Diabetic macular edema (DME) is the most threatening complication of diabetic retinopathy that affects visual function, which is characterized by intractability and recurrent attacks. Currently, the clinical routine treatments for DME mainly include intravitreal injection, grid laser photocoagulation in the macular area, subthreshold micropulse laser, periocular corticosteroid injection, and vitrectomy. Although conventional treatments are effective for some patients, persistent, refractory, and recurrent DME remains a clinical challenge that needs to be urgently addressed. In recent years, clinical studies have found that certain combination therapies are superior to monotherapy, which can not only restore the anatomical structure of the macular area and effectively reduce macular edema but also improve visual function to some extent while reducing the number of treatments and the overall cost. This makes up for the shortcomings of single treatment modalities and is highly anticipated in the clinical setting. However, the application of combination therapy in clinical practice is relatively short, and its safety and long-term effectiveness need further exploration. Currently, new drugs, new formulations, and new therapeutic targets are still under research and development to address different mechanisms of DME occurrence and development, such as anti-vascular endothelial growth factor agents designed to anchor repetitive sequence proteins with stronger inhibition of vascular leakage, multiple growth factor inhibitors, anti-inflammatory agents, and stem cell therapy. With the continuous improvement of the combination application of existing drugs and treatments and the development of new drugs and treatment technologies, personalized treatment for DME will become possible.
ObjectiveTo evaluate the effects of Fufang Xueshuantong combined with laser photocoagulation versus laser photocoagulation alone in the treatment of diabetic retinopathy (DR). MethodThe Web of Science, Medline, Embase, the Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, VIP and Wanfang databases were searched from their establishment until June 2015. We used the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trails. RevMan 5.2 software was used for the analysis. ResultsEight studies were included. The results of Meta-analysis demonstrated that Fufang Xueshuantong combined with laser photocoagulation was superior to laser photocoagulation alone in the effective rate of visual acuity[RR=1.19, 95%CI (1.12, 1.26), P<0.000 01], fundus[RR=1.34, 95%CI (1.18, 1.52), P<0.000 01], and elimination rate of macular edema[RR=1.29,95%CI(1.09,1.54),P=0.004]. ConclusionsFufang Xueshuantong combined with laser photocoagulation is effective for DR. However, due to the limited quantity and quality of the included studies, the results suggest that larger-scale trials are needed.
The effect and opportunity of argon laser photocoagulation for the retinal neovascularization in branch retinal vein occlusion in 30 patients were investigated with a control group of 34 patients received nonlaser but routine treatment. The results of the therapeutic effect demonstrated that the neovascularization disappeared completely in 23 cases and became smaller in 7 cases after laser photocoagulation. The incidnce of vitreous hemorrhage in laser group was 43.3% before laser treatment and none after treatment in the duration of observation,and 70.6% in control group. The progression of visual acuity after treatment in laser group was much better than in control group(P＜0. 005)at the time of the latest examination. We found the therapeutic effect was relation to the area, location of the neovascularization in retina,as well as whether the new vessels protruding into vitreous or not. （Chin J Ocul Fundus Dis,1994,10:195-198）
Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.
Retinal vein occlusion (RVO) is a closely related disease of ophthalmology and systemic diseases. The Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China (consensus) emphasizes that etiological diagnosis and treatment should be paid primary attention to, and etiological exploration should be placed in an important position in the diagnosis and treatment path. In addition to etiological treatment, the consensus emphasizes that clinical attention should be paid to the management of anterior segment neovascularization, neovascular glaucoma and macular edema. Especially for patients with short course of central retinal vein occlusion, the occurrence of 100-day glaucoma should be vigilant, and active anti-vascular endothelial growth factor (VEGF) drugs, laser photocoagulation and intraocular pressure treatment should be taken. For the treatment of macular edema, the consensus points out that anti-VEGF drugs and intraocular glucocorticoid sustained-release agents are effective, but the latter should be used cautiously to avoid problems such as high intraocular pressure glaucoma and accelerated cataract formation. For deficient RVO, the consensus defines its concept, defines the time point of treatment when combined with macular edema, and clarifies the applicable conditions of laser therapy.