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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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Objective To evaluate the clinical efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema (DME).Methods Retrospective case series study.A total of 30 patients (35 eyes) with center-involving DME were enrolled in this study.All the patients received the examinations of best corrected visual acuity (BCVA),fundus colorized photography,fluorescein fundus angiography (FFA) and optical coherence tomography (OCT).BCVA was measured by Early Treatment Diabetic Retinopathy Study charts.The average retinal thickness (ART),total macular volume (TMV) and the retinal thickness (RT) and macular volume (MV) of 9 ETDRS domains were measured by the Japanese Topcon 3D-OCT 2000 instrument.The mean BCVA was 62.4± 10.5 letters.The mean ART was 327.3± 41.2 μm.The mean TMV was 9.24 ± 1.17 mm3.All patients were treated with 577 nm subthreshold micropulse laser treatment.Subthreshold micropulse laser were performed in the micropulse mode,using a 200 μm spot diameter,a 0.2 s duration with 5％ duty cycle and its treatment energy was 6-7 times of threshold energy.Three months after treatment,re-treatment was performed on patients with incomplete absorption of macular edema.The treatment was the same as before.The BCVA,ART,TMV and the RT and MV of each ETDRS domain were compared and analyzed before and after treatment.The possible complications of micropulse laser treatment were also observed and the safety was evaluated.Results The difference of BCVA were statistically significant in month 3 and month 6 (t=-5.58,-7.24;P＜0.05),but not in month 1 (t=-1.82,P＞0.05).The average CRT (t=4.11,4.17,5.96),CMV (t=3.92,4.05,5.80) significantly decreased in 1,3 and 6 months after treatment,the difference was statistically significant (P＜0.05).At sixth months,the average retinal thickness (t=3.53,5.07,5.02,4.87,4.94,3.48,4.03,3.17,3.73) and retinal volume (t=3.54,5.16,4.99,4.91,5.05,3.47,4.08,3.10,3.70) of the 9 ETDRS subdomains significantly decreased,and the difference was statistically significant (P＜0.05).There was no visible laser spots,changes in the outer retina and complications of neovascularization and subretinal fibrosis in the fundus of all patients.Conclusion 577 nm subthreshold micropulse laser can reduce the CMT,CMV and improve the BCVA of DME patients with high security.
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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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Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients.It mainly includes focal DME and diffuse DME,while DME of clinical significance needs timely intervention treatment.Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME.Currently,the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation.Among them,anti-VEGF injection is becoming the first-line therapeutic,and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients.During the diagnosis and treatment of DME,attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME.With the appearance of heterogeneity in the efficacy of anti-VEGF drugs,it remains to be further studied how to choose alternative therapeutics and when to replace them.
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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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Background Diabetic macular edema (DME) is one of serious ocular complications of diabetes mellitus and is often treated by laser photocoagulation,peribulbar injection of triamcinolone acetonide (TA) and intravitreal injection of ranibizumab.However,some adverse responses occur in each approach.To seek a safe,effective and ecnomic therapy for DME is of clinical significance.Objective This study was to observe the safety and efficacy of post-sclera injection of TA with a self-made innovative device for DME and compare the outcome with peribulbar injection of TA and the intravitreal injection of ranibizumab.Methods A prospective non-randomized controlled study was performed.This study protocol was approved by Ethic Committee of Southwest Hospital of Third Military Medical University and complied with Helsinki declaration.Written informed consent was obtained from each patient before any medical treatment.Sixty eyes of 60 patients with DME were included in Southwest Hospital of Third Military Medical University from March 2013 to July 2016.The eyes were divided into post-sclera injection group,peribulbar injection group and intravitreal injection group,with 20 eyes for each group.TA at the dose of 20 mg was injected via posterior sclera with a self-made divice in the post-sclera injection group and via periphery of eyeball in the peribulbar injection group,and 0.5 mg ranibizumab was intravitreally injected in the intravitreal injection group.Best corrected visual acuity (BCVA) was examined and retinal thickness at macular area was measured by OCT in 1 month and 3 months after injection respectively.The outcome and complication were grouply compared.Results The BCVA was significantly improved 1 month and 3 months after injection in comparison with before injection in the post-sclera injection group and intravitreal injection group,and BCVA in the post-sclera injection group and intravitreal injection group was superior to that in the peribulbar injection group (all at P =0.000).No significant difference was found in post-injected BCVA between post-sclera injection group and intravitreal injection group (P =0.244,0.397).Retinal edema at macular area was gradually disappeared in the post-sclera injection group and intravitreal injection group and that in the peribulbar injection group was still visible after injection.The retinal thickness at macula was (321.85±31.98),(382.75±39.28) and (315.75 ± 40.43) μm at 1 month and was (311.95±32.73),(393.65±33.84) and (302.65±38.99) μm at 3 months after injection in the post-sclera injection group,peribulbar injection group and intravitreal injection group respectively,and the retinal thickness values at macula in the post-sclera injection group and intravitreal injection group were significantly lower than those in the peribulbar injection group (all at P =0.000).The decrease rate of retinal thickness was higher in the post-sclera injection group and intravitreal injection group than that in the peribulbar injection group at various time points after injection (all at P＜0.01).Conclusions The efficacy and safety of post-sclera injection of TA for DME are similar to intravitreal injection of ranibizumab,which are superior to peribulbar injection of TA.
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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 observe the visual acuity change in patients with different patterns of optical coherence tomography (OCT) of diabetic macular edema (DME) after intravitreal ranibizumab injection and/or laser photocoagulation.Methods A retrospective observational case series.Seventy patients (99 eyes) with DME were enrolled.Best-corrected visual acuity (BCVA) was evaluated using the international vision test chart,and then convert the result to the logarithm of the minimum angle of resolution (logMAR).According to the morphological characteristics of OCT,the DME was divided into 3 patterns,including diffuse macular edema (DRT),cystoid macular edema (CME) and serous neuroepithelial layer detachment.The average follow-up was (80.43 ± 74.89) days.The patients were divided into 3 groups according to the different treatments,including intravitreal ranibizumab injection group (group A,21 patients,25 eyes),intravitreal ranibizumab injection and laser photocoagulation group (group B,23 patients,26 eyes),laser photocoagulation group (group C,26 patients,48 eyes).The changes of absolute BCVA (ABCVA) and improved visual acuity were compared between different treatment groups and different OCT patterns.ABCVA =logMAR BCVA before treatment-logMAR BCVA after treatment.Improvement more than 0.3 of logMAR value was considered as improved visual acuity.Results There was no significant difference in ABCVA between different treatment groups (F=0.050,P＞0.05).The improved visual acuity in group A and B were great than group C (x2=5.645,6.301;P＜0.05).In group A,B and C,there was no significant difference in ABCVA and improved visual acuity between different OCT patterns (P＞0.05).Improved visual acuity of DRT and CME eyes were higher in group A&B (70.59％ and 50.00％) than in group C (26.47％ and 14.29％),the difference was statistically significant (x2=5.075,4.453;P＜0.05).Conclusions There is no obvious change of visual acuity in patients with different OCT patterns of DME after the same treatment by intravitreal ranibizumab injection and/or laser photocoagulation.The improved visual acuity is not consistent in same OCT patterns after different treatment.
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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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Objective To observe the efficacy of intravitreal injection of ranibizumab (IVR) for different patterns of optical coherence tomography (OCT) of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes.Methods Eighty-five IVR treated eyes were enrolled.The examination of BCVA was according to Early Treatment Diabetic Retinopathy Study,and the results were recorded as logarithm of the minimum angle of resolution (logMAR).Frequency-domain OCT was used to measure the central foveal thickness (CFT) and the integrity of ellipsoidal zone.All eyes were classified as diffuse macular edema (DRT group,31 eyes),cystoid macular edema (CME group,29 eyes),and serous retinal detachment (SRD group,25 eyes).All the patients were treated with intravitreal injection of 0.05 ml (0.5 mg) ranibizumab.The mean follow-up time was (9.21+3.56) months after IVR treatment.The changes of BCVA and CFT in 3 groups were compared and analyzed after 3,6 and 12 months.According to visual acuity at different ranges,the relationship between integrity of ellipsoidal zone and BCVA was analyzed.Results Compared with the average logMAR BCVA before treatment,except for 12 months after treatment in group SRD (t=2.104,P=0.053),the average logMAR BCVA after IVR at 3 months,6 months and 12 months improved in DRT group (t=7.847,6.771,6.426;P=0.000,0.000,0.000),CME group (t=8.560,6.680,5.082;P=0.000,0.000,0.000) and SRD group (t=5.161,3.968,2.104;P=0.000,0.001,0.053).The average logMAR BCVA of the DRT group was lesser than that in CME and SRD group after 12 months treatment (t=-2.043,-3.434;P=0.030,0.001).The average CFT after IVR at 3 months,6 months and 12 months reduced significantly in DRT group (t=12.746,10.687,9.425;P=0.000,0.000,0.000),CME group (t=13.400,11.460,10.169;P=0.000,0.000,0.000),and SRD group (t=1 1.755,10.100,9.173;P=0.000,0.000,0.000).After 12 months of treatment,the average CFT of the SRD group was thicker than that in DRT group and CME group (t=-3.251,-1.227;P=0.003,0.025);there was significant difference in the integrity of ellipsoidal zone among 3 groups (x2=1.267,P=0.531).The results showed that there were significant differences in the integrity of ellipsoidal zone with different ranges of BCVA before and after 12 months treatment (x2=20.145,41.035;P=0.000,0.000).Conclusions IVR could significantly improve the visual acuity of different patterns of DME,reduced the CFT,and had the best efficacy in the DRT group.There was relationship between the integrity of ellipsoidal zone and the visual acuity outcomes.
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Background The studies on intravitreal ranibizumab for diabetic macular edema (DME) primarily focuses on the absolute change of central retinal thickness, while the affection of the relative change of central retinal thickness (RCRT) or relative change of central retinal thickening (RCRTing) on visual prognosis has not been elucidated completely.Objective This study aimed to evaluate the effect of RCRT and RCRTing in assessing visual prognosis in DME patients following intravitreal injection of ranibizumab.Methods A self-controlled observational study was designed.Thirty eyes of thirty patients with clinically significant DME (CSDME) were recruited in Beijing 401 Hospital of China Nuclear Industry from November 2013 to October 2014.Ranibizumab of 0.05 ml (10 mg/ml) was intravitreally injected by 30G syringe needle at 3.5 mm posterior corneal limbus.Best corrected visual acuity (BCVA) far 2.5 meters away modified ETDRs visual chart was examined before injection and 3 and 6 months after injection,and the BCVA difference value between before injection and 6 months after injection was calculated as the absolusion BCVA (ABCVA).Spectral domian optical coherence tomography (SD-OCT) system was employed to measure the central retinal thickness (CRT) and to calculate the RCRT and RCRTing value.The correlations of RCRT or RCRTing with ABCVA was analyzed.Results The LogMAR values were (0.66±0.20) ,(0.40±0.25) BCVA and (0.37±0.25) before injection and 3,6 months after injection respectively in the CSDME patients,with a significant difference among them (F =36.79,P＜0.05).The values were obviously improved 3 and 6 months after injection compared with before injection (both at P＜0.05).The mean ABCVA (LogMar) of the patients was (0.30±0.21).The CRT 3,6 ,pmyjd sgyrt omkrvyopm values were (508.63±130.44), (331.07±71.84) and (311.77±64.47)μm before injection and respectively in the CSDME patients, showing a significant difference among them (F=49.78,P＜0.05).The CRT values were evidently reduced 3 and 6 months after injection in comparison with before injection (both at P＜0.05) ,and the mean ACRT value was (196.87±140.59) μm.The ABCVA values were (0.13±0.13),(0.44±0.14),(0.07±0.09) and (0.41±0.15) LogMAR in the RCRT＜35％ group,RCRT≥ 35％ group,RCRTing＜69％ group and RCRTing ≥ 69％ group, respectively.Significant differences were found in ABCVA between the RCRT＜35％ group and RCRT≥35％ group (t=-6.27,-8.65,both at P＜0.05).RCRT and RCRTing showed the positive correlations with ABCVA in the CSDME patients (r =0.86,0.79, P ＜ 0.05).Conclusions RCRT and RCRTing can identify well the optimal responders to intravitreal ranibizumab and predict BCVA improvement after treatment.RCRT has better association with ABCVA than RCRTing.RCRTing may be preferable when retinal thickening is more severe.
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Diabetic macular edema (DME) is thickening retina with two disc diameter,which is the leading cause of blindness in diabetic retinopathy patients.The initial studies demonstrated that laser treatment of DME prevented further visual deterioration but did not improve visual acuity.Although glucocorticoid slow-release system can extend the time of effective drug concentration,to help glucocorticoid better carry out its biological effect,further studies are needed to warrant their safety due to increasing intraocular pressure and cataract progression.Novel studies identifying the presence of vascular endothelial growth factor (VEGF) in the eye with DME allowed for the development of an alternative anti-VEGF therapy,which revolutionized the management of DME by not only preventing vision loss,but also improving overall vision.Anti-VEGF therapy is becoming the first-line treatment of DME.However,present treatment modalities including anti-VEGF for DME had limitations,which build on the current understanding of DME pathogenesis.Further in-depth study of the development and outcome of DME is needed to optimize the therapeutic schemes,based on objective and scientific observation of treatment response.Finally we need to fully utilize the public health services and clinical management resources for diabetic patients,to prevent the visual impairment of DME before its occurrence.