ObjectiveTo investigate the therapeutic effects of thrombolysis infusion via microcatheter on the treatment of central retinal artery occlusion(CRAO). MethodsUrokinase (UK) was directly infused via ophthalmic artery (OA) by microcatheter (6 patients) or via intravenous (7 patients) to dissolve the thrombus. The patency of the artery was evaluated by fundus fluorescein angiography (FFA), and the effect of fibrinolytic activity on the systemic changes was observed by blood biochemical examination simultaneously. ResultsIn 6 patients in the microcatheter group, 5 had completely and 1 had partly reopened OA on the morrow of UK infusion with the patency rate of 83.33%, while in 7 patients in vein group, 3 completely reopened, 2 partly reopened and 2 obstructed OA were found with the patency rate of 42.86%. The difference between the two groups was significant. No obvious change of index of blood coagulation system was found in catheter group, which had great disparity compared with the vein group.ConclusionUrokinase infusion via microcatheter in CRAO has better therapeutic impact and smaller effect on systemic action. (Chin J Ocul Fundus Dis, 2005,21:16-19)
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.
Objective The present study focus on the macular branch retinal vein occlusion (MBRVO) with and without laser treatment,and evaluate prospectively whether laser treatment is useful in improving the visual acuity and reducing the macular edema. At the same time to learn the difference of macular light sensitivity before and after laser treatment.Methods Forty-five eyes of forty-five patients with MBRVO and macular edema were randomized to laser treatment and no laser treatment. Follow up examinations were performed every 3 months. We compared the difference of visual improvement, resolution of macular edema between the two groups. The central 30°visual field of 20 patients with MBRVO were examined at pretreatment and 3 months after laser treatment. A comparison of light sensitivity at fovea ，central 10°and 11~30°eccentricity were done between before and after laser treatment. Results Comparison of visual improvement and resolution of macular edema showed a statistical difference between laser treatment and no laser treatment. The mean reduction of macular light sensitivity at the fovea and 11~30°3 months after the treatment has no statistical difference between before and after treatment (Pgt;0.05). But the mean light sensitivity at central 10°eccentricity were significantly decreased 3 months after photocoagulation (Plt;0.05).Conclusion The laser treatment might promote or accelerate visual acuity recovery and reduce the macular edema. There is no significant difference about the efficiency on macular function after laser treatment.(Chin J Ocul Fundus Dis，2003，19：201-268)
ObjectivesTo evaluate the therapeutic effect of argon laser photocoagulation combined with intravitreous injection of triamcinolone acetonide (TA) on ischemic central retinal vein occlusion (CRVO).MethodsArgon laser photocoagulation combined with intravitreous injection of TA was performed on 17 patients (17 eyes) with CRVO between December 2003 and July 2004.ResultsDuring the follow-up of 4-10 months, the visual acuity improved in 16 patients, including alleviated or even disappeared cystoid macular edema (CME) in 5, and recurred macular edema in 5 with decreased visual acuity after 3 months. Six patients had increased ocular pressure after intra-ocular injection which alleviated after treated suitably. No neovascularization in angle or secondary neovascular glaucoma was found.ConclusionArgon laser photocoagulation combined with intravitreous injection of TA may improve the visual acuity and reduce complications in ischemic CRVO, though macular edema may recur in some cases. (Chin J Ocul Fundus Dis, 2005,21:224-225)
Objective To evaluate the therapeutic effect of laser-induced chorioretinal venous anastomosis on macular edema of non-ischemic retinal vein occlusion. Methods Thirty-seven eyes of 37 cases of non-ischemic retinal vein occlusion received the treatment of laserinduced chorioretinal venous anastomosis and were followed up for 6～12 months. All affected eyes underwent the clinical examinations of visual acuity, ocular fundus photography, fundus fluoreceine angoigraphy (FFA) and light sensitivity of central 5 degree of the retina, and the pre- and post-operative clinical materials were analyzed. Results Successful chorioretinal venous anastomosis was formed in 18 eyes (48.6%) within 2 months after laser photocoaglation, with the mean best improved corrected visual acuity of (4.25±0.46) lines, while the mean best corrected visual acuity of the other 19 eyes with unsuccessful anastomosis decreased (0.20±0.54) lines（P＜0.001）. The light sensitivity of central 5 degree of the 18 eyes with successful anastomosis improved（P＜0.001）, with resolution of macular edema in 16 eyes, although cystoid macular edema in 2 eyes remained no change. The light sensitivity of central 5 degree of the 19 eyes with unsuccessful anastomosis have decreased（P＜0.05）, with aggrevation of the macular edema. Conclusion Successful laser-induced chorioretinal anastomosis can resolute the macular edema caused by retinal vein occlusion, especially for diffused macular edema caused by early retinal vein occlusion. (Chin J Ocul Fundus Dis,2002,18:10-12)
Objective To observe the effectiveness of combined therapy of intravitreal injections of ranibizumab and macular grid laser photocoagulation for branch retinal vein occlusion (BRVO) with macular edema (ME).Methods Forty-six patients of BRVO with ME were enrolled in this study. All the patients were examined for corrected visual acuity of Early Treatment Diabetic Retinopathy Study (ETDRS), slit lamp microscope, direct ophthalmoscope, intraocular pressure, fundus color photography, fundus fluorescein angiography and optical coherence tomography. The patients were divided into three groups by different treatments: injection group (18 eyes) received intravitreal injections of ranibizumab only, joint group (17 eyes) received intravitreal injections of ranibizumab combined with grid laser photocoagulation, and laser group (11 eyes) received laser photocoagulation only. The follow-up ranged from three to 15 months, with a mean of (8.0plusmn;3.2) months. The same equipment and methods were used to return visit in follow-up period. Repeated injections were adopted in injection group and joint group according to the results of subsequent visits. Then the repeated times of injection in two groups were compared. The visual acuity, macular retinal thickness (CRT) and ocular and systemic adverse reactions about drugs and treatments were followed up. The last follow-up time was considered as the judgment time for the therapeutic effects. Results The mean repeat times of injection in the injection group was 5.4plusmn;0.4, which more than that in the joint group 3.2plusmn;0.6 (t=12.17,P＜0.05). No ocular or systemic adverse events were observed in follow-up period. ETDRS visual acuity of injection group, joint group and laser group increased by 7.30plusmn;8.68,8.50plusmn;6.04,1.55plusmn;6.85 letters respectively after treatment. The differences were statistically significant before and after treatment in injection group and joint group (t=3.58, 5.78;P＜0.05), but there was no significant difference in laser group (t=0.75,P＞0.05). The difference was not statistically significant between injection group and joint group (t=0.45,P＞0.05). The difference was statistically significant between injection group and laser group, but also between joint group and laser group (t=2.13, 2.81;P＜0.05). CRT of injection group, joint group and laser group decreased by (110.56plusmn;43.08), (125.47plusmn;35.19), (50.73plusmn;19.68) mu;m respectively after treatment, with statistically significant differences (t=-10.89,-14.70, -8.55;P＜0.05). Conclusion In the treatment of BRVO with ME, intravitreal injection of ranibizumab combined with macular grid laser photocoagulation can reduce repeat times of injection, improve visual function and relieve ME.
Objective To investigate the efficacy and the safety of external therapy of ultrasound (ETUS) enhancing thrombolysis on the experimental retinal vein occlusion. Methods The effect of ETUS enhanced thrombolysis and the impact of ultrasound energy and exposure were investigated respectively after both eyes of 51 rabbits with retinal branch vein occlusion created by photodynamic initiated thrombosis were divided into 4 groups. The first 2 groups are the ETUS groups, including one group (15 rabbits) underwent intravenous injection with urokinase (UK) (1700-2200 UK dissolved into 20 ml normal saline), and other group (12 rabbits) underwent intravenous injection with normal saline. In these 2 groups, each rabbit received ETUS treatment (1.0 W/cm2, 20 min) in one eye and the fellow eye did not which was as the control. The latter 2 groups are the energy and duration of ultrasound groups, and 12 rabbits in each group underwent ETUS with the energy of 0.7 and 1.0 W/cm2 respectively. Each of the 2 groups was divided into 3 subgroups (8 rabbits in each) according to the radiated durations (8, 14, and 20 minutes). All of the eyes except the control ones underwent ETUS with 1 MHz ultrasound and 100 Hz pulsed ultrasound once a day for 3 days. Fundus fluorescein angiography (FFA) was used to detect the vascular condition 4 days after ETUS, and at the 15th day, retinal light microscopy and electron microscopy were performed. Results The vascular recanalization rate in ETUS+UK treatment group was 66.7%, which is obviously higher than which in single UK group (20.0%, P=0.025), normal saline group (8.3%, P=0.005), and ETUS+ normal saline group (8.3%, P=0.005). The vascular recanalization rates in groups with different energy of ultrasound increased obviously as the radiated durations increased (P=0.006, 0.001), while no apparent effect of energy of ultrasound on the vascular recanalization rate was found in the groups with different radiated duration (Pgt;0.05). The eyes which had undergone ETUS treatment had retinal tissue damage and ultrastructure changes of the retinal ganglion cells (RGC), and deteriorated as the radiated duration increased. Conclusion ETUS may enhance the thrombolysis induced by urokinase in experimental retinal vein occlusion. Simultaneously, ETUS can lead to the damage of retinal tissue and changes of the ultrastructure of RGC. (Chin J Ocul Fundus Dis, 2007, 23: 166-169)
Macular edema is a common cause of visual loss in patients with retinal vascular diseases represented by diabetic retinopathy and retinal vein occlusion. Laser photocoagulation has been the main treatment for this kind of diseases for decades. With the advent of antagonist of vascular endothelial growth factor and dexamethasone implant, diabetic macular edema and macular edema secondary to retinal vein occlusion have been well controlled; the use of laser therapy is decreasing. However, considering possible risks and complications, lack of extended inspection of efficacy and safety of intravitreal pharmacotherapy, laser therapy cannot be replaced by now. Therefore, the efficacy and safety of laser therapy will improve by sober realization of role of photocoagulation and proper selection of treatment indication.
Pharmaceutical therapy, including anti-vascular endothelial growth factor treatment and intravitreal corticosteroids, is the most common treatment for branch retinal vein occlusion (BRVO) and its complications, however there are confusing ideas about the protocol, patient selection, timing and endpoint of this treatment. The disease is easy to relapse with these drugs therapy. Collateral vessel formation was found in patients receiving intravitreal injection of ranibizumab or triamcinolone for BRVO and secondary macular edema. The mechanism of collateral vessel formation has not been carefully investigated. In the past thrombolysis, arteriovenous fasciostomy and laser choroidal retinal vascular anastomosis were used to reconstruct the retinal circulation, but their rationality, effectiveness and safety need to be further were studied. In recent years, because of the key technology is still immature, the artificial vascular bypass surgery experiment is not yet practical, but provides us a new idea worth looking forward to for the treatment of BRVO.
ObjectiveTo investigate the efficacy and safety of intravitreal ranibizumab and (or) triamcinolone combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion (BRVO) during one year period. MethodsThe data of 31 eyes from 31 consecutive patients with macular edema secondary to BRVO during one year follow-up visit were retrospectively analyzed. Mean best corrected visual acuity (BCVA) logMAR was (0.74±0.36) and mean central retinal thickness (CRT) was (484.48±164.81)μm at baseline. All patients received standardized clinical comprehensive examinations including vision, intraocular pressure and optical coherence tomography for diagnosis before treatment. All patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml) at first visit. The continue PRN treatment were based on the visual acuity changes and the optical coherence tomography findings. Eyes received combined triamcinolone acetonide 0.05 ml (40 mg/ml) and ranibizumab for macular edema recurrence after two injections of ranibizumab and received laser photocoagulation during 10-14 days after third injections of ranibizumab. Mean injection of ranibizumab was 3.52±2.01, 15 eyes with triamcinolone acetonide (0.84±1.21), 21 eyes with laser photocoagulation (0.97±0.95) and 12 eyes with three treatment. Compared the visual acuities and CRTs of the first and the last visits by statistical analysis. ResultsMean visual acuity improved significantly to 0.42±0.33 logMAR (t=6.611, P=0.000). Mean improvement of visual acuity was 2.90±3.07 lines. A gain of three or more logarithmic lines was evaluated in 20/31 eyes (64.52%) at the last visit. Mean CRT was (326.19±117.80)μm (t=4.514, P=0.000).Mean reduction of CRT was (333.58±134.17)μm. A decrease of 100μm of CRT was evaluated in 17/31 eyes (54.84%). No severe ocular and systematic side effect was found. ConclusionThe efficacy and safety of intravitreal ranibizumab and (or) triamcinolone combined with laser photocoagulation for macular edema secondary to BRVO were assured.