ABSTRACT
Objective To observe the clinical effect ofintravitreal injection of tissue plasminogen activator (t-PA),ranibizumab and C3F8 in the treatment of early submacular hemorrhage (SMH) induce to polypoid choroidal vasculopathy (PCV).Methods The clinical data of 20 eyes of 20 patients with early SMH induce to PCV were enrolled in this study.The duration of bleeding in the eye was 7 to 28 days,and the mean duration of bleeding was 14.8± 5.6 days.All eyes are measured using the Snellen chart best corrected visual acuity (BCVA),logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity.Measure central retinal thickness (CRT) and central retinal pigment epithelial detachment (PED) thickness using frequency-domain optical coherence tomography.The average logMAR BCVA of eyes was 1.73 ±0.91;the mean CRT was 620.0±275.8 μm;the average central PED thickness was 720.3±261.9 μm.All eyes receive intravitreal injection of t-PA,ranibizumab and C3F8.The intravitreal injection of ranibizumab was administered once a month for 3 consecutive months,followed by an on-demand treatment plan.Mean follow-up time was 9.9 ± 3.6 months.The changes in BCVA,CRT,central PED thickness and clearance degree of SMH at 6 months after treatment were observed.Results On the 6 months after treatment,the average logMAR BCVA,CRT and central PED thickness of the eyes were respectively 0.42 ± 0.37,290.2 ± 97.4 μmn and 41.6 ± 78.1 μm.Compared with baseline,the after treatment BCVA was significantly increased (F=38.14,P=0.000),but the CRT and central PED were significantly decreased (F=7.48,75.94;P=0.000,0.000).Among the 20 eyes,16 eyes of SMH was completely cleared,accounting for 80％;4 eyes was partially cleared,accounting for 20％.No recurrence and systemic or local complications occurred during follow-up of all eyes.Conclusion Intravitreal injection oftPA,ranibizumab,and C3F8 in the treatment of early SMH induce to PCV can effectively remove SMH,improve vision,reduce CRT and central thickness of PED.
ABSTRACT
Choroidal nevus is one of the most common benign melanocytic tumor.The prevalence rate of choroidal nevi is 0.15％-10.00％,which is high among whites and low among colored people,and is obvious higher in male than that in female.Secondary changes in the surrounding retina of the benign tumor,such as subretinal fluid and choroidal neovascularization,may result in vision loss.This benign tumor carries risks for transformation into malignant melanoma.The factors predictive of transformation into melanoma included greater thickness,subretinal fluid,visual symptoms,orange lipofuscin pigment,tumor location (tumor margin near optic disc),ultrasonography hollowness and absence of halo.Early identification of the related features which impair visual acuity is important for early treatment and better prognosis,and it is especially important to monitor the tendency of malignant transformation.Optical coherence tomography (OCT) could provide detailed information which aid in diagnosing,differentiating and monitoring of choroidal nevi.OCT and optical coherence tomography angiography are emerging as excellent techniques to investigate choroidal melanocytic lesions.The treatment modalities,such as laser photocoagulation,photodynamic therapy and intravitreal anti-vascular endothelium growth factor,have been proved to be effective for choroidal nevi with secondary changes.In the future,the relevant researches should be imposed to provide more detailed information in order to explore the nature and characteristics of this disease.
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Objective To systematically review the efficacy and safety of photodynamic therapy (PDT) and intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV),and to investigate the primary treatment tentatively.Methods A systematic search of Pubmed,Embase,the Cochrane Library and the Wanfang Data was performed to identify all comparative studies that compared the outcomes of PDT alone,intravitreal VEGF inhibitors alone and combined intravitreal VEGF inhibitors and photodynamic therapy.Outcomes of interest included the regression and recurrence rate of polypoidal lesions,best corrected visual acuity (BCVA),central retinal thickness (CRT),therapeutic times,and the occurrence rate of adverse events.2 randomized controlled trials (RCT) and 19 non-RTCs were identified.According to treatment methods,the data extracted was classified to 3 groups,analyzed with odds ratio (OR),weighted mean difference (WMD) and 95％confidence interval (95％CI).Results Meta-analysis suggests that the regression rate of polypoidal lesions (OR=0.34,0.07;95％CI=0.13-0.88,0.02-0.36) and BCVA (WMD=0.25,0.11;95％CI=0.14-0.36,0.01-0.21) in combined therapy group were significantly better than those in PDT group and intravitreal VEGF inhibitors group (P＜0.05).The recurrence rate of polypoidal lesions in PDT group was significantly lower than intravitreal VEGF inhibitors group (OR=0.35,95％CI=0.16-0.74,P=0.006).BCVA (P=0.025) and the occurrence rate of adverse events (OR=60.36,95％CI=6.04-603.50,P=0.000 5) in intravitreal VEGF inhibitors group were significant better than PDT group.Conclusions Combined treatment appeared to be superior to PDT alone or intravitreal VEGF inhibitors alone.Combined treatment takes priority over all others in the primary treatment of PCV.
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Objective To compare the efficacy of photodynamic therapy (PDT) alone or in combined with ranibizumab versus ranibizumab monotherapy (intravitreal injection,IVR) in patients with polypoidal choroidal vasculopathy (PCV).Methods 80 eyes of 72 patients with PCV were enrolled into this retrospective and comparative study according to their therapeutic plan.30 eyes of 28 patients,28 eyes of 30 patients and 22 eyes of 21 patients were divided into PDT group,ranibizumab 0.5 mg group (IVR group) or the combination group,respectively.The patients with PCV were diagnosed according to clinical symptoms,optical coherence tomography (OCT) and fluorescent indocyanine green angiography (ICGA).The baseline best-corrected visual acuity (BCVA) before treatment was more than 0.05,and there was no retinal fibrosis and scar for all patients.There was no statistical difference of age (F=0.187),gender (x2 =0.423),average BCVA (F=1.120) and central retinal thickness (CRT) (F=0.431) among three groups (P＞0.05).They had not received any treatment before.Patients received verteporfin PDT in PDT group,3 consecutive monthly IVRs starting day 1 in IVR group,and 3 IVRs after 3 days,1 month,2 months of PDT starting day 1 in combination group.Re-treatment was considered 3 months later if the follow up shown no changes in fundus photography,OCT and ICGA.The average follow-up time was 19 months.BCVA at baseline and follow-up visit at 1,3,6,12 months was measured,and the proportion of patients with ICGA-assessed complete regression of polyps at month 6 was recorded as primary outcome.The CRT was measured at baseline and 6 months as secondary outcome.Results There were significant difference of BCVA at 1,3,6 and 12 months among three groups(F=5.480,5.249,3.222,4.711;P＜0.05).The average BCVA was significantly better at 1,3,6,12 month than that at baseline(t =-6.632,-4.127,-3.904,-4.494;P＜ 0.05) in combination group,and was significantly better at 3,6,12 months than that at baseline (t=-5.636,-3.039,-3.833;P＜0.05) in IVR group.However there was no significant difference of the average BCVA in PDT group between follow-up at 1,3,6,l 2 months and baseline (t=1.973,0.102,-0.100,-0.761;P＞0.05).The proportion of patients with complete regression of polyps at 6 months was higher in PDT (76.7％) or combination group (68.2％) than IVR group (35.7％) (x2=0.003,0.025;P＜0.05).There was no significant difference of CRT among 3 groups at baseline (P=0.651).The mean CRT decreased in all 3 treatment groups over 6 months (t=5.120,3.635,5.253;P＜0.05),but there was no significant difference of CRT among 3 groups (F=1.293,P＞ 0.05).Conclusions Three therapies could effectively decrease CRT.IVR or IVR combined with PDT are both more effective than PDT therapy to improve vision of PCV patients.PDT or PDT combined with IVR was superior to IVR pnly in achieving complete regression of polyps in 6 months in PCV patients.
ABSTRACT
The pathogenesis of polypoidal choroidal vasculopathy (PCV) is still controversial.More evidence of clinical and basic research is needed to distinguish PCV from an independent disease to a subtype of age-related macular degeneration.Not only that,there are also many puzzles in the diagnosis,treatment options and prognosis of PCV.In addition to these common problems,we also face a large population with risk factors,a large number of PCV patients with multiple and complex challenges in China.There is a long way to go to reduce the damage effects of PCV on visual function.To fulfil this goal,we need make full use of the huge resources of PCV patients and turn these challenges into opportunities,and contribute the improvement of diagnosis and better understanding of PCV pathogenesis.
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Objective To further compare the effect of intravitreal injection of bevacizumab (IVB) and photodynamic therapy (PDT) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia by meta-analysis.Methods Pertinent publications were identified through systemic searches of PubMed,EMBASE and the Cochrance Controlled Trials Register.All clinical comparative studies of IVB or PDT as initial treatment for CNV secondary to pathologic myopia were included.Meta analysis of these clinical trials was performed to analyze the effect of IVB and PDT for CNV secondary to pathologic myopia.Measurements included best corrected visual acuity (BCVA) and central foveal thickness (CFT).Results A total of 6 comparative studies involving 351 eyes were included.There were 196 eyes in IVB group and 215 eyes in PDT group.Funnel plots,Egger linear regression and Begg method did not show publication bias.Compared with PDT group,at 3,6 and 12 months after IVB treatment,BCVA significantly increased [3 months:weighted mean difference (WMD) =-0.14,95 ％ confidence interval (CI)=-0.26 to-0.01,P=0.04; 6 months:WMD=-0.18,95％ CI=-0.33 to-0.03,P=0.02; 12 months:WMD=-0.26,95％ CI=-0.35 to-0.18,P＜0.001].However,change of CFT at 3,6 and 12 months did not vary significantly between IVB group and PDT group (3 months:WMD=-22.49,95％ CI=-93.49 to 48.52,P=0.53; 6 months:WMD=-17.34,95％ CI=-56.00 to 21.31,P=0.38; 12 months:WMD=-5.32,95％ CI=-56.37 to 45.74,P=0.84).Conclusion Patients with CNV secondary to pathologic myopia experienced a significant benefit of visual improvement after IVB,but reduction in CFT after the IVB or PDT did not vary significantly.