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Objective:To investigate the expression levels of serum miR-126 and miR-9 in patients with wet age-related macular degeneration (wAMD) and their relationship with vascular endothelial growth factor (VEGF) and central macular thickness (CMT).Methods:A total of 73 wAMD patients(observation group) admitted to the ophthalmology department of Taizhou Municipal Hospital from May 2020 to May 2021 and 60 healthy subjects (control group) who underwent physical examination during the same period were selected. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression levels of miR-126 and miR-9 in serum of the two groups. Serum angiogenesis regulatory factors [VEGF, tissue inhibitor of melalloproteinuses-1 (TIMP-1), endostatin (ES), platelet-derived growth factor (PDGF)] were detected by enzyme-linked immunosorbent assay (ELISA), and CMT and intraocular pressure (IOP) were measured. Pearson correlation analysis was performed to determine the correlation between miR-126 and miR-9 and serum angiogenesis regulatory factor levels, CMT and IOP. The diagnostic value of miR-126 and miR-9 in wAMD was analyzed by receiver operating characteristic (ROC) curve.Results:The relative expression level of serum miR-126 in observation group was significantly lower than that in control group ( P<0.05) , while the relative expression level of serum miR-9 was significantly higher than that in control group ( P<0.05). The levels of serum VEGF and PDGF in observation group were significantly higher than those in control group (all P<0.05), while the levels of serum TIMP-1 and ES were significantly lower than those in control group (all P<0.05). CMT and IOP in observation group were significantly higher than those in control group (all P<0.05). The expression level of serum miR-126 in observation group was negatively correlated with serum VEGF, PDGF, CMT and IOP ( r=-0.275, -0.523, -0.302, -0.542, all P<0.05), and was positively correlated with TIMP-1 and ES ( r=0.460, 0.263, all P<0.05). Serum miR-9 expression level was positively correlated with serum VEGF, PDGF, CMT and IOP ( r=0.434, 0.438, 0.396, 0.307, all P<0.05), and was negatively correlated with TIMP-1 and ES ( r=-0.256, -0.310, all P<0.05). The area under curve (AUC) values of serum miR-126 and miR-9 in diagnosing wAMD were 0.713 and 0.847 respectively. Conclusions:The expression level of serum miR-126 is significantly decreased while the expression level of miR-9 is significantly increased in patients with wAMD. miR-126 is negatively correlated with VEGF and CMT, and miR-9 is positively correlated with VEGF and CMT, which may aggravate the disease by promoting the inflammatory response. The detection of expression levels of serum miR-126 and miR-9 is helpful to provide the reference basis for early diagnosis of wAMD and early prevention and treatment.
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Objective:To observe the efficacy of intravitreal injection of conbercept (IVC) in the treatment of type 1 macular neovascularization (MNV) with different types of pigment epithelial detachment (PED) in neovascular age-related macular degeneration (nAMD).Methods:A retrospective clinical study. From June 2018 to June 2021, 42 patients with 42 eyes of nAMD type 1 MNV patients with different types of PED diagnosed in the ophthalmological examination of the Department of Ophthalmology, General Hospital of Central Theater Command were included in the study. All eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT). The OCT examination was performed with a 3D-OCT 2000 instrument from Topcon Company in Japan. The fovea was scanned, and the PED height (PEDH), PED area (PEDA), PED volume (PEDV), and central foveal thickness (CFT) were measured. According to the OCT image features of PED, the affected eyes were divided into serous PED (sPED), fibrovascular PED (fPED), and hemorrhagic PED (hPED), and were grouped accordingly. Among the 42 eyes, 16 (38.1%, 16/42), 14 (33.3%, 14/42), and 12 (28.6%, 12/42) eyes were in the sPED group, fPED group, and hPED group, respectively. All patients received IVC treatment once a month for 3 consecutive months, and then on-demand treatment after assessment. BCVA and OCT were re-examined 3, 6, and 12 months after treatment, and the changes of BCVA, PEDH, PEDA, PEDV, and CFT in the affected eyes before and after treatment were compared, and repeated measures analysis of variance was used for statistical analysis.Results:At 12 months after treatment, the PEDH, PEDA and PEDV of the affected eyes in the sPED group, fPED group and hPED group were significantly lower than those before treatment, and the difference was statistically significant ( P<0.05). The difference in the degree of improvement was -318.67±258.09 μm, -6.50±6.33 μm 2, -1.95±1.78 μm 3 in the hPED group; -119.31±224.13 μm, -0.86 ±5.00 μm 2, -0.56±1.64 μm 3 in the sPED group; fPED group were -53.93±92.51 μm, -0.76±2.54 μm 2, -0.19±0.46 μm 3. The improvement degree of the affected eyes in hPED group was significantly greater than that in sPED group and fPED group, and the difference was statistically significant ( F=5.918, 6.029, 5.494; P<0.05). Compared with the BCVA and CFT before treatment, 12 months after treatment, the difference was statistically significant in the fPED group and the hPED group ( P<0.05); there was no significant improvement in the sPED group ( P>0.05). There was no significant difference in the BCVA of the affected eyes in the three groups compared with those before treatment ( F=0.817, 0.741, 0.848; P>0.05). Conclusion:Conbercept can effectively improve or stabilize the visual function and anatomical morphology of eyes with type 1 MNV in nAMD with sPED, fPED and hPED, among which the anatomical effect is better for hPED.
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With the rapid development of fundus imaging technology, it is of great significance to establish a new naming system for neovascular age-related macular degeneration (nAMD) based on the multi-mode imaging. In 2020, an international panel of retina specialists, imaging and image reading center experts, and ocular pathologists reached a consensus after repeated discussions, a new name for nAMD subtype and related lesions was established based on the previous knowledge of fundus fluorescein angiography and pathology, combining indocyanine green angiography, optical coherence tomography and optical coherence tomography angiography with current pathological knowledge, in order to help ophthalmologists to study nAMD. The consensus proposed the term "macular neovascularization" and classified it into type 1, type 2 and type 3. Many lesions related to macular neovascularization, such as pigment epithelial detachment, hemorrhage, fibrosis, rip of retinal pigment epithelium and so on, were named. The new designation will help improve clinical communication between different studies, establish standard definitions and terms between reading centers and researchers, and further promote the understanding and communication of nAMD among ophthalmologists.
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Objective:To observe the relationship between the response to anti-vascular endothelial growth factor (VEGF) drug treatment and single nucleotide polymorphism (SNP) genotype in patients with wet age-related macular degeneration (wAMD).Methods:A retrospective clinical study. From August 2019 to September 2020, 103 eyes of 103 wAMD patients diagnosed in Tianjin Medical University Eye Hospital were included in the study. Among them, there were 59 males (57.28%, 59/103) and 44 females (42.72%, 44/103); the average age was 68.74±7.74 years. The standard logarithmic visual acuity chart was used to detect the Best Corrected Visual Acuity of the affected eye and converted to the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. Optical coherence tomography was used to detect the central retinal thickness (CRT) of the affected eye. At the same time, the patient's high-density lipoprotein cholesterol (HDL-C) was tested. All eyes were treated with intravitreal injection of anti-VEGF drugs once a month for 3 months. Before the initial treatment, peripheral venous blood from the patient were collected. Interleukin-8 ( IL-8), complement C3 gene ( C3), complement factor H ( CFH), liver lipase ( LIPC), cholesterol ester transfer protein ( CETP), ATP binding cassette subfamily a member 1 ( ABCA1), lipoprotein lipase ( LPL), fatty acid desaturation gene cluster ( FADS1) SNP. According to gene frequency, genotypes are divided into wild type and mutant type were detected. Qualitative data such as the frequency difference of the genotype distribution in the clinical phenotype and the Hardy-Weinberg equilibrium of the genotype distribution were compared with the Chi-square test or Fisher's exact test. Results:There were fewer CRT responders in IL-8 rs4073 mutant (TA+AA) patients than wild-type (TT) [odds ratio ( OR)=0.310, 95% confidence interval ( CI) 0.106-0.910, P<0.05). Among them, after the drug stratification test, the proportion of patients with IL-8 rs4073 locus TT genotype in the conbercept treatment group was less CRT non-responders ( OR=0.179, 95% CI=0.034-0.960, P=0.033). Patients with LIPC rs2043085 mutant (CT+TT) with BCVA increased ≥0.2 logMAR are more likely than wild-type (CC) ( OR=3.031, 95% CI 1.036-8.867, P<0.05); HDL-C level was significantly lower Compared with wild type (CC), the difference was statistically significant ( t=2.448, P=0.016). There was no significant difference in logMAR BCVA and CRT between IL-8 rs4073, LIPC rs2043085 mutant and wild-type patients before treatment ( IL-8 rs4073: Z=-0.198, -1.651; P=0.843, 0.099; LIPC rs2043085: Z=-0.532, -0.152; P=0.595, 0.879). C3 rs 225066, CFH rs800292, CETP rs708272, ABCA1 rs1883025, FADS1 rs174547, LPL rs12678919 have no correlation with anti-VEGF drug treatment response. Conclusions:Patients with wAMD are treated with anti-VEGF drugs. Those with IL-8 rs4073 locus A genotype may be less responsive to CRT. LIPC rs2043085 locus T genotypes may be relatively more responsive to BCVA.
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Objective:To observe the short-term effects of intravitreal injection of aflibercept (IVA) for initial treatment and dressing change on exudative age-related macular degeneration (eAMD).Methods:A retrospective clinical study. From June 2018 to February 2021, forty-nine eAMD eyes of 38 patients who underwent IVA treatment in Department of Ophthalmology of Central Theater Command Hospital of People’s Liberation Army were included in the study. Among them, there were 24 males with 29 eyes and 14 females with 20 eyes; the average age was 66.82±8.71 years. All affected eyes were treated with IVA. The initial loading dose was 2.0 mg, which was injected once a month for 3 consecutive months, followed by monthly review and treatment as needed. Of the 49 eyes, 26 eyes were initially treated (initial treatment group), they were diagnosed within 3 months of the first onset and followed by IVA treatment, and no intraocular drugs and surgery were performed from the onset to the first diagnosis. Twenty-three eyes were treated with drug exchange therapy (dressing change group), they received intravitreal injection of ranibizumab and/or conbercept more than 4 times 6 months before the replacement therapy, during which there was persistent interlaminar cystoid edema and/or subretinal fluid (SRF) in the macular area and no improvement in pigment epithelial detachment (PED). Before IVA treatment, there were no statistically significant differences in the best corrected visual acuity (BCVA), foveal thickness (CMT), PED height (PEDH), and PED volume (PEDV) of the two groups of eyes before IVA treatment ( P>0.05). The same equipment and methods as before treatment were used for related examinations, and the changes of BCVA, CMT, PEDH, PEDV and complications of the two groups of eyes were recorded in 1, 3, and 6 months after treatment. The comparison of BCVA, CMT, PEDH, and PEDV between the two groups were used repeated measures analysis of variance. Results:Six months after treatment, the number of IVA injections in the eyes of the initial treatment group and dressing change group were 4.15±0.73 and 4.39±0.72 times, respectively, and the difference was not statistically significant ( t=-1.141, P=0.260). The BCVA, CMT, PEDH, and PEDV of the the initial treatment group ( F=5.345, 22.995, 6.764, 5.425) and the dressing change group ( F=12.519, 15.576, 8.843, 9.406) were significantly improved compared before treatment with 1, 3, and 6 months. All were statistically significant ( P<0.05). There was no significant difference in BCVA, CMT, PEDH, and PEDV between the initial treatment group and the dressing group at each time point after treatment ( F=1.741, 0.069, 0.876, 3.455; P>0.05). During the follow-up period, none of the affected eyes had complications such as persistent intraocular pressure increase, endophthalmitis, and retinal pigment epithelial tear. Conclusions:IVA can improve eyesight of patients with eAMD and reduce CMT, PEDH, and PEDV. The initial treatment and dressing change have the same effect.
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Objective@#To investigate the efficacy and safety of conbercept injection in the treatment of exudative age-related macular degeneration(AMD).@*Methods@#From October 2016 to October 2017, 300 patients(300 eyes) with exudative AMD in Linfen Central Hospital were divided into two groups according to the random number table method.The study group(150 cases and 150 eyes) received intravitreal injection of 0.05 mL of conbercept once a month for 3 months.The control group(150 cases and 150 eyes) received conservative treatment.All patients were followed up for 12 months after treatment.The differences of BCVA, CMT, QOL, clinical efficacy and complications between the two groups were compared.@*Results@#BCVA was significantly increased and CMT was significantly decreased in the two groups after treatment, and BCVA was higher in the study group at 9 months [(0.55±0.11) vs.(0.51±0.15)], 12 months [(0.59±0.21) vs.(0.53±0.11)] after treatment compared with the control group(t=2.634, 3.010, all P<0.05), and CMT was lower in the study group at 1-12 months after treatment(t=5.321, 20.035, 25.593, 22.456, 26.326, 27.005, all P<0.05). At the last follow-up, the distant vision, regulating ability, reading and fine work scores in the study group were (55.27±8.24)points, (30.21±5.20)points, (20.15±5.01)points, (47.02±12.34)points, respectively, which were better than those in the control group[(50.21±6.35)points, (25.34±4.17)points, (16.24±3.27)points, (40.25±9.25)points](t=6.352, 5.324, 6.392, 8.251, all P<0.05). The total effective rate of the study group[88.00%(132/150)] was higher than that of the control group[76.67%(115/150)](χ2=6.623, P<0.05). There were no serious complications in the two groups.@*Conclusion@#Conbercept injection can significantly improve the eyesight of exudative AMD patients, improve the quality of life, it is safe and reliable, and its treatment effect for AMD is better than traditional conservative treatment.
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Objective To investigate the efficacy and safety of conbercept injection in the treatment of exudative age－related macular degeneration ( AMD).Methods From October 2016 to October 2017,300 patients (300 eyes) with exudative AMD in Linfen Central Hospital were divided into two groups according to the random number table method.The study group (150 cases and 150 eyes ) received intravitreal injection of 0.05 mL of conbercept once a month for 3 months.The control group(150 cases and 150 eyes) received conservative treatment. All patients were followed up for 12 months after treatment.The differences of BCVA ,CMT,QOL,clinical efficacy and complications between the two groups were compared.Results BCVA was significantly increased and CMT was significantly decreased in the two groups after treatment,and BCVA was higher in the study group at 9 months [(0.55 ± 0.11) vs.(0.51 ±0.15)],12 months [(0.59 ±0.21) vs.(0.53 ±0.11)] after treatment compared with the control group(t＝2.634,3.010,all P＜0.05),and CMT was lower in the study group at 1－12 months after treatment(t＝5.321, 20.035,25.593,22.456,26.326,27.005,all P＜0.05).At the last follow－up,the distant vision,regulating ability, reading and fine work scores in the study group were (55.27 ±8.24) points,(30.21 ±5.20) points,(20.15 ± 5.01)points,(47.02 ±12.34) points,respectively, which were better than those in the control group [( 50.21 ± 6.35)points,(25.34 ±4.17)points,(16.24 ±3.27)points,(40.25 ±9.25) points](t＝6.352,5.324,6.392,8.251, all P＜0.05).The total effective rate of the study group [88.00%(132／150)] was higher than that of the control group[76.67%(115／150)](χ2 ＝6.623,P＜0.05).There were no serious complications in the two groups.Conclusion Conbercept injection can significantly improve the eyesight of exudative AMD patients ,improve the quality of life,it is safe and reliable,and its treatment effect for AMD is better than traditional conservative treatment .
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Objective To assess the efficacy and safety ofintravitreal aflibercept injection (IAI) compared with photodynamic therapy (PDT) in the treatment of Chinese patients with predominantly classic subfoveal choroidal neovascularization (CNV) lesions secondary to neovascular age-related macular degeneration (nAMD).Methods A randomized,double-blind,multi-center phase-3 clinical trial lasting for 52weeks (from December 2011 to August 2014).Subjects were randomized in a 3:1 ratio to either IAI group or PDT-to-IAI group.Subjects in the IAI group received 2 mg IAI at baseline and at week 4,8,16,24,32,40,48,with sham injection at week 28,36.Subjects in the PDT-to-IAI group were forced to receive PDT once at baseline and more time at week 12,24 if PDT retreatment conditions were met.Sham injections were given in PDT-to-IAI group at baseline and at week 4,8,16 and 24,followed by 2 mg IAI at week 28,32,36,40,48.The primary outcome of efficacy were the change in mean Best Corrected Visual Acuity (BCVA) from baseline to week 28,and that of week 52.Safety evaluation included the percentage of subjects who suffered treatment emergent adverse events (TEAEs).Results Among the 304 subjects enrolled,there were 228 and 76 cases in IAI group and PDT-to-IAI group respectively.At week 28,the changes of mean BCVA in IAI group,PDT-to-IAI group compared to baseline were +14.0,+3.9 letters,respectively.At week 52,the changes of mean BCVA in two groups were + 15.2,+8.9 letters respectively with the difference of +6.2 letters (95％CI 2.6-9.9,P=0.000 9).At week 52,the mean foveal retinal thickness in the two groups decreased by-189.6,-170.0 μm,respectively.Subjects with the most BCVA increase in IAI group were those aged ＜65,and those with active CNV lesion area ＜50％ of total lesion area.The most common TEAEs in IAI group and PDT-to-IAI group are macular fibrosis [11.8％ (27/228),6.6％ (5/76)] and BCVA decline [6.6％ (15/228),21.1％ (16/76)].There were 3 cases of arterial thromboembolic events defined in the antiplatelet experimental collaboration group,but all were considered unrelated to interventions.Conclusions The efficacy of aflibercept is superior to that of PDT in nAMD patients in China.The therapeutic effect of aflibercept persisted to week 52 in all subjects.The rate of adverse events was consistent with the safety data of aflibercept known before.
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Objective To observe the OCT angiography imaging features of choroidal neovascularization (CNV) with different activity in age-related macular degeneration (AMD).Methods A retrospective case analysis.Forty-two eyes of 33 patients (21 males and 12 females,aged 65.3 ± 8.61 years) who were diagnosed with AMD by multi-mode fundus imaging examination at the Ophthalmology Department of Yunnan Second People's Hospital during January 2017 and October 2018 were enrolled in this study.All patients underwent BCVA,slit-lamp biomieroscopy,indirect ophthalmoscopy,fundus colorized photography,FAF,FFA and OCT examinations.The patients were divided into active CNV (27 eyes of 19 patients) and inactive CNV (15 eyes of 14 patients) by comprehensive analysis of fundus imaging characteristics and treatment process.The imaging features of OCTA in the two groups were compared.The number of eyes of each active or inactive indicator in the active CNV group and the inactive CNV group was calculated,and the composition ratio of each group of the indicators was subjected to the x2 test.Results Among the 27 eyes of active CNV,22 eyes (81.5％) of OCTA showed abundant small capillary branching structure,while 13 eyes (13.3％) of 15 eyes of inactive CNV showed more coarse blood vessel.Among the 27 eyes of active CNV,26 eyes (96.3％) of OCTA showed that the marginal vascular end points of CNV lesions were "arcaded" or "ring",while 12 eyes (80.0％) of 15 eyes of inactive CNV showed the presence of isolated branches of peripheral vessels.Among the 27 eyes with active CNV lesions,there were no large feeder vessels inside the lesions,and 8 (53.3％) of the 15 inactive CNV lesions showed feeder vessels in the center of the lesion.Among the 27 eyes with active lesions,23 eyes (85.2％) of OCTA showed a low-reflection "halo" around the CNV lesion,and no low-reflection "halo" structure was observed in the 5 eyes of the inactive CNV lesion.The statistical results showed that there were abundant small blood vessel branches (x2=22.759,P=0.000),annular anastomosis around the lesion (x2=31.704,P=0.000),lowreflection halo (x2=32.327,P=0.000),and large nourishing blood vessels (x2=26.063,P=0.000),dilated choroidal vessels (x2=32.912,P=0.000).All the above indicators were statistically different between the two groups.Conclusion The abundant small vessel branches in OCTA,the surrounding anastomosis in a ring structure and the low reflex halo around the lesion are markers of active CNV,while the large feeding vessels and dilated choroidal vessels are indicators of inactive CNV.
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Objective To compare the features of OCT angiography (OCTA) between neovascular agerelated macular degeneration (nAMD) and myopic ehoroidal neovascularization (mCNV) patients before and after intravitreal anti-VEGF treatment.Methods A prospective cohort study.Twenty-nine patients (37 eyes) with nAMD (19 males and 10 females,aged 68.20±8.76) and 31 patients (34 eyes) with mCNV (9 males and 22 females,aged 43.10± 11.80,with the mean diopter of-9.71 ± 1.20 D) from Department of Ophthalmology,West China Hospital of Sichuan University during May and December 2017 were included in this study.Ranibizumab or Conbercept (0.5 mg/0.05 ml) was intravitreally injected in all eyes.The patients were follow-up for 3-6 months.The OCTA was conducted before treatment and 1 day,1 week,1 month and 3-6 months after treatment.In order to ensure that the scanning position was the same,the tracking mode was adopted for each scanning.According to the OCTA images,the lesion area,parafoveal superficial vessel density and perfusion area were measured and analyzed contrastively between nAMD and mCNV patients.Results The mean lesion area before and 1 month after treatment in nAMD patients were 0.38± 1.87 mum2 and 0.06±0.12 mm2,while in mCNV patients,those were 0.26± 1.06 mm2 and 0.03 ± 0.05 mm2,respectively.There were statistically significant differences (Z=4.181,4.475;P＜0.001) in CNV lesion area before and 1 month after treatment between nAMD and mCNV patients.Compared with those before treatment,the absolute change (Z=1.853,P=0.064) and the percentage changes (t=2.685,P=0.010) of CNV lesion area l month after treatment in nAMD and mCNV patients show a statistical meaning.There were significantly decreases in both parafoveal superficial vessel density (F=8.997,P=0.003) and perfusion area (F=7.887,P=0.015) 3 months after treatment in nAMD patients,while decreases in parafoveal superficial vessel density (F=11.142,P=0.004) and perfusion area (F=7.662,P=0.013) could be detected 1 day after treatment in mCNV patients,before rising 1 month after treatment.Conclusions There are significantly differences in lesion area before and after the treatment of intravitreal anti-VEGF between nAMD and mCNV patients by OCTA examination.Moreover,the changes of both parafoveal superficial vessel density and perfusion area after anti-VEGF treatment are statistically different in two groups.
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Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs,including monoclonal antibodies (such as bevacizumab and ranibizumab) and fusion protein agents (such as aflibercept and conbercept) have been proven to be effective in the treatment of wet age-related macular degeneration (wAMD).However,there are still some patients with poor efficacy,such as no response to initial treatment or poor response,and even relapse during the course of treatment.In view of the different targets and molecular characteristics of anti-VEGF drugs,the switch of anti-VEGF drugs and the adjustment of delivery pattern,dosages and intervals have been the strategies to cope with the poor efficacy in clinic.However,there are some differences in the results of current studies.Overall,the recovery of retinal anatomical outcome achieves more benefits,and it is relatively difficult to improve visual acuity.To determine which regimen would get the biggest benefits,a large number of randomized controlled clinical trials and long study period will be needed.
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Objective To observe the effects of repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs on vitreous macular interface (VMI) in patients with exudative age-related macular degeneration (AMD).Methods Retrospective study.Thirty-four exudative AMD patients who treated with intravitreal anti-VEGF drugs were included in this study.There were 26 males and 8 females.The age ranged from 50 to 80 years,with the average of (62.8± 8.35) years.The eyes with at least 6 treatments during the 1-year follow-up were taken as the study eyes,and the eyes with no anti-VEGF drug treatment were the control eyes.Optical coherence tomography (OCT) examination was used to observe the VMI status of both eyes before treatment.Vitreous macular adhesion (VMA),macular epiretinal membrane (MEM),and complete vitreous detachment (C-PVD) were defined as abnormalities in VMI.The VMA was classified as focal (≤ 1500 μrn) and broad (＞ 1500 μtm) depending on the diameter of the vitreous and macular adhesions on the OCT images.Before treatment,there were 12 eyes with abnormal VMI in study eyes,including 8 eyes with broad VMA,3 eyes with focal VMA,and 1 eye with MEM;12 eyes with abnormal VMI in control eyes:broad VMA in 7 eyes,focal VMA in 2 eyes,C-PVD in 2 eyes,and MEM in 1 eye.The average follow-up time after treatment was 16.4 months.During the follow-up period,OCT was performed monthly in a follow-up mode.Comparing the changes on VMI between before and after treatment in both eyes of patients,respectively.The chi-square test was used to compare the difference on VMI.Because the number of samples was ＜40,Fisher's exact test was used for the analysis.Results At the final follow-up,12 eyes with abnormal VMI in the study eyes,including 5 eyes with broad VMA,2 eyes with focal VMA,3 eyes with C-PVD,and 2 eyes with MEM.There were 6 eyes altered comparing with baseline.In the control eyes,there were 13 eyes with abnormal VMI,including 5 eyes with broad VMA,7 eyes with C-PVD,and 1 eye with MEM.A total of 6 eyes changed on VMI comparing with baseline.At the final follow-up,there was no significant difference on VMI changes between the study eyes and its corresponding control eyes (P=0.053).In all eyes,a total of 4 eyes changed from focal VMA to C-PVD at the final follow-up,accounting for 80.0％ of the total focal VMA;3 eyes changed from broad VMA to C-PVD,accounting for 21.4％ of the total broad VMA.Conclusions Repeated anti-VEGF treatment has little effect on VMI.Regardless of anti-VEGF therapy,eyes with focal VMA appears to be more prone to C-PVD than the broad one.
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AIM: To explore curative effect of different drugs in treatment of senile wet macular degeneration.METHODS: We selected 98 patients 98 eyes with senile wet macular degeneration from July 2014 to January 2016 in our hospital as the research subjects.They were divided into control group and research group as the administration sequence, 49 patients in each group.Research group was treated with ranibizumab.The control group was treated with Conbercept.Both once per month and for 3mo.RESULTS: Uncorrected visual acuity, central macular retinal thickness and area of choroidal neovascularization (CNV) leakage before treatment of the two groups were not statistically different (P>0.05).At 1, 3 and 6mo after treatment, the uncorrected visual acuity was improved significantly, the central macular retinal thickness decreased significantly, and the area of CNV leakage decreased significantly (P0.05).In the follow up period, there was no severe complications in the two groups, such as persistent high intraocular pressure, retinal detachment or tear, endophthalmitis, or other systemic complications.There were subconjunctival hemorrhage in 10 eyes in research group, 8 eyes in control group, all of which recovered within 15d after treatment.Transient elevated intraocular pressure occurred in 7 eyes in research group, in 9 eyes in control group.The complication rates of the two groups were not significant (P>0.05).CONCLUSION: In the clinical treatment of senile patients with wet macular degeneration, treatment effect of Conbercept is not obvious at the early stage, but the effect is equivalent later and more economical.
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Background Intravitreal injection of ranibizumab is a primary approach to the treatment of wet age-related macular degeneration (wAMD),but whether it is necessary for wAMD with subfoveal scarring and active lesion to receive the intravitreal injection of ranibizumab is in dispute.Objective This study was to evaluate the possible therapeutic effect of intravitreal injection of ranibizumab on wAMD with subfoveal scarring and active lesion.Methods The clinical data of the patients with wAMD with subfoveal scarring and active lesion were retrospectively analyzed,including 89 eyes of 89 cases who received diagnoses and treatments in Second Hospital of Yunnan Province from February 2013 to May 2015.Sixty-eight patients who received intravitreal injections of ranibizumab were treated group,and 21 patients who received clinical observations only served as the untreated group.Intravitreal injection of ranibizumab was carried out following the 3+prn principle,and all of the patients were followed-up for 6-24 months.Best corrected visual acuity (BCVA) of the patients were examined with ETDRS chart.The fundus findings was examined by fundus color photography and fundus fluoresceinangiography (FFA).The subjective assessment of visual improvements was obtained from each patient,and the recession of retinal active lesions was assessed by OCT,including the absorbing state of subretinal fluid,the change of central retinal thickness (CRT) and subfoveal scarring.Results The mean injection times were (4.1 ± 1.2) for each eye.The BCVA at the end of following-up was evidently improved in both groups,and no significant difference was found among various time points (P＞0.05).However,the patient rate of BCVA improvement was 69.12％ in the treated group,which was signnificantly higher than 28.58％ of the untreated group (P =0.016).In the treated group,subretinal fluid was gradually absorbed in all eyes in the treating duration,however,in the untreated group,the fluid was completely absorbed in 7 eyes,unchanged in 8 eyes and increased in 6 eyes.The CRT reduced by (220.16±34.76) μm in treated group,and that in the untreated group was (101.56±31.59) μm,showing significant difference between them (P =0.004).The patient rate of perceived improvement of vision was 91.12％ and 42.85％ in the treated group and untreated group respectively,with significant difference between the two groups (P=0.008).Conclusions Intravitreal injection of ranibizumab can make active lesion recess in end-stage wAMD with subfoveal scarring and active lesion and improve the life quality of the patients.
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Objective To investigate the correlation between the vitreomacular adhesion (VMA) and exudative age-related macular degeneration (AMD).Methods A literature research was performed in PubMed,EMbase,Cochrane Library,CNKI and Wanfang database from January 2000 to December 2016.Case-control studies on the relationship between VMA or posterior vitreous detachment and exudative AMD were included in this analysis.Literature screening and data extraction were performed according to inclusion and exclusion criteria.The qualities of the literatures were evaluated according to the Newcastle-Ottawa Scale (NOS).Seven literatures were selected into meta-analysis.The NOS score was 9 points in 1 article,8 scores in 4 articles,7 points in 2 articles.A total of 947 eyes with exudative AMD,638 eyes with dry AMD,and 618 eyes with controls were included.The correlation between exudative AMD and VMA were analyzed using the software Review manager 5.3.Results The prevalence of VMA in exudative AMD eyes was higher than that in controls [odds ratio (OR)=2.14,95％ confidence interval (CI)=1.19-3.84,P=0.010] and dry AMD eyes (OR=2.24,95％CI=1.24-4.03,P=0.007).There was no difference in PVD prevalence among exudative AMD eyes,dry AMD eyes (OR=0.44,95％CI=0.16-1.20,P=0.110) and controls (OR=0.70,95％CI=0.41-1.18,P=0.180).Conclusion There is correlation between VMA and exudative AMD.
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Exudative or wet age-related macular degeneration (AMD) is characterized by the progressive growth of choroidal neovascularization (CNV).Anti-vascular endothelial growth factor (VEGF) drugs have been used in the control of the development of CNV and vision improvement,but there are still defects like frequent injections,drug resistance and so on.Radiotherapy can deactivate local inflammatory cell populations,and make CNV unstable in the absence ofpericytes and VEGF stimulation,which induce apoptosis of the vascular endothelial cells.Therefore,radiotherapy is considered as a potential adjuvant treatment of anti-VEGF therapy.The current clinical approaches include epimacular brachytherapy (EMBT) and long-range stereotactic radiotherapy (SRT).SRT may be a preferred adjuvant treatment for patients receiving anti-VEGF therapy.Knowing the progress of radiotherapy for the treatment of exudative AMD may help us to fully understand the pathogenesis of wAMD in China
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Anti-vascular endothelial growth factor (VEGF) drugs,including monoclonal antibodies (such as bevacizumab and ranibizumab) and fusion protein agents (such as aflibercept and conbercept) have been clinically proven to be effective to treat exudative age-related macular degeneration AMD).However,there are still some patients do not or poorly respond to the initial anti-VEGF agents,usually after several injections,ophthalmologists may switch to another anti-VEGF agent.In general,switching of anti-VEGF agent is considered for recurrent AMD,AMD resistance to anti-VEGF treatments.Current switching protocols include the replacement of monoclonal antibodies with fusion protein agents,the replacement of fusion protein agents with monoclonal antibodies,the substitution of one monoclonal antibody with another one,and the replacement of monoclonal antibodies with fusion protein agents and switching back with monoclonal antibodies.However,current researches on the switching of anti-VEGF drugs for exudative AMD are mostly retrospective and single-arm studies,and there are some differences in the results of different studies.Therefore,for patients with exudative AMD who do not respond to or respond poorly to anti-VEGF drugs,the efficacy of switching of anti-VEGF drugs is uncertain right now.Switching ofanti-VEGF agents may improve the retinal anatomical outcome of the affected eye but may not necessarily improve visual acuity.Thus it is an option in the clinical practice to treat AMD.To determine the benefits of above mentioned switching regimens,randomized controlled clinical trials with large sample number and long study period will be needed.
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Neovascular age-related macular degeneration is also known as wet age-related macular degeneration (wAMD) , which is now one of potentially blinding diseases in elder population worldwide.The application of anti-vascular endothelial growth factor (VEGF) drugs is becoming the first-line therapy for wAMD at present.However, during the long-term follow up, we find that the vision of some patients dose not improve even falls after treatment, or the vision is unable to keep for a long term after its improvement.Hence,to find the key factors that affect the therapeutical effect is the focus issue nowadays.There are many factors that affect wAMD curative effect,including the limitation of drug itself, the personal conditions of the patients, the features of the choriodal neovascularization (CNV) , the formulation and implementation of the treatment regimen, etc.Imaging features of CNV and treatment timing can serve as the available indexs to analyze the prognosis.In addition,reasonable and optimized managing regimens for wAMD probably is an approach to improve the treating effect.Understanding of the factors that affect curative effect of wAMD is benefit for us to setup the individualized therapy and achieve the best vision.Ophthalmologists should fully recognize the importance of wAMD individualized treatment and management.
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The therapeutic effect of anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) was determined by a number of factors.Comprehensive thorough analysis of clinical features,imaging results and treatment response can predict the potential efficacy and possible vision recovery for the patient,and also can optimize the treatment regime to make a personalized therapy plan.Precise medicine with data from genomics,proteomics and metabolomics study will provide more objective and accurate biology basis for individual precise treatment.The future research should focus on comprehensive assessment of factors affecting the efficacy of anti-VEGF therapy,to achieve individualized precise diagnosis and treatment,to improve the therapeutic outcome of nAMD.
ABSTRACT
Choroidal neovascularization (CNV) is the key characteristic of neovascular age-related macular degeneration (nAMD),and the effective therapy is intravitreal injection of anti vascular endothelial growth factor (VEGF) agents based on clinical and basic research.In the meantime the challenge is how to further improve the inhibiting effect for CNV and visual function of anti-VEGF treatment on nAMD.The new strategy and drug delivery devices for anti-VEGF treatment will optimize the clinical scheme.From bench to bedside,the research on targeted treatment of angiogenesis brings the bloom of nAMD medical therapy.