Risk of renal damage associated with intravitreal anti-VEGF therapy for diabetic macular edema in routine clinical practice

Purpose: Vascular endothelial growth factor inhibitors (anti?VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little information about the systemic effects of intraocular administration of anti?VEGF drugs in patients with coexistent diabetic nephropathy because it can produce adverse renal effects. Methods: This retrospective cohort study analyzed the effect of intravitreal anti?VEGF drugs (bevacizumab, ranibizumab, or aflibercept) on eFGR and microalbuminuria (MicA) in patients with diabetic macular edema and nonproliferative retinopathy without chronic kidney disease (CKD). Results: Sixty?six patients were included, 54.5% male and 45.5% female, with a mean age of 66.70 ± 11.6 years. The mean follow?up of patients with antiangiogenic treatment was 42.5 ± 28.07 months, and the mean number of injections was 10.91 ± 7.54. In 12.1% of the cases, there was a worsening of the glomerular filtration rate (eFGR) and a 19.7% worsening of the microalbuminuria (MicA). The number of injections was not related to the worsening of the eFGR (P = 0.74) or the MicA (P = 0.239). No relationship was found between the type of drug and the deterioration of the GFR (P = 0.689) or the MicA (P = 0.53). Conclusions: Based on the results, there is a small proportion of patients with increase in MicA and the decrease in eFGR after anti?VEGF therapy, and these was no associated with the number of injection or the drug type. Ophthalmologists should be aware of renal damage in order to do a close monitoring of renal function and proteinuria after intravitreal administration of anti?VEGF mainly in hypertensive patients.

Efficacy and safety analysis of intravitreal bio-similar products of bevacizumab in patients with macular edema because of retinal diseases

Purpose: The purpose of this study was to evaluate retrospectively the efficacy and safety profile of intravitreal injection of bevacizumab bio?similar product Zybev(Z) for macular edema because of retinal diseases. Methods: A retrospective analysis was conducted on patients with macular edema because of retinal diseases, who had been administered intravitreal injections of bio?similar bevacizumab at a tertiary eye care center. Changes in the retinal thickness and visual acuity were evaluated to judge the efficacy, and adverse events were noted for the safety profile over a period of 6 weeks. Results: A total of 104 patients were included in the study. The mean age of the patients was 53 ± 13.5 years. The mean pre?injection best corrected visual acuity (BCVA) was 1.32 ± 0.70 log minimum angle of resolution (logMAR) with a central subfield thickness (CST) of 429.26 ± 204.30 ?m, and the post?injection BCVA at 6 weeks was 1.13 ± 0.71 logMAR with a CST of 302.26 ± 104.50 ?m; this change was statistically significant (P < 0.05) for all groups. The mean average cube thickness (?m) decreased from 11.85 ± 1.96 pre?injection to 10.52 ± 1.75 post?injection, and the mean average cube volume (mm3) decreased from 329.30 ± 54.35 to 302.23 ± 49.56 (P < 0.05). During the follow?up period after injection, no patient had inflammation, endophthalmitis, an increase in intra?ocular pressure, or systemic side effects. Conclusion: This short?term retrospective analysis provides evidence regarding the efficacy and safety of intravitreal injection of bio?similar products of bevacizumab for the treatment of macular edema because of retinal diseases

Role of Suprachoroidal Anti-VEGF Injections in Recalcitrant Serous Pigment Epithelium Detachment

Purpose: Retinal pigment epithelial detachments (PEDs) are characterized by a separation between the RPE and the innermost aspect of Bruch's membrane. Many chorioretinal diseases can lead to pigment epithelial detachment of which the most common is age-related macular degeneration; but a significant number of PEDs are idiopathic in etiology. PEDs can be classified as drusenoid, serous, vascularized, or fibrovascular type.Currently, serous PED has not shown much response to treatment, so no specific treatment guidelines are established. Whereas vascularized PEDs, have several treatment options such as intravitreal anti-Vascular endothelial growth factor (VEGF) therapy, laser photocoagulation, photodynamic therapy (PDT) and intravitreal steroids. Hence, the need of the hour is to formulate a treatment strategy for serous PED.Methods: We report an original study of thirty patients who were diagnosed with serous pigment epithelial detachment on Spectral-domain optical coherence tomography and fundus fluorescence angiography. All the patients presented to our outpatient department with the chief complaint of diminution of vision, central/paracentralscotoma and metamorphopsia. All of them underwent treatment with suprachoroidal anti-VEGF (bevacizumab).The patients were followed 8 weeks.Results: BCVA and Amsler grid assessment was recorded on the 3rd day,1st week, 2nd week, 4th week, 6th week, and 8th week. Post-injection SD-OCT macular scan was performed on the 6thweek. Functional improvement (BCVA) was reported by all patients. All the patients had reduced size and height of PED in SD-OCT.Conclusion: Thus, our result indicates that suprachoroidalbevacizumab is an efficacious treatment for serous PED. It can be hypothesized that as degenerative changes in bruch membrane due to metabolite deposit plays a key role in development of PED; injecting the anti VEGF drug in the suprachoroida space adjacent to the choroid has a superior effect.

Retinopatía de la prematuridad agresiva posterior / Aggressive Posterior Retinopathy of Prematurity

Introducción: La retinopatía del prematuro es una enfermedad ocular provocada por una alteración en la vasculogénesis de la retina, que lleva a la pérdida parcial o total de la visión. Objetivo: Presentar el primer caso, en la provincia de Santa Clara, de retinopatía de la prematuridad agresiva posterior y el tratamiento realizado. Presentación del caso: Niña prematura con más de 5 factores de riesgo al nacer que presentó retinopatía de la prematuridad agresiva posterior y se le realizó tratamiento con bevacizumab intravítreo. Conclusiones: La evolución de la niña en un período de un 1 año resultó satisfactoria con regresión total de la enfermedad. El tratamiento establecido constituye un método alternativo con buenos resultados en algunas condiciones específicas como la retinopatía del prematuro agresiva posterior(AU)

Introduction: Retinopathy of prematurity is an ocular disease caused by an alteration in retinal vasculogenesis, leading to partial or total loss of sight. Objective: To present the first case, in the province of Santa Clara, of aggressive posterior retinopathy of prematurity and the treatment performed. Case presentation: Premature girl with more than 5 risk factors at birth who presented aggressive posterior retinopathy of prematurity and was treated with intravitreal bevacizumab. Conclusions: The evolution of the girl in a period of 1 year was satisfactory with total regression of the disease. The established treatment constitutes an alternative method with good results in some specific conditions such as aggressive posterior retinopathy of prematurity(AU)

Long-term real-world outcomes in retinal vein occlusions: How close are we to the trials?

Purpose: To assess and analyze the visual outcomes of patients with retinal vein occlusions in a real?world setting with a long?term follow?up of more than 5 years. Methods: Retrospective analysis of 56 patients having retinal vein occlusions from a tertiary eye center, with a mean follow?up of 7 years was performed. Primary outcome measures were mean change in best?corrected visual acuity (BCVA) from baseline at 6 months, 1 year, 2 years, 3 years, and final visit (?5 years), proportion of patients having BCVA better than 20/40 and worse than 20/200, and mean number of injections. Secondary outcome measures were change in central macular thickness (CMT), development of subsequent retinal vein occlusion (RVO) in same eye or the other eye, and development of neovascular complications. Results: The mean change in letter score was + 11.84 in branch RVO (BRVO), +7.14 in non?ischemic central RVO (CRVO), and ?9.5 in ischemic CRVO at 1 year, which changed to + 8.57, ?5 and ? 24, respectively, at the end of follow?up. CMT had improved from 506 ± 98.8 ?m, 576.44 ± 149 ?m, and 618 ± 178.27 ?m, respectively, at baseline to 267 ± 94 ?m, 345.20 ± 122.61 ?m, and 265.50 ± 107.75 ?m, respectively, in BRVO, non?ischemic, and ischemic hemi RVO (HRVO)/CRVO groups. The total mean number of injections given in BRVO, non?ischemic CRVO, and ischemic CRVO groups were 4.6, 6.6, and 4.1, respectively. None of the patients with BRVO developed neovascular glaucoma (NVG). Non?ischemic to ischemic HRVO/CRVO conversion was noted in 4/11 eyes at a mean duration of 12.6 months. NVG was noted in 7/9 eyes (77.8%) in initial ischemic CRVO/HRVO group and 3/4 (75%) converted eyes. Conclusion: Patients with BRVO have good visual outcomes with anti?VEGF, while in CRVO results may vary considerably owing to patient compliance and treatment burden on long?term follow?up in a real?world setting

Patterns of treatment discontinuation in patients receiving anti-vascular endothelial growth factor for neovascular age-related macular degeneration

Purpose: To report the reasons for treatment discontinuation within 5 years in patients receiving intravitreal anti?vascular endothelial growth factor (anti?VEGF) therapy for neovascular age?related macular degeneration (nAMD). Methods: A retrospective case?notes review of patients commenced on anti?VEGF for nAMD who failed to complete 5 years of follow?up was undertaken. The reasons for treatment discontinuation, baseline age, baseline visual acuity (VA) in Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and the VA change at the last follow?up were recorded. Age?specific all?cause mortality was calculated for deceased patients. Results: Of the 1177 patients, 551 patients (46.8%) failed to complete the 5?year follow?up. The reasons for treatment discontinuation were death (251), early discharge due to stable disease (110), further treatment deemed futile (100), failure to attend (15), ill health (14), patient choice (7), and transfer of care (1). In 53 patients, no reason was documented. The mean baseline age of those who completed the 5?year follow?up (77.4 ± 7.8 years, 95% confidence interval (CI): 76.8–77.9) was significantly lower than those who discontinued the treatment for any reason (82 ± 7.7 years, 95% CI: 81.4–82.6) (P < 0.0001). Survival analysis showed that baseline VA was not a factor in treatment discontinuation; however, visual stability (±5 letters from baseline) was associated with treatment continuation. The age?specific all?cause mortality in deceased patients was lower than that in the general population. Conclusion: At 5 years, only 53% of patients remained in active care, and death was the most common reason for treatment discontinuation. Lower baseline age and VA stability during therapy were associated with treatment continuation.

Initial experience in treating polypoidal choroidal vasculopathy with brolucizumab in Indian eyes � A multicenter retrospective study

Purpose: To report the initial experience of managing treatment?resistant and treatment?na飗e eyes with polypoidal choroidal vasculopathy (PCV) by using brolucizumab 6 mg. Methods: This was a retrospective multicentric series of all consecutive eyes with PCV treated with brolucizumab. Treatment resistance was defined as taking at least six prior anti?VEGF injections over the past 1 year and showing persistent disease activity in the form of intra (IRF) or subretinal fluid (SRF) or both. All patients were treated on a pro re nata (PRN) basis and followed up monthly. Retreatment was considered when either SRF or IRF were present at any time point during the study. Results: We included 21 eyes of 21 patients with PCV with a mean age of 65.1 � 9.9 years, of which 16 eyes (76%) were treatment?resistant. The mean follow?up period from receiving the first brolucizumab was 27.3 � 3.3 weeks. Of the 21 eyes, seven eyes (33%) received three injections during follow?up, 13 eyes (62%) received two injections, and one eye received one injection. The mean injection?free interval was 12 � 1.2 weeks. The median pretreatment vision was 0.6 logMAR (IQR = 0.47�logMAR) and improved to 0.3 logMAR (IQR = 0.25�6 logMAR), whereas the mean macular thickness improved from 443 � 60 ?m at baseline to 289 � 25 ?m (P < 0.001) at the last follow?up period. None of the eyes experienced any intraocular inflammation across 48 injection sessions. Conclusion: Brolucizumab is safe and effective in controlling PCV disease in both treatment?resistant and treatment?na飗e eyes

Effect of intravitreal anti-VEGF injection on choroidal thickness in patients with diabetic macula edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate for any detectable change in sub-foveal choroidal thickness following intravitreal injections of Ranibizumab or Aflibercept in patients with central involving diabetic macula edema(DME), evidenced by optical coherence tomography(OCT).<p>METHODS: Totally 17 patients with central involving DME who required and agreed to intravitreal anti-VEGF injection were invited to be the subject of this study. These injection-naive subjects were undergone three loading doses of monthly intravitreal anti-VEGF(Ranibizumab 0.5 mg/0.05 mL for 9 patients or Aflibercept 2 mg/0.05 mL for 8 patients)injection, and a clinic review appointment 1mo after the third injection. The changes of foveal choroidal thickness, visual acuity and central retinal thickness at 1mo were observed before and after treatment in 2 groups by enhanced depth image-optical coherence tomography(EDI-OCT). <p>RESULTS: We recorded a significant sub-foveal choroidal thinning and vision improvement after three loading doses of anti-VEGF(all <i>P</i><0.05). The thinning effect between Ranibizumab and Aflibercept group was insignificant(all <i>P</i>>0.05). There was no significant correlation between pre-treatment sub-foveal choroidal thickness and vision improvement(<i>r_s</i>=-0.269, <i>P</i>=0.296). There was also no significant correlation between choroidal thickness changes with vision improvement, central retinal thickness change and age of subjects(all <i>P</i> >0.05).<p>CONCLUSION: Intravitreal Ranibizumab and Aflibercept injections both leads to significant sub-foveal choroidal thinning in DME subjects. It was accompanied with significant vision improvement with no evidence of immediate detrimental effect of choroidal thinning. Future research with a longer study duration would help in establishing the duration and long term effect of choroidal thinning.

Efficacy of minimally invasive vitreous surgery combined with or without anti-VEGF drug injection in PCV complicated with vitreous hemorrhage / 中华实验眼科杂志

Objective:To compare the clinical effects of minimally invasive vitreous surgery with and without anti-vascular endothelial growth factor (VEGF) drugs for polypoid choroidal vascular disease (PCV) complicated with vitreous hemorrhage.Methods:A cohort study was performed.Thirty-six consecutive cases (36 eyes) with PCV combined with vitreous hemorrhage who underwent 25G minimally invasive vitreous surgery in Xuzhou First People's Hospital from June 2015 to June 2020 were enrolled.According to surgical methods, the patients were divided into pars plana vitrectomy (PPV) group (24 eyes) receiving vitrectomy only and PPV+ anti-VEGF group (12 eyes) receiving vitrectomy first and intravitreal injection of anti-VEGF drugs one week after the operation.All patients were followed up for at least 6 months.The best corrected visual acuity (BCVA) and central retinal thickness (CRT) of the two groups before treatment, 1 month after treatment and at the last follow-up were measured and compared.Postoperative complications such as recurrence of vitreous hemorrhage and macular scar formation were recorded.This study followed the Declaration of Helsinki and was reviewed and approved by the Medical Ethics Committee of Xuzhou First People's Hospital (No.xyyll[2021]014).Written informed consent was obtained from each patient before surgery.Results:Statistically significant differences were found in BCVA between the two groups before and after treatment ( Fgroup=8.552, P=0.006; Ftime=31.775, P<0.001).The BCVA of the two groups at 1 month after operation and at the last follow-up were significantly improved in comparison with before treatment, and the BCVA at the last follow-up was significantly better than that at 1 month after operation (all at P<0.05).One month after operation and at the last follow-up, the BCVA of PPV+ anti-VEGF group was better than that of PPV group, showing statistically significant differences (both at P<0.05).Statistically significant differences were found in CRT between the two groups before and after treatment ( Fgroup=4.797, P=0.041; Ftime=295.764, P<0.001).One month after operation and at the last follow-up, the CRT of both groups was significantly improved in comparison with before treatment, and the CRT was significantly better at the last follow-up than 1 month after operation (both at P<0.05).The postoperative 1-month CRT of PPV+ anti-VEGF treatment group was lower than that of PPV group, with statistically significant difference ( P<0.05).No statistically significant difference was found in CRT between the two groups at the last follow-up ( P>0.05).Elevated intraocular pressure occurred in 2 eyes and rhegmatogenous retinal detachment in 1 eye in PPV group, accounting for 8.33% and 4.17%, respectively.Cataract aggravated in 2 eyes in PPV+ anti-VEGF group.The incidence of vitreous rebleeding in PPV group and PPV+ anti-VEGF group was 16.67%(4/24) and 8.33%(1/12), respectively, with no significant difference ( P=0.646).The incidence of macular scarring in PPV group and PPV+ anti-VEGF group was 4.17%(1/24) and 33.3%(4/12), respectively, showing a statistically significant difference ( P=0.030). Conclusions:Minimally invasive vitreous surgery is a safe and effective way to treat PCV combined with vitreous hemorrhage.It can improve vision, reduce CRT, and the effect is gradually enhanced in the short term.Intravitreal injection of anti-VEGF drugs can enhance the postoperative effect of PPV and present better vision and anatomical structure of retina.

Changes of Ocular Biometry and Intraocular Pressure in Patients Treated With Intravitreal Injection of Antivascular Endothelial Growth Factors

@#Introduction: Anti-vascular endothelial growth factors (anti-VEGF) intravitreal injection is one of the popular procedures for medical retina diseases. However, the incidence of angle-closure post intravitreal injection was reported. Several similar studies were conducted previously, but the results were inconsistent and mostly focused on bevacizumab. Methods: A prospective cohort study was conducted. After informed consent, patients who were more than 17 years old and received the first intravitreal anti-VEGF injections (ranibizumab or aflibercept) were recruited. Exclusion criteria included patients with underlying glaucoma, ocular hypertension, intumescence cataract, high refractive error or those with history of intraocular operation or ocular trauma. Pre- and post-injection’s intraocular pressure (IOP) and ocular biometry included “central anterior chamber depth” (CACD), “angle opening distance” (AOD500), and “trabeculo-iris angle” (TIA500) at nasal and temporal 500 µm away the scleral spur were acquired and analyzed. Results: 72 eyes from 66 patients were studied. Mean (SD) increment of IOP following injection within 30 minutes and 1 hour were 6.16 (0.68) mmHg (p<0.001) and 1.26 (0.35) mmHg (p=0.002) respectively. Mean (SD) differences of temporal TIA500 between pre with within 30 minutes and 1-hour post-injection were 1.66 (0.66) degrees (p=0.04) and 1.45 (0.57) degrees (p=0.04) respectively. No significant relationship between the changes of IOP and ocular biometry was found. Conclusion: A single dose of anti-VEGF in a normal population is relatively safe. However, concern on the risk of glaucoma progression and acute angle-closure still needs to be addressed. Further studies on at-risk populations and repeated injections are useful.

Protocolo assistencial de injeções intravítreas do HCPA: edema macular diabético / HCPA's patient care protocol for intravitreal injections: diabetic macular edema

RESUMO: O edema macular diabético é uma das principais causas de baixa visual no mundo e a indicação mais frequente de injeções intravítreas no Hospital de Clínicas de Porto Alegre. O tratamento com injeção intra-vítrea de medicamentos anti-vascular endothelial growth factor, incluindo o bevacizumaberevolucionou o desfecho visual destes pacientes às custas de múltiplas aplicações mensais. Assim como em outros centros, discrepâncias entre condutas da equipe assistencial e dificuldades logísticas acabam comprometendo a efetividade do tratamento. Portanto, desenvolvemos um protocolo de tratamento para a doença embasado na literatura, estabelecendo critérios de inclusão, exclusão, regime de tratamento e seguimento do paciente. Com isto, esperamos otimizar a efetividade e assistência do paciente com edema macular diabético.

ABSTRACT: Diabetic macular edema is one of the leading causes of visual impairment worldwide and the most common indication for intravitreal injections at the Hospital de Clínicas de Porto Alegre. Treatment with intravitreal injection of anti-vascular endothelial growth factor drugs, including bevacizumab, has revolutionized patient outcome at the expense of multiple monthly injections. As in other hospitals, discrepancies in health team conduct and logistical difficulties compromise treatment effectiveness. Therefore, we developed a literature-based treatment protocol for diabetic macular edema, in which we established criteria for patient inclusion and exclusion, treatment regimen, and patient follow-up. We expect the treatment protocol to optimize patient care effectiveness in diabetic macular edema.

A Retrospective Study Of Pre And Post Treatment OCT( Optical Coherence Tomography)In Patients Of BRVO (Branch Retinal Vein Occlusion)With Macular Edematreated With Intravitreal Injection Bevacizumab(1.25mg/0.05ml) Attending Ophthalmology Department Of Ter

Background:Retinal vein occlusion (RVO) is the second most common sight threatening retinal vascular disorder after diabetic retinopathy. Retinal vein occlusion is a common form of retinal vascular disease, especially in middle-aged and older individuals. Occlusion results due to thrombotic effect on the retinal vein . BRVO is classified according to the anatomical location as major or macular. Major BRVO refers to occlusion of a retinal vein that drains one of the quadrants. Macular BRVO refers to occlusion of a venule within the macula. BRVO is further classified into perfused (non-ischemic) or non-perfused (ischemic). Ischemic BRVO is defined as > 5 disc diameters of nonperfusion on fluorescein angiography (FA).Objectives:To study pre and post treatment (Intravitreal Bevacizumab 1.25mg/0.05ml)OCTin patients with macular edema secondary to BRVO. Material And Methods:30 Eyes of 30 patients of BRVO with macular edema were studied retrospectively who attended eye opd during Sept-2012 to Aug-2014 according inclusion and exclusion criteria Afterroutine ophthalmic examination with slitlamp biomicroscopy and dilated fundus examination with indirect ophthalmoscope and preop OCT done for CFT(central foveal thickness)patient underwent intravitreal injection anti VEGF.Posttreatment OCTof these patients were reviewed after 1 week and 1 month retrospectively.Result:Significant improvements in CFT were observed in these patients after treatment. Results were analyzed based on the duration Of the treatment given, after 1 week and after 1 month.Conclusion:Early diagnosis & treatment of the pathology contributes to the better visual outcome.

Meta-analysis of anti-VEGF drugs combined steroids for macular edema secondary to retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical effects of using anti-VEGF drugs combined with Steroids to treat macular edema(ME)secondary to retinal vein occlusion. <p>METHODS: Chinese and English electronic databases(Pubmed, Embase, Cochrane, CNKI, Wanfang and Weipu)were searched to obtain qualified random controlled test(RCT)researches from their foundation to January 2020. According to inclusion and exclusion criteria, two researchers retrieved the literature independently, extracted data and evaluate methodological quality. Review Manager 5.3 was used for Meta-analysis.<p>RESULTS: A total of 5 RCTs were identified with 212 patients. There was no significant difference in patients' best correct visual acuity(BCVA)improvement in 1mo, 3mo and 6mo between anti-VEGF combined with steroids and anti-VEGF monopoly. Significant difference was found in the relieve of ME in 1mo and 3mo(1mo: <i>MD</i>=-20.89, 95% <i>CI</i>: -34.65 to -7.13, <i>P</i>=0.003; 3mo: <i>MD</i>=-22.83, 95% <i>CI</i>: -33.68 to -11.97, <i>P</i><0.0001), but not in 6mo between two groups. As for side effects and complications, the combination group occurs more often than the monopoly group(<i>P</i>=0.02). Meanwhile, significant difference was found in the number of injections between two groups(<i>P</i><0.001). <p>CONCLUSION: Compared with the single use of anti-VEGF drugs, anti-VEGF drugs combined with corticosteroids for the treatment of ME secondary to RVO have the characteristics of rapid onset, fewer injections, and more economical. The treatment process should closely follow the patient's intraocular pressure and lens status.

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

@#AIM:To evaluate the long-term efficacy and safety of retinal photocoagulation combined with intravitreal injection of Ranibizumab(IVR)and simple Ranibizumab in the treatment of branch retinal vein occlusion secondary macular edema(BRVO-ME).<p>METHODS: The literatures related to randomized controlled clinical studies on the treatment of BRVO-ME with laser and Ranibizumab in Embase, The Cochrane Library, PubMed, China National Knowledge Infrastructure(CNKI), Wanfang Database and China Science and Technology Journal Database(VIP)were systematically retrieved, and the risk assessment was carried out and data indicators were extracted for the included studies. RevMan 5.3 software was used for data analysis and funnel plot was used to evaluate publication bias.<p>RESULTS: Totally 7 studies were included, with 641 eyes. There was no significant difference in the best corrected visual acuity(BCVA)between the laser combined with Ranibizumab group and the simple Ranibizumab group at 12mo \ and 24mo \ after treatment. There was no significant difference in central foveal thickness between the two groups at 12mo \ and 24mo \. There were no statistically significant differences in the injection times of Ranibizumab and the incidence of final adverse events between the two groups at 12mo and 24mo after treatment.<p>CONCLUSION: Compared with the treatment of BRVO-ME with simple Ranibizumab, there was no significant difference in the long-term efficacy of vision and central foveal thickness for the laser combined with Ranibizumab, and there was no significant difference in the injection times and safety of Ranibizumab.

Anti-VEGF therapy in pediatric retinal and choroidal disease / 国际眼科杂志(Guoji Yanke Zazhi)

@#Vascular endothelial growth factor(VEGF)is a key factor of the angiogenesis during embryonic period, and it is also an important mediator of the pathological neovascularization and vascular permeability in various ophthalmic diseases. With the increasing use of anti-VEGF therapy in adults, more and more clinical studies are focused on the application of anti VEGF therapy in pediatric retinal and choroidal diseases, including retinopathy of prematurity, Coats disease, familial exudative vitreoretinopathy, incontinence pigmented related retinopathy, sickle cell retinopathy, retinoblastoma and choroidal neovascularization caused by various causes. In this article, the application of anti VEGF therapy in these pediatric retinal and choroidal diseases was reviewed.

Clinical therapeutic effects of intravitreal injection of Conbercept for macular edema in different types of retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the therapeutic efficacy of intravitreal injection of conbercept for macular edema in different types of retinal vein occlusion(RVO).<p>METHODS: Retrospective cohort study of 79 patients 79 eyes in different types of RVO(BRVO:54; non-ischemic CRVO: 16; ischemic CRVO: 9)received intravitreal injection of conbercept. After 3mo injection of conbercept(IVIC), a pro re nata(PRN)strategy was adopted. The best-corrected visual acuity(BCVA,LogMAR)and central macular thickness(CMT)were recorded at baseline and at 1d, 1, 2, 3, 4, 5, 6mo post-treatment.<p>RESULTS: At 6mo, in different types of RVO, the BCVA were improved significantly than baseline(0.22±0.23 <i>vs</i> 0.70±0.32; 0.24±0.19 <i>vs</i> 0.73±0.27; 1.20±0.37 <i>vs </i>1.92±0.23; all <i>P</i><0.05). CMT were decreased significantly than baseline(199±27 <i>vs </i>422±162μm; 195±16 <i>vs </i>550±158μm; 231±55 <i>vs</i> 583±152μm; all <i>P</i><0.05). In three different treatment time groups, CMT in different types of RVO were decresed than the baselineat different time points after treatment(<i>P</i><0.05), and there was no difference between groups(<i>P</i>>0.05). In three different treatment time groups, BCVA in BRVO and non-iCRVO were improved than the baseline in three groups(<i>P</i><0.05), but in iCRVO there were little improved in >90d group.<p>CONCLUSION: Intravitreal injection of conbercept can effectively treat macular edema caused by RVO. Early and timely treatment of anti-VEGF may help improve and maintain the stability of long-term vision, and delayed anti-VEGF treatment may reduce the space for the improving vision.

Anti-VEGF and laser therapy for type 1 retinopathy of prematurity: a Meta analysis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To systematically evaluate the effect of anti-VEGF and laser treatment on type 1 retinopathy of prematurity(ROP). <p>METHODS: Randomized controlled trials(RCTs)comparing the efficacy of anti-VEGF and laser therapy for type 1 ROP were retrieved from PubMed, EMbase, CBM, The Cochrane Library, WanFang Data, CNKI and VIP databases. The search time was from the establishment of the databases to January 2020. The data were extracted according to the inclusion and exclusion criteria. After quality evaluation, then Meta-analysis was made by Revman 5.3 software. <p>RESULTS: A total of 6 RCTs were included. The results of Meta-analysis showed that: there was no statistical difference in the recurrence incidence between anti-VEGF group and laser group [<i>RR</i>=0.94, 95% <i>CI </i>(0.17-5.23), <i>P</i>=0.94]; subgroup analysis revealed a statistical significant in zone Ⅰ[<i>RR</i>=0.17, 95% <i>CI </i>(0.05-0.62), <i>P</i>=0.007], while zone II has no statistical significant [<i>RR</i>=2.20, 95% <i>CI </i>(0.07-73.48), <i>P</i>=0.66]. Compared with the laser group, the retreatment rate [<i>RR</i>=2.36, 95% <i>CI </i>(0.70-7.99), <i>P</i>=0.17]was statistical significant; There was no significant difference in subgroup analysis of zone Ⅰ[<i>RR</i>=0.33, 95% <i>CI </i>(0.01-7.50), <i>P</i>=0.49], while the difference in zone Ⅱ[<i>RR</i>=13, 95% <i>CI </i>(1.84-92.01), <i>P</i>=0.01] was statistically significant. There was no significant difference in the incidence of adverse reactions between the two groups[<i>RR</i>=0.87,95%<i> CI</i>(0.54-1.40),<i>P</i>=0.57]. <p>CONCLUSION: Laser and anti-VEGF treatment are equally effective. Anti-VEGF has less recurrence rate in zone Ⅰ while laser is more effective in the retreatment rate in zone Ⅱ.

Effect of anti-VEGF combined with laser therapy on macular blood flow density in patients with severe non-proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Meta-analysis of long-term efficacy of vitrectomy combined with anti-VEGF in the treatment of proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the long-term efficacy of vitrectomy combined with or without anti-VEGF in the treatment of proliferative diabetic retinopathy(PDR).<p>METHODS: Randomized controlled trials(RCTs)comparing the efficacy of vitrectomy combined with or without anti-VEGF therapy for PDR were retrieved from databases including PUBMED, EMBASE, Cochrane Central Register of Controlled Trials(CENTRAL)and Web of Science. The retrieval time was from the establishment of the databases to July 2020. According to the inclusion and exclusion criteria, the literature was selected, then data extraction and quality evaluation was completed. Primary evaluation measures included postoperative incidence of retinal detachment, central retinal thickness(CRT), and best corrected visual acuity(BCVA). <p>RESULTS: In this article, 11 randomized controlled studies(880 eyes)were included. Meta-analysis results showed that the incidence of retinal detachment after vitrectomy was significantly lower in PDR patients who received anti-VEGF injection before vitrectomy than in patients who did not receive anti-VEGF injection \〖Risk ratio(<i>RR</i>)=0.39, 95% Confidence interval(<i>CI</i>)0.22 to 0.71, <i>P</i>=0.002\〗. There were significant differences in the incidence of retinal detachment after vitrectomy between the anti-VEGF group and the non-VEFG group in both Asian and non-Asian populations(Asian:<i> RR</i>=0.20, 95%<i>CI</i> 0.05 to 0.87, <i>P</i>=0.03; Non-Asian:<i> RR</i>=0.46, 95%<i>CI</i> 0.24 to 0.89, <i>P</i>=0.02). The central retinal thickness of PDR patients who received preoperative anti-VEGF therapy was significantly lower than that of patients who did not receive anti-VEGF therapy 3 and 6mo after PPV(<i>MD</i>=-78.49, 95%<i>CI</i> -94.81 to -62.17, <i>P</i><0.00001. <i>MD</i>= -39.62, 95%<i>CI</i> -48.44 to -30.80, <i>P</i><0.00001). The BCVA at 6mo after PPV in PDR patients with preoperative anti-VEGF treatment was better than that in patients without preoperative anti-VEGF treatment(<i>MD</i>=-0.16, 95%<i>CI</i> -0.21 to -0.10, <i>P</i><0.00001).<p>CONCLUSION: Anti-VEGF injection before PPV can effectively reduce the incidence of retinal detachment, alleviate postoperative macular edema, reduce the central retinal thickness, and improve BCVA in PDR patients.