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1.
International Eye Science ; (12): 130-134, 2022.
Article in Chinese | WPRIM | ID: wpr-906748

ABSTRACT

@#AIM: To observe the therapeutic effects of different dosage regimens of conbercept on clinical significant diabetic macular edema(CSME).<p>METHODS: Totally 65 patients with diabetes and CSME who were admitted to the Ophthalmology Department at Ganzhou People's Hospital between January 2019 and January 2020 were selected as the research subjects, and divided into observation group(<i>n</i>=33, conbercept 5+PRN regimen)and control group(<i>n</i>=32, conbercept 3+PRN regimen)using random number table method. Visual acuity test and optical coherence tomography(OCT)were carried out at 1, 2, 3, 6, 9, 12mo after treatment. Changes in the best corrected visual acuity(BCVA,LogMAR)and central macular thickness(CMT)were compared between the two groups. The mean injection times and complications in the two groups were recorded.<p>RESULTS: The BCVA was improved and CMT thinned in the two groups at 1, 2, 3, 6, 9, 12mo after treatment(<i>P</i><0.05). There was no statistically significant difference in BCVA and CMT between the two groups before treatment, and at 1, 2, 3, 6, 9, 12mo after treatment(<i>P</i>>0.05). The mean injection times in observation group was more than that in the control group \〖(5.81±0.54)times <i>vs </i>(4.19±0.41)times\〗(<i>P</i><0.05). In the early stage of postoperative follow-up, there were 30 times(23%)and 15 times(22%)of subconjunctival hemorrhage in observation group and control group, respectively(<i>P</i>>0.05). No other severe complications were observed in the two groups.<p>CONCLUSION:Both conbercept 3+PRN and conbercept 5+PRN are effective in the treatment of patients with diabetes and CSME. Both can significantly improve the patients' visual acuity and reduce CMT, with equivalent effect. The latter may increase the injection times but its adverse reactions are tolerable. In addition, it is safe and reliable.

2.
International Eye Science ; (12): 127-129, 2022.
Article in Chinese | WPRIM | ID: wpr-906747

ABSTRACT

@#AIM: To evaluate the visual function and visual quality of patients with diabetic macular edema treated with conbercept injection.<p>METHODS: The average change of contrast sensitivity(CS), best corrected visual acuity(BCVA), central retinal thickness(CRT)and NEIVFQ-25 score were observed for 3mo after intravitreal injection of conbercept in 43 eyes of 38 patients with diabetic macular edema.<p>RESULTS: The mean CS increased from(1.060±0.14)units to(1.47±0.31)units at 12wk after intravitreal injection of conbercept(<i>P</i><0.05). The average LogMAR BCVA decreased significantly from 0.535±3.32 to 0.333±0.11 at 12wk(<i>P</i><0.05), and the average CRT decreased significantly from 369.45±36.42μm to 226.53±39.48μm at 12wk(<i>P</i><0.05). There is not a correlation between the changes in CRT and BCVA and the improvement of CS. The NEIVFQ-25 score improved in 30 cases(79%)from baseline to 12wk. 6 cases(16%)had no change in the NEIVFQ-25 score, and 2 cases(5%)declined in the NEIVFQ-25 score.<p>CONCLUSION: The treatment of conbercept injection for diabetic retinal macular edema can significantly improve the visual function and the quality of life.

3.
International Eye Science ; (12): 39-43, 2022.
Article in Chinese | WPRIM | ID: wpr-906726

ABSTRACT

@#AIM: To observe and analyze the efficacy of Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation in the treatment of macular edema(ME)secondary to ischemic branch retinal vein occlusion(BRVO).<p>METHODS: Totally 71 patients(71 eyes)diagnosed as ME secondary to ischemic BRVO during the period from March 2016 to March 2019 were retrospectively included, and they were divided into laser group(<i>n</i>=33, 33 eyes)and combined group(<i>n</i>=38, 38 eyes)according to the different treatment methods. The patients in the laser group all received 577nm yellow subliminal micropulse laser photocoagulation, and the patients in the combined group all received Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation. The best corrected visual acuity(BCVA), central macular thickness(CMT)and total macular volume(TMV)were compared between the two groups before treatment and at 1, 2, 3, 6, 9 and 12mo after surgery, and the therapeutic efficacy was observed and the occurrence of complications were recorded.<p>RESULTS:There were statistically significant differences in the BCVA, CMT and TMV between the two groups before and after treatment(<i>P</i><0.05), and the BCVA, CMT and TMV in the two groups at 1, 2, 3, 6, 9 and 12mo after treatment were significantly lower than those before treatment(<i>P</i><0.05), and the differences between the two groups were statistically significant(<i>P</i><0.05). During follow-up, there were 30 eyes with once laser photocoagulation, 7 eyes with twice and 1 eye with 3 times in combined group, and there were 16 eyes with once laser photocoagulation, 14 eyes with twice and 3 eyes with 3 times in laser group(<i>Z</i>=2.670, <i>P</i><0.05). There were 3 eyes of corneal epithelial exfoliation on the 1d after vitreous injection in combined group, and the symptoms disappeared after symptomatic treatment. All patients did not have serious complications such as persistent intraocular pressure increase, retinal detachment and intraocular inflammation.<p>CONCLUSION: Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation has a significant efficacy in the treatment of ME secondary to ischemic BRVO, and it can effectively improve the visual acuity and promote the macular edema absorption, and it is safe and reliable.

4.
International Eye Science ; (12): 509-512, 2022.
Article in Chinese | WPRIM | ID: wpr-920443

ABSTRACT

@#AIM: To observe the effect of intravitreal injection of ranibizumab in the treatment of retinal vein occlusion macular edema(RVO-ME), and to apply Logistic regression analysis to screen the factors that affect the vision recovery of patients. <p>METHODS: A total of 106 patients(106 eyes)with retinal vein occlusion and macular edema who were treated in the ophthalmology clinic of our hospital from January 2018 to June 2019 were selected for the study. The clinical data of the patients were retrospectively analyzed and all were given 0.05mL ranibizumab. The monoclonal antibody was injected into the vitreous cavity of the affected eye, and the patients were followed up to observe the treatment effect. The patients were divided into good group and poor group according to the degree of vision recovery after 3mo of treatment, and the two-class Logistic regression analysis was used to screen the factors that affect the vision recovery of patients.<p>RESULTS: The Logarithm of the minimum angle of resolution(LogMAR)of the affected eye at 1d, 1wk, 1, and 3mo after treatment was significantly lower than before treatment, and the macular foveal retinal thickness(CRT)was significantly lower than before treatment. The difference was statistically significant(all P<0.05), and there was no significant difference in the average intraocular pressure of the affected eye before and after treatment(P>0.05). During and after the treatment, the patient did not develop complications such as endophthalmitis, increased intraocular pressure, lens opacity, and retinal detachment. Logistic regression analysis showed that there was no capillary perfusion in the foveal area of the macula and the center of the macula before treatment. Incomplete outer membrane and incomplete inner plexiform layer structure in the concave area are risk factors that affect the efficacy of ranibizumab injection. <p>CONCLUSION: Intravitreal injection of ranibizumab in the treatment of retinal vein occlusion combined with macular edema is effective and safe in the short term. It can effectively reduce macular edema of the affected eye, improve vision, and normal intraocular pressure after treatment, and it is easy to operate and effective. It has the advantages of repeating, little damage to tissues, no obvious adverse reactions, less pain for patients, economical and practical. In addition, the lack of capillary perfusion in the foveal area of the macula before treatment, the incomplete outer membrane of the foveal area, and the incomplete structure of the inner plexiform layer are risk factors that affect the efficacy of ranibizumab in the treatment of retinal vein occlusion and macular edema.

5.
International Eye Science ; (12): 500-504, 2022.
Article in Chinese | WPRIM | ID: wpr-920441

ABSTRACT

@#AIM: To investigate the efficacy of anti-inflammatory treatment and anti-vascular endothelial growth factor(VEGF)treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME).<p>METHODS: The clinical data of RVO-ME patients who were treated in the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University from 2019-06/2020-12 were retrospectively collected. A total of 108 cases(108 eyes)of RVO-ME patients were collected, including 52 cases(52 eyes)with cystoid macular edema(CME), 38 cases(38 eyes)with macular edema with serous retinal detachment(SRD), and 18 cases(18 eyes)with diffuse retinal thickening(DRT). Patients with various types of ME were further classified into anti-VEGF group and anti-inflammatory group. The observation metrics such as best corrected visual acuity(BCVA)and foveal thickness(CMT)before and 3mo after surgery were collected and compared in each group.<p>RESULTS: There was no difference in baseline data between the anti-VEGF group and the anti-inflammatory group in all types of ME patients(all P>0.05). Patients with CME in the anti-VEGF group in BCVA, CMT, and the sum of CME diameter after operation were different from that before operation(Z= -4.463, -4.541, -4.541, all P<0.001); the postoperative BCVA, CMT, and the sum of CME diameter in the anti-inflammatory group were significantly different from those before operation(Z= -3.743, -4.345, -4.372, all P<0.001); and there was no difference between the anti-VEGF group and the anti-inflammatory group in the postoperative CMT and the sum of CME diameter(Z= -1.017, -0.968, all P>0.05), but there was a difference in BCVA after operation in two groups(Z= -1.978, P<0.05). SRD patients in the anti-VEGF group had differences in postoperative BCVA, CMT, and SRD heights compared with preoperative ones(Z= -4.111, -4.198, -4.198, all P<0.01); the BCVA, CMT, and SRD height in the anti-inflammatory group after operation were different from those before operation(Z= -3.410, -3.408, -3.408, all P<0.05); and there was no difference in BCVA and CMT between the two groups after operation(Z= -0.857, -1.030, all P>0.05), but the postoperative SRD height in the anti-inflammatory group was significantly lower than that in the anti-VEGF group(Z= -2.117, P<0.05). DRT patients in the anti-VEGF group were significantly different in BCVA and CMT after operation compared with preoperative ones(Z= -2.207, -2.521, all P<0.05), and in the anti-inflammatory group after injection, BCVA and CMT were significantly different from preoperative ones(Z= -2.207, -2.521, all P<0.05). There were differences in BCVA and CMT after injection in the anti-inflammatory group compared with those before operation(Z= -2.207, -2.803, all P<0.05). There was no difference in postoperative BCVA and CMT between the two groups(Z= -0.359, -0.845, all P>0.05). <p>CONCLUSION: Anti-inflammatory and anti-VEGF treatments are effective for all kinds of ME in improving vision and reducing CMT. Anti-VEGF treatment is superior to anti-inflammatory treatment in improving BCVA of CME patients and is inferior to anti-inflammatory in decreasing SRD thickness of SRD patients.

6.
International Eye Science ; (12): 474-479, 2022.
Article in Chinese | WPRIM | ID: wpr-920434

ABSTRACT

@#AIM: To observe the changes of retina superficial capillary plexus densities and aqueous humor factors in patients with diabetic macular edema(DME)before and after conbercept injection, and to explore the effect of conbercept on macular microcirculation in DME patients. <p>METHODS: A prospective case-control study was conducted. Totally 11 eyes of 10 patients diagnosed as DME in the Ophthalmology Department of the First Affiliated Hospital of Hainan Medical University from December 2019 to December 2020 were collected as DME group, 15 cataract patients without systemic basic diseases and fundus oculi diseases were collected as cataract group, and 20 age-and sex-matched healthy people with normal vision were collected as control group. All patients in DME group were treated by intravitreal injection of conbercept once a month for a total of 6 times. The retinal perfusion densities of the superficial capillary plexus(PSCP), retinal vessel densities of the superficial capillary plexus(VSCP), foveal avascular zone(FAZ), central macular thickness(CMT)and best corrected visual acuity(BCVA)were compared between the control group and DME patients before operation. The aqueous humor factors in cataract group and DME group were measured by multiplex flow immunoassay. The differences of aqueous humor factors in cataract group and DME group were compared. The changes of VSCP, PSCP, FAZ, CMT, BCVA and factors of aqueous humor in DME group after 6 conbercept injections were compared.<p>RESULTS: There were significant differences in PSCP, VSCP, FAZ area, BCVA and CMT between DME group and control group before operation(P<0.01); there were significant differences in angiopoietin-like protein 4(ANGPTL4), vascular endothelial growth factor(VEGF), interleukin-6(IL-6), interleukin-8(IL-8)in aqueous humor of DME group and cataract group before operation(P<0.001); PCSP and BCVA were increased and CMT were decreased in DME group after continuous conbercept injection for 6mo(all P<0.05); the concentrations of ANGPTL4, VEGF and IL-6 in aqueous humor of DME group decreased significantly(all P<0.05); patients injected with 1mo conbercept in the DME group had the most obvious improvement of BCVA and PSCP as well as the most obvious decline of CMT; while the ANGPTL4, VEGF and IL-6 in aqueous humor concentration had the most obvious decrease when they were injected with 1mo conbercept; VEGF in aqueous humor was positively correlated with the absolute value of CMT. <p>CONCLUSION: Conbercept injection in DME patients can improve retinal ischemia, reduce the concentration of VEGF and related factors in aqueous humor, effectively increase BCVA and relieve macular edema.

7.
International Eye Science ; (12): 858-862, 2022.
Article in Chinese | WPRIM | ID: wpr-923428

ABSTRACT

@#AIM:To explore the relationship between the parameters of macular integrity assessment(MAIA), best corrected visual acuity(BCVA)and macular morphology in patients with diabetic macular edema. <p>METHODS: From March 2018 to January 2020, a total of 43 patients(74 eyes)with diabetic macular edema were randomly selected for treatment in the department of ophthalmology in our hospital.To compare the relationship between MAIA micro field meter parameters and the integrity of macular external membrane, junction of inner and outer photoreceptors(IS/OS)layer and hard exudation. Pearson correlation test was used to analyze the relationship between retinal thickness and retinal sensitivity. Pearson correlation test was used to analyze the correlation between retinal thickness, retinal sensitivity and BCVA in the intact and defect groups of IS/OS layer.<p>RESULTS: Compared with the IS/OS layer defect group, the levels of BCVA(LogMAR), central retinal thickness(CRT), elliptical area of binary contour 63(BCEA63), elliptical area of binary contour 95(BCEA95)and macular integrity index(MI)in the IS/OS layer intact group were lower, and the levels of average threshold(AT)and P2 were higher(all <i>P</i><0.01), but there was no significant difference in the levels of central retinal volume(CRV)and P1 between the two groups(all <i>P</i>>0.05). Compared with the external membrane defect group, the levels of BCVA(LogMAR), CRT and MI in the external membrane intact group were lower(all <i>P</i><0.05), but there was no significant difference in the levels of CRV, AT, P1, P2, BCEA63 and BCEA95 between the two groups(all <i>P</i>>0.05). Compare the group with and without hard exudation, there was no significant difference in eye parameters between the two groups(<i>P</i>>0.05).There was a significant negative correlation between retinal thickness and sensitivity in temporal, central and nasal sides of fovea(<i>P</i><0.05), but no significant correlation in the upper and lower parts of fovea(<i>P</i>>0.05). In the complete group of IS/OS layer, AT was significantly negatively correlated with CRT and BCVA, while CRT was significantly positively correlated with BCVA(all <i>P</i><0.05). In the IS/OS layer defect group, there was a significant negative correlation between AT and BCVA(<i>P</i><0.05).<p>CONCLUSION:MAIA in the diabetic macular edema is closely related to the morphology and structure of macular area, especially the integrity of IS/OS layer and outer membrane. MAIA may be an important index to evaluate the visual function of patients with diabetic macular edema.

8.
International Eye Science ; (12): 809-812, 2022.
Article in Chinese | WPRIM | ID: wpr-923417

ABSTRACT

@#Diabetic macular edema(DME)is a severe ocular complication of diabetes and one of the leading causes of vision loss in diabetic patients. The pathogenesis of DME is complicated, and the key to treatment is controlling the systemic factors that cause the deterioration of DME. The existing studies have shown that the increased risk of DME is related to many factors. In this paper, the risk factors of DME were reviewed to provide theoretical support for the research and prevention of DME.

9.
International Eye Science ; (12): 693-697, 2022.
Article in Chinese | WPRIM | ID: wpr-922995

ABSTRACT

@#AIM: To investigate the pathogenic mutations of the <i>OAT</i> gene in a Chinese family affected with gyrate atrophy of choroid and retina(GA)and describe their clinical manifestations.METHODS: All available family members have underwent detailed ophthalmological examinations. The sequencing results and pathogenic mutations were clarified by whole exome sequencing, bioinformatics analysis and Sanger sequencing.RESULTS: Based on the clinical manifestations and symptoms, the proband was diagnosed with GA. A missense mutation of c.722C>T(p.P241L)in exon 6 and a nonsense mutation of c.1186C>T(p.R396X)in exon 10 were identified in the <i>OAT</i> gene of the proband, which was a compound heterozygotic mutation. This compound heterozygous mutation showed co-segregation in the family. The heterozygous pathogenic variant of p.R396X was detected in both the proband's father and elder brother, and the heterozygous pathogenic variant of p.P241L was detected in proband's mother. Except for the proband, no other family members have abnormal clinical manifestations.CONCLUSION: The proband of this family is a compound heterozygous mutation, in which p.P241L is the first reported gene mutation type. This result expands the range of <i>OAT</i> gene variation and is conducive to further understanding the pathogenic factors of GA at the molecular basis level. The discovery and confirmation of the novel mutation type will also help to provide a new basis for the clinical diagnosis and gene therapy of GA.

10.
Rev. bras. oftalmol ; 81: e0027, 2022. tab, graf
Article in English | LILACS | ID: biblio-1376789

ABSTRACT

ABSTRACT The objective of this article was to review the disorganization of inner retinal layers as a biomarker in diabetic macular edema. A systematic search was conducted in PubMed®/MEDLINE®, Cochrane and Embase until August 2021. The keywords used were: "disorganization of inner retinal layers (DRIL)", "diabetic macular edema (DME)" and "biomarkers". No restrictions were imposed on the types of study to be included. The studies selected for eligibility were those that included the diagnosis of diabetic macular edema (center involved, resolved), that were well documented with spectral domain optical coherence tomography, that included disorganization of inner retinal layers as one of the reported alterations, with a follow-up of at least 3 months, and those in which the best corrected visual acuity was evaluated pre and post. There were no limitations regarding the type of treatment established. References of identified studies were searched for additional relevant articles. Articles not published in peer review journals were excluded. All studies were evaluated by two investigators independently. When one of them was in doubt, it was assessed by a third evaluator. A total of seven studies were included. Four were retrospective, longitudinal cohort study and three cross-sectional observational. Regarding the population studied, 61.5% were men and 38.4% were women, most of them had diabetes mellitus type 2 (85.8%). Regarding the stage of diabetes, the percentage of patients with mild nonproliferative diabetic retinopathy was 28.2%, with moderate nonproliferative diabetic retinopathy was 28.5%, with severe nonproliferative diabetic retinopathy was 15.9% and with nonproliferative diabetic retinopathy was 27.4%. In 100% of the studies, the diagnosis of diabetic macular edema in the center involved was included by spectral domain optical coherence tomography (Heidelberg). In all the studies, the presence of disorganization of inner retinal layers was recorded and its association with best corrected visual acuity was evaluated. The measurement was carried out using the LogMAR scale. In all the studies, the presence or absence of disorganization of inner retinal layers was associated with the best corrected worse/better final visual acuity using p <0.05 as a statical significance. The disorganization of inner retinal layers as a biomarker and their presence have shown to be important predictors of visual acuity in the future in patients with diabetic macular edema. Histopathological studies are required to understand its mechanism of action.


RESUMO O objetivo deste artigo foi revisar sobre a desorganização das camadas internas da retina como biomarcador no edema macular diabético. Uma busca sistemática foi realizada no PubMed®/MEDLINE®, Cochrane e Embase até agosto de 2021. As palavras-chave utilizadas foram "disorganization of inner retinal layers (DRIL)", "diabetic macular edema (DME)" e "biomarkers". Não foram impostas restrições quanto aos tipos de estudo a serem incluídos. Os estudos selecionados para elegibilidade foram aqueles que incluíram o diagnóstico de edema macular diabético (centro envolvido, resolvido), que foram bem documentados com tomografia de coerência óptica de domínio espectral, que incluíram a desorganização das camadas internas da retina como uma das alterações relatadas, com acompanhamento de pelo menos 3 meses, e aqueles em que a melhor acuidade visual corrigida foi avaliada pré e pós. Não houve limitações quanto ao tipo de tratamento estabelecido. Referências de estudos identificados foram pesquisadas para artigos relevantes adicionais. Foram excluídos os artigos não publicados em revistas de revisão por pares. Todos os estudos foram avaliados por dois investigadores de forma independente. Quando havia dúvida com algum deles, a mesma era avaliada por um terceiro avaliador. Um total de sete estudos foram incluídos. Quatro eram estudos de coorte retrospectivos longitudinais e três eram observacionais transversais. Em relação à população estudada, a proporção de homens foi de 61,5% e de mulheres, 38,4%, a maioria com diabetes mellitus tipo 2 (85,8%). Em relação ao estágio do diabetes, o percentual de pacientes com retinopatia diabética não proliferativa leve foi de 28,2%, retinopatia diabética não proliferativa moderada foi de 28,5%, de retinopatia diabética não proliferativa grave foi de 15,9% e de retinopatia diabética não proliferativa foi de 27,4%. Em 100% dos estudos, o diagnóstico de edema macular diabético no centro envolvido foi incluído pela tomografia de coerência óptica de domínio espectral (Heidelberg). Em todos os estudos, foi registrada a presença de desorganização das camadas internas da retina e avaliada sua associação com a melhor acuidade visual corrigida. A medição foi realizada usando a escala LogMAR. Em todos os estudos, a presença ou ausência de desorganização das camadas internas da retina foi associada a pior/melhor acuidade visual final melhor corrigida usando p<0,05 como significância estática. A desorganização das camadas internas da retina como biomarcador e sua presença têm se mostrado importantes como preditor da acuidade visual no futuro em pacientes com edema macular diabético. Estudos histopatológicos são necessários para entender seu mecanismo de ação.


Subject(s)
Humans , Male , Female , Retina/pathology , Biomarkers , Macular Edema/physiopathology , Tomography, Optical Coherence , Diabetes Mellitus, Type 2/complications , Diabetic Retinopathy/physiopathology , Vision Disorders/physiopathology , Retinal Vein Occlusion/physiopathology , Visual Acuity/physiology , Diabetes Complications , Systematic Review
11.
Clin. biomed. res ; 42(2): 165-175, 2022.
Article in Portuguese | LILACS | ID: biblio-1391568

ABSTRACT

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.


Subject(s)
Humans , Macular Edema/physiopathology , Diabetic Retinopathy/complications , Intravitreal Injections/methods , Treatment Outcome
12.
Rev. bras. oftalmol ; 80(2): 140-142, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1280115

ABSTRACT

ABSTRACT This report aims to describe the effectiveness of a unilateral intravitreal dexamethasone implant (Ozurdex®) used for the treatment of cystoid macular edema in a patient with recurrent intermediate uveitis. Bearing in mind the adverse effects of the prolonged use of systemic corticosteroids, the objective here was to provide a less damaging form of intervention, and also to demonstrate the safety of the dexamethasone implant for patients who fail to respond to conventional treatment. In the present case, there was bilateral improvement in retinal anatomy and function with use of the unilateral intravitreal dexamethasone implant (Ozurdex®).


RESUMO Neste estudo, o objetivo foi descrever, a partir de um relato de caso, a eficácia do uso de implante de dexametasona intravítrea (Ozurdex®) unilateral, para o tratamento de edema macular cistoide, em um paciente com quadro de uveíte intermediária recorrente, visando uma terapêutica menos lesiva, diante dos efeitos colaterais do uso prolongado de corticoesteroides sistêmicos, demonstrando também a segurança desse tratamento alternativo para aqueles pacientes que se apresentam refratários a terapêutica tradicional. No caso relatado, vale ressaltar a melhora bilateral da anatomia e função retiniana com o implante unilateral de dexametasona intravítrea (Ozurdex®).


Subject(s)
Humans , Female , Middle Aged , Dexamethasone/administration & dosage , Uveitis, Intermediate/complications , Macular Edema/etiology , Macular Edema/drug therapy , Visual Acuity , Uveitis, Intermediate/diagnosis , Macular Edema/diagnosis , Tomography, Optical Coherence , Drug Implants/administration & dosage , Intravitreal Injections
13.
International Eye Science ; (12): 689-693, 2021.
Article in Chinese | WPRIM | ID: wpr-873871

ABSTRACT

@#AIM: To study the clinical efficacy, complications and visual related quality of life(VRQoL)of Ozurdex in the treatment of macular edema secondary to retinal vein occlusion(RVO-ME). <p>METHODS: Totally 30 patients with ME, which had developed secondary to either CRVO(13 eyes)or BRVO(17 eyes), were monitored for 6mo after treatment with Ozurdex in the Department of Ophthalmology of our Hospital. We measured the best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT)at different time after treatment(1wk, 1mo, 2mo, 3mo, 4mo, 5mo, and 6mo after treatment), and we also measured the Chinese version vision related quality of life questionnaire-25(CVRQoL-25)at 3mo after treatment and compared them separately with the ones measured before treatment to evaluate the efficacy, adverse reactions and the visual related quality of life. <p>RESULTS: Generalized estimation equation results showed that BCVA, CMT and IOP all had differences at different time points(<i>P</i><0.001). A BCVA increase was achieved and CMT decreased in all patients at any time point after the onset of treatment(<i>P</i><0.001). The changes of BCVA and CMT were the largest in the 2mo compared to the baseline(<i>P</i><0.001). The score of CVRQol-25 at 3mo after treatment was significantly higher than that before treatment and then the central retinal thickness decreased and a BCVA increased compared to the baseline level(<i>P</i><0.01). The score of CVRQoL-25 at 3mo was negatively correlated both with the LogMAR BCVA evaluated before treatment and at 3mo after treatment(<i>r</i>s= -0.717, -0.746, all <i>P</i><0.001); Meanwhile, the score of CVRQoL-25 was also negatively correlated with CMT at 3mo after treatment(<i>r</i>s= -0.862,<i> P</i>=0.001). In 19 eyes(63%)of the patients with RVO-ME,a relapse was observed after a follow-up time of 1-3mo and the average recurrence time was(2.8±0.5)mo. In follow-up of 6mo, about(2.3±0.4)intravitreal Ozurdex injections per eye was observed. The increase in IOP was observed at 1wk, 1, 2, 3mo after pretherapy(<i>P</i><0.05). The mean IOP values reached a peak at 2mo after injection, which rose(7.85±0.32)mmHg above the baseline level(<i>P</i><0.05)and decreased to normal at 4mo after treatment. 10% of patients had an elevation in IOP above 25mmHg, which could be medically controlled and 4 eyes(13%)of patients had cataract formation, two of which needed to surgery. <p>CONCLUSION: Ozurdex proved to be efficacious with increase in visual acuity and reduction of central retinal thickness and improve the visual function-related quality of life of RVO-ME patients. After single injection of Ozurdex, visual acuity benefited for 2-3mo. 63% of the patients relapsed at about 3mo after treatment. Adverse reactions associated to the use of Ozurdex include the formation of cataracts and an increase in IOP.

14.
International Eye Science ; (12): 684-688, 2021.
Article in Chinese | WPRIM | ID: wpr-873870

ABSTRACT

@#AIM: To analyze the effect of Yiqi Yangyin Huoxue Decoction combined with Conbercept on diabetic macular edema(DME), and the influence on TCM syndromes and serum vascular endothelial growth factor(VEGF)expression. <p>METHODS: Between January 2017 and June 2019, 60 patients admitted to the ophthalmology department at Henan Province Hospital of Traditional Chinese Medicine were perspective enrolled in the study. They were divided into observation group and control group by random number table method, 30 cases with 30 eyes in each group. The control group were treated with intravitreal injection of Conbercept, while the observation group were treated with Yiqi Yangyin Huoxue Decoction combined with intravitreal injection of Conbercept. Changes in TCM symptom scores, the best corrected visual acuity(BCVA), central macular thickness(CMT), retinal neovascularization(RNV)fluorescein leakage area under fundus fluorescein angiography(FFA)and VEGF expression were compared between the two groups, and complications were recorded.<p>RESULTS: Three months after treatment, the observation group had lower scores for blurred version, dry eyes, fatigue, soreness and weakness of waist and knees, and thirst than the control group(<i>P</i><0.05). There were statistically significant differences in BCVA between the 2 groups before and after treatment(all <i>P</i><0.01). The observation group had higher BCVA than the control group at 1mo, 3mo and 6mo(<i>P</i><0.05). Differences in CMT between the 2 groups before and after treatment were statistically significant(all <i>P</i><0.01). Besides, the observation group had smaller CMT than the control group at 7d, 14d, 1mo, 3mo and 6mo(<i>P</i><0.05). There were statistically significant differences in RNV between the two groups before and after treatment(all <i>P</i><0.01), and the observation group had smaller RNV than the control group at 7d, 14d, 1mo, 3mo and 6mo(<i>P</i><0.05). Difference in VEGF between the 2 groups before and after treatment were statistically significant(all <i>P</i><0.01). The VEGF expression level was lower in the observation group than in the control group at 7d, 14d, 1mo, 3mo and 6mo(<i>P</i><0.05). No statistically significant difference was found in the incidence of complications between the two groups(7% <i>vs </i>10%, <i>P</i>>0.05).<p>CONCLUSION: Yiqi Yangyin Huoxue Decoction combined with intravitreal injection of Conbercept is more effective than Conbercept alone in the treatment of DME. The former can significantly improve the patient's vision and CMT, reduce leakage area, down regulate the expression of VEGF, and promote the absorption of retinal edema, with good safety.

15.
International Eye Science ; (12): 339-343, 2021.
Article in Chinese | WPRIM | ID: wpr-862439

ABSTRACT

@#AIM:To evaluate optical quality, intraocular scatter, and determine the impact of retinopathy on optical quality in macular edema(ME)patient by using the Optical Quality Analysis System(OQAS<sup>TM</sup>Ⅱ).<p>METHODS: This was a prospective case-control study. Fifty-eight eyes of 49 macular edema patients who were confirmed by ophthalmic examination in our hospital from August 2019 to January 2020 were selected as the ME group, and 30 eyes of 30 healthy volunteers who were matched with gender and age range for the study were selected for the normal control group. The clinical data of the two groups of patients were recorded. Under the same test conditions, the same operator used OQAS<sup>TM</sup>Ⅱ to check the visual quality of the study object, including the cutoff of the modulation transfer function(MTF cutoff), strehl ratio(SR), OQAS<sup>TM</sup>Ⅱ values(100%, 20%, 9%)and contrast levels(OV100%, OV20%, OV9%). The difference of data between the two groups were analyzed, and the correlation between the visual quality and the thickness and volume of the macular fovea in the ME group were analyzed.<p>RESULTS: The average best corrected visual acuity in the macular edema group was significantly lower than the control group, and the thickness and volume of macular fovea were significantly higher than the control group(<i>P</i><0.001). Compared with the control group, the OSI of the macular edema group was significantly higher, and MTF cutoff, SR value, OV(100%, 20%, 9%)significantly decreased(<i>P</i><0.001). In the macular disease group, the thickness of macular fovea was positively correlated with OSI(<i>r</i>=0.566, <i>P</i><0.001), while MTF cutoff(<i>r</i>=-0.336, <i>P</i>=0.010), OV100%(<i>r</i>=-0.326, <i>P</i>=0.013), OV20%(<i>r</i>=-0.349, <i>P</i>=0.007)and OV9%(<i>r</i>=-0.321, <i>P</i>=0.014)were negative correlation, but it had no correlation with SR. In the macular edema group, the volume of macular fovea was positively correlated with OSI(<i>r</i>=0.574, <i>P</i><0.001). It was negatively correlated with MTF cutoff(<i>r</i>=-0.367, <i>P</i>=0.005), SR(<i>r</i>=-0.265, <i>P</i>=0.045), OV100%(<i>r</i>=-0.351, <i>P</i>=0.007), OV20%(<i>r</i>=-0.385, <i>P</i>=0.003)and OV9%(<i>r</i>=-0.375, <i>P</i>=0.004).<p>CONCLUSION: The optical quality of patients with macular edema is lower than the normal population, and the changes in macular retina morphology and thickness could affect the optical quality and intraocular scattering. The optical quality parameters measured by OQAS<sup>TM</sup>Ⅱ may provide new clinical reference for macular function evaluation.

16.
International Eye Science ; (12): 2183-2186, 2021.
Article in Chinese | WPRIM | ID: wpr-904699

ABSTRACT

@#AIM: To observe the efficacy of aflibercept and ranibizumab in the treatment of diabetic macular edema(DME).<p>METHODS: Patients with DME who visited the ophthalmology department of Xingtai People's Hospital for the first time from November 2019 to February 2020 were included in the study. They were randomly divided into the aflibercept group and the ranibizumab group. 3+PRN(pro re nata)was used, and the interval time between two injections was at least 4wk. All patients were given three injections first. During follow-up, the patient's best corrected visual acuity(BCVA)and central foveal thickness(CFT)were used to determine whether to inject again. All patients were followed-up for 12mo. The changes of BCVA, CFT, intraocular pressure and injection times were recorded in two groups before and after treatment.<p>RESULTS: During preoperative and postoperative follow-up, there were statistical differences in LogMAR BCVA and CFT of the two groups respectively(<i>P</i><0.05). The comparison between the two groups showed no statistical significance during the BCVA and the CFT follow-up(<i>P</i>>0.05). At the end of follow-up, there was a statistical difference in the number of injections between the two groups(<i>t</i>= -6.403, <i>P</i><0.05). The average number of injections was 6.094±0.689 in the aflibercept group and 7.231±0.652 in the ranibizumab group. No ocular complications or systemic adverse reactions occurred in all patients.<p>CONCLUSION: Compared with intravitreal injection of ranibizumab and aflibercept for the treatment of DME can achieve similar treatment effect, but the number of injections is less in the aflibercept.

17.
International Eye Science ; (12): 2150-2155, 2021.
Article in Chinese | WPRIM | ID: wpr-904692

ABSTRACT

@#AIM: To study the clinical effects and safety of iontophoresis of xueshuantong injection combined with anti-vascular endothelial growth factor(VEGF)in the treatment of retinal vein occlusion(RVO)with macular edema(ME). <p>METHODS: Totally 106 patients(106 eyes)with RVO and ME in the hospital between June 2017 and June 2019 were divided into observation group and control group according to the random number table method with 53 cases(53 eyes)in each group, and they were all given intravitreal injection of conbercept, and observation group was additionally given iontophoresis of Xueshuantong injection for intervention, and they were treated for 3mo. Both groups were followed up for 1a and given supplementary therapy according to the condition of the disease. The best corrected visual acuity(BCVA), central retinal thickness(CRT)in macular area, supplementary therapy status, VEGF level in aqueous humor and adverse drug reactions were observed and compared between the two groups before and after treatment. <p>RESULTS: After treatment, the BCVA of the two groups was significantly improved(<i>P</i><0.05)while the CRT in macular area was significantly thinned(<i>P</i><0.05), and the BCVA on the 3, 6 and 12mo of treatment in observation group was better than that in control group while the CRT was thinner than that in control group(<i>P</i><0.05). The macular volume and VEGF level in aqueous humor were significantly reduced in the two groups after treatment(<i>P</i><0.05), and the macular volume and VEGF level on the 1, 3, 6 and 12mo of treatment in observation group were lower than those in control group(<i>P</i><0.05). The injection frequencies of conbercept and triamcinolone acetonide and the proportion of patients with laser photocoagulation in observation group were lower than those in control group(<i>P</i><0.05). During treatment, there was 1 eye of intraocular pressure increase and 3 eyes of subconjunctival hemorrhage in observation group, and there were 2 eyes of subconjunctival hemorrhage and 1 eye of endophthalmitis in control group(<i>P</i>>0.05).<p>CONCLUSION: Xueshuantong iontophoresis combined with intravitreal injection of conbercept for RVO with ME can effectively inhibit the expression of VEGF, reduce the ME and improve the visual acuity of the affected eyes. The efficacy and safety are worthy of recognition.

18.
International Eye Science ; (12): 2145-2149, 2021.
Article in Chinese | WPRIM | ID: wpr-904691

ABSTRACT

@#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.

19.
Article in Chinese | WPRIM | ID: wpr-912396

ABSTRACT

Objective:To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs combined with retinal laser photocoagulation and anti-VEGF drugs alone in the treatment of retinal vein occlusion (RVO) combined with macular edema (ME).Methods:A evidence-based medicine study. Retinal vein occlusion (obstruction), macular edema, anti-vascular endothelial growth factor, bevacizumab, ranibizumab, conbercept, aflibercept, and retinal laser photocoagulation were the Chinese and English search terms. Related literature was searched in China National Knowledge Infrastructure, Wanfang, Weipu, PubMed, Embase, Cochrane Library. RVO combined with ME was selected as the research object, and the treatment plan was a clinical randomized controlled study comparing intravitreal injection of anti-VEGF drugs combined with laser photocoagulation and anti-VEGF drugs alone. The search time range was from January 2011 to February 2021. Repeated, incomplete or irrelevant literature, case reports and review literature were excluded. Review Manager 5.4 statistical software was used to conduct a meta-analysis of the literature. The weighted mean difference (WMD) and 95% confidence interval ( CI) were selected as the estimated value of effect size, and the fixed effect model was used for analysis. The evaluation indicators were best corrected visual acuity (BCVA), center macular thickness (CMT), and the number of injections. Results:According to the search strategy, 461 articles were initially retrieved, and 21 articles were finally included for meta-analysis. A total of 1156 patients were enrolled, of which 576 were treated with anti-VEGF drugs combined with laser photocoagulation (combined treatment group), and 580 were treated with anti-VEGF drugs alone (drug treatment group). Meta-analysis results showed that there was no statistically significant difference in BCVA and CMT between the drug treatment group and the combination treatment group at 6, 9, and 12 months after treatment (BCVA: WMD =-0.82, 95% CI -2.38-0.74, P=0.30; CMT: WMD=-3.12, 95% CI -17.25-11.01, P=0.67). For patients with branch retinal vein occlusion and ME, combined therapy can reduce the number of injections more effectively than drug therapy alone ( WMD=-0.80, 95% CI -1.18--0.42, Z=4.10, P <0.000 1). Conclusion:Compared with pure intravitreal injection of anti-VEGF drugs, combined retinal laser photocoagulation can not better improve BCVA and CMT in patients with RVO and ME. For patients with branch retinal vein occlusion and ME, combined retinal laser photocoagulation can effectively reduce the resistance. The number of VEGF injections.

20.
Article in Chinese | WPRIM | ID: wpr-912394

ABSTRACT

Objective:To observe the efficacy of conbercept in the treatment of different types of diabetic macular edema (DME).Methods:A retrospective clinical study. From March 2019 to March 2021, 136 eyes of 136 patients with DME diagnosed in Department of Ophthalmology of Xi'an No.3 Hospital were included in the study. Among them, there were 65 males and 71 females; the average age was 56.65±8.65 years. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT) examination, and glycosylated hemoglobin level (HbA1c) examination. Early Treatment Diabetic Retinopathy Study visual acuity chart was used for BCVA examination, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. An OCT instrument was used to measure the central retinal thickness (CRT) of the macula. According to the characteristics of OCT, DME was divided into diffuse retinal thickening (DRT) type, cystoid macular edema (CME) type, serous retinal detachment (SRD) type, mixed type, and grouped accordingly, respectively, about 30, 38, 33, 35 eyes. There was no significant difference in age ( F=1.189), sex ratio ( χ2=1.331), and HbA1c level ( F=3.164) of the four groups of patients ( P>0.05). All eyes were treated with intravitreal injection of 10 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg) once a month for 3 consecutive times, and then treated as needed after evaluation. BCVA and OCT examinations were performed 1, 3, and 6 months after treatment with the same equipment and methods as before treatment. The changes of BCVA and CRT before and after treatment were compared and observed. For measurement data subject to normal distribution, one-way analysis of variance was performed for comparison between groups; χ2 test was performed for comparison of count data. Results:Before treatment, the logMAR BCVA of the eyes in the DRT group, CME group, SRD group, and mixed group were 0.68±0.11, 0.69±0.15, 0.71±0.12, 0.73±0.14, and CRT was 631.4±50.7, 640.6±55.7, 652.3±63.4, 660.4±61.8 μm. Compared with before treatment, 1, 3, 6 months after treatment, DRT group (BCVA: t=8.139, 11.552, 11.672; CRT: t=16.163, 21.653, 25.855), CME group (BCVA: t=8.923, 9.995, 13.842; CRT: t=16.163, 21.653, 25.855), SRD type group (BCVA: t=5.171, 7.315, 6.051; CRT: t=9.099, 13.731, 21.306), mixed type group (BCVA: t=5.072, 6.939, 7.142; CRT: t=6.920, 15.352, 17.538) The BCVA of the affected eyes was significantly increased, and the CRT was significantly decreased, and the difference was statistically significant ( P<0.05). At 6 months after treatment, the differences in logMAR BCVA and CRT of the 4 groups of eyes were statistically significant ( χ2=58.478, 64.228; P<0.05). The average number of injections in the eyes of the DRT group, CME group, SRD group, and mixed group were 3.37±1.35, 3.68±1.38, 4.18±1.40, 4.13±1.50 times, respectively. Compared with the average number of injections in the eye, the difference was statistically significant ( χ2=9.139, P=0.028). Conclusions:Conbercept can effectively reduce CRT and increase BCVA in eyes with different types of DME. Compared with SRD type and mixed type, DRT and CME type eye are more effective in improving vision, CRT reduction degree is greater, and the number of injections is less.

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