Compound anisodine combined with retinal laser photocoagulation for the treatment of severe non-proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of the compound anisodine combined with retinal laser photocoagulation in the treatment of severe non-proliferative diabetic retinopathy(NPDR). METHODS: According to the retrospective study, totally 120 eyes of patients with severe NPDR who admitted to Daxing Teaching Hospital Affiliated to Capital Medical University from May 2023 to July 2023 were selected. The patients were divided into the observation group and the control group according to treatment methods, with 60 eyes in each group. The observation group was treated with panretinal photocoagulation combined with the compound anisodine injection. The control group was only treated with panretinal photocoagulation. The optical coherence tomography angiography(OCTA)and optical coherence tomography(OCT)were used to quantitatively analyze the fundus retinal structure and blood flow. Furthermore, the best corrected visual acuity(BCVA), superficial vascular density(SVD), deep vascular density(DVD), choroidal blood flow density and central macular foveal retinal thickness(CMT)were compared before treatment and at 1 d, 1 and 2 mo after treatment.RESULTS:At 2 mo postoperatively, the rate of visual improvement and the BCVA in the observation group of patients were significantly better than those of the control group, and the incidence of macular edema in the observation group was significantly lower than the control group(P<0.05). The BCVA at 1 and 2 mo after treatment were significantly higher than those before treatment in both groups(P<0.05). The SVD in the observation group was better than the control group at 1 d, 1 and 2 mo after treatment(all P<0.05). The DVD and choroidal flow density in the observation group were better than those of the control group at 1 d after treatment(all P<0.05). The CMT of the observation group was smaller than that of the control group at 1 d after treatment(P<0.05).CONCLUSION:Compound anisodine can effectively improve the fundus microcirculation after panretinal photocoagulation and reduce the incidence of macular edema, thus promoting the visual function.

Effect of anti-VEGF combined with laser therapy on macular blood flow density in patients with severe non-proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the effect of anti-VEGF combined with panretinal photocoagulation(PRP)in the treatment of severe non-proliferative diabetic retinopathy(sNPDR)with diabetic macular edema(DME)on the change of macular blood flow density.<p>METHODS: Data of 30 eyes in 30 patients at Guangxi Zhuang Autonomous Region People's Hospital from October 2018 to April 2019 were retrospectively reviewed, and they were randomly divided into group A and group B each with 15 cases. Group A was received PRP treatment after one initial intravitreal ranibizumab injection followed by pro re nata(PRN)at 7d, while group B was administered PRP alone. The blood flow density of superficial capillary plexus(SCP)and deep capillary plexus(DCP)in macular area(6mm×6mm), central macular thickness(CMT), and best corrected visual acuity \〖BCVA(LogMAR)\〗 were compared between the two groups before and after treatment. <p>RESULTS: Compared with before operation, the DCP blood flow density was significantly increased, CMT was obviously decreased, and BCVA was markedly improved in group A at 2wk and 1mo after surgery(all <i>P</i><0.05), while CMT was decreased and BCVA was improved in group B at 1mo after operation(all <i>P</i><0.05). Postoperative in group A at 2wk and 1mo, the DCP blood flow density was significantly higher than that in group B(43.37%±2.72% <i>vs</i> 41.03%±2.60%, 45.01%±2.28% <i>vs</i> 41.20%±2.43%, <i>P</i><0.05), CMT was obviously lower than group B(303.4±30.36μm <i>vs</i> 329.60±31.47μm, 268.67±30.27μm <i>vs</i> 319.40±28.63μm, all <i>P</i><0.05), and BCVA(LogMAR)was markedly improved compared with group B(0.28±0.11 <i>vs</i> 0.40±0.13, 0.23±0.14 <i>vs</i> 0.38±0.15, all <i>P</i><0.05).<p>CONCLUSION: Anti-VEGF combined with PRP can effectively increase DCP blood flow density, reduce macular edema and improve visual acuity in the short term in patients with sNPDR with DME.

Long-term effects of pattern scan laser pan-retinal photocoagulation on diabetic retinopathy in Chinese patients: a retrospective study.

AIM: To evaluate the long-term effects of pattern scan laser (PASCAL) pan-retinal photocoagulation (PRP) on diabetic retinopathy (DR) in Chinese patients. METHODS: In this retrospective study, we evaluated clinical data of 29 patients (53 eyes) with severe non-proliferative DR (SNPDR) or proliferative DR (PDR) who received PRP and follow-up at our hospital from 2008 to 2013. Sixteen patients (29 eyes) received PASCAL PRP and 13 patients (24 eyes) received 100-ms conventional laser PRP. RESULTS: After long-term follow-up (mean, min-max days: 719.8, 290-1666 for PASCAL PRP vs 743.5, 240-1348 for conventional PRP, P=0.569), patients receiving PASCAL PRP required fewer photocoagulation sessions than the conventional PRP group (2.6±1.0 vs 3.9±0.9, P<0.01). Best corrected visual acuity (BCVA) was reduced slightly in PASCAL PRP group while reduced significantly in conventional PRP group. At last visit, 24 eyes in the PASCAL group (88.9%) and 21 eyes in the conventional group (91.7%) were improved or stable. Two eyes in PASCAL PRP group (7.4%) and 3 eyes in the conventional PRP group (12.5%) developed vitreous hemorrhage or vitreous fibrovascular proliferation. CONCLUSION: PASCAL PRP is as effective and may be more conducive to maintaining visual acuity with less treatment sessions for DR treatment compared to conventional laser PRP.

Timing of administration of Conbercept in the treatment of SNPDR with DME in PRP / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the timing of using anti-VEGF drugs in severe non-proliferative diabetic retinopathy(SNPDR)patients with diabetic macular edema(DME)treated with intravitreal injection of Conbercept(IVC)combined with panretinal photocoagulation(PRP). <p>METHODS: Totally 85 SNPDR patients(85 eyes)with DME diagnosed in our hospital from May 2017 to October 2018 were randomly divided into control group(<i>n</i>=29 cases), IVC group(<i>n</i>=28 cases), PRP group(<i>n</i>=28 cases). The control group was treated with PRP only; the IVC group was given PRP 1wk after IVC; the PRP group was given IVC 1wk after PRP. The follow-up time was 12mo. Changes of the best corrected visual acuity(BCVA)and central macular thickness(CMT)were observed before and 1, 3, 6, 12mo after treatment, and the frequency of IVC were recorded.<p>RESULTS: Compared with before treatment, the BCVA of the three groups after treatment improved, and the CMT decreased(<i>P</i><0.05). after treatment, the BCVA of the IVC group and the PRP group was better than the control group, and the CMT was lower than the control group(<i>P</i><0.05). 3mo after treatment, BCVA(0.24±0.18, LogMAR)in the ICV group decreased more than that in the PRP group(0.38±0.29, LogMAR)(<i>P</i><0.05). At 1 and 3mo after treatment, CMT in the ICV group(1mo 313.89±61.69um, 3mo 287.64±43.94μm)decreased more than that in the PRP group(1mo 347.50±56.55μm, 3mo 318.04±49.334μm), and the difference was significant difference(<i>P</i><0.05). The frequency of IVC was(3.07±1.33)times in the IVC group and(3.93±1.60)times in the PRP group(<i>P</i><0.05).<p>CONCLUSION: In SNPDR patients with DME, IVC combined with PRP is better than PRP alone. Anti-VEGF drugs before PRP can obtain better BCVA, reduce macular edema in the short-term observation. In long-term observation, it can also reduce the frequency of IVC, the risk of infection and the financial burden.

Clinical study of panretinal photocoagulation combined with anti-VEGF drugs in the treatment of severe non proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the effect of panretinal photocoagulation (PRP) combined with anti-vascular endothelial growth factor (VEGF) drugs in the treatment of severe non proliferative diabetic retinopathy (NPDR),and to investigate the influence of the treatment on the prognosis of NPDR patients.METHODS:Totally 120 patients (227 eyes) with NPDR diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were randomly divided into observation group (60 cases,112 eyes) and control group (60 cases,115 eyes).Patients in the observation group were treated by PRP combined with anti-VEGF drugs,while patients the control group were treated with PRP alone.The clinical efficacy and complications of the two groups were compared.Before and after treatment,the best corrected visual acuity (BCVA),central macular thickness (CMT),levels of serum VEGF and angiopoietin 2 (Ang-2) in the two groups were analyzed.RESULTS:The total effective rate of the observation group was significantly higher than that of the control group (P＜0.05).Compared with before treatment,BCVA of the two groups in the time of 2wk,1,3 and 6mo after treatment improved significantly (P＜0.05).And the BCVA of the observation group at each time point after treatment was better than that of the control group (P＜0.05).Compared with before treatment,the CMT and the levels of VEGF and Ang-2 in the observation group decreased significantly starting at 2wk after treatment (P＜ 0.05).While those in the control group decreased significantly starting at 1mo after treatment (P＜ 0.05).The levels of VEGF and Ang-2 in the observation group at each time point after treatment was lower than that of the control group (P＜0.05).CMT of the observation group were significantly lower than that of the control group in the time of 1,3 and 6mo after treatment (P＜0.05).There was no significant difference in the total complication rate between the two groups (P＞0.05).CONCLUSION:PRP combined with anti-VEGF drugs could effectively improve vision of NPDR patients,alleviate macular edema,and improve the clinical efficacy.

Effect of intravitreal injection of Ranibizumab on choroid in patients with severe NPDR with macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the changes of choroidal thickness in patients with severe non-proliferative diabetic retinopathy (NPDR) after vitreous injection of ranibizumab,and to analyze the relationship between the thickness of choroid and the visual acuity of the patients.METHODS:Eighty patients with severe non-proliferative diabetic retinopathy were selected from January 1,2014 to January 1,2017.All patients were divided into observation group and control group according to the random number table,40 cases in each group.The control group was treated in a conventional manner,and the observation group was injected with ranibizumab in the vitreous.The thickness of the choroid in the macular area and the thickness of the retinal neuroepithelium in the macular area were compared between the two groups before and after treatment.The changes of the corrected visual acuity were analyzed at 1mo before and after treatment.The relationship between the thickness of the choroid and the thickness of the retinal neuroepithelium and the best corrected visual acuity were compared.The complications and adverse events were compared between the two groups after 6wk of treatment.RESULTS:The thickness of the choroid and the retinal neuroepithelium in the macular area before were 219.57± 51.24μm and 474.76 ± 95.56μm,respectively,in the observation group and the control group,217.56± 50.36μm and 473.27 ± 96.48μm,respectively.The thickness of the choroid and the thickness of the retinal neuroepithelium in the macular area after treatment were 180.15±42.06μm and 382.18±84.26,202.48±48.28μm and 407.88± 44.25μm,respectively.The difference between the two groups was statistically significant (P＜0.05).The best corrected visual acuity in the observation group and the control group were 0.47±0.19 and 0.53±0.25 respectively (P＜0.05).There was a positive correlation between the choroidal thickness and the best corrected visual acuity in the macular fovea (regression coefficient=1.12,S=0.48,OR=1.376,P＜ 0.05).There was a positive correlation between retinal neuroepithelial thickness and best corrected visual acuity in the macular area (regression coefficient =0.95,S=0.27,OR=1.020,P＜ 0.05).There were 2 eyes (5％) with subconjunctival hemorrhage,1 eyes (2.5％) of glaucoma,1 eyes (2.5％) of vitreous hemorrhage,0 of choroidal detachment,retinal detachment in 0 in observation group at 6wk after treatment.There were 4 eyes (10％) with subconjunctival hemorrhage,2 eyes (5％) of glaucoma,2 eyes of vitreous hemorrhage (5％),2 eyes of choroidal detachment (5％),retinal detachment in 2 eyes (5％) in the control group,and the difference between the two groups on the complications and adverse reactions was statistically significant (P＜0.05).CONCLUSION:The choroidal thickness of patients with macular edema in severe non-proliferative diabetic retinopathy is correlated with the best corrected visual acuity.Intravitreal injection of ranibizumab can effectively reduce the macular fovea choroidal thickness,reduce macular edema and improve vision,and less complications.

Ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy / 眼科新进展

Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy.Methods Sixty-four cases (90 eyes) with severe non-proliferative diabetic retinopathy from July 2014 to June 2016 in our hospital were randomly divided into two groups according to the digital table.The observation group (32 cases,46 eyes) underwent intravitreal injection of reizumab combined with panretinal photocoagulation,and the control group (32 cases,44 eyes) were treated with only panretinal photocoagulation.The visual acuity,fundus,fundus fluorescein angiography and macnlar thickness postoperative 1 month,3 months,6 months were observed and detected.The mean thickness of the retinal neuroepithelium in the macular region and total volume of the 6 mm diameter neuroepithelium in the macular area were compared and statistically analyzed.The laser energy,number of spots and energy density were calculated and recorded.Results BCVA at postoperative 1 month,3 months,6 months in the observation and the control group were better than that before treatment(all P ＜ 0.05),and the observation group was better than the control group (all P ＜ 0.05).In the control group,BCVA had no statistically significant difference between 3 months and 6 months (P ＞ 0.05),and the differences were statistically significant among other time points (all P ＜ 0.05).In the observation group,the differences were statistically significant among all time points after treatment (all P ＜ O.05).In the comparison of mean thickness of the retinal neuroepithelium in the macular region and total volume of the 6 mm diameter neuroepithelium in the macular area in the control group and the observation group before and after treatment,there were statistically significant differences at different time points between the two groups (all P ＜ 0.05).Moreover,the average thickness of the retinal neuroepithelium and total volume of 6 mm diameter neuroepithelium in the macular region at postoperative 1 month,3 months,6 months were better than those in the control group (all P ＜ 0.05).The laser energy,spot number and energy density of the observation group were significantly lower than those of the control group (all P ＜ 0.05).Conclusion Intravitreal injection of ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy can accelerate retinal neovascularization in a short period of time,reduce macular edema and improve the visual function of patients with less laser energy,the curative effect is better than application of retinal laser photocoagulation alone,is worthy of clinical promotion.

Effect of PRP on Visual Acuity, Visual Field and Subjective Symptoms in Very Severe NPDR

PURPOSE: To evaluate the effect of panretinal photocoagulation (PRP) on visual acuity, visual field and subjective symptoms in very severe non-proliferative diabetic retinopathy (NPDR) patients. METHODS: Forty eyes of 20 patients with NPDR were evaluated. Complete ophthalmic examination, visual acuity, Humphrey field test and interview of questionnaire were evaluated before, 2 and 8 weeks after PRP. RESULTS: The mean corrected visual acuity was not significantly changed from before PRP to 2, 8 weeks after PRP (p>0.05). Visual field deteriorated in 2 weeks and then improved in 8 weeks after PRP, however the recovery did not reach to pre-PRP level (p0.05). Thoses number decreased in 15~30degrees field (p<0.01) following PRP. In spite of deterioration of visual field after PRP, subjective symptoms was rarely noted. CONCLUSIONS: Our result suggest that early PRP may be advisable for very severe NPDR patients to prevent the development of possible visual field deterioration following PRP.