At present, intravitreal injections of anti-VEGF agents is the main method for the treatment of macular edema secondary to retinal vein occlusion (RVO), which can significantly inhibit neovascularization, release macular edema and improve the vision of patients. However, VEGF is a survival factor of vascular endothelial cells, whether it can lead to the progress of retinal ischemia and it has an effect on retinal capillaries deserves our clinical attention. Most scholars currently think that the anti-VEGF agents will not aggravate the occlusion of retinal capillaries in the treatment of macular edema secondary to RVO from the aspects of the changes of perifoveal capillary arcade, the quantification of foveal avascular zone area, retinal nonperfusion area and retinal vascular density of the superficial and deep capillary plexus In addition, the changes of these indicators may be related to the number of times patients need treatment, visual prognosis and so on. In the future, with the gradual popularization of OCT angiography and the prolongation of the number and time of anti VEGF drug treatment, we look forward to the study of larger samples and longer follow-up time to further analyze the influence of the retinal capillary after anti-VEGF therapy in patients with macular edema associated with RVO.
ObjectiveTo analyze the influencing factors on clinical response to conbercept for diabetic macular edema (DME).MethodsA total of 51 patients (51 eyes) with DME who underwent intravitreal injection of conbercept were included in this retrospective study. The general information (age, sex, body mass index, smoking history, drinking history), blood glucose indicators (duration of diabetes, fasting blood glucose, HbA1c), blood pressure indicators (history of hypertension, systolic blood pressure, diastolic blood pressure), lipid indicators [total cholesterol (TC), high-density lipoprotein (HDL), apolipoprotein A (APOA)], biochemical indicators [neutrophil concentration, hemoglobin (HB), serum creatinine (Scr)] were collected. The best corrected visual acuity (BCVA) and macular central macular thickness (CMT) before and after treatment were comparatively analyzed. CMT reduced not less than 20% and BCVA increased by 2 lines as effective standards. Univariate analysis and multivariate logistic regression analysis were used to determine the factors affecting the efficacy of intravitreal injection of conbercept in patients with DME.ResultsUnivariate analysis showed that diastolic blood pressure, HDL, serum neutrophil concentration, baseline CMT and baseline BCVA were associated with edema regression (P＜0.05); HbA1c was associated with vision improvement (P＜0.05). Multivariate logistic regression analysis showed that there was a history of smoking (OR=0.122, 95% CI 0.017 − 0.887), low diastolic blood pressure (OR=0.850, 95%CI0.748 − 0.966), low HDL (OR=0.007, 95%CI 0.000 1 − 0.440), thin baseline CMT (OR=0.986, 95%CI0.977 − 0.995) were independent risk factors for failure outcome of edema regression (P＜0.05); long duration of diabetes (OR=1.191, 95%CI 1.011 − 1.404), high APOA (OR=1.007, 95% CI 1.000 − 1.013) were independent risk factors for failure outcome of vision improvement. Age, fasting blood glucose, systolic blood pressure, TC, HB, Scr and other indicators had no effect on the efficacy of edema regression and vision improvement after treatment (P＞0.05).ConclusionsSmoking history, long duration of diabetes, low diastolic blood pressure, low HDL level, high APOA level and thin baseline CMT are independent risk factors for the treatment of DME with intravitreal injection of conbercept.
ObjectiveTo observe the short-term efficacy of sub-Tenon’s triamcinolone acetonide (TA) in the treatment of cystoid macular edema (CME) after cataract surgery.MethodsA retrospective study. From October 1, 2013 to October 1, 2018, 21 patients (21 eyes) with CME after cataract surgery diagnosed at The Affiliated Eye Hospital of Wenzhou Medical University were included in this study. All eyes underwent BCVA, intraocular pressure, frequency domain OCT examination. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity when recorded. A frequency domain OCT instrument was used to measure the foveal retinal thickness (CRT). Among 21 eyes of 21 patients, 9 eyes were male and 12 eyes were female; the average age was 66.38±10.88 years. The average logMAR BCVA was 0.46±0.23; the average CRT was 519.90±131.59 μm; the average intraocular pressure was 11.01±3.97 mmHg (1 mmHg=0.133 kPa). All eyes underwent a single treatment of 100 mg/ml TA suspension 0.4 ml (containing TA 40 mg) under Tenon's capsule. The average follow-up time after treatment was 32.86±20.2 days. The changes of BCVA, CRT and intraocular pressure were observed 1 month after treatment. The BCVA, CRT and intraocular pressure before and after treatment were compared by paired t test.ResultsOne month after treatment, the average logMAR BCVA, CRT, and intraocular pressure of the CME eyes were 0.29±0.22, 307.71±35.82 μm and 14.19±6.30 mmHg, respectively. Compared with those before treatment, the differences were statistically significant (t=5.252, 8.166, 4.128; P=0.000, 0.000, 0.001). Among 21 eyes, 13 eyes (61.90%) of the retinal cysts in the macular area completely disappeared; 8 eyes (38.1%) were still visible between the retinal layers. Three eyes with intraocular pressure over than 21 mmHg were treated with lowering intraocular pressure and returned to normal.ConclusionSub-Tenon’s capsular injection of TA to treat CME after cataract surgery can reduce CRT and improve vision in a short time.
ObjectiveTo observe the effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema (DME).MethodsA prospective randomized controlled clinical study. From June 2016 to June 2017, 68 eyes of 68 patients with DME diagnosed in Central Theater Command General Hospital were enrolled in the study. The patients were randomly assigned to two different treatment groups: 36 eyes (36 patients) in the conbercept combined with 577 nm subthreshold micropulse lase group (combined treatment group) and 32 eyes (32 patients) in conbercept group (drug treatment group). All patients received three initial intravitreous injection of conbercept and re-treatment was performed according to the criteria which has been disigned before. BCVA was measured by ETDRS charts. The central macular thickness (CMT), total macular volume (TMV) were measured by Topcon 3D-OCT 2000. The BCVA, CMT and TMV in the combined treatment group and the drug treatment group were 57.9±12.4 letters, 427.8±129.4 μm, 10.14±1.50 mm3 and 59.0±16.0 letters, 441.0 ±135.7 μm, 10.43±2.10 mm3, respectively. There was no significant difference (t=0.321, 0.410, 0.641; P=0.749, 0.683, 0.524). The follow-up period was more than 12 months. The changes of BCVA, CMT and TMV were compared between the two groups. Comparison of BCVA, CMT, TMV before and after treatment in and between groups using repeated measures analysis of variance.ResultsThe average annual injection times was 5.8±1.9 in the combined treatment group and 8.5±2.4 in the drug treatment group. The difference was statistically significant (t=5.12, P=0.000). The BCVA in the 3rd, 6th, 9th and 12th month were 64.9±11.1, 65.6±10.5, 67.0±10.8, 66.6±10.7 letters and 65.7±15.8, 66.9±15.7, 66.4±13.0, 67.3±16.4 letters, respectively, and there were significant differences compared with BCVA before treatment (F=34.234, 10.137; P=0.000, 0.000). The CMT were 335.2±105.9, 352.6±106.6, 336.2±120.8, 305.9±97.0 μm and 323.9±92.8, 325.5±90.2, 327.6±108.2, 312.2±106.8 μm, respectively. The TMV were 9.20±1.08, 9.26±1.20, 9.20±1.63, 9.05±1.18 mm3 and 9.19±1.21, 9.35±1.69, 9.09±1.20, 8.92±1.10 mm3, respectively. Compared with the CMT (F=12.152, 12.917; P=0.000, 0.000) and TMV (F=11.198, 11.008; P=0.000, 0.000) before treatment, the differences were statistically significant.ConclusionConbercept combined with 577 nm subthreshold micropulse laser and conbercept can effectively reduce CMT, TMV and improve BCVA in patients with DME, but combination therapy can reduce the injection times of conbercept.
Objective To evaluate the efficacy and safety of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO). Methods Thirty-nine patients (39 eyes) with ME secondary to RVO were enrolles in this study. Of the patients, 27 were male and 12 were female. The mean age was (41.9±16.3) years. The mean course of disease was (5.0±5.3) months. The best corrected visual acuity (BCVA), intraocular pressure and optical coherence tomography (OCT) were performed. BCVA was measured by Early Treatment Diabetic Retinopathy Study charts. Central macular thickness (CMT) was measured by OCT. The mean BCVA was (13.4±15.3) letters. The mean intraocular pressure (IOP) was (14.1±2.8) mmHg (1 mmHg=0.133 kPa). The mean CMT was (876.1±437.9) μm. Of the 39 eyes, 33 were central RVO, 6 were branch RVO. Patients were categorized into ischemic (18 eyes)/non-ischemic (21 eyes) groups and previous treatment (22 eyes)/treatment naïve (17 eyes) groups. All eyes underwent intravitreal 0.7 mg Ozurdex injections. BCVA, IOP and CMT were assessed at 1, 2, 3, 6, 9, 12 months after injection. Three months after injection, intravitreal injections of Ozurdex, triamcinolone acetonide or ranibizumab could be considered for patients with ME recurrence or poor treatment effects. Change of BCVA, IOP and CMT were evaluated with paired t test. The presence of ocular and systemic adverse events were assessed. Results BCVA, IOP significantly increased and CMT significantly decreased at 1 month after injection compared to baseline in all groups (t=3.70, 3.69, 4.32, 3.08, 4.25, 6.09, 6.25, 4.02, 5.49, 8.18, 6.54, 5.73; P＜0.05). Two months after injection, change of BCVA, IOP and CMT was most significant (t=4.93, 6.80, 6.71, 5.53, 4.97, 5.89, 5.13, 7.68, 7.31, 8.67, 8.31, 5.82; P＜0.05). Twelve months after injection, there was no statistical difference regarding BCVA of ischemic RVO group and previous treatment group, compared to baseline (t=1.86, 0.67; P＞0.05); BCVA of non-ischemic RVO group and treatment naïve group significantly increased compared to baseline (t=2.27, 2.30; P＜0.05); there was no statistical difference regarding IOP in all groups (t=0.30, 0.13, 0.64, 1.53; P＞0.05);however, CMT significantly decreased in all groups (t=4.60, 3.26, 3.00, 4.87; P＜0.05). Twenty-seven eyes (69.2%) experiences ME recurrence (4.5±1.5) months after injection. Most common side-effect was secondary glaucoma. 41.0% eyes had IOP more than 25 mmHg, most of which were lowered to normal range with use of topical IOP lowering drugs. Four eyes (10.3%) presented with significant cataract progression and needed surgical treatment, all were central RVO eyes. No serious ocular or systemic adverse events such as vitreous hemorrhage, retinal detachment or endophthalmitis were noted. Conclusions Intravitreal injection of Ozurdex for patients with ME secondary to RVO is effective in increasing BCVA and lowering CMT in the first few months. Significant treatment effect could be seen at 1 month after injection and was most significant at 2 months after injection. The long-term vision of eyes in non-ischemic RVO group and treatment naïve group are better. 69.2% eyes experience ME recurrence at 4 months after injection. Short term adverse events were mostly secondary glaucoma and long term adverse events are mostly cataract progression.
Integrins is a family of multi-functional cell-adhesion molecules, heterodimeric receptors that connect extracellular matrix to actin cytoskeleton in the cell cortex, thus regulating various physiological and pathological processes. Risuteganib (Luminate®) is a novel broad-spectrum integrin inhibitor. Based on multiple biological functions of anti-angiogenesis, vitreolysis, and neuroprotection, risuteganib is hopeful in treating several fundus diseases such as diabetic macular edema, vitreomacular traction, and non-exudative age-related macular degeneration. By far, risuteganib has successfully met the endpoints for three phase 2 studies and is preparing to enter the phase 3 of diabetic macular edema clinical trials. Overall the risuteganib is safe with no serious ocular or systemic adverse events. Given the unique mechanism of action and longer duration of efficacy, intravitreal injection of risuteganib has the potential to serve as a primary therapy, or adjunctive therapy to anti-VEGF agents.
ObjectiveTo observe the short-term intraocular pressure changes of the affected eye after the implantation of dexamethasone vitreous implant (Ozurdex), and indirectly understand the tightness of the scleral perforation of the 22G implant device.MethodsThis is a prospective cohort design clinical observational study. From January 2018 to January 2020, 90 eyes (90 patients) who underwent vitreous Ozurdex implantation in the Department of Ophthalmology of Beijing Hospital were included in the study. There were 52 males (52 eyes), and 38 females (38 eyes); they were 14-79 years old. Forty-three eyes (43 patients) had retinal vein occlusion with macular edema, 29 eyes (29 patients) had uveitis with or without macular edema, 18 eyes (18 patients) had diabetic macular edema. All eyes underwent standard scleral tunnel vitreous cavity implantation Ozurdex treatment. The intraocular pressure was measured with a non-contact pneumatic tonometer 10 min before implantation (baseline) and 10, 30 min and 2, 24 h after implantation. The difference were compared between the intraocular pressure at different time points after implantation and the baseline. Wilcoxon signed rank test was used to compare intraocular pressure between baseline and different time points after implantation.ResultsThe average baseline intraocular pressure of the affected eye was 14.85 [interquartile range (IQR): 11.60, 17.63] mmHg (1 mmHg=0.133 kPa). The average intraocular pressure at 10, 30 and 2, 24 hours after implantation were 11.90 (IQR: 8.95, 16.30), 13.75 (IQR: 9.95, 16.80), 13.60 (IQR: 10.95, 17.20), and 14.65 (IQR: 12.20, 17.50) mmHg. Compared with the baseline intraocular pressure, the intraocular pressure decreased at 10 and 30 minutes after implantation, the difference was statistically significant (P＜0.001, P=0.002); the intraocular pressure difference was not statistically significant at 2, 24 h after implantation (P=0.140, 0.280).ConclusionsThere is a statistically significant difference in intraocular pressure reduction compared with the baseline in 10 and 30 minutes after vitreous implantation of Ozurdex, and there is no statistically significant difference between 2, 24 hours. This suggests that the 22G scleral puncture port of the preinstalled implant device cannot be completely closed immediately, and short-term intraocular pressure monitoring after implantation should be appropriately strengthened.