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@#AIM: To explore the effect of vitreous macular adhesion(VMA)on the efficacy of anti-VEGF therapy in patients with branch retinal vein occlusion(BRVO).<p>METHODS: Retrospective case study. According to initially diagnosed OCT characteristics, 110 patients(110 eyes), selected from those who received intravitreal injection of Conbercept in the ophthalmology department of our hospital from January 2017 to May 2019,were divided into VMA-present group(VMA+ group, 34 eyes)and VMA-free group(VMA- group, 76 eyes). After the first injection, at least 6mo follow-up was ensured, to record the number of injection and to examine the best corrected visual acuity(BCVA)and central macular thickness(CMT). And it's <i>via</i> the OCT reports to evaluate status of the vitreous macular adhesion and the occurrence of posterior vitreous detachment(PVD).<p>RESULTS: During the 6mo follow-up after the first injection, there was no difference in the average number of intravitreal injections between patients in VMA+ group and VMA- group(2.91±1.05 times <i>vs</i> 3.08±1.22 times, <i>P</i>=0.915). At the 6mo after the first injection, BCVA and CMT were significantly improved in both groups, and BCVA gain in VMA+ group was more obvious than that in VMA- group \〖-0.20(-0.33, -0.10)LogMAR <i>vs</i> -0.20(-0.30, -0.10), <i>P</i>=0.041\〗, but there was no difference in CMT changes between the two groups(<i>P</i>=0.914). During this follow-up period, in the VMA+ group, 3 eyes, which were focal VMA at baseline, all developed into macular PVD(100.0%); and 5 of 31 eyes, which were extensive VMA at baseline, developed into macular PVD(16.1%). Compared with the extensive VMA, PVD was more likely to develop into focal VMA(<i>P</i>=0.009).<p>CONCLUSION: BRVO patients combined with VMA have greater potentiality in visual improvements under anti-VEGF treatments. Therefore, the presence of VMA does not prevent BRVO patients from receiving anti-VEGF therapy.
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AIM:To observe the the effect of vitreomacular adhesion on the anti-vascular endothelial growth factor (VEGF) treatment in patients with macular edema (ME) induced by branch retinal vein occlusion (BRVO).METHODS:A retrospective clinical study.Totally 58 patients(60 eyes) were induced in this study during April 2014 to May 2016,who were diagnosed with macular edema due to branch retinal vein occlusion.All subjects were assigned to 2 groups according to the examination of optical coherence tomography (OCT):combined with vitreomacular adhesion groups (Group A) and uncombined with vitreomacular adhesion groups (Group B).The basic situation of the two groups was as follows:Group A:23 cases (24 eyes),the average age was 55.91± 7.34,the mean disease course was 3.4±1.01mo,the mean macular central retinal thickness (CMT) was 463.26±53.73μm and the average BCVA was 0.63±0.11;Group B:35 cases (36 eyes),the average age was 56.33± 5.34,the mean disease course was 2.82± 1.33mo,the mean CMT was 482.90± 37.43μ m and the average BCVA was0.59±0.12.All cases received vitreous injection of 0.5mg Conbercept.Injections were repeated based on the visual changes and the OCT findings.The follow-up time was more than 6mo.BCVA,CMT,and the numbers of injections of two groups were recorded at pre-operation and postoperative 1,6mo and the statistical analysis was conducted.RESULTS:BCVA and CMT of the most patients were improved compared to prior treatment and the difference had statistical significance (P ＜ 0.05).There were significant differences on CMT between two groups at 1 and 6mo after treatment (t=9.13,10.01;P＜0.05).While BCVA between two groups at 1 and 6mo after treatment was not statistically different (t=2.13,5.32;P＞0.05).At 6mo after treatment,the average numbers of injections in combined vitreomacular adhesion groups were 4.38±0.97 times and the average numbers of injections in uncombined vitreomacular adhesion groups were 3.56 ± 0.71 times.The difference had statistical significance (t=4.56,P＜ 0.05).Systematic adverse reactions and persistent intraocular pressure elevation,retinal detachment,endophthalmitis,vitreous hemorrhage were never found in the follow-up period.CONCLUSION:Vitreous injection of anti-VEGF treatment for macular edema induced by branch retinal vein occlusion has good clinical results.However,if there is merged with vitreomacular adhesion at the same time,the treatment effect of anti-VEGF will be weakened to some extent.
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Vitreous retinal interface abnormalities are associated with many macular diseases.The main approach of treatment is to release the vitreomacular adhesion with pars plana vitrectomy.Because of its complication and limitation,researches of pharmacologic posterior vitreous detachment (PVD) were undertaken.Gene recombinant ocriplasmin was proved by several experiments and clinical trials by inducing a complete PVD,showing its promising prospect.This article reviewed the literatures of ocriplasmin,including pathobiology in treatment of vitreomacular adhesion,pharmacokinetics,vitreodynamics,experimental studies and clinical trials and adverse events.