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Purpose: This study aims to evaluate the incidence and risk factors for vitreous rebleed (VRB) following 25-gauge sutureless vitrectomy for vitreous hemorrhage (VH) in diabetic retinopathy. Methods: A retrospective review of 190 diabetic patients having undergone vitrectomy for VH at a tertiary eye care center was analyzed. Demographic data of patients along with risk factors such as blood sugar levels (BSL), blood pressure (BP), anticoagulant use, and pan-retinal photocoagulation status (PRP) were tabulated. Depending on the commencement of VRB, patients were divided into immediate rebleed-within 2 weeks and delayed rebleed-beyond 2–4 weeks. Results: Forty-one patients had VRB, out of which 18 patients had immediate VRB and 23 patients had delayed VRB. The average duration between vitrectomy and VRB was 3.28 months. Twenty-eight patients were male and 13 were females. Average age at presentation was 53.8 years. Thirty-four patients (82.9%) were found to have high BSL and 28 patients (68.3%) had high BP and they developed rebleed (P < 0.01) after an initial hemorrhage-free period (average = 5.15 months). Fifteen patients (36.6%) underwent first time PRP intraoperatively, and they had immediate rebleed (P < 0.01) without any hemorrhage-free period (average = 0.9 months). Eight patients (19.5%) were on perioperative anticoagulants; however, their statistical significance did not persist in the multivariable model. There were neither age nor gender predilection toward rebleed (P > 0.05). Conclusion: The incidence rate of VRB was found to be 21.6%. Age and gender did not contribute to rebleed. Intraoperative PRP was a risk factor for immediate rebleed. Poor glycemic and BP control was a risk factor for delayed rebleed.
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·AIM: To investigate the effect of calcium dobesilate on vitreous hemorrhage in patients with proliferative diabetic retinopathy ( PDR ) after pan retinal photocoagulation (PRP). ·METHODS:Totally 62 patients (30 cases with binocular lesions, 32 cases with monocular lesions, a total of 92 eyes) with PDR who were treated in our hospital from January 2015 to July 2017 were selected as the subjects. They were divided into the control group ( treated with pan retinal photocoagulation, n = 30, 17 cases with monocular lesions, 13 cases with binocular lesions, a total of 43 eyes ) and the study group ( treated with calcium dobesilate on the basis of treatment for the control group, n=32, 15 cases with monocular lesions, 17 cases with binocular lesions, a total of 49 eyes ). The recovery of visual acuity, blood rheology ( plasma viscosity, hematocrit, erythrocyte deformation index) and the incidence of complications such as vitreous hemorrhage in the two groups after surgery were observed. ·RESULTS: There was no significant difference between the two groups in the rate of excellent and good visual acuity, plasma viscosity, hematocrit or erythrocyte deformability index before treatment ( P>0. 05 ). After treatment, the rate of excellent and good visual acuity in the study group was significantly higher than that in the control group (P<0. 05). After treatment, the plasma viscosity and hematocrit decreased significantly while the erythrocyte deformability index significantly increased only in the study group, and changes of above -mentioned indexes in the study group were more obvious than those in the control group after treatment (P<0. 05). The incidence rate of vitreous hemorrhage and total incidence rate of complications in the study group were significantly lower than those in the control group ( P<0. 05). ·CONCLUSION: The application of calcium dobesilate in patients with PDR after pan retinal photocoagulation can effectively improve the recovery of visual acuity and reduce the incidence of complications such as vitreous hemorrhage. The mechanism may be related to effectively improving the hemodynamics.
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OBJECTIVES: To investigate the effect of laser pan-retinal photocoagulation with or without intravitreal bevacizumab injections on macular choroidal thickness parameters in eyes with high-risk proliferative diabetic retinopathy. METHODS: High-risk proliferative diabetic retinopathy patients undergoing laser treatment were prospectively enrolled in this study. One eye was randomly selected for laser treatment combined with bevacizumab injections, study group, whereas the corresponding eye was subjected to laser treatment alone, control group. Spectral-domain optical coherence tomography with enhanced depth imaging was used to measure the macular choroidal thickness prior to and 1 month after treatment. Measurements in both groups were compared. Clinicaltrials.gov: NCT01389505. RESULTS: Nineteen patients (38 eyes) with a mean±standard deviation age of 53.4±9.3 years were evaluated, and choroidal thickness measurements for 15 patients were used for comparison. The greatest measurement before treatment was the subfoveal choroidal thickness (341.68±67.66 μm and 345.79±83.66 μm for the study and control groups, respectively). No significant difference between groups was found in terms of macular choroidal thickness measurements at baseline or after treatment. However, within-group comparisons revealed a significant increase in choroidal thickness parameters in 10 measurements in the study group and in only 5 temporal measurements in the control group when 1-month follow-up measurements were compared to baseline values. CONCLUSIONS: The macular choroidal thickness does not appear to be significantly influenced by laser treatment alone but increases significantly when associated with bevacizumab injections in patients with proliferative diabetic retinopathy and macular edema. Because bevacizumab injections reduce short-term laser pan-retinal photocoagulation-induced macular edema, our findings suggest that the choroid participates in its pathogenesis.
Subject(s)
Humans , Male , Female , Middle Aged , Retina/pathology , Choroid/pathology , Angiogenesis Inhibitors/administration & dosage , Diabetic Retinopathy/therapy , Bevacizumab/administration & dosage , Visual Acuity , Retrospective Studies , Treatment Outcome , Laser Coagulation , Combined Modality Therapy , Tomography, Optical Coherence , Diabetic Retinopathy/pathology , Intravitreal InjectionsABSTRACT
Objective To observe the curative effects of anti-vascular endothelial growth factor (anti-VEGF) intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope for neovascular glaucoma (NVG).Methods NVG patients with uncontrolled intraocular pressure (IOP) and retinopathy was enrolled from May,2014 to May,2016.Eighteen patients were enrolled with 15 males(15 eyes) and 3 females(3 eyes) with age at (61.7 ± 13.9) years old.Anti-VEGF intracameral and intravitreal injection with anterior chamber puncture was performed in the first day of sequential treatment.Trebeculectomy was performed 3-5 days after injection and finally the pan-retinal photocoagulation was started 5-7 days after anti-glaucoma surgery.The best corrected visual acuity (BCVA),IOP,cornea,neovascularization of iris and retinal disease were observed and recorded.Results The diagnosis included 1 eye with central retinal artery occlusion (CRAO),6 eyes with central retinal vein occlusion (CRVO),5 eyes with branch retinal vein occlusion,5 eyes with proliferative diabetic retinopathy and 2 eyes with combined CRAO and CRVO.IOP before and after treatment were (43.5 ±5.1) mmHg (1 kPa =7.5 mmHg) and (15.2 ± 2.2) mmHg,there was significantly statistical difference (t =21.68,P ＜0.001).The categories of antiglaucoma medicines were 5.1 ± 0.5 and 0.5 ± 1.0 before and after treatment respectively,and the difference was statistical significant (t =12.30,P ＜ 0.001).BCVA was improved in 4 eyes,maintained in 13 eyes and decreased in only 1 eye.Conclusion The sequential treatment including anti-VEGF intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope is safe and effective.
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Neovascular glaucoma (NVG) is a dreadful pathology and it will be rapid spontaneous evolution responsible for eventual visual loss in many cases,with poor therapeutic efficiency.The main challenges in clinical practice for the management of NVG are as follows:(1) What is the goal of NVG treatment,to decrease intraocular pressure (IOP) or to reserve visual function? (2) How to create an optimal condition or timing for the treatment of primary disease? (3)What is exactly the key of NVG treatment? Anti-vascular endothelial growth factor (VEGF) medication,anti-glaucoma surgery or pan-retinal photocoagulation (PRP) for strict control of clinical situations potentially responsible for retinal ischemia ? (4)How to set up a comprehensive management strategy for NVG? In this paper,we established a comprehensive treatment strategy for NVG,including a core aim for preserving visual function,a goal of completing PRP and the main methods of anti-VEGF injection and anti-glaucoma surgery in order to preserve visual status of NVG patients as much as possible.
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Diabetic retinopathy ( DR ) is one of the most serious microvascular complications of diabetes. It also is a world's major causes of blind eye diseases. Although the injection of anti - vascular endothelial growth factor intraocular drug is becoming a hotspot of current research. Pan retinal photocoagulation (PRP) remains the effective and economical treatment for DR. As a destructive treatment, PRP will inevitably cause some changes on the normal morphology and function of the retinal and cornea. Currently, with the development of the optical coherence tomography, confocal microscopy and other auxiliary examination, we have more accurate and objective research to better understand the laser-neural tissue interaction. This may help us to protect the patient's visual function more efficiently.
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·AIM: To study plasma levels of vascular endothelial growth factor (VEGF), endothelin-1(ET-1) and nitric oxide (NO) in patients with proliferative diabetic retino-pathy (PDR) before and after pan-retinal photocoagula-tion (PRP).·METHODS: In this prospective study, forty patients (23 females and 17 males, mean age 48.5±12.2) with PDR without previous PRP therapy were studied. Blood samples were obtained before and 3 months after the last PRP session. Baseline (prelaser) plasma levels of VEGF, ET-1 and NO were compared with their levels in 30 healthy age- and sex- matched controls and also with plasma levels 3 months post-PRP. ·RESULTS: Patients with PDR had significantly raised plasma VEGF (375±89ng/L), ET-1(20±5ng/L) and NO (135±53μmol/L) when compared with healthy control group (P<0.01). After PRP, there was a significant re-duction in plasma VEGF (179±66ng/L), ET-1 (11±5ng/L) and NO (91±49μmol/L) levels at 3 months' follow-up but still significantly higher than healthy controls.·CONCLUSION: Patients with PDR demonstrate elevated VEGF, ET-1 and NO, which decreased after successful laser treatment.
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We studies 8 eyes of 7 patients with neovascular glaucoma from June 1, 1995 to May 31 1997 retrospectively in order to note the clinical characteristics of disease. The mean age of the patients was 54. 3 years and the mean period of follow up was 9.5 months. Predisposing factors were proliferative diabetic retinopathy [7 eyes] , central retinal vein occlusion [I eye]. Vision at first visit was mainly hand motion or finger counting. Vision after operation was increased in 4 eyes, but deteriorated to no light perception in 3 eyes. The mean IOP at preoperative period was 35mmHg, at just postoperative period 20mmlHg at I week after operation, 25mmHg at last follow-up. Neovascularization of anterior chamber and angle were regressed in 6 eyes, but progressed in 2 eyes. Additional medical treatment was needed in all 8 eyes after operation. To treat. the early neovascular glaucoma, we used endoscopic laser photocoagulation. The endoscopy was good for observing far peripheral retina, pars plana, ciliary body and posterior segment of iris. We found the endoscopic laser was suitable for wider photocoagulation of ischemic retina against corneal opacity, miosis, cataract and intraocular gas.