Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study. Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female. The average age was (51.25±12.24) years and the course was 5–17 days. All patients were given best corrected visual acuity (BCVA), intraocular pressure, slit lamp with preset lens, fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination. The patients were divided into conbercept and laser group (group Ⅰ), laser group (group Ⅱ) and conbercept group (group Ⅲ), with 30 eyes in each group. The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072, 0.286;P=0.930, 0.752). Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg), and macular grid pattern photocoagulation 3 days later. Group Ⅱ patients were given macular grid pattern photocoagulation. Times of injection between group Ⅰ and Ⅲ, laser energy between group Ⅰ and Ⅱ, changes of BCVA and CMT among 3 groups at 1 week, 1 month, 3 months and 6 months after treatment were compared. Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20±0.41) and (2.23±1.04) times respectively, and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections. The difference of injection times between two groups was significant (P＜0.001). Patients in group Ⅱ had received photocoagulation (1.43±0.63) times, 9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation. The average laser energy was (96.05±2.34) μV in group Ⅰ and (117.41±6.85) μV in group Ⅱ, the difference was statistical significant (P=0.003). BCVA improved in all three groups at last follow-up. However, the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607, –4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=–0.802,P=0.429). The mean CMT reduced in all three groups after treating for 1 week and 1 month, comparing that before treatment (t=–11.855, –10.620, –10.254;P＜0.001). There was no statistical difference of CMT between group Ⅰand Ⅲ at each follow up (t=0.404, 1.723, –1.819, –1.755;P=0.689, 0.096, 0.079, 0.900). CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=–4.621, –3.230;P＜0.001, 0.003). The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month, but the difference was not statistically significant (t=1.995,P=0.056). All patients had no treatment-related complications, such as endophthalmitis, rubeosis iridis and retinal detachment. Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO. Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.
ObjectiveTo evaluate the therapeutic efficacy of vitrectomy with internal limiting membrane (ILM) peeling and subretinal injection of balance salt solution (BSS) for refractory diabetic macular edema (DME).MethodsA retrospective case series study. From November 2017 to August 2018, 24 eyes of 19 patients affected with DME resistant to anti-VEGF therapy [central macualar thickness (CMT) more than 275 μm despite undergoing anti-VEGF therapy at least 3 times] in Ophtalmology Department of Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent 25G pars plana vitrectomy with ILM peeling and subretinal injection of BSS. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The CMT and the macular volume (MV) were assessed with swept-source optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT and MV before and after surgery were analyzed.ResultsThe mean BCVA was 0.74±0.29 at baseline, which increased significantly to 0.62±0.28, 0.56±0.25, 0.47±0.26, 0.46±0.23 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=4.828, P=0.001). At 6 months, BCVA improved by more than 0.3 logMAR units in 16 eyes (66.7%). The mean CMT was 554.58±102.86 μm at baseline, which reduced to 338.17±58.09 μm, 299.42±52.66 μm, 275.75±41.24 μm and 270.96±38.33 μm at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=84.867, P＜0.001). The mean MV was 13.01±0.88 mm3 at baseline, which decreased to 11.50±0.73 mm3, 11.00±0.74 mm3, 10.68±0.61 mm3 and 10.52±0.56 mm3 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=47.364, P＜0.001). Macular edema recurred in 5 eyes (20.8%) 6 months after surgery. No severe systemic or ocular side effect was reported during the follow-up.Conclusions25G vitrectomy with ILM peeling and subretinal injection of BSS for refractory DME can improve the visual acuity, facilitate a rapid resolution of macular edema.
Objective To compare the clinical results of yellow micro-pulse laser and traditional laser grid (MLG) photocoagulation for diabetic macular edema (DME). Methods Seventy-eight patients (106 eyes) with DME diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in this study. The patients were divided into micro-pulse group (39 patients, 51 eyes) and MLG group (39 patients, 55 eyes). The patients of micropulse group underwent 577 nm yellow micro-pulse laser therapy, while the patients of MLG group underwent continuous wavelength laser photocoagulation with a 561 nm yellow green laser. All the patients were examined documenting corrected visual acuity, macular retinal thickness (CMT) and mean sensitivity within macular 10 deg; examination before and after treatment. Six months after treatment was considered as the judgment time for the therapeutic effects. The mean corrected visual acuity, CMT and MS were comparatively analyzed. Results Six months after treatment, the mean corrected visual acuity of micropulse group and MLG group were 0.45plusmn;0.20 and 0.42plusmn;0.20, which increased significantly compared to those before treatment (t=3.404,2.316; P＜0.05). The difference of mean corrected visual acuity between before and after treatment of micro-pulse group and MLG group were 0.08plusmn;0.02 and 0.06plusmn;0.03, the difference was statistically significant between two groups (t=0.532, P＞0.05). The mean CMT of micropulse group and MLG group were (323.94plusmn;68.30) and (355.85plusmn;115.88) mu;m, which decreased significantly compared to those before treatment (t=4.028, 2.039; P＜0.05). The difference of mean CMT between before and after treatment of micro-pulse group and MLG group were (55.12plusmn;13.68) and (22.25plusmn;10.92) mu;m. The difference was not statistically significant between two groups (t=1.891,P＞0.05). The mean MS of micro-pulse group and MLG group were (6.63plusmn;2.65) and (4.53plusmn;1.81) dB. The mean MS of micro-pulse group increased significantly compared to that before treatment(t=3.335,P＜0.05). The mean MS of MLG group decreased significantly compared to that before treatment (t=3.589,P＜0.05). The difference of mean MS between before and after treatment of micro-pulse group and MLG group were (1.10plusmn;0.33) and (-0.91plusmn;0.25) dB.The difference was statistically significant between groups (t=4.872，P＜0.05). Conclusions In the treatment of DME, yellow micro-pulse laser therapy and MLG can improve visual acuity, and reduce CMT. In addition, yellow micro-pulse laser therapy can improve the MS, but MLG reduces MS.
Objective To observe the therapeutic effects of photodynamic therapy（PDT）on choroidal neovascularization（CNV）with or without cystoid macular edema（CME）in patients with wet agerelated macular degeneration（AMD）. Methods The clinical data of 54 patients (54 eyes) with wet AMD who had undergone the standard PDT，including 16 patients（21 eyes）with CME and 28 patients（33 eyes）without CME were retrospectively analyzed. The visual acuity and BFT of patients were examined by early treatment diabetic retinopathy study (ETDRS) and optical coherence tomography（OCT）before and per three months after PDT. The follow up was 3-18 months with the mean of 8.3 months.Results At the last time of follow up, in CME group，ETDRS letter score was（29.429plusmn;17.907）and the BFT was （316.429plusmn;77.161）mu;m，compared with that before the treatment, the difference were statistically significant (t=-0.389，2.246；P＝0.701，0.019). In nonCME group, ETDRS letter score was (48.121plusmn;17.911) and the BFT was (244.667plusmn;37.619) mu;m, compared with that before the treatment, the difference were statistically significant (t=-3.424，6.880；P＝0.002，0.000). There were statistical significance for the change of ETDRS letter score and BFT between the two groups (t=-2.194，2.212；P＝0.033，0.031）). Conclusions Therapeutic effect of PDT on CNV with CME was better than without CME in patients with wet AMD.
Objective To evaluate the effectiveness of repeated intravitreal conbercept injection in patients with macular edema (ME) of retinal vein occlusion (RVO), guided by optic coherence tomography (OCT). Methods It is a retrospective case study. Forty patients (40 eyes) diagnosed as ME secondary to RVO were enrolled in this study. There were 19 males (19 eyes) and 21 females (21 eyes), with the mean age of (53.58±13.19) years and the mean course of 1.5 months. The best corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus fluorescein angiography (FFA) and OCT were performed. The mean baseline of BCVA, central macular thickness (CMT) were 0.25±0.18 and (509.48±170.13) μm respectively. All the patients were treated with 10.00 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg). Follow-up of these patients was 1 to 6 months after treatments, the BCVA, fundus manifestations, OCT were retrospectively observed by every month, the FFA was retrospectively observed by every 3 months. When there was retinal edema or CMT ≥50 μm by OCT during follow-up, those patients were retreated with intravitreal conbercept injection. The changes of the BCVA, CMT were evaluated before and after treatment. Meanwhile, complications in eyes related to medicine and treatment methods were evaluated too. Results At the 6 months, the BCVA was improved (increase≥2 lines) in 25 eyes (62.50%), stabilized (±1 line) in 13 eyes (32.50%) and decreased 2 lines in 2 eyes (5.00%). Retinal hemorrhage and exudates were absorbed in most patients. FFA showed no fluorescein leakage in 11 eyes (27.50%), minor fluorescein leakage in 26 eyes (65.00%), and retinal capillary non-perfusion in 3 eyes (7.50%). OCT showed absorption of the subretinal fluid. The mean CMT were (235.20±100.44) μm at 6 months. Intravitreal injection of conbercept was applied for 4 times in 8 eyes (20.00%), 3 times for 18 eyes (45.00%), and 2 times for 14 eyes (35.00%). The mean number of intravitreal injection was 2.85 times. There were no ocular or systemic adverse events observed in all patients. Conclusion Intravitreal conbercept injection is an efficacy and safe treatment for the patients with ME of RVO guided by OCT. It can stabilize and improve the visual acuity.
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients. It mainly includes focal DME and diffuse DME, while DME of clinical significance needs timely intervention treatment. Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME. Currently, the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation. Among them, anti-VEGF injection is becoming the first-line therapeutic, and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients. During the diagnosis and treatment of DME, attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME. With the appearance of heterogeneity in the efficacy of anti-VEGF drugs, it remains to be further studied how to choose alternative therapeutics and when to replace them.
Objective To evaluate the clinical efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema (DME). Methods Retrospective case series study. A total of 30 patients (35 eyes) with center−involving DME were enrolled in this study. All the patients received the examinations of best corrected visual acuity (BCVA), fundus colorized photography, fluorescein fundus angiography (FFA) and optical coherence tomography (OCT). BCVA was measured by Early Treatment Diabetic Retinopathy Study charts. The average retinal thickness (ART), total macular volume (TMV) and the retinal thickness (RT) and macular volume (MV) of 9 ETDRS domains were measured by the Japanese Topcon 3D-OCT 2000 instrument. The mean BCVA was 62.4±10.5 letters. The mean ART was 327.3±41.2 μm. The mean TMV was 9.24±1.17 mm3. All patients were treated with 577 nm subthreshold micropulse laser treatment. Subthreshold micropulse laser were performed in the micropulse mode, using a 200 μm spot diameter, a 0.2 s duration with 5% duty cycle and its treatment energy was 6−7 times of threshold energy. Three months after treatment, re-treatment was performed on patients with incomplete absorption of macular edema. The treatment was the same as before. The BCVA, ART, TMV and the RT and MV of each ETDRS domain were compared and analyzed before and after treatment. The possible complications of micropulse laser treatment were also observed and the safety was evaluated. Results The difference of BCVA were statistically significant in month 3 and month 6 (t=−5.58, −7.24; P＜0.05), but not in month 1 (t=−1.82, P＞0.05). The average CRT (t=4.11, 4.17, 5.96), CMV (t=3.92, 4.05, 5.80) significantly decreased in 1, 3 and 6 months after treatment, the difference was statistically significant (P＜0.05). At sixth months, the average retinal thickness (t=3.53, 5.07, 5.02, 4.87, 4.94, 3.48, 4.03, 3.17, 3.73) and retinal volume (t=3.54, 5.16, 4.99, 4.91, 5.05, 3.47, 4.08, 3.10, 3.70) of the 9 ETDRS subdomains significantly decreased, and the difference was statistically significant (P＜0.05). There was no visible laser spots, changes in the outer retina and complications of neovascularization and subretinal fibrosis in the fundus of all patients. Conclusion577 nm subthreshold micropulse laser can reduce the CMT, CMV and improve the BCVA of DME patients with high security.