Real-World Analysis of the Curative Effect in Patients with Proliferative Diabetic Retinopathy of Different Traditional Chinese Medicine Syndrome Types Treated by Anti-vascular Endothelial Growth Factor Combined with Pars Plana Vitrectomy / 广州中医药大学学报

Objective To compare the clinical efficacy of anti-vascular endothelial growth factor(VEGF)combined with pars plana vitrectomy(PPV)treatment for patients with proliferative diabetic retinopathy(PDR)of different traditional Chinese medicine(TCM)syndrome types in the real world.Methods A prospective real-world study was performed in the 36 patients(involving 42 eyes)with PDR treated by anti-VEGF combined with PPV in the Department of Ophthalmology of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2019 to December 2019.According to the TCM syndrome manifestations,the patients were differentiated as qi-yin deficiency complicated with blood stasis obstructing collaterals type(15 cases,involving 18 eyes;shorten as qi-yin deficiency type),liver-kidney deficiency and ocular collaterals failing in the nourishment type(14 cases,involving 17 eyes;shorten as liver-kidney deficiency type),and yin-yang deficiency complicated with blood stasis and phlegm coagulation type(7 cases,involving 7 eyes;shorten as yin-yang deficiency type).The patients were treated with anti-VEGF therapy first and then received PPV after 5-7 days.Aqueous humor was sampled during anti-VEGF therapy and PPV.After treatment,the efficacy of PDR patients with different TCM syndromes was compared.Moreover,the patients were observed in the best corrected visual acuity(BCVA)of the affected eyes before surgery and 3 months after surgery,levels of cytokines in the aqueous humor before and after anti-VEGF treatment,macular central retinal thickness(CRT),area of the foveal avascular zone(FAZ),the blood density of macular center,inner ring,outer ring and intact macula 3 months after surgery,and the postoperative complications.Results(1)The difference of the therapeutic efficacy of PDR patients with various TCM syndrome types was statistically significant(P＜0.05).Among 3 syndrome types,the best efficacy was found in the qi-yin deficiency type,followed by liver-kidney deficiency type,and then yin-yang deficiency type,with the total efficacy rate being 88.89%(16/18),52.94%(9/17),and 42.86%(3/7),respectively.(2)Three months after surgery,the logarithmic value of minimum angle of resolution(LogMAR)for BCVA of patients with qi-yin deficiency type was significantly superior to that of patients with yin-yang deficiency type,with the difference being statistically significant(P＜0.05).After the anti-VEGF treatment,the levels of cytokines in the aqueous humor of the patients varied in the 3 syndrome types:vascular endothelial growth factor A(VEGF-A)level in the patients with the 3 syndrome types was significantly lower,placental growth factor(PLGF)and angiopoietin-like protein 4(ANGPTL4)levels in the patients with qi-yin deficiency type were higher,and interleukin 8(IL-8)level in the patients with liver-kidney deficiency type was higher than those before treatment,and the differences were statistically significant(P＜0.05 or P＜0.01).The blood density of macular outer ring and intact macula in the patients with qi-yin deficiency type and liver-kidney deficiency type was larger than that in the patients with yin-yang deficiency type,and the differences were statistically significant(P＜0.05).However,the differences of CRT,FAZ area,and blood density of macular center and inner ring among the 3 syndrome types were not statistically significant(P＞0.05).(3)The incidence of postoperative complications in the patients with yin-yang deficiency type was relatively high,but the difference among the 3 syndrome types was not statistically significant(P＞0.05).Conclusion In the real world,the best efficacy of anti-VEGF combined with PPV treatment in PDR patients with different TCM syndrome types can be achieved in the patients differentiated as qi-yin deficiency type,followed by liver-kidney deficiency type,and then yin-yang deficiency type.After anti-VEGF treatment,the levels of cytokines in the aqueous humor of the patients vary in the 3 syndrome types.Three months after the operation,the patients with qi-yin deficiency type and liver-kidney deficiency type have larger blood density of macular outer ring and intact macula,and exert good prognosis.

Effect of 25G+pars plana vitrectomy combined with preoperative intravitreal injection of Conbercept on proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical effect of 25G+pars plana vitrectomy(PPV)combined with preoperative intravitreal injection of conbercept in the treatment of patients with proliferative diabetic retinopathy(PDR), and analyze the influence on visual acuity, central foveal thickness(CMT)and serum vascular endothelial growth factor(VEGF)level.METHODS: A retrospective study was conducted from October 2019 to January 2022. A total of 80 patients(87 eyes)with PDR were divided into the two groups according to the treatment method, with 40 patients(45 eyes)treated with 25G+PPV in the control group, and 40 patients(42 eyes)treated with 25G+PPV combined with preoperative intravitreal injection of conbercept in the observation group. The two groups were compared in terms of the best corrected visual acuity(BCVA), intraocular pressure, CMT and serum VEGF level before treatment and at 2wk, 1 and 3mo after treatment. The patients were followed up for 3mo, with postoperative complications and recurrence recorded.RESULTS: The incidence of intraoperative bleeding in the observation group was significantly lower than that in the control group(P<0.05). After treatment, the BCVA of the two groups was improved(P<0.05), CMT and serum VEGF level were decreased(P<0.05), but there was no significant change in intraocular pressure(P>0.05). The BCVA and CMT of observation group were lower than those of control group at 1 and 3mo after treatment(P<0.05). Serum VEGF level in the observation group was lower than that in the control group at 3mo after treatment(P<0.05). The incidence of complications in observation group(5%)within 3mo after treatment was significantly lower than that in control group(18%; P<0.05). There was no statistically significant difference in recurrence rate of PDR between the two groups(P>0.05).CONCLUSION: With few complications, 25G+PPV combined with preoperative intravitreal injection of conbercept is effective in the treatment of patients with PDR, which can better promote postoperative vision recovery, improve macular edema, and reduce serum VEGF level.

Pars plana vitrectomy combined with inverted internal limiting membrane flap technique for treating macular hole retinal detachment in high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane flap technique in the treatment of macular hole retinal detachment(MHRD)in high myopia.METHODS: A retrospective clinical study was conducted. A total of 63 patients(64 eyes)with high myopia and MHRD who treated at our hospital from October 2017 to October 2021 were selected as research subjects. They were divided into two groups according to different surgery, with 34 cases(35 eyes)who received PPV combined with inverted internal limiting membrane flap technique in group A, and 29 cases(29 eyes)received PPV combined with internal limiting membrane peeling in group B. The patients were followed up for 6mo. The two groups were compared in terms of the hole closure rate, the reduction rate of retinal detachment and best corrected visual acuity(BCVA)before operation and at 1wk, 1, 3 and 6mo after operation, and the postoperative complications were recorded.RESULTS: The hole closure rate within 6mo after operation was significantly higher in group A than in group B(P<0.05), but there was no statistically significant difference in the reduction rate of retinal detachment(P>0.05). The BCVA of the two groups was significantly improved over time after operation(P<0.05). There was no statistically significant difference in BCVA between the two groups before operation and at 1wk, 1, 3 and 6mo after operation(P>0.05). Complications were observed in the two groups, but there was no statistically significant difference in the incidence of complications between the two groups(P<0.05).CONCLUSION: PPV combined with inverted internal limiting membrane flap technique is safe and effective in the treatment of MHRD in high myopia, which can effectively improve the patients' BCVA and the hole closure rate without influence on intraocular pressure.

Functional and morphological evaluation of autologous retinal graft in large traumatic macular hole

A 7-year-old boy presented with history of blunt trauma 1 month back. Best corrected visual acuity (BCVA) was 20/200 with optical coherence tomography (OCT) showing a large macular hole. Spontaneous closure of the macular hole seemed unlikely following a month of observation. Pars plana vitrectomy along with autologous retinal graft was performed. At subsequent follow up, hole appeared closed with nasal shrinkage of graft and BCVA improved to 20/100. OCT showed mechanical integration of the graft with adjoining retina. Autologous retinal graft is a feasible option in cases where conventional internal limiting membrane peeling shows lower anatomical success.

Comparison of Silicone Oil Removal Using 23-Gauge and 20-Gauge System for Pars Plana Vitrectomy

PURPOSE: The purpose of this study was to compare the clinical results of silicone oil removal using a 23-gauge transconjunctival sutureless pars plana vitrectomy (TSVS) and the 20-gauge pars plana vitrectomy (PPV) system and to evaluate the clinical value of 23-guage PPV system in silicone oil removal. METHODS: Eight eyes of 8 patients who received removal of silicone oil using the 23-gauge TSVS and 6 eyes of 6 patients using the 20-gauge PPV system were included in this study. The total operation time, silicone oil removal time, intraoperative and postoperative advantages, shortcomings, and complications were compared. RESULTS: The operation time and silicone oil removal time were 44.6+/-14.1 minutes, 42.7+/-10.5 minutes and 2.0+/-0.9 min/cc, 1.4+/-0.6 min/cc when silicone oil removal was performed using 23-gauge TSVS and 20-gauge PPV system, respectively. They were not significantly different (p=0.80, 0.22). Attention for the complete removal of the oil is necessary because of the intraocular trocar length when the 23-gauge TSVS is used. There were no complications except transient hypotonies (2 eyes), transient hypertonies (2 eyes) in the 23-gauge system and transient hypertonies (2 eyes) in the 20-gauge system. CONCLUSIONS: The operation time for silicone oil removal using the 23-gauge TSVS was not different than that of the 20-gauge PPV system and can be performed safely without any particular complications. Care and precautionary measures are needed in order to remove silicone oil completely.

Efficacy of Intravitreal Triamcinolone Acetonide Injections at the End of Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of intravitreal injections of triamcinolone acetonide (TA) at the end of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: We analyzed 50 patients (52 eyes) who underwent PPV for treatment of PDR and received an intravitreal injection of 4 mg TA at the end of surgery. The study group (Group 1) was compared with a control group (Group 2, 46 patients, 51 eyes) (matched with the study group for preoperative parameters) who underwent PPV without intravitreal injection of TA. RESULTS: In Group 1, the grade of anterior chamber cells at postoperative days 1 and 7 was significantly lower than that of Group 2. There was slight mean IOP elevation in Group 1 at postoperative weeks 2, 3, 4, and 8, but it was not statistically significant. Forty-four eyes (84.6%) from Group 1 showed better visual acuity at the last follow-up than at the preoperative visit (Group 1). Thirty-two eyes (62.8%) from Group 2 showed better visual acuity at the last follow-up than at the preoperative visit. The degree of visual improvement was 0.75 logMAR in Group 1 and 0.59 logMAR in Group 2. Vitreous hemorrhage occurred in 9 eyes (17.3%) from Group 1 and in 19 eyes (37.3%) from Group 2. However, the differences in the occurrence of neovascularization in iris and neovascular glaucoma between two groups were not statistically significant. CONCLUSIONS: Intravitreal TA injection at the end of PPV seems to be effective in improving visual acuity and decreasing early postoperative inflammation and the frequency of vitreous hemorrhage.