Effect of SiWuWuZi decoction combined with intravitreal injection of Conbercept in the treatment of wet ARMD and its effect on inflammatory factors / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effect of SiWuWuZi decoction combined with intravitreal injection of conbercept on patients with wet age-related macular degeneration(ARMD)and its effects on serum vascular endothelial growth factors(VEGF), transforming growth factor-β1(TGF-β1)and inflammatory factors.<p>METHODS: A retrospective study. A total of 60 cases(60 eyes)wet ARMD patients admitted to the ophthalmology department of our hospital from May 2019 to November 2020 were divided into 30 cases(30 eyes)of the control group were treated with intravitreal injection of conbercept, while observation group 30 cases(30 eyes)was added with SiWuWuZi decoction on the basis of treatment for control group. The best corrected visual acuity(BCVA), the neovascular area were not be vanished fundus hemorrhage, exudation, choriocapillario-Bruch's membrane-retinal pigment epithelium complex(CBRC), and retinal neuroepithelial layer(RNL), serum VEGF, TGF-β1, interleukin-6(IL-6)and interleukin-13(IL-13)levels and overall efficacy after 3mo were compared.<p>RESULTS: After 3mo treatment, BCVA, fundus hemorrhage, exudation, CBRC and RNL thickness in 2 groups were improved compared with before treatment(<i>P</i><0.05), and the observation group was better than the control group(<i>P</i><0.05). Compared with before treatment, serum VEGF, TGF-β1, IL-6 and IL-13 in 2 groups after 3mo treatment were decreased(<i>P</i><0.001), and serum VEGF, TGF-β1, IL-6 and IL-13 levels in observation group were significantly lower than those in control group(<i>P</i><0.05). The overall effect of observation group was significantly better than control group(<i>P</i>=0.037). <p>CONCLUSION: SiWuWuZi decoction combined with intravitreal injection of conbercept can gradually vanish fundus neovascularization in patients with wet ARMD, serum levels of VEGF, TGF-β1 and inflammatory factors, improve ocular microcirculation and promote vision recovery in patients with wet ARMD.

A novel small molecule anti-VEGF drug Brolucizumab in the treatment of neovascular age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

@#Anti-vascular endothelial growth factor(anti-VEGF)drugs have become the first choice for the treatment of intraocular neovascularization, but the inconvenience and possible complications caused by frequent intravitreal injection cannot be ignored. Therefore, it is necessary to seek new drugs with long-lasting effects, so as to reduce the number of injections. Brolucizumab, a novel small molecule anti-VEGF drug, has the advantages of stronger tissue penetration, higher drug concentration, smaller injection dose, long-lasting efficacy and longer injection interval. Registered clinical studies and real-world evidence showed that Brolucizumab is non-inferior to aflibercept in efficacy, while its ability to improve intraretinal/subretinal fluid is more significant, and it can maintain a longer dosing interval. In addition, Brolucizumab is safe and has a low incidence of serious adverse events, such as retinal vasculitis reported. Brolucizumab provides a new treatment option for neovascular age-related macular degeneration(nARMD). This article reviews the latest progress of Brolucizumab in the treatment of nARMD.

Research progress of pharmacogenetics with wet age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

@#Age-related macular degeneration(ARMD)is a multifactorial disease, genetic factors play important roles in the pathogenesis of the disease. To date, intraocular injection of anti-vascular endothelial growth factor drugs is the first choice for the treatment of wet ARMD, but the response is variable. This review summarizes vascular endothelial growth factor(<i>VEGF</i>)gene, complement factor H(<i>CFH</i>)gene, age-related maculopathy susceptibility 2(ARMS2)gene and high-temperature requirement A-1(<i>HTRA1</i>)gene single-nucleotide polymorphisms(SNP)in the study of pharmacological genetics of wet ARMD. It is still worthy of further investigations that the genetic mechanism of the disease, so that we can provide individualized treatment sequences and predict the response to anti-VEGF therapy.

Study of psycho-social impairment in patients presenting with age related macular degeneration in a tertiary eye care hospital.

Background: Age Related Macular Degeneration (ARMD) is an eye condition affecting old age people causing severe vision loss. This study was carried out to assess the psycho-social impairment in the ARMD patients and compare it with the normal eye patients. Methods: A Two study groups were made: 1. ARMD patients. 2. Control group patients. Patients of both the groups were made to fill “The validated Gujarati version of: General Health Quality Questionnaire-28 (GHQ 28)”. Self-scoring was done according to 0-1-2-3 lower to higher disability respectively. Results: Prevalence GHQ Mean score of ARMD patients was 34.27 and that of normal eye patients was 24.66. 80.85% of ARMD patients and 26.73% of normal eye patients were psychosocially impaired. Conclusion: ARMD patients are psychosocially more impaired as compared to control group patients (p value <0.001, highly significant).

Retinal Toxicity of Intravitreal Tissue Plasminogen Activator on Submacular Hemorrhage

PURPOSE:To present the clinical feature of retinal toxicity of intravitreal tissue plasminogen activator which was used for treatment of submacular hemorrhage. CASE SUMMARY: An intravitreal injection of tPA (100 microg) with C3F8 gas tamponade (0.2 cc) was given to treat the submacular hemorrhage in a patient with ARMD. The therapeutic effect was measured by visual acuity, slit lamp examination, indirect funduscopy and fluorescein angiogram. Three months after the operation, the hemorrhage was decreased but a pigmentary change was observed on the peripheral retina. After 8 months, the submacular hemorrhage completely reabsorbed but the peripheral pigmentary change had increased. Ten months later, the retinal pigmentary change was observed on the entire retina except the posterior pole. The fluorescein angiogram showed peripheral hyperfluorescene of the retina due to window defect from the pigmentary change but no leakage was detected. The electroretinogram showed reduced amplitude in the right eye. CONCLUSIONS: Intravitreal tPA injection of 25 to 100 microg with pneumatic displacement is typically used for the treatment of submacular hemorrhage. However, there is no established safety dose of tPA for use in human eyes. In the present study, 100 microg of tPA was used and retinal toxicity was noted. Establishing a safety dose of tPA to prevent dosage dependent complications is necessary.

Photodynamic Therapy Results of Retinal Angiomatous Proliferation with Pigmented Epithelial Detachment in Age-related Macular Degeneration

PURPOSE: To evaluate the incidence of retinal angiomatous proliferation (RAP) and retinal pigmented epithelial detachment (PED) in Korean age-related macular degeneration (ARMD) patients and results of photodynamic therapy (PDT) with verteporfin. METHODS: Between May 2001 and December 2004, two hundred fifty-eight patients diagnosed of ARMD were evaluated and nine eyes of seven patients were as having RAP with PED. All patients underwent two or more sessions of PDT. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography and ICG angiography were performed before and after treatment. RESULTS: The incidence of RAP with PED was 2.8%. The mean age of onset was 71.7 and five of seven patients were female. After 17 months and mean 2.3 PDT treatments, mean BCVA decreased from 0.2 to 0.04. In two eyes, additional Transpupillary thermotherapy was undertaken. Occlusion of RAP and flattening of PED was observed in one eye, and four evolved toward stage 3 RAP. Three eyes with PDT developed tear of retinal pigmented epithelium. CONCLUSIONS: Korean ARMD patients showed a low incidence of RAP and poor visual outcomes even with treatment.

Surgical Removal of Subfoveal Choroida l Neovascular Membranes in Older Patients

We report the result of surgical removal of subfoveal choroidal neovascular membranes[CNVM] in patients older than 50 years. Eleven eyes treated consecutively by submacular surgery were included. Etiology of CNVM was age-related macular degeneration in 7 eyes, myopia in 2 eyes, and idiopathic in 2 eyes. All the eyes had vision of 20/200 or worse and had undergone surgeries within 3 months from the onset of visual symptom. After creation of posterior vitreous detachment, neovascular membranes were completely dissected and removed through 36Gsize retinotomies. No laser photocoagulation was placed to the retinotomies, and air bubble of 30% volume of vitreous cavity was left for tamponade at the end of the surgery. Within one month postoperatively, fluorescein angiogram was obtained and confirmed the absence of residual CNVM in all cases. One eye developed a recurrent CNVM 6 months following surgery and was lasered successfully. At the mean follow-up period of 6.4 months, visual acuity was improved in 6 eyes[55%], unchanged in 4 eyes[36%], and worsened in 1 eye[9%] which suffered from diffuse RPE loss during surgery. Although the visual outcome of submacular surgery is expected to be poor in older patients, surgical approach may be beneficial in carefully selected cases with CNVM for improvement or preservation of vision.

The Variants of Macular Choroidal Veins in ICG Angiography

The choroidal vascular structure in macula is anatomically different from that in other region. And choroidal venous drainage in macula represents various types. This study attempted to classify the choroidal venous drainage in macula and focused on the relationship between the choroidal venous drainage type and a disease involving macula, esp. age-related macular degeneration(ARMD). The authors performed indocyanine green(ICG) angiography in 115 eyes (93 patients) without macular disease and in 31 eyes (24 patients) with ARMD, which were presented with choroidal new vessels. The choroidal venous drainage in macula was classified as 4 types. They were superotemporal drainage, inferotemporal drainage, horizontal watershed, and irregular type. The most common type of choroidal venous drainage was horizontal watershed type which was showed in 55 eyes (48%) without macular diease and 15 eyes (48%) with ARMD. Any relationship between a type of choroidal venous, drainage and ARMD was not found.