Comparison of big data before and after the establishment of one-stop intravitreal injection mode in the real-world research / 中华眼底病杂志

Objective:To compare and analyze the application of anti-vascular endothelial growth factor (VEGF) drugs for intravitreal injection in the real world before and after the establishment of one-stop intravitreal injection center, as well as the advantages and disadvantages of different management modes.Methods:A retrospective clinical study. A total of 4 015 patients (4 659 eyes) who received anti-VEGF drugs for ocular fundus diseases at the Tianjin Medical University Eye Hospital from July, 2018 to June, 2022 were included in the study. There were 2 146 males and 1 869 females. The ocular fundus diseases in this study were as follows: 1 090 eyes of 968 patients with wet age-related macular degeneration (wAMD); 855 eyes of 654 patients with diabetic macular edema (DME); 1 158 eyes of 980 patients with diabetic retinopathy (DR); 930 eyes of 916 patients with macular edema secondary to retinal vein occlusion (RVO-ME). A total of 294 eyes of 275 patients with choroidal neovascularization secondary to pathological myopia (PM-CNV); 332 eyes of 222 patients with other fundus diseases. A total of 13 796 anti-VEGF needles were injected. A total of 1 252 patients (1 403 eyes) from July 2018 to June 2020 were regarded as the control group. From July 2020 to June 2022, 2 763 patients (3 256 eyes) who received anti-VEGF treatment in the intravitreal injection center were regarded as the observation group. The total number of intravitreal injection needles, the distribution of anti-VEGF therapy in each disease according to disease classification, the proportion of patients who chose the 3+ on-demand treatment (PRN) regimen and the distribution of clinical application of different anti-VEGF drugs were compared between the control group and the observation group. The waiting time and medical experience of patients were investigated by questionnaire. χ2 test was used to compare the count data between the two groups, and t test was used to compare the measurement data. Results:Among the 13 796 anti-VEGF injections in 4 659 eyes, the total number of anti-VEGF drugs used in the control and observation groups were 4 762 and 9 034, respectively, with an average of (3.39±3.78) and (2.78±2.27) injections per eye ( t=6.900, P<0.001), respectively. In the control and observation groups, a total of 1 728 and 2 705 injections of anti-VEGF drugs were used for wAMD with an average of (5.14±4.56) and (3.59±2.45) injections per eye, respectively; a total of 982 and 2 038 injections of anti-VEGF drugs were used for DME with an average of (4.36±4.91) and (3.24±2.77) needles per eye, respectively. Additionally, a total of 942 and 2 179 injections of anti-VEGF drugs were injected for RVO-ME with an average of (3.98±3.71) and (3.14±2.15) injections per eye, respectively; a total of 291 and 615 injections of anti-VEGF drugs were injected for PM-CNV with an average of (3.31±2.63) and (2.99±1.69) injections per eye, respectively. A total of 683 and 1 029 injections of anti-VEGF drugs were injected for DR with an average of (1.60±1.26) and (1.41±1.05) injections per eye, respectively. The clinical application and implementation of "3+PRN" treatment were as follows: 223 (66.4%, 223/336) and 431 eyes (57.2%, 431/754) in the wAMD ( χ2=8.210, P=0.004), 75 (33.3%, 75/225) and 236 (37.5%, 236/630) eyes in the DME ( χ2=1.220, P>0.05), and 97 (40.9%, 97/237) and 355 eyes (51.2%, 355/693) in the RVO-ME ( χ2=7.498, P=0.006), 39 (44.3%, 39/88) and 111 eyes (53.9%, 111/206) in the PM-CNV ( χ2=2.258, P>0.05), respectively. In addition, the results of the questionnaire survey showed that there were significant differences between the control and observation groups regarding the time of appointment waiting for surgery ( t=1.340), time from admission to entering the operating room on the day of injection ( t=2.780), time from completing preoperative treatment preparation to waiting for entering the operating room ( t=8.390), and time from admission to discharge ( t=6.060) ( P<0.05). Conclusions:The establishment of a one-stop intravitreal injection mode greatly improved work efficiency and increased the number of injections. At the same time, the compliance, waiting time, and overall medical experience of patients significantly improved under centralized management.

Effect of anti-VEGF drugs on the lens / 国际眼科杂志(Guoji Yanke Zazhi)

Anti-vascular endothelial growth factor (VEGF) drugs can effectively treat the diseases which related with the formation of pathological angiogenesis.However,after the intravitreal injection of anti-VEGF drugs,the distribution of this drugs in our eyes will have certain impact on different organizations,due to its specifical mechanism of action.Previously,the studies mainly concentrated on the structures which are rich in vascular tissues.Nevertheless,the structures which are lack of vascular tissues is often overlooked.This article viewed the influence of lens after intravitreal injection of anti-VEGF drugs on early development of the lens,and when it was injected during or after the cataract operation.

Effect and complications of different combined surgeries for proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the efficacy and postoperative complications of different combined surgeries in the treatment of proliferative diabetic retinopathy(PDR). <p>METHODS: The clinical data of 72 patients(82 eyes)with PDR were retrospectively analyzed. According to the different combined methods, the patients were divided into three groups: Group A(28 eyes)underwent vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation; Group B(24 eyes)underwent vitrectomy combined with intravitreal injection of conbercept, phacoemulsification and IOL implantation; and Group C(30 eyes)underwent vitrectomy in the first phase, and then underwent silicone oil removed combined with phacoemulsification and IOL implantation in the second phase. Visual acuity and postoperative complications were observed. <p>RESULTS: The follow-up period was 6-12mo. The mean postoperative LogMAR BCVA of Group A(1.007±0.455), Group B(1.000±0.482)and Group C(1.033±0.531)had all improved than their preoperative BCVA respectively, the difference was statistically significant(<i>t</i>=5.666, 5.113, 5.496; <i>P</i><0.05). There was no statistical difference compared postoperative BCVA among three groups(<i>F</i>=1.670, <i>P</i>=0.195). The main postoperative complications were anterior chamber fibrin exudation(Group A: 6 eyes, Group B: 0 and Group C: 1 eyes), temporary intraocular hypertension(Group A: 5 eyes; Group B: 4 eyes and Group C: 10 eyes), macular edema(Group A: 1 eyes, Group B: 0 and Group C: 0), neovascular glaucoma(Group A: 2 eyes, Group B: 0 and Group C: 0)and rebleeding(Group A: 2 eyes, Group B: 1 eyes and Group C: 3 eyes). There were statistical difference compared anterior chamber fibrin exudation among three groups(<i>χ</i>²=7.556,<i>P</i>=0.008). The incidence of anterior chamber fibrin exudation in Group A was significantly higher than that in Group B(<i>χ</i>²=5.814,<i>P</i>=0.016), without significant difference compared with Group C(<i>χ</i>²=4.469,<i>P</i>=0.035). There was no statistical difference compared other postoperative complications among three groups(<i>P</i>>0.05). <p>CONCLUSION: Each group could help earlier visual rehabilitation and avoid second operation for post-vitrectomy cataract. Compared with the Group C, Group A or Group B is much clearer to observe the ocular fundus and easier to operate. Anterior chamber fibrin is heavier in Group A, intravitreal injection of conbercept can reduce anterior chamber fibrin exudation in combined surgical method.

Effective study in the real-world study of intravitreal anti-VEGF drugs injection in the treatment of fundus diseases / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To understand the clinic effect of intravitreal anti-vascular endothelial growth factor(VEGF) drugs injection in the treatment of fundus disease in the real-world study (RWS).METHODS:The clinical cases treated with anti-VEGF drugs in our department from September 2012 to June 2015 were enrolled in this study.Retrospective investigation was reviewed to the kinds of diseases, frequency, usage, efficacy, adverse reaction, and the effects on visual acuity, fundus and macular thickness which were treated with intravitreal anti-VEGF drugs injection.RESULTS:In 305 patients (340 eyes) treated with anti-VEGF drugs, 53 patients (60 eyes, 17.6%) were wet age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV) 16 cases (18 eyes, 5.3%), diabetic macular edema (DME) 120 cases (134 eyes, 39.4%), branch retinal vein occlusion (BRVO) secondary macular edema 61 cases (68 eyes, 20.0%), central retinal vein occlusion (CRVO) secondary macular edema 29 cases (32 eyes, 9.4%), idiopathic choroidal neovascularization (ICNV) 16 cases (18 eyes, 5.3%), high myopia with choroid neovascularization 4 cases (4 eyes, 1.2%), neovascular glaucoma 4 cases (4 eyes, 1.2%), retinal angiomatous proliferation (RAP) 1 cases (1 eyes, 0.2%) and optic papillary neovascularization 1 cases (1 eyes, 0.2%).The minimum age was 16 years old, and the maximum age 90 years old.There were 247 cases (275 eyes, 80.9%) were treated with intravitreal ranibizumab injection, 58 cases (65 eyes, 19.1%) intravitreal conbercept injection.The time number of all patients accepted anti-VEGF drugs treatment was 465, with an average of 1.7 times per eye.Which, the 3 + PRN treatment method in 98 patients (109 eyes, 32.1%), 1 + PRN treatment in 207 patients (231 eyes, 67.9%).69 cases (77 eyes, 22.6%) were used alone to receive anti-VEGF drugs therapy, 10 cases (11 eyes, 3.2%) combined with intravitreal triamcinolone injection(TA), 35 cases (39 eyes, 11.5%) combined with vitrectomy, 26 cases (29 eyes, 8.5%) combined with photodynamic treatment (PDT), 165 cases (184 eyes, 54.1%) combined with simple laser treatment.After anti-VEGF drug treatment, majority of patients' the best corrected visual acuity (BCVA), fundus and central macular thickness(CMT) were significantly improved, compared with the pre-treatment, the difference is significant (P<0.05).So that anti-VEGF drugs can effectively improve visual function and ocular fundus for fundus diseses.There were no serious adverse reactions except 3 patients appearling skin redness, itching, rash, 1 patient low low-grade fever and 1 patient acute cerebral infarction during the treatment.CONCLUSION:Intravitreal anti-VEGF drugs injection can significantly improve the visual function and ocular fundus for patients with fundus diseases, but there are still some adverse events, which should be attached great importance to medical workers.

The effects of anti-VEGF drugs on the retinal pigment epithelium and inner segment after intravitreal injection in the monkeys / 国际眼科杂志(Guoji Yanke Zazhi)

? AIM: To compare the effects on the retina inner segment and retinal pigment epithelium ( RPE ) of intravitreally injecting bevacizumab, ranibizumab and aflibercept into monkey eyes.? METHODS: Fourteen healthy cynomolgus monkeys (Macaca fascicularis, aged 3-8y,10 males,4 females) were raised at the Covance Laboratories under standard conditions. The 14 monkeys were grouped into 4 groups. Three of the groups with 4 monkeys each were injected intravitreally with one of the drugs, either bevacizumab, ranibizumab or aflibercept, while the 4th group with 2 monkeys served as a negative control. On 1d and 7d of injection, 2 monkeys from each drug treatment group were sacrificed under general anaesthesia and the 4 eyes were enucleated. All the enucleated eyes were fixed in formalin, embedded in paraffin wax, cut into 4. 0 μm sections and deparaffinized according to standard procedures. Image-Pro Plus was used for all the photos to measure the content of vascular endothelial growth factor ( VEGF) in the inner segment and RPE. The ANOVA test from JMP10. 0 statistical program was used to evaluate the results.?RESULTS:Retinal sections were checked for their anti-VEGF immune reactivity. The untreated control samples had the highest level of VEGF in the RPE and inner segment. All of these three drugs can reduce the level of VEGF in the RPE and inner segment, but Avastin seems to be more effective than Eylea in this regard. Lucentis treatment at 1d seems to be more effective than Eylea at VEGF 1d. But at 7d, both Lucentis and Eylea have the same effect on reducing VEGF expression level in the RPE and inner segment.?CONCLUSION: All of these three drugs can reduce the level of VEGF in the RPE and inner segment.

Research status of conbercept treating age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

Age-related macular degeneration( AMD) is one of the major reasons of blindness among the elderly in the developed countries. As AMD patients are increasing year by year, AMD has become one of the important topics of ophthalmic research to prevent blindness. Its pathogenesis is not fully understood, but many studies have shown that vascular endothelial growth factor ( VEGF ) plays an important role in the pathogenesis. With the development and application of anti - VEGF drugs, there are a variety of drugs applied to the disease. This article introduces conbercept for the treatment of AMD.