(BCVA), and FD-300 were compared between the two groups at baseline, 1, 3, 6 and 12mo after the third injection.RESULTS: The BCVA(LogMAR)of the affected eye in both groups B and C at 1, 3, 6 and 12mo after the third injection was significantly lower than baseline(all P<0.05); the CMT and FD-300 were significantly lower than baseline(all P<0.05). Pearson correlation analysis showed that the change of BCVA(LogMAR)was positively correlated with the baseline FD-300 and CMT(group B: r=0.77, 0.70, all P<0.01; group C: r=0.89, 0.78, all P<0.01). The number of intraocular injections was negatively correlated with the baseline FD-300(group B: r=-0.63, P<0.01; group C: r=-0.71, P<0.01). Logistic regression analysis showed that the FD-300 at baseline is a factor that affects the number of intraocular drug injection.CONCLUSION: IVC can effectively alleviate macular edema of the affected eye,improve visual acuity and reduce FD-300. The eyes with worse BCVA and lower FD-300 at baseline may require more injections of anti-VEGF. Observation of FD-300 with OCTA can better predict eventual vision recovery of non-ischemic BRVO with ME before treatment.

Micropulse laser combined with intravitreal injection of Ranibizumab in the treatment of macular edema secondary to non-ischemic branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of micropulse laser combined with intravitreal injection of ranibizumab in the treatment of macular edema(ME)secondary to non-ischemic branch retinal vein occlusion(BRVO).METHODS: A total of 200 cases(200 eyes)of non-ischemic BRVO secondary to ME who were treated in our hospital from January 2020 to March 2022 were selected and divided into the control group(100 cases, 100 eyes)and the observation group(100 cases, 100 eyes)by random number table. The control group was given intravitreal injection of ranibizumab, and the observation group was given micropulse laser combined with intravitreal injection of ranibizumab. The best corrected visual acuity(BCVA), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), total number of injections, macular leakage and complications were compared between two groups.RESULTS: After treatment, the BCVA of the two groups were improved, and the BCVA of the observation group was better than those in the control group at 1, 3, 6 and 12mo after treatment(all P<0.05). After treatment, the CMT and SFCT of the two groups decreased, and the CMT and SFCT of the observation group was lower than those in the control group at 1, 3, 6 and 12mo after treatment(all P<0.05). The total number of injections in the observation group during the treatment period was less than that in the control group [(4.06±1.12)times vs.(5.32±1.15)times](t=5.852, P<0.001). The leakage rates of the control group and the observation group after 12mo of treatment were 69.0% and 27.0% respectively, with statistical significance between the two groups(χ2=35.337, P<0.001). The incidence of complications in the control group and observation group were 11.0% and 5.0% respectively, with no statistical significance between the two groups(χ2=2.446, P=0.118).CONCLUSION: Micropulse laser combined with intravitreal injection of ranibizumab has a significant clinical efficacy in the treatment of ME secondary to non-ischemic BRVO, which is safe and can improve patients' vision and ME, reduce the total doses of ranibizumab without increasing the incidence of complications.

Establishment and validation of nomogram model for visual prognosis of macular edema secondary to retinal branch vein occlusion treated with ranibizumab / 中华眼底病杂志

Objective:To explore the influencing factors of visual prognosis of macular edema secondary to branch retinal vein occlusion (BRVO-ME) after treatment with ranibizumab, and construct and verify the nomogram model.Methods:A retrospective study. A total of 130 patients with BRVO-ME diagnosed by ophthalmology examination in the Department of Ophthalmology, Liuzhou Red Cross Hospital from January 2019 to December 2021 were selected in this study. All patients received intravitreal injection of ranibizumab. According to the random number table method, the patients were divided into the training set and the test set with a ratio of 3:1, which were 98 patients (98 eyes) and 32 patients (32 eyes), respectively. According to the difference of logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) at 6 months after treatment and logMAR BCVA before treatment, 98 patients (98 eyes) in the training set were divided into good prognosis group (difference ≤-0.3) and poor prognosis group (difference >-0.3), which were 58 patients (58 eyes) and 40 patients (40 eyes), respectively. The clinical data of patients in the two groups were analyzed, univariate and multivariate logistic regression analysis were carried out for the different indicators, and the visualization regression analysis results were obtained by using R software. The consistency index (C-index), convolutional neural network (CNN), calibration curve and receiver operating characteristic (ROC) curve were used to verify the accuracy of the nomogram model.Results:Univariate analysis showed that age, disease course, outer membrane (ELM) integrity, elliptical zone (EZ) integrity, BCVA, center macular thickness (CMT), outer hyperreflective retinal foci (HRF), inner retina HRF, and the blood flow density of retinal deep capillary plexus (DCP) were risk factors affecting the visual prognosis after treatment with ranibizumab in BRVO-ME patients ( P<0.05). Multivariate logistic regression analysis showed that course of disease, ELM integrity, BCVA and outer HRF were independent risk factors for visual prognosis after ranibizumab treatment for BRVO-ME patients ( P<0.05). The ROC area under the curve of the training set and the test set were 0.846[95% confidence interval ( CI) 0.789-0.887) and 0.852 (95% CI 0.794 -0.873)], respectively; C-index were 0.836 (95% CI 0.793-0.865) and 0.845 (95% CI 0.780-0.872), respectively. CNN showed that the error rate gradually stabilized after 300 cycles, with good model accuracy and strong prediction ability. Conclusions:Course of disease, ELM integrity, BCVA and outer HRF were independent risk factors of visual prognosis after ranibizumab treatment in BRVO-ME patients. The nomogram model based on risk factors has good differentiation and accuracy.

Preliminary results of anti-vascular endothelial growth factor treatment for macular edema secondary to branch retinal vein occlusion in Lhasa Tibet / 中华眼底病杂志

Objective:To observe and evaluate the safety and efficacy of anti-vascular endothelial growth factor (VEGF) in the treatment of eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) in Lhasa, Tibet.Methods:A retrospective case series. From September 2018 to January 2022, a total of 41 patients (41 eyes) with BRVO-ME, who were diagnosed in Department of Ophthalmology of Tibet Autonomous Region People’s Hospital, were included in this study. There were 21 eyes in 21 males and 20 eyes in 20 females. The median age was 53 (31,75) years. There were 24 patients with hypertension (58.8%, 24/41). Best corrected visual acuity (BCVA), ocular pressure, fundus color photography and optical coherence tomography (OCT) were performed in all eyes. The BCVA was performed using the international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The foveal macular thickness (CMT) was measured by OCT. All eyes were treated with intravitreous injection of anti-VEGF drugs, once a month, among which 23 eyes (56.1%, 23/41) received intravitreous injection of ranibizumab (IVR), and 18 eyes (43.9%, 18/41) received intravitreous injection of conbercept (IVC), and were grouped accordingly. There was no significant difference in age ( Z=-0.447), gender composition ( Z=-0.485), logMAR BCVA ( t=-1.591), intraocular pressure ( t=-0.167) and CMT ( t=-1.290) between two groups ( P>0.05). During the follow-up, the same devices and methods were used at baseline to perform relevant examinations, and the changes of BCVA, intraocular pressure, CMT and new cardiovascular and cerebrovascular events were compared between baseline and the last follow-up. logMAR BCVA, intraocular pressure and CMT were compared between baseline and last follow-up using Student t test. The comparison of injection times and follow-up time between IVR group and IVC group was conducted by Mann-Whitney U test. Results:At baseline, logMAR BCVA, intraocular pressure, and CMT were 0.852±0.431, (12.5±2.5) mm Hg (1 mm Hg= 0.133 kPa), and (578.1±191.1) μm, respectively. At the last follow-up, the number of anti-VEGF drug treatments was (2.7±1.2) times; logMAR BCVA and CMT were 0.488±0.366 and (207.4±108.7) μm, respectively, with CMT > 250 μm in 14 eyes (34.1%, 14/41). Compared with baseline, BCVA ( t=4.129) and CMT ( t=-0.713) were significantly improved, with statistical significance ( P<0.001). The injection times of IVR group and IVC group were (2.6±0.9) and (3.0±1.5) times, respectively. There were no significant differences in the number of injection times ( t=-1.275), logMAR BCVA ( t=-0.492), intraocular pressure ( t=0.351) and CMT ( t=-1.783) between the two groups ( P>0.05). No new hypertension, cardiovascular and cerebrovascular events occurred in all patients during follow-up. At the last follow-up, there were no eye complications related to treatment modalities and drugs. Conclusion:Short-term anti-VEGF treatment can improve the visual acuity of BRVO secondary ME patients and alleviate ME in Lhasa, Tibet. The safety and efficacy of ranibizumab and conbercept were similar.

Make full use of the new imaging technology to further explore the key problems of retinal branch vein occlusion / 中华眼底病杂志

With high morbidity, branch retinal vein occlusion (BRVO) is a common retinal vascular disease in the clinic. Although the classic characteristics of BRVO have been recognized for a long time, the traditional understanding of BRVO has been challenged along with development and application of new imaging technologies, including the reasonable classification and staging of the disease, and the vascular characteristics at the occlusive site via multimodal imaging, etc. Thus, re-summarizing and refining these features as well as further improving and optimizing traditional imaging evaluation, can not only deepen the correct acknowledge of the entity, but also find biomarkers of prognosis of visual function, which is helpful to establish better diagnosis and treatment strategy. In the meanwhile, it is necessary that clinical characteristics of BRVO on imaging and the reliability of these imaging techniques are worth correct understanding and objective assessment.

Retinal vasoocclusive spectrum following COVID-19

The coagulation abnormalities and thromboembolic complications of coronavirus 2 (SARS-CoV-2) are now a well-established fact. The hypercoagulable state, the tendency for thromboembolism, and a cytokine surge state have been the exclusive reasons for multiorgan failure and other morbidities that have been regularly reported in COVID-19 patients. Ocular involvement in patients with active disease and those who have recovered is uncommon but not rare. We report a case series of four patients with CRVO, BRVO, CRAO, and vitreous hemorrhage in patients with proven COVID-19 infection and no other systemic ailments. The case series also tries to correlate the elevated D-dimer values, which signify a plausible prothrombotic state with the vaso-occlusive phenomenon in the retina leading to significant visual morbidity.

Secondary glaucoma after intravitreal dexamethasone implant (Ozurdex) injection in patients with retinal disorder: A retrospective study

Purpose: To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center. Methods: Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow?up. The post?T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre?existing glaucoma and lost to follow?up were excluded. Results: A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post?injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post?T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22–25 mmHg; 8 in the range 26–30 mmHg; and 1 eye had 34 mmHg and required multiple AGM—no surgical intervention was needed. Conclusion: A secondary IOP spike post?IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field

Efficacy of Conbercept combined with laser photocoagulation in the treatment of macular edema secondary to ischemic BRVO / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe and analyze the efficacy of Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation in the treatment of macular edema(ME)secondary to ischemic branch retinal vein occlusion(BRVO).<p>METHODS: Totally 71 patients(71 eyes)diagnosed as ME secondary to ischemic BRVO during the period from March 2016 to March 2019 were retrospectively included, and they were divided into laser group(<i>n</i>=33, 33 eyes)and combined group(<i>n</i>=38, 38 eyes)according to the different treatment methods. The patients in the laser group all received 577nm yellow subliminal micropulse laser photocoagulation, and the patients in the combined group all received Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation. The best corrected visual acuity(BCVA), central macular thickness(CMT)and total macular volume(TMV)were compared between the two groups before treatment and at 1, 2, 3, 6, 9 and 12mo after surgery, and the therapeutic efficacy was observed and the occurrence of complications were recorded.<p>RESULTS:There were statistically significant differences in the BCVA, CMT and TMV between the two groups before and after treatment(<i>P</i><0.05), and the BCVA, CMT and TMV in the two groups at 1, 2, 3, 6, 9 and 12mo after treatment were significantly lower than those before treatment(<i>P</i><0.05), and the differences between the two groups were statistically significant(<i>P</i><0.05). During follow-up, there were 30 eyes with once laser photocoagulation, 7 eyes with twice and 1 eye with 3 times in combined group, and there were 16 eyes with once laser photocoagulation, 14 eyes with twice and 3 eyes with 3 times in laser group(<i>Z</i>=2.670, <i>P</i><0.05). There were 3 eyes of corneal epithelial exfoliation on the 1d after vitreous injection in combined group, and the symptoms disappeared after symptomatic treatment. All patients did not have serious complications such as persistent intraocular pressure increase, retinal detachment and intraocular inflammation.<p>CONCLUSION: Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation has a significant efficacy in the treatment of ME secondary to ischemic BRVO, and it can effectively improve the visual acuity and promote the macular edema absorption, and it is safe and reliable.

Observational study of macular capillary perfusion with branch retinal vein occlusion by using DART-OCTA / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the imaging characteristics of dense automatic real time B-scan optical coherence tomography angiography(DART-OCTA)in macular-involved branch retinal vein occlusion(BRVO)and the diagnostic value of capillary perfusion imaging in the macular area.METHODS: From June 2020 to December 2020, there were 51 cases of 51 eyes with BRVO diagnosed in Eye Hospital, Wenzhou Medical University. Imaging characteristics of the BRVO macular area were observed by fluorescein angiography(FA), optical coherence tomography angiography(OCTA)and DART-OCTA examination, respectively. According to the retinal capillary perfusion status, the included patients were divided into capillary and non-imaging groups, comparing the results of capillary perfusion imaging in the BRVO macular area among the three examination methods.Furthermore, quantitative analysis of capillary perfusion density in the lesion involved area and the lesion non-involved area was performed in DART-OCTA images. RESULTS: Patients with 51 eyes were included in this study, FA identified 10 eyes of capillary perfusion imaging, OCTA identified 14 eyes of capillary perfusion imaging, DART-OCTA identified 34 eyes of the capillary perfusion imaging.Comparison of the three test methods for capillary perfusion imaging findings in the BRVO macular area showed that DART-OCTA was more sensitive compared to FA and OCTA for capillary perfusion imaging in the ischemic area. In DART-OCTA examination, retinal capillary blood flow density was lower in the lesion-involved areas in both the capillary perfusion imaging group and the non-imaging groups(0.65±0.20/mm vs 1.16±0.31/mm,0.41±0.16/mm vs 1.06±0.38/mm, all P<0.0001).CONCLUSION: DART-OCTA can provide clearer tomographic imaging of retinal capillary perfusion. And the imaging with its observation of BRVO involving the macular area is least affected by macular hemorrhage and it is an important complementary method for BRVO patients with significant retinal hemorrhage.

Effect of Conbercept combined with laser photocoagulation on macular edema secondary to branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the effect of conbercept combined with laser photocoagulation on patients with macular edema secondary to branch retinal vein occlusion.METHODS: According to the random number table method, 102 patients(102 eyes)with macular edema secondary to branch retinal vein occlusion who treated in our hospital from January 2019 to June 2021 were divided into observation group and control group. There were 51 patients(51 eyes)in each group. The control group was treated with laser photocoagulation and the observation group was treated with conbercept combined with laser photocoagulation. The macular foveal retinal thickness, best corrected visual acuity and incidence of complications were compared among the patients of two groups.RESULTS: After treatment at 3mo, the retinal thickness of macular fovea in the observation group was lower than that in the control group(P&#x003C;0.05), the best corrected visual acuity in the observation group was higher than that in the control group(P&#x003C;0.05). The incidence of complications was not different between the two groups(P&#x003E;0.05).CONCLUSION:The effect of conbercept combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion is remarkable to reduce the retinal thickness of macular fovea and improve the vision of patients and the complications did not increase compared with retinal laser photocoagulation therapy alone, which were safe and effective.

Meta-analysis of long-term efficacy of combined regimen in treatment of macular edema secondary to branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Observation on the changes of macular microvessels in BRVO patients and its relationship with prognosis by using OCTA / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the changes of macular microvascular parameters and their correlation with best corrected visual acuity(BCVA)in patients with branch retinal vein occlusion(BRVO)by using optical coherence tomography angiography(OCTA).<p>METHODS: The superficial retinal capillary layer in the posterior pole of 29 patients with BRVO was scanned by OCTA. Macular vascular density including vessel density(VD), perfusion density(PD), foveal avascular zone(FAZ), and morphological index were obtained at baseline, 1 and 6mo respectively.<p>RESULTS: The FAZ area in BRVO group was 0.32±0.08mm², significantly larger when compared to the fellow eyes(0.21±0.06mm²)(<i>t</i>=-6.958, <i>P</i><0.001). The VD of full area of 3mm×3mm and 6mm×6mm was lower in BRVO eyes compared to fellow eyes(<i>P</i><0.05). As for PD, a difference was found between the two groups in the central and inter area in the 3mm×3mm scan pattern(<i>P</i><0.001), while a significant difference was found in central, the outer, and the full area in the 6mm×6mm scan pattern(<i>P</i><0.05). The BCVA at baseline was significantly better than that at 6mo(<i>t</i>=2.43, <i>P</i><0.05); BCVA(LogMAR)was positively correlated with VD and PD of centre area in 3mm×3mm mode, and PD of central and full area in 6mm×6mm model, but negatively correlated with PD in the outer area in 6mm×6mm mode.<p>CONCLUSION: As a non-invasive examination, quantitative OCTA measurements confirm vascular density changes in the superficial vascular networks in eyes with BRVO. Moreover, vascular density and FAZ area appear to correlate with visual function.

Curative effect of Triamcinolone acetonide combined with macular grid photocoagulation in the treatment of macular edema secondary to BRVO / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the efficacy and safety of triamcinolone acetonide(TA)combined with macular grid photocoagulation in the treatment of macular edema(ME)secondary to branch retinal vein occlusion(BRVO).<p>METHODS: A total of 147 patients(147 eyes)with ME secondary to BRVO treated in the hospital were enrolled between January 2016 and January 2020. They were randomly divided into observation group(73 eyes)and control group(74 eyes). The observation group was given intravitreal injection of TA and macular grid photocoagulation, while control group was given intravitreal injection of conbercept and macular grid photocoagulation. All were followed up for 6mo. Efficacy and safety indexes between the two groups were compared.<p>RESULTS:After treatment, best corrected visual acuity(BCVA, LogMAR)in both groups was improved. At 1mo after treatment, BCVA in observation group was better than that in control group(0.22±0.15 <i>vs </i>0.27±0.13, <i>P</i><0.05). At 6mo after treatment, BCVA of patients under 50 years in observation group was significantly better than that of patients under 50 years in control group(0.09±0.04 <i>vs </i> 0.14±0.06, <i>P</i><0.05).BCVA was the best in patients with type serous retinal detachment(SRD), followed by type ME and mixed type(<i>P</i><0.05). However, there was no significant difference in BCVA between any two groups in ME classifications(<i>P</i>>0.05). After treatment, central macular thickness(CMT)in both groups was significantly decreased. At 3mo after treatment, CMT in observation group was higher than that in control group(309.76±84.24μm <i>vs </i>258.75±88.76μm, <i>P</i><0.01). At 1wk, 1, 3 and 6mo after treatment, intraocular pressure in observation group was higher than that in control group(<i>P</i><0.01). At 6mo after treatment, blood flow density of superficial capillary plexus(SCP)in both groups was significantly higher than that before treatment(<i>P</i><0.05), but there was no significant change in blood flow density of deep capillary plexus(DCP)or the area of foveal avascular zone(FAZ)(<i>P</i>>0.05). The incidence of increased intraocular pressure was higher in observation group than control group(28.8% <i>vs </i>14.9%), and times of intravitreal injection were fewer than those in control group(1.21±0.74 times <i>vs </i>3.62±2.08 times).<p>CONCLUSION: TA combined with macular grid photocoagulation in the treatment of ME secondary to BRVO can maintain visual acuity at a certain level in the short term. The curative effect is comparable to that of conbercept combined with macular grid photocoagulation in terms of improving visual acuity and CMT. However, there is increased intraocular pressure, and the intraocular pressure monitoring needs to be strengthened.

Intraocular Pressure: Intravitreal Preservative-free Triamcinolone Injection in Diabetic Macular Edema and Branch Retinal Vein Occlusion

PURPOSE: To compare the intraocular pressure (IOP) in diabetic macular edema (DME) patients and macular edema associated with branch retinal vein occlusion (BRVO) patients after intravitreal preservative-free Triamcinolone injection.METHODS: This study included 36 patients diagnosed with DME and 44 patients diagnosed with BRVO with macular edema. Both groups were treated with intravitreal preservative-free Triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection, and we compared the IOPs of the two groups determined before injection and at 1, 2, 3, and 6 months after injection. We also compared the IOP elevation ratios and durations, and central foveal thickness (CFT) changes using optical coherence tomography.RESULTS: In both groups, there was no statistical significance in the IOP before injection and at 1, 2, 3, and 6 months after injection. However, the IOP elevation ratio in the DME patients (38.9%) was significantly higher than that in the BRVO patients (15.9%) (p = 0.02). The duration of IOP elevation in the DME patients (1.14 ± 1.85 months) was significantly longer than that in the BRVO patients (0.30 ± 1.20 months) (p = 0.03). When the IOP was not controlled, we used IOP-lowering agents, and two patients in the DME were treated with glaucoma surgery. There was no statistical significance in the CFT before injection and at 1, 2, or 3 months after injection between the two groups (p = 0.72, p = 0.26, p = 0.66, p = 0.34, respectively). However, the CFT after 6 months was 328 ± 103 µm in the DME group and 434 ± 189 µm in the BRVO; this difference was significant (p < 0.01).CONCLUSIONS: Intravitreal injection of preservative-free Triamcinolone was effective in the treatment of both DME patients and macular edema patients associated with BRVO. Furthermore, Triamcinolone was more safely injected in macular edema associated with BRVO patients than in DME patients.

Bromfenac as Adjunctive Treatment with Intravitreal Bevacizumab in Branch Retinal Vein Occlusion of Macular Edema

PURPOSE: To evaluate the effectiveness of 0.1% topical bromfenac as an adjunctive treatment with intravitreal bevacizumab (IVB) injection for branch retinal vein occlusion (BRVO) patients.METHODS: We retrospectively evaluated 68 eyes of 68 patients with macular edema (ME) secondary to BRVO who were treated with IVB injection and followed up for at least 12 months. Of the 68 eyes, 38 were treated with IVB combined with 0.1% topical bromfenac and 30 were treated with IVB alone. IVB reinjection was performed in cases of recurrence. The primary outcome measurement was the number of IVB injections. Changes in the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) during the 12-month follow-up were compared.RESULTS: There was no significant difference in the BCVA or CFT between the two groups at the initial and final examinations. However, the number of IVB injections was significantly lower in the 0.1% bromfenac-treated eyes (p < 0.01) than in the control eyes (4.1 ± 0.7 vs. 5.0 ± 0.6 times).CONCLUSIONS: Compared to IVB monotherapy, topical bromfenac as an adjunctive treatment with IVB injection of eyes with ME secondary to BRVO did not affect visual outcomes, but it reduced the number of IVB injections.

Analysis on the clinical effect and visual acuity prognostic factors of BRVO-ME treated with Ranibizumab / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Clinical study of macular edema secondary to ischemic branch retinal vein occlusion treated by dual laser and single intravitreal injection with Conbercept / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To appraise the therapeutic effect of dual laser(micro-pulse laser and traditional laser)and single intravitreal injection with conberceptin on macular edema secondary to ischemic branch retinal vein occlusion.<p>METHODS: A prospective cohort study was conducted. 83 patients(83 eyes)participated in the study from November 2017 to November 2018. They were randomly divided into two groups. Group A(42 eyes)accepted the treatment of dual laser and single intravitreal injection with conbercept and group B(41 eyes)accepted only traditional laser treatment and single intravitreal injection with anti-VEGF, and the aim is to analysis the data including BCVA, CMT in follow-up visit after treatment 1, 3, 6mo.<p>RESULTS: After 1mo: in group A, BCVA improved from 0.88±0.11 to 0.43±0.19(<i>P</i><0.01), CMT changed from 595.00±61.12 to 379.8±76.08μm(<i>P</i><0.01). In group B, BCVA changed from 0.82±0.19 to 0.39±0.16(<i>P</i><0.01)while CMT changed from 601.70±81.37 to 381.50±70.92 μm(<i>P</i><0.01). There were no difference between two groups(<i>P</i>>0.05). After 3mo: in group A, BCVA raised to 0.13±0.07(<i>P</i><0.01), CMT reduced to 282.80±31.93μm(<i>P</i><0.01); in group B, BCVA hold on 0.41±0.09(<i>P</i>=1.00), CMT retained 395.80±34.53μm(<i>P</i>=0.99). The improvement of BCVA and CMT were better in group A(<i>P</i><0.01). After 6mo: in group A, BCVA maintained 0.28±0.12(<i>P</i><0.01), CMT keeped 335.60±33.98μm(<i>P</i>=0.02); in group B, BCVA rebounded to 0.77±0.15(<i>P</i><0.01), CMT was 579.60±19.61μm(<i>P</i><0.01). Both BCVA and CMT were better in group A than group B(<i>P</i><0.01). No serious complications happened in all phases.<p>CONCLUSION: The treatment of dual laser and single intravitreal injection with conbercept for macular edema secondary to ischemic branch retinal vein occlusion can maintain good effect more than 3mo.

Effects of intravitreal injection of triamcinolone acetonide on angiogenesis and Notch pathway in photochemistry-induced retinal branch vein occlusion model in rats / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effects of intravitreal injection of triamcinolone acetonide(TA)on angiogenesis and Notch pathway in photochemistry induced branch retinal vein occlusion(BRVO)model in rats. <p>METHODS: BRVO model rats were induced by photochemistry induction and randomly divided into BRVO model group and TA(1, 7, 21)d groups; at the same time, blank control group was set for comparison. The intraocular pressure of rats was measured by ophthalmotonometer; the condition of rat fundus was observed fluorescein fundus color photography(FFA)and optical coherence tomography(OCT); retinal angiogenesis related factors vascular endothelial growth factor(VEGF)and vascular endothelial growth factor receptor 2(VEGFR2), the protein expressions of Notch pathway important factors Notch 1, Jagged 1 and DLL4 were detected in rat retina by Western blotting(WB). <p>RESULTS: In the normal control group, the fundus vessels were arranged neatly and in a clear state. In the BRVO model group, edema appeared in the fundus, the retina turned white, the arrangement of blood vessels was disordered, the optic disc pit was disappeared, retinal vessels were in the state of vasoconstriction. In TA 1, 7 and 21d groups, edema gradually decreased, blood vessels expansion and bending gradually slowed down, and the optic disc pit was restored. Compared with the blank control group, the intraocular pressure of BRVO model group increased, the thickness of the retina increased at the injured site and 250μm far from injured site, the protein expressions of VEGF, VEGFR2, Notch1 and Jagged1 increased, the protein expression of DLL4 protein was decreased(<i>P</i><0.05). Compared with the BRVO model group, in TA 1d group, the retinal thickness decreased at 250μm far from injured site, the protein expressions of VEGFR2, Notch1 and Jagged1 decreased, the protein expression of DLL4 protein increased; in TA 7d group, the retinal thickness was decreased at the injured site and 250μm far from injured site, the protein expressions of VEGFR2, Notch1 and Jagged1 decreased, the protein expression of DLL4 protein increased; the intraocular pressure of TA 21d group decreased, the thickness of the retina decreased at the injured site and 250μm far from injured site, the protein expressions of VEGF, VEGF R2, Notch1 and Jagged1 decreased, the protein expression of DLL4 protein increased(<i>P</i><0.05). <p>CONCLUSION: Vitreous injection of TA may inhibit angiogenesis by regulating Notch pathway to inhibit the activation of VEGF, thus achieving the retinal protection in BRVO rats.

Comparison of different types of macular edema secondary to BRVO treated by intravitreal injection of Conbercept / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the changes of microvascular structure of different patterns of macular edema(ME)secondary to branch retinal vein occlusion(BRVO)after intravitreal injection of conbercept.<p>METHODS: A total of 70 patients(70 eyes)with ME secondary to BRVO were classified as cystoid macular edema(CME group, 24 eyes), diffuse retinal thickening(DRT group, 22 eyes)and serous retinal detachment(SRD group, 24 eyes)according to features under OCT examination. After an initial intravitreal injection of 0.5mg(0.05mL)conbercept(IVIC). The changes of best corrected visual acuity(BCVA), central macular thickness(CMT), foveal avascular zone(FAZ), vascular density of superficial capillary plexus(SCP), vascular density of deep retinal capillary plexus(DCP)and the injection times were compared among three groups after 1, 6mo treatment.<p>RESULTS: After 6mo follow up, the BCVA(0.24±0.13、0.11±0.07、0.33±0.13)and the CMT(268.75±19.01、245.64±23.20、277.00±21.21μm)of the three groups showed a significant downward trend; The FAZ(0.37±0.09、0.30±0.08、0.36±0.03mm2)of the three groups showed a significant decreased trend; The SCP(46.18%±3.21%、47.49%±3.48%、42.76%±3.66%)and the DCP(43.50%±4.34%、47.69%±2.76%、43.88%±3.54%)of the three groups showed a significant increased trend(<i>P</i><0.01). After 6mo treatment, DRT group was better than CME group and SRD group in improving BCVA, reducing CMT and FAZ area, increasing the density of SCP and DCP. The DRT group had the least injection numbers(2.55±0.69)(<i>F</i>=5.584, <i>P</i><0.05).<p>CONCLUSION: The intravitreal injection of conbercept significantly improved the BCVA, reduced the CMT and the FAZ, increased the vascular density of SCP and DCP of different patterns of ME. Best outcomes were achieved in DRT group.