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.
Objective To observe the preventive and therapeutic effect of different times, spot reactions and spot density of argon laser photocoagulation on retinal neovas cularization of ischemic retinal vein occlusion (IRVO).Meth9al of 244 patients (268 eyes) with IRVO diagnosed by fundus fluorescein angiography (FFA) were treated by HGM argon laser photocoagulator with green-blue light with 200~500 μm lightspot, 0.1~0.5 s, 0.3~1.0 w, and II~III class spot reaction . All capillary nonperfusion areas (CNA) were photocoagulated, and so were the retinal neovascularization in some patients. The follow up periods were from 6 to 60 months. After 3 and 24 weeks after photocoagulation FFA was performed again. Photocoagulation was performed supplementarilly for the new CNA or incompletely photocoagulated areas. Ophthalmoscopic examination and FFA were performed in all the patients after half a year.Results Only 17 eyes (10.6%) with neovascularization were found after preventive photocoagulation in 160 eyes in non-neovacularization group. Sixty-nine eyes(63.9%) with neovascular atrophy and 39 eyes (36 .1%) with unsuccessful photocoagulation were found after therapeutic photocoagulation in 108 eyes in neovascularization group. There was statistical significance between the two groups (P＜0.01). Photocoagulation energy with reaction of III class and density of 1 lightspot diameter was more effective than which with reaction of II~III class and density of 1.5 lightspot diameter or reaction of ≤II class and density of 2 lightspot diameter (P＜0.01). Conclusion Efficacy of preventive photocoagulation is better than which of therapeutic photocoagulation. Photocoagulation energy with reaction of III class and density of 1 lightspot diameter is an effective method for IRVO.(Chin J Ocul Fundus Dis，2003，19：201-268)
ObjectiveTo observe the alterations of microvascular structure in patients with macular edema (ME) associated with branch retinal vein occlusion (BRVO) before and after anti-VEGF drug therapy.MethodsA retrospective case study. Thirty-two eyes of 32 patients with unilateral BRVO-ME at Department of Ophthalmology in Beijing Hospital during November 2016 to June 2018 were enrolled in this study. There were 14 males (14 eyes) and 18 females (18 eyes), with the mean age of 57.81±10.58 years, and the mean course of the disease of 12.13±7.13 d. The affected eyes was defined as the eyes with BRVO-ME. All the affected eyes received intravitreal anti-VEGF drug injections (3+PRN). BCVA and OCT angiography (OCTA) were performed on the BRVO and fellow eyes before and after intravitreal anti-VEGF drug injections. The scanning region in the macular area was 3 mm×3 mm. Macular blood flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), macular hemodynamics parameters [foveal avascular area (FAZ) area, perimeter (PERIM), acircularity index (AI) and vessel density within a 300um width ring surrounding the FAZ (FD-300)] and central retinal thickness (CRT) were measured in all eyes. Paired samples t-test and Univariate Linear Regression were used in this study.ResultsComparing with fellow eyes, the mean macular blood flow density measured in the entire scan was lower in BRVO-ME eyes in the SCP (t=6.589, P=0.000) and DCP (t=9.753, P=0.000), PERIM (t=4.054, P=0.000) ), AI enlarged in BRVO-ME eyes (t=4.988, P=0.000), FD-300 was lower in BRVO-ME eyes (t=2.963, P=0.006), FAZ area enlarged in BRVO-ME eyes (t=0.928, P=0.361). The blood flow density in the DCP was the parameter most significantly correlated with BCVA and FAZ area (r=0.462, −0.387;P＜ .05). After 3 intravitreal injections of anti-VEGF drug, the CRT and FD-300 decreased, BCVA increased (t=9.865, 3.256, −10.573; P＜0.05), PERIM and AI was not changed significantly (t=0.520, 2.004; P＞0.05). The blood flow density in the SCP decreased (t=2.814, P＜0.05), but the blood flow density in the DCP was not changed significantly (t=0.661, P=0.514). Contrarily, comparing with after 1 anti-VEGF drug injection, the blood flow density in the DCP increased after 2 anti-VEGF drug injections (t=3.132, P＜0.05). FAZ area enlarged in BRVO-ME eyes (t=5.340, P＜0.001). Comparing with last anti-VEGF drug injection, FAZ area enlarged after every anti-VEGF drug injection (t=2.907, 3.742, 2.203; P＜0.05).ConclusionsIn BRVO-ME eyes, the blood flow density in the SCP and DCP are decreased. The blood flow density in the DCP is positively correlated with BCVA and negatively correlated with FAZ area. After anti-VEGF drug therapy, the blood flow density is decreased in the SCP and increased in the DCP, FAZ area enlarged gradually, PERIM and AI are not changed significantly.
Retinal vein occlusion (RVO) is the second visual threatening retinal disorders followed by diabetic retinopathy in the elderly. In the past decades, increasing knowledge of the natural history, aetiology and risk factors, medical management investigation, together with the support of high level evidence-based medical evidence and the results of real-world clinical trials play key roles in guiding the clinical practice. However, without understanding the pathogenesis and pathogeny of the disease, it is difficult to implement a comprehensive, precise and personalized treatment strategy for the RVO patients. It is of significance in the clinic to discuss the pathological process of RVO, analyze the etiological characteristics of the disease, reveal the clinical outcomes, which aim to facility the optimal treatment and follow-up procedure for the patients.
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.