ObjectiveTo compare the short-term efficacy of conbercept and ranibizumab for macular edema in central retinal vein occlusion (CRVO)and explore the relationship between the integrity of ellipsoidal zone and visual acuity. MethodsForty-four eyes of 44 patients with macular edema in CRVO were enrolled into this retrospective and comparative study. There were 15 eyes of 15 males, 29 eyes of 29 females; age ranged from 49-61 years old,with an average age of (54.65±3.10) years. All patients were examined with best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp, fundus photograph, fundus fluorescein angiography (FFA), optical coherence tomography(OCT). BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution acuity. Twenty-three eyes were intravitreal injected with conbercept 0.5 mg (group A) and 21 eyes were intravitreal injected with ranibizumab 0.5 mg (group B). There was no statistical difference of age (t=-1.41), gender (χ2= 0.55),the percentage of hypertension patients (χ2=0.27), average BCVA (t=-2.06), IOP (t=-2.52), central macular thickness (CMT) (t=-1.96), number of different integrity of ellipsoidal zone patients (χ2=1.00) and number of different types of macular edema patients (χ2=1.03) among the two groups (P > 0.05). The change in BCVA and CMT at 3, 6 months between the two groups were compared. The relationship between BCVA at 6 months and BCVA, CMT at baseline were explored. The relationship between three groups of ellipsoidal zone and BCVA at baseline were evaluated. The change of BCVA after treatment between the three groups of ellipsoidal zone were Compared. The number of intravitreal injections between two groups was compared. ResultsDuring the 3, 6 months after treatment, the mean BCVA were all improved with statistically difference in group A (t=5.13, 7.39; P < 0.05) and group B (t=6.60, 11.52; P < 0.05). There was no significant difference of BCVA at 3, 6 moths between group A and group B (t=-0.99, -0.40; P > 0.05). During the 3, 6 months after treatment, the mean CMT were all decreased with statistically difference in group A (t=11.58, 15.96; P < 0.05) and group B (t=18.77, 35.16; P < 0.05). There was no significant difference of CMT at 3, 6 months between group A and group B (t=-1.52, -1.63; P > 0.05). In both groups,BCVA at 6 months was related to BCVA at baseline (r= 0.44, 0.62; P < 0.05), but not related to CMT at baseline (r=0.19, 0.01; P > 0.05). In the two groups, BCVA at baseline was related to the integrity of ellipsoidal zone (r=0.97, 0.70; P < 0.05). There was statistical difference of the number of intravitreal injections in the two groups (t=-6.88, P < 0.05). There was no systemic or ocular serious side effects during the follow up. ConclusionsComparing to ranibizumab, conbercept has the same effective to the treatment of macular edema in CRVO, but the number of intravitreal injections is less. The integrity of ellipsoidal zone is related to BCVA.
ObjectiveTo observe the efficacy of phacoemulsification with intravitreal triamcinolone injection (IVTA) in diabetic patients with severe cataract and diabetic macular edema (DME). MethodsTwenty-one patients (25 eyes) with severe cataract and DME were enrolled in this retrospective study. Fifteen eyes underwent standard phacoemulsification and intraocular lens implantation with 4 mg IVTA at completion of surgery. Ten eyes underwent standard phacoemulsification and intraocular lens implantation. All the patients were followed up for best corrected visual acuity (BCVA), optical coherence tomography(OCT) and ophthalmological examination.Changes in logarithm of he minimal angel of resolution (logMAR) BCVA and central macular thickness (CMT) were evaluated preoperatively and 1 month, 3 months and 6 months postoperatively by repeated measures ANOVA. Correlations between logMAR BCVA and CMT preoperatively and postoperatively were analyzed by Pearson correlation analysis. Postoperative 6 months logMAR BCVA and affecting factors were evaluated by multivariate linear regression analysis. ResultsBoth groups showed significant improvements of logMAR BCVA after surgery (F=4.855, 6.235; P=0.037, 0.020). There were no statistical differences of logMAR BCVA improvement at different time points postoperatively (F=0.007, 0.006, 0.023; P=0.973, 0.938, 0.882). The CMT reductions in IVTA group at month 1 and month 3 postoperatively were statistically significant than the reductions in group without IVTA(F=10.449, 7.374; P=0.012, 0.026), and there was no statistical difference of CMT reduction at month 6 postoperatively between two groups(F=2.173; P=0.114). Correlation Coefficients between CMT and BCVA were not statistically significant preoperatively and 6 months postoperatively(r=0.279, 0.172; P=0.295, 0.574). Analysis of multiple linear regression showed that external limiting membrane status and duration of diabetes are factors affecting the visual recovery (β=0.577, -0.411; P=0.025, 0.030). ConclusionsPhacoemulsification with concurrent IVTA for treatment of patients with severe cataract and DME is effective in reducing edema. But IVTA does not further improve logMAR BCVA postoperatively.
Uveitic macular edema (UME) is a major reason of permanent visual loss. Early treatment is essential for achieving a good visual outcome, but some patients are resistant or nonresponsive to the treatment, which is called refractory UME (RUME). Intravitreous injection of glucocorticoids can improve the intraocular drug concentration and avoid systemic side effects. Immunosuppressive agents have a certain role in improving RUME by inhibiting immune cells through a variety of ways. Non-steroidal anti-inflammatory drugs, carbonic anhydrase inhibitors and new biological agents also can improve RUME outcome, but their effectiveness and safety need to be confirmed by large scale randomized clinical trials. Vitrectomy can improve RUME outcome but whether peeling of internal limiting membrane is necessary or not is still controversial. Peeling the inner limiting membrane can eliminate the potential incentive for macular edema and remove the barrier. But the process of stripping may injury the retinal neurepithelium. To eliminate edema and protect the visual function, we should analysis the causes of RUME and treat it individually.
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.
Diabetic macular edema (DME) is a common ocular complication of diabetes patients. It mainly involve macular which is closely related with visual function, thus DME is one of the major reasons causing visual impairment or blindness for diabetes patients. How to reduce the visual damage of DME is always a big challenge in the ophthalmic practice. In the past three decades, there are tremendous developments in DME treatments, from laser photocoagulation, antiinflammation drugs to antivascular endothelial growth factor therapy. However, the mechanism of DME development is not yet completely clear; every existing treatment has its own advantages and weaknesses. Therefore DME treatment still challenges us to explore further to reduce the DME damages.
ObjectiveTo compare the one year efficacy of intravitreal injection with ranibizumb for macular edema (ME) secondary to ischemic and non-ischemic central retinal vein occlusion (CRVO).MethodsA total of 88 patients (88 eyes) with ME secondary to CRVO were enrolled in this retrospective study. The best corrected visual acuity (BCVA) was detected by the Early Treatment Diabetic Retinopathy Study Chart. The optical coherence tomography was used to measure the foveal retinal thickness (CRT) and macular edema volume. The patients were divided into non-ischemic group and ischemic group, 44 eyes of 44 patients in each group. There was no significant differences in age (t=0.650, P=0.517) and gender (χ2=0.436, P=0.509) between the two groups. Compared with the ischemic group, the CRT was significantly decreased in the non-ischemic group (t=−2.291, P=0.024), and the edema volume in the macular area was significantly reduced (t=−2.342, P=0.022). All eyes were treated with continuous intravitreal injection of ranibizumab three times, and repeated injections were performed as needed. The patients without obvious ME regression after treatment were combined with triamcinolone acetonide injection. The patients with peripheral retinal non-perfusion area were combined with peripheral retinal laser photocoagulation. The follow-up was 1 year. The number of injections was counted. The changes of BCVA, CRT and edema volume in the macular area were compared between the two groups.ResultsDuring the 1-year follow-up period, 88 eyes were injected 1 to 10 times, with the mean of 4.51±2.33. The number of injections in the ischemic group and non-ischemic group were 4.55±1.59 and 4.48±2.91, respectively. There was no significant difference in the average number of injections between the two groups (t=0.136, P=0.892). The number of acetonide injections and laser treatment in the ischemic group was significantly higher than that in the non-ischemic group (t=3.729, 9.512; P＜0.001). At the last follow-up, compared with the ischemic group, the BCVA was increased (t=8.128), the CRT was decreased (t=−7.029) and the edema volume in the macular area was decreased (t=−7.213) in the non-ischemic group (P＜0.001).ConclusionCompared with ME secondary to ischemic CRVO, intravitreal injection of ranibizumab for ME secondary to non-ischemic CRVO has the better outcome of vision improvement and edema regression as well as less frequent of acetonide injections and laser treatment.