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Background: Many a young doctors in training find retinal laser photocoagulation a daunting task. However, if correct protocols are followed and checklists are observed, then it is not difficult to have a successful laser sitting with a happy patient. Most of the complications can be avoided with correct settings and techniques. Purpose: To enumerate the basic protocols of retinal laser photocoagulation and provide practical tips including laser settings and checklists for hassle?free laser experience. Synopsis: Laser settings for a pan?retinal photocoagulation (PRP) for proliferative diabetic retinopathy differ from those for a focal laser for macular edema. A fill in PRP is indicated when an active Proliferative diabetic retinopathy (PDR) is seen after the initial PRP is completed. The settings and protocols for laser photocoagulation for lattice degeneration are different, and various techniques of barrage laser are discussed. Practical tips and checklists are given, which will not be found in any textbooks. Highlights: Animated illustrations and fundus photos are used to explain the correct techniques of performing laser photocoagulation in different indications and scenarios. Detailed instructions and checklists are provided, which can be very useful to avoid complications and medicolegal problems. The practical tips and guidelines in an easy?to?understand manner make this video highly educational for the novice retinal surgeons who want to perfect their technique of retinal laser photocoagulation.
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AIM:To systematically evaluate the efficacy and safety of intravitreal ranibizumab combined with compound trabeculectomy and panretinal photocoagulation(PRP)compared with compound trabeculectomy combined with PRP in the treatment of neovascular glaucoma(NVG).METHODS: Databases including Wanfang database, China National Knowledge Infrastructure(CNKI), PubMed, EMbase, China Biomedical Document Service System(CBM), Clinicalkey, and Cochrane Library were retrieved. Literatures about intravitreal ranibizumab combined with compound trabeculectomy and PRP in the treatment of NVG in the experimental group and compound trabeculectomy and PRP in the treatment of NVG in the control group from creation of database to July 20, 2022 were searched. At the same time, relevant reference were consulted. The best corrected visual acuity, intraocular pressure, occurrence of complications and the success rate of the surgery were systematically evaluated.RESULTS: A total of 8 clinical studies were included, with 864 patients(864 eyes)with NVG. Meta-analysis showed that the intraocular pressure of patients in the experimental group was lower than that in the control group at 1wk, 1 and 3mo after surgery(1wk: MD=-4.00, 95%CI: -4.62～-3.38, P<0.05; 1mo: MD=-4.11, 95%CI: -4.66～-3.56, P<0.05; 3mo: MD=-4.58, 95%CI: -5.61～-3.55, P<0.05). The best corrected visual acuity of the experimental group was better than that of the control group at 1mo after surgery(MD=0.17, 95%CI: 0.11～0.23, P<0.05), but there was no significant difference at 1wk after surgery(MD=0.08, 95%CI: -0.13～0.29, P=0.47). The patients in the experimental group had fewer complications(OR=0.30, 95%CI: 0.18～0.52, P<0.05)and higher surgical success rate(OR=5.15, 95%CI: 2.78～9.53, P<0.05).CONCLUSION:With decreased intraocular pressure, improved visual acuity and surgical success rate, intravitreal ranibizumab combined with compound trabeculectomy and PRP was better than the compound trabeculectomy and PRP in the treatment of NVG.
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AIM: To investigate the effectiveness of panretinal photocoagulation(PRP)combined with intravitreal conbercept(IVC)for patients with different stages of proliferative diabetic retinopathy(PDR).METHODS: Retrospective study. The medical records for 100 patients(100 eyes)with PDR treated with PRP combined with IVC from January 2018 to June 2020 were reviewed, including 34 eyes with early PDR(group A), 43 with high-risk PDR(group B), and 23 with fibrovascular PDR(group C). The baseline information, best corrected visual acuity(BCVA), central macular thickness(CMT), the rate of vitrectomy and retinal detachment of the patients in the three groups at 1, 3, 6mo and the last follow-up after combination treatment were observed.RESULTS: The patients were followed up for 14.60±11.64mo(6-52mo), with a mean age of 54.22 ±9.32 years. We found 15 eyes(15.0%)who underwent vitrectomy after the combination treatment. The vitrectomy rates of the three groups were 2.9% in group A, 13.9% in group B, and 34.7% in group C. We found no instances of retinal detachment after the treatments. Most patients demonstrated improved BCVA and CMT values with the treatments.CONCLUSION: PRP combined with IVC is safe and effective in patients with different PDR stages.
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@#AIM: To evaluate the differences of macular vascular network measured by optical coherence tomography angiography(OCTA)between severe non-proliferative diabetic retinopathy(S-NPDR)eyes and health eyes, and explore the changes of these OCTA characteristics in patients with S-NPDR before and after panretinal photocoagulation(PRP).<p>METHODS: This was a prospective study including 31 eyes from 18 consecutive patients with S-NPDR and 31 eyes of healthy subjects. We measured macular vascular density and foveal avascular zone(FAZ)area and volume by an OCTA device.<p>RESULTS: Compared to the normal control group, in superficial retinal capillary plexus(SCP), macular vascular density decreased in S-NPDR group, except foveal vascular density unchanged. Consistently, in deep retinal capillary plexus(DCP), macular vascular density was also lower in S-NPDR group. In addition, FAZ area and volume expanded in S-NPDR eyes. At 6mo post-PRP in S-NPDR eyes, foveal SCP and DCP densities increased significantly, while FAZ area and volume decreased. At 3mo post-PRP, only foveal vascular density in DCP increased. The changes of foveal SCP and DCP densities as well as FAZ area and volume were not statically significant at 1mo post-PRP.<p>CONCLUSION: Macular vascular network was impaired in S-NPDR assessed by OCTA. Although OCTA parameters were not significantly affected by PRP in 1 and 3mo period, at 6mo follow-up parameters became significant after PRP.
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@#Targeted retinal photocoagulation(TRP)refers to targeted photocoagulation of the non-perfusion areas(NPA)of the retina, which can greatly reduce the risk of complications of panretinal photocoagulation(PRP). Ultra-wide field fluorescein angiography(UWFFA)can clearly show NPA of the far peripheral retina, which is conducive to precise positioning and implementation of TRP therapy. At present, the safety of short-term TRP treatment programs for proliferative diabetic retinopathy(PDR)is reasonable, but the long-term efficacy is still uncertain. In the future, TRP may become an early treatment option for some PDR patients, by delaying PRP to maintain the visual acuity and central field of vision. Anti-vascular endothelial growth factor(VEGF)drugs are currently the first-line drugs for diabetic macular edema(DME), for which with retinal neovascularization(NV)or poor compliance, combined TRP therapy may be considered. The ischemic index(ISI)is used to quantitatively analyze NPA of the retina under the vision of UWFFA, which is expected to become an important index in the future to guide the selection of clinical TRP treatment options.
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Objective:To explore the damage of panretinal photocoagulation (PRP) to the subbasal nerve plexus (SNP) and its related mechanisms by comparing SNP changes in wide-field mosaic between before and after PRP treatment in diabetic patients.Methods:A randomized controlled study was conducted.Fifty-seven patients (114 eyes) with type 2 diabetes mellitus and binocular diabetic retinopathy (DR) stage IV to receive PRP treatment in Shanxi Eye Hospital from April to November 2019 were enrolled.The subjects were randomly divided into horizontal-vertical laser group and vertical-horizontal laser group according to a random number table.Twenty-nine eyes from 29 patients were assigned to the horizontal-vertical laser group with the photocoagulation sequence of temporal-nasal-inferior-superior.Twenty-eight eyes from 28 patients were assigned to the vertical-horizontal laser group with the photocoagulation sequence of inferior-superior-temporal-nasal.The severer eyes of each subject were chosen as the treatment eye and the contralateral eyes were chosen as the control eye.Corneal confocal laser scanning microscopy (CCM) was performed before PRP treatment, 1 week after each photocoagulation, and 1 month after the completion of PRP treatment to collect images of the SNP over an area of 2-3 mm around the whorl-like pattern.Captured images at each time were merged into one image by using the Photoshop CC 2017 image processing software, and then the nerve fiber length (NFL) of whorl-like pattern was measured by Neuron J image analysis software.McGill pain questionnaire was used to investigate the pain of patients after each photocoagulation.The NFL changes of SNP at different time points were compared between different eyes and different photocoagulation sequence groups.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Shanxi Eye Hospital (No.201804b). Written informed consent was obtained from each patient prior to entering the study cohort.Results:After PRP treatment, there were different degrees of neural structure loss of SNP nerve fibers in 11 treatment eyes, but there was no significant change in SNP nerve fibers in the control eyes.There were significant differences in NFL between the treatment eyes and the control eyes at various time points ( Feyes=2.020, P=0.039; Ftime=4.062, P=0.001). In the horizontal-vertical laser group, different degrees of neural structure loss on the photocoagulation side were found in SNP nerve fibers after the first and second photocoagulation.In the vertical-horizontal laser group, different degrees of neural structure loss on the photocoagulation side were found in SNP nerve fibers after the third and fourth photocoagulation.There was no significant difference in NFL of treatment eyes between the two groups ( Fgroup=0.099, P=0.754), but there was a significant difference in NFL at various time points before and after treatment ( Ftime=5.231, P<0.001). There were 9 (9/57) patients who complained of pain after PRP, which occurred at the first time of photocoagulation in 7 of them. Conclusions:SNP damage may occur after PRP in patients with DR, and SNP is prone to be damaged on the photocoagulation side when performing horizontal photocoagulation.
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@#AIM: To investigate the clinical effectiveness of conbercept intravitreal injection combined with panretinal photocoagulation for ischemic central retinal vein occlusion.<p>METHODS: A retrospective study has been conducted on 80 patients(80 eyes)of ischemic central retinal vein occlusion diagnosed and treated at Dalian No.3 People's Hospital from January 2017 to January 2019. These 80 patients have been divided into two groups based on treatment methods. In Group A, 40 patients(40 eyes)were given 3+PRN intravitreal injection of conbercept combined with panretinal photocoagulation. In Group B, 40 patients(40 eyes)accepted the treatment of 3+PRN intravitreal injection with conbercept. The best corrected visual acuity(BCVA)and central macular thickness(CMT)before and after treatment were recorded respectively at 3mo, 6mo and 12mo, and the clinical effectiveness and adverse reactions were observed and documented.<p>RESULTS: After 12mo: In group A, BCVA improved from 1.05±0.58 to 0.41±0.37(<i>P</i><0.01).In group B, BCVA improved from 0.98±0.51 to 0.63±0.53(<i>P</i><0.01). There was no significant difference between the two groups(<i>P</i>>0.05). In group A, CMT changed from 592.30±79.75μm to 260.08±86.23μm(<i>P</i><0.01). In group B, CMT changed from 604.98±81.73μm to 406.83±162.97μm(<i>P</i><0.01).CMT was better in Group A than Group B(<i>P</i><0.01). The mean number of injections in group A(3.15±0.43 times)and group B(3.83±1.06 times)was statistically significant(<i>P</i><0.01). During follow-up, no adverse events happened in Group A. Two patients were neovascular glaucoma after central retinal vein occlusion in Group B.<p>CONCLUSION:It is safe and effective to use intravitreal injection of conbercept to treat central retinal vein occlusion. Combining intravitreal injection of conbercept with panretinal photocoagulation can significantly improve BCVA, lead to further regression of macular edema and a more stabilized positive effect. It proves to reduce recurrence rate of the central retinal vein occlusion and decrease the chances of any complications.
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@#AIM:To investigate the effect of anti-VEGF combined with panretinal photocoagulation(PRP)in the treatment of severe non-proliferative diabetic retinopathy(sNPDR)with diabetic macular edema(DME)on the change of macular blood flow density.<p>METHODS: Data of 30 eyes in 30 patients at Guangxi Zhuang Autonomous Region People's Hospital from October 2018 to April 2019 were retrospectively reviewed, and they were randomly divided into group A and group B each with 15 cases. Group A was received PRP treatment after one initial intravitreal ranibizumab injection followed by pro re nata(PRN)at 7d, while group B was administered PRP alone. The blood flow density of superficial capillary plexus(SCP)and deep capillary plexus(DCP)in macular area(6mm×6mm), central macular thickness(CMT), and best corrected visual acuity \〖BCVA(LogMAR)\〗 were compared between the two groups before and after treatment. <p>RESULTS: Compared with before operation, the DCP blood flow density was significantly increased, CMT was obviously decreased, and BCVA was markedly improved in group A at 2wk and 1mo after surgery(all <i>P</i><0.05), while CMT was decreased and BCVA was improved in group B at 1mo after operation(all <i>P</i><0.05). Postoperative in group A at 2wk and 1mo, the DCP blood flow density was significantly higher than that in group B(43.37%±2.72% <i>vs</i> 41.03%±2.60%, 45.01%±2.28% <i>vs</i> 41.20%±2.43%, <i>P</i><0.05), CMT was obviously lower than group B(303.4±30.36μm <i>vs</i> 329.60±31.47μm, 268.67±30.27μm <i>vs</i> 319.40±28.63μm, all <i>P</i><0.05), and BCVA(LogMAR)was markedly improved compared with group B(0.28±0.11 <i>vs</i> 0.40±0.13, 0.23±0.14 <i>vs</i> 0.38±0.15, all <i>P</i><0.05).<p>CONCLUSION: Anti-VEGF combined with PRP can effectively increase DCP blood flow density, reduce macular edema and improve visual acuity in the short term in patients with sNPDR with DME.
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@#AIM: To investigate the effect of conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation for neovascular glaucoma(NVG)with and without vitreous hemorrhage.<p>METHODS: In this retrospective study, 39 eyes in 37 patients who were diagnosed with NVG with and without vitreous hemorrhage(where iridotrabecular contact is more than 180°)in the ophthalmology department of Xi'an No.1 Hospital between January 2016 and December 2017 were enrolled in this study. Patients were divided into two groups, based on whether they had vitreous hemorrhage. All patients received 0.5 mg(0.05 mL)conbercept intravitreal injection. Twenty-one eyes in 20 patiants(Group 1)without vitreous hemorrhage received EX-PRESS(P50)glaucoma drainage device implantation on 4d after conbercept intravitreal injection and then received panretinal photocoagulation 2wk after implantation. Eighteen eyes in 17 patients(Group 2)with vitreous hemorrhage received vitrectomy combined with the EX-PRESS(P50)glaucoma drainage device implantation and panretinal photocoagulation on 4d after conbercept intravitreal injection. Air or silicone oil was selectively filled according to the situation during the operation. All patients were followed up for 6mo after operation.<p>RESULTS: No statistical difference was found between preoperative best corrected visual acuity(BCVA)and postoperative(6mo)BCVA in Group 1(<i>P</i>>0.05). There was statistical difference between preoperative BCVA and postoperative(6mo)BCVA in Group 2(<i>P</i><0.05). The intraocular pressure( IOP)of Group 1 at postoperative 1d, 1wk, 1, 3 and 6mo was 20.5±4.3 mmHg, 19.6±3.8 mmHg, 20.1±3.7 mmHg, 19.9±4.2 mmHg, and 19.3±2.9 mmHg, respectively. The postoperative IOP of Group 2 was 22.3±3.7 mmHg, 20.6±2.8 mmHg, 20.4±3.8 mmHg, 18.9±4.1 mmHg, and 19.3±3.4 mmHg, respectively. The postoperative IOP of every time point was significantly lower than the preoperative IOP in Group 1 and Group 2(<i>P</i><0.05). During the follow up, three eyes in three patients showed a recurrence of iris neovascularization and were given one more 0.05 mL conbercept intravitreal injection. <p>CONCLUSION: Conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation can effectively reduce IOP in NVG(where the iridotrabecular touch is more than 180°).
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@#AIM: To evaluate the efficacy and safety of preoperative intravitreal injection of ranibizumab(IVR)and panretinal photocoagulation(PRP)combined with conventional trabeculectomy without drainage device in patients with neovascular glaucoma(NVG).<p>METHODS: The charts of 27 patients(27 eyes)who presented with NVG in our hospital between August 2015 and November 2018 were reviewed. All eyes were treated using the standard protocol of IVR accompanied by PRP, followed by conventional trabeculectomy without drainage device. The main outcomes were intraocular pressure(IOP)control, change in best-corrected visual acuity(BCVA), and surgical complications.<p>RESULTS: The postoperative follow-up periods for all patients were at least 18(mean 21.7±4.3)mo. The IOP significantly decreased from 45.7±5.1 mmHg(baseline)to 18.4±3.6 mmHg(last visit), and BCVA(LogMAR)improved from 2.42±0.68(baseline)to 1.77±0.93(last visit). The success rate was higher in eyes with peripheral anterior synechiae(PAS)≤50% than in those with PAS >50% after 3mo postoperatively. The main surgical complications were hyphema(11.1%)and hypotony with a shallow anterior chamber(14.8%)during the early postoperative stage, along with encapsulated bleb(37.0%)during the mid-late postoperative stage. Serious intraoperative or postoperative complications were not observed.<p>CONCLUSION: IVR and PRP combined with conventional trabeculectomy without drainage device is a safe and effective way in NVG treatment, especially for eyes with PAS ≤50%. Preoperative IVR and PRP appear to improve the success rate.
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ABSTRACT Purpose: To compare visual acuity, macular thickness, and the area of active neovascularization based on fluorescein angiography outcomes associated with standard single-spot panretinal photocoagulation in the Early Treatment Diabetic Retinopathy Study (ETDRS) pattern combined with intravitreal ranibizumab injection versus multiple-spot full scatter (PASCAL) panretinal photocoagulation combined with intravitreal ranibizumab injection versus intravitreal injection alone in patients with proliferative diabetic retinopathy. Methods: Patients with proliferative diabetic retinopathy and no prior laser treatment were randomly assigned to receive three different types of treatment. Panretinal photocoagulation in the ETDRS group was administered in two sessions (weeks 0 and 2), and panretinal photocoagulation in the PASCAL group was administered in one session (week 0). Intravitreal injection of ranibizumab was administered at the end of the first laser session in both the ETDRS and PASCAL groups and at week 0 in the intravitreal injection group. Comprehensive ophthalmic evaluations were performed at baseline and every 4 weeks through week 48. Results: Thirty patients (n=40 eyes) completed the 48-week study period. After treatment, best-corrected visual acuity was significantly (p<0.05) improved at all follow-up visits in the group receiving intravitreal injection alone, at all but week 4 in the ETDRS group, and at all but weeks 4 and 8 for the PASCAL group. A significant decrease in central subfield macular thickness was observed in the PASCAL group at weeks 4, 8, and 48; only at week 48 in the intravitreal injection group; and never in the ETDRS group. There was no significant difference among the three treatment groups with respect to change from baseline to week 48 in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization. Conclusions: Intravitreal injection alone or combined with single- or multiple-spot panretinal photocoagulation yielded similar outcomes with respect to mean change in best-corrected visual acuity, central subfield macular thickness, and fluorescein leakage from active neovascularization at up to one-year of follow-up. All subjects provided written informed consent to participate (NCT02005432 in clinicaltrials.gov).
RESUMO Objetivo: Comparar as medidas de acuidade visual, espessura macular central e área de neovasos ativos na angiofluoresceinografia submetidos a panfotocoagulação retiniana padrão ETDRS associado a injeção intravítrea de ranibizumabe versus panfotocoagulação padrão PASCAL associado a injeção intravítrea de ranibizumabe versus somente injeção intravítrea de ranibizumabe em pacientes com retinopatia diabética proliferativa. Métodos: Pacientes com retinopatia diabética proliferativa e virgens de tratamento, randomicamente divididos nas três diferentes terapias retinianas. Panfotocoagulação no grupo ETDRS em 2 sessões (semanas 0 e 2) e no grupo PASCAL, na semana 0. Injeção intravítrea de ranibizumabe realizado ao fim da primeira sessão de laser em ambos os grupos: ETDRS e PASCAL, e na semana 0 no grupo injeção intravítrea de ranibizumabe. Avaliações oftalmológicas, tomografia de coerência óptica e angiofluoesceinografia realizados na visita basal e a cada 4 semanas por 48 semanas. Resultados: Trinta pacientes (n=40 olhos) completaram as 48 semanas de seguimento. Após o tratamento, a acuidade visual melhorou significantemente em todas a visitas no grupo injeção intravítrea de ranibizumabe (p<0,05); em todas exceto na semana 4 no grupo ETDRS, em todas exceto nas semanas 4 e 8 no grupo PASCAL. Redução significativa na espessura do subcampo central foi evidenciada no grupo PASCAL nas semanas 4, 8 e 48; somente na semana 48 no grupo injeção intravítrea de ranibizumabe, e em nenhuma visita no grupo ETDRS. Redução também na área de neovasos ativos em todas as visitas em todos os grupos. Não houve diferença significante entre os três grupos com relação a mudança media na medidas de acuidade visual, espessura macular central ou área de neovasos ativos da visita inicial para a semana 48. Conclusões: Somente IVB ou este associado a panfotocoagulação ETDRS ou PASCAL, apresentaram efeitos semelhantes em relação a medidas de acuidade visual, espessura do subcampo central e área de neovasos ativos no decorrer de 48 semanas de seguimento.
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Humans , Angiogenesis Inhibitors/therapeutic use , Diabetes Mellitus , Diabetes Mellitus/drug therapy , Diabetic Retinopathy , Diabetic Retinopathy/surgery , Diabetic Retinopathy/drug therapy , Treatment Outcome , Laser Coagulation , Intravitreal Injections , Ranibizumab/therapeutic useABSTRACT
@#AIM: To investigate the timing of using anti-VEGF drugs in severe non-proliferative diabetic retinopathy(SNPDR)patients with diabetic macular edema(DME)treated with intravitreal injection of Conbercept(IVC)combined with panretinal photocoagulation(PRP). <p>METHODS: Totally 85 SNPDR patients(85 eyes)with DME diagnosed in our hospital from May 2017 to October 2018 were randomly divided into control group(<i>n</i>=29 cases), IVC group(<i>n</i>=28 cases), PRP group(<i>n</i>=28 cases). The control group was treated with PRP only; the IVC group was given PRP 1wk after IVC; the PRP group was given IVC 1wk after PRP. The follow-up time was 12mo. Changes of the best corrected visual acuity(BCVA)and central macular thickness(CMT)were observed before and 1, 3, 6, 12mo after treatment, and the frequency of IVC were recorded.<p>RESULTS: Compared with before treatment, the BCVA of the three groups after treatment improved, and the CMT decreased(<i>P</i><0.05). after treatment, the BCVA of the IVC group and the PRP group was better than the control group, and the CMT was lower than the control group(<i>P</i><0.05). 3mo after treatment, BCVA(0.24±0.18, LogMAR)in the ICV group decreased more than that in the PRP group(0.38±0.29, LogMAR)(<i>P</i><0.05). At 1 and 3mo after treatment, CMT in the ICV group(1mo 313.89±61.69um, 3mo 287.64±43.94μm)decreased more than that in the PRP group(1mo 347.50±56.55μm, 3mo 318.04±49.334μm), and the difference was significant difference(<i>P</i><0.05). The frequency of IVC was(3.07±1.33)times in the IVC group and(3.93±1.60)times in the PRP group(<i>P</i><0.05).<p>CONCLUSION: In SNPDR patients with DME, IVC combined with PRP is better than PRP alone. Anti-VEGF drugs before PRP can obtain better BCVA, reduce macular edema in the short-term observation. In long-term observation, it can also reduce the frequency of IVC, the risk of infection and the financial burden.
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@#AIM: To explore the effect of fundus laser combined with Qi Ming granule on diabetic retinopathy in stage Ⅲ.<p>METHODS: Fifty six patients with Ⅲ stage diabetic retinopathy who were treated in our hospital from December 2017 to June 2018 were divided into control group(28 cases)and observation group(28 cases)according to the treatment method. The control group was treated with panretinal photocoagulation. The observation group was treated with Qi Ming granule combined with retinal laser photocoagulation. The best-corrected visual acuity(BCVA), mean defect of visual field(MD), and central macular thickness(CMT)were examined before photocoagulation and 1mo, 3mo and 6mo after photocoagulation to compare the retinal function between the two groups.<p>RESULTS: The mean BCVA, MD and CMT values of the eyes in the PRP+ drug treatment group and the PRP treatment group were statistically significant(<i>P</i><0.05)at 1, 3, and 6mo after treatment. The mean BCVA, MD and CMT values between the two groups were statistically significant(<i>P</i><0.05)at 1 and 3mo after treatment. There was no significant difference at 6mo after treatment(<i>P</i>>0.05).<p>CONCLUSION: Qi Ming granule can alleviate the degree of laser photocoagulation damage to the retina, promote the rapid repair of laser damage, and reduce diabetic macular edema. It is worthy of popularization and application in the clinic.
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@#AIM: To observe the changes of retinal nerve fiber layer(RNFL)thickness and visual field loss in patients with severe non proliferative diabetic retinopathy(NPDR)treated by panretinal photocoagulation(PRP).<p>METHODS: This was a prospective clinical study. From January 2017 to March 2018, 35 patients(52 eyes)with severe NPDR diagnosed in our hospital were selected as photocoagulation group(conventional therapy combined with PRP)and 35 patients(52 eyes)with severe NPDR matched with age and gender in the same period were selected as the control group(conventional therapy, use difrarel, ginkgo leaves tablets, mecobalamin and other drugs to protect blood vessels, improve microcirculation and nourish nerves). The best corrected visual acuity(BCVA), RNFL thickness and visual field of the two groups were compared after 1a after treatment.<p>RESULTS: There was no significant difference in BCVA before and after treatment in the photocoagulation group(<i>P</i>>0.05), but the BCVA of the control group decreased(<i>P</i><0.05). There was no significant difference in temporal RNFL thickness(74.5±13.7μm <i>vs</i> 70.8±11.3μm, <i>P</i>>0.05)in the photocoagulation group, and the thickness of RNFL in the other quadrants and the mean RNFL were thinner than those before treatment(<i>P</i><0.05); there was no significant change in the MS of the corresponding field of vision of the temporal nerve fiber(22.5±8.7dB <i>vs</i> 20.8±7.2dB, <i>P</i>>0.05), the other quadrants and the mean MS were lower than those before treatment(<i>P</i><0.05). Before and after treatment, the change of RNFL thickness of the patients in the photocoagulation group showed weak positive correlation or no correlation with the change of visual field MS corresponding to the RNFL at nasal, nasal superior, temporal superior, temporal, temporal superior, temporal inferior and average RNFL.<p>CONCLUSION: PRP can effectively control the further development of severe NPDR and maintain the visual acuity of patients, but the damage of PRP to RNFL and visual field cannot be ignored.
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@#Neovascular glaucoma(NVG)is a common refractory glaucoma in ophthalmology, which is usually secondary to central retinal vein occlusion(CRVO), diabetic retinopathy(DR), long-standing retinal detachment, ocular tumors, <i>etc</i>. Previous treatments mainly included panretinal photocoagulation(PRP), drugs, anti-glaucoma surgery or ciliary destruction, but the therapeutic effect was unsatisfactory. With the continuous development and application of anti-vascular endothelial growth factor(VEGF)drugs, combination therapy of anti-vascular endothelial growth factor(VEGF)drugs has been proposed gradually, and the success rate of NVG surgery has been increased significantly, and NVG can be controlled. The treatment progress of NVG in recent years will be described in detail.
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@#Neovascular glaucoma(NVG)is a common refractory glaucoma in ophthalmology, which is usually secondary to central retinal vein occlusion(CRVO), diabetic retinopathy(DR), long-standing retinal detachment, ocular tumors, <i>etc</i>. Previous treatments mainly included panretinal photocoagulation(PRP), drugs, anti-glaucoma surgery or ciliary destruction, but the therapeutic effect was unsatisfactory. With the continuous development and application of anti-vascular endothelial growth factor(VEGF)drugs, combination therapy of anti-vascular endothelial growth factor(VEGF)drugs has been proposed gradually, and the success rate of NVG surgery has been increased significantly, and NVG can be controlled. The treatment progress of NVG in recent years will be described in detail.
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@#AIM: To investigate the effect of panretinal photocoagulation(PRP)combined with intravitreal injection of conbercept as an adjuvant to neovascular glaucoma secondary to central retinal vein occlusion(CRVO). <p>METHODS: This was a prospective case-control study. Patients diagnosed with neovascular glaucoma(stage Ⅰor Ⅱ)secondary to CRVO in our hospital from January 2014 to March 2019 were enrolled and randomly divided into two groups. Patients in combination group were treated with both PRP and intravitreal conbercept injection. In the other group(PRP only group)patients were treated with PRP only. Changes of best corrected visual acuity(BCVA), intraocular pressure(IOP)and iris neovascularization(NVI)were observed before treatment, 1wk, 1mo, 3mo, 6mo and 9mo after treatment.<p>RESULTS: Sixty patients 60 eyes were enrolled, with the mean age of 54.45±6.08 years. 56.67% were males. There were no significant difference between two groups in age and gender. After treatment, all the indexes of the two groups improved obviously with significant different(<i>F</i>=154.992, 92.519, 30.696, 82.374, all <i>P</i><0.001), visual acuity improved, IOP decreased, and NVI decreased at different time points. The difference was statistically significant compared with the control group one week after treatment(<i>F</i>=50.870, 24.265, 13.125, 11.829, all <i>P</i><0.001), and it was maintained continuously.<p>CONCLUSION: For eyes with CRVO secondary with neovascular glaucoma, intravitreal injection of conbercept combined with panretinal photocoagulation PRP is better than panretinal photocoagulation PRP only.
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@#AIM: To observe the clinical effect of ranibizumab injection combined with vitrectomy,panretinal photocoagulation(PRP)and trabeculectomy in the treatment of neovascular glaucoma(NVG).<p>METHODS: Retrospective study. From March 2017 to October 2018, 44 NVG patients(44 eyes)were treated, 22 patients(22 eyes)were treated with intravitreal injection of ranibizumab + vitrectomy + PRP+trabeculectomy(group A), and 22 patients(22 eyes)were treated with intravitreal injection of ranibizumab + trabeculectomy+PRP(group B).The patients were followed up for 6mo, the visual acuity, intraocular pressure(IOP), IOP control rate, neovascularization and complications were observed. <p>RESULTS: There was no significant difference in IOP between the two groups before treatment(46.2±9.41mmHg <i>vs</i> 49.1±10.15mmHg, <i>P</i>>0.05). The IOP of group A was lower than that of group B at 1wk, 1mo and 6mo after treatment(<i>P</i><0.05). 6mo after treatment, the visual acuity, IOP control rate(95%)and neovascularization regression(91%)in group A were better than those in group B(<i>P</i><0.05), but there was no difference in the incidence of complications between the two groups during the follow-up period(<i>P</i>>0.05).<p>CONCLUSION: It is safe and effective to treat NVG with intravitreal ranibizumab injection combined with vitrectomy, PRP and trabeculectomy, which can control IOP steadily and improve visual acuity of some patients.
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@#AIM: To analyze the effect of 532nm laser panretinal photocoagulation(PRP)combined with calcium dobesilate on fundus microcirculation and macular thickness in patients with diabetic retinopathy(DR), so as to provide experimental data for their clinical treatment. <p>METHODS: According to the non-randomized clinical concurrent control study and voluntary principle, 174(239 eyes)DR patients were divided into observation group and control group. Both groups were treated with 532nm laser PRP, and the observation group was additionally treated with calcium dobesilate. BCVA(LogMAR)vision, clinical effect, fundus microcirculation, macular thickness and other clinical indexes were compared between the two groups before and after treatment(at 3mo after PRP). The incidence of complications during treatment was statistically analyzed. <p>RESULTS: After treatment, BCVA in both groups were increased, and it was higher in observation group than control group. The clinical curative effect of observation group was better than that of control group(<i>P</i><0.001). After treatment, the resistance index(RI)of central retinal artery(CRA)and osterior ciliary artery(PCA)in both groups were decreased(<i>P</i><0.05), while the peak systolic velocity(PSV)and end diastolic velocity(EDV)were increased(<i>P</i><0.05). RI in observation group was lower than that in control group, while EDV and PSV were higher than those in control group(<i>P</i><0.001). After treatment, the macular thicknesses and other clinical indexes(hemangioma, bleeding spots, gray value of visual field)in both groups were decreased(<i>P</i><0.05), and they were lower in observation group than control group(<i>P</i><0.001). There was no significant difference in the incidence rate of complications between the two groups(0.8% <i>vs </i>2.6%)(χ2=0.344, <i>P</i>=0.557). <p>CONCLUSION: Compared with 532nm PRP in treatment of DR, curative effect of 532nm PRP combined with calcium dobesilate is better. The latter can improve fundus microcirculation and macular thickness more significantly, with high safety.
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@#Diabetic retinopathy(DR)is a common microvascular complication of diabetes caused by chronic hyperglycemia and ischemia, which can seriously impair the patient's vision or even cause blindness. The main causes of visual impairment include macular edema, vitreous hemorrhage and neovascular glaucoma. Retinal laser photocoagulation is one of the most important therapies for DR. The thermal effects of laser photocoagulation can denature proteins, coagulate and destruct tissue, and finally scars occur. The scar tissue which consumes very low oxygen replaces the cones and rod and reduces tissue oxygen consumption significantly, and relieves the retinal ischemia and hypoxia especially for the middle and peripheral part of retina. However, complications such as macular edema, vitreous hemorrhage, and visual field defects may occur easily following laser treatment. This article reviews recent literatures about the complications and preventions of laser photocoagulation in DR treatment.