ObjectiveTo evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).MethodsA prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.ResultsSix months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.ConclusionReduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.
Objective To observe the clinical effect of minimally invasive vitreoretinal (MIV) surgery combined with a modified suprachoroidal drainage surgery for retinal detachment associated with choroidal detachment (RRDCD). Methods A prospective clinical study. A total of 27 patients (27eyes) diagnosed as RRDCD were recruited in this study. There were 16 males and 11 females, with an average of (53.67±14.82) years. The mean intraocular pressure (IOP) was (8.2±2.1) mmHg (1 mmHg=0.133 kPa) and best corrected visual acuity (BCVA) of minimum resolution angle logarithm (logMAR) was 1.87±0.58. All subjects underwent 23G MIV combined a modified suprachoroidal drainage surgery, which 23G stab knife and 1 ml syringe needle were used for surgery. The visual outcome, IOP, rate of retinal reattachment and complications were comparatively analyzed preoperatively and postoperatively. Results At 1 day, 10 days, 1 month and 3 months after surgery, the average of logMAR BCVA were 1.62±0.67, 1.51±0.63, 1.39±0.54, 1.32±0.56 and the mean of IOP were (13.47±5.06), (14.43±4.09), (14.89±4.30), (15.38±3.37) mmHg, respectively. There were significant differences of logMAR BCVA and IOP between before and after surgery (F=6.19, 15.21; P＜0.05). Retinal reattachments were achieved in 27 eyes (100%) at 1 day and 10 days after surgery. At 1 month and 3 months after surgery, the rate of retinal reattachment were 88.89% (24 eyes) and 85.19% (23 eyes), respectively. No severe complications such as endophthalmitis and choroidal hemorrhage were found at follow-up visits. Conclusion MIV combined with a modified suprachoroidal drainage surgery is an effective and safe treatment for RRDCD, which can promote retina tear closure, improve visual acuity.
Objective To systematically review the treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients, and to provide evidence for treatment. Methods Databases including PubMed, Web of Science, ScienceDirect, CNKI, WanFang Data and VIP were electronically searched to collect literature related to MDR-TB from inception to April 28th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using R 4.0.5 software, subgroup and meta-regression analyses were performed based on sample size, survey time, etc. Results A total of 36 studies involving 7 981 patients were included. The results of meta-analysis showed that the overall treatment success rate of MDR-TB patients was 60% (95%CI 56% to 63%). The subgroup analysis showed that the treatment success rates of MDR-TB were 49% (95%CI 41% to 58%) from 1992 to 2010, 62% (95%CI 58% to 65%) from 2011 to 2015, and 62% (95%CI 55% to 68%) from 2016 to 2020; those with sample size above 100 and less than 100 were 60% (95%CI 55% to 65%) and 59% (95%CI 54% to 63%), respectively; those with average age above 45 and less than 45 were 58% (95%CI 51% to 65%) and 56% (95%CI 53% to 59%); those of MDR-TB were 63% (95%CI 57% to 68%) in central China, 63% (95%CI 52% to 73%) in the Northwest, 60% (95%CI 55% to 65%) in the Southeast, and 53% (95%CI 48% to 58%) in the Northeast. Conclusions The overall success rate of treatment for MDR-TB patients in China is low. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.
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.
Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis. Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study. There were 38 patients (55 eyes) with optic nerve papillitis, 36 patients (63 eyes) with retrobulbar neuritis. The patients were divided into treatment and control group, 37 patients (59 eyes) in each group. The treatment group received semiretrobulbar injection of 500 μg Mecobalamin per day, 10 times for one course; after two to three courses changed oral 500 μg Mecobalamin, three times per day. Systemic intravenous injection of 15 dexamethasone mg per day for one week, then prednisolone 30 mg per day orally, the dosage was reduced every five days for 5 mg; oral administration of vitamin B1, 10 mg three times per day, use of energy mixture, vasodilators. Control group underwent the same therapy as the treatment group without Mecobalamin. The efficacy differences between two groups were comparatively analyzed. Results Among 59 eyes in the treatment group, 42 eyes (71.19%) were markedly effective, 15 eyes (25.42%) were valid and two eyes (3.39%) were invalid. The total effective rate was 96.61%. Among 59 eyes in the control group, 30 eyes (50.85%) were markedly effective, 26 eyes (44.07%) were valid and three eyes (5.08%) were invalid. The total effective rate was 94.92%. The difference of total effective rate between two groups was not statistically significant (χ2=1.10, P＞0.05); but there was a difference in markedly effective rate between two groups (χ2=5.65, P＜0.05). Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.
ObjectiveTo observe the effect of micro-pulse laser in the treatment of acute central serous chorioretinopathy (CSC). Methods105 cases (114 eyes) with clinically diagnosed acute CSC were included in the study, including 78 males (86 eyes) and 27 females (28 eyes) with an average age of (40.40±7.80) years, and mean duration of 26 days. All patients were examined for best corrected visual acuity (BCVA), slit lamp microscope and pre-lens, direct ophthalmoscopy, color fundus photography, fluorescein angiography combined with indocyanine green angiography (ICGA), and micro-perimetry. Patients were randomly divided into micro-pulse laser treatment group (treatment group, 61 eyes) and control group (51 eyes). The age (Z=-0.374), gender ratio (χ2=0.010), disease duration (Z=-0.525), BCVA (t=1.885), foveal thickness (CFT) (t=-1.754) and macular light sensitivity (t=1.255) were similar between the two groups. The micro-pluse laser treatment was performed with an 810 nm infrared diode laser at the active leakage site on retinal pigment epithelium guided by ICGA. The exposure time was 0.2 s, effective working time was 15%, the laser spot diameter was 100 μm, and the distance between 2 spots was 100 μm. The control group received pseudo-treatment using the same laser parameters. After 2 weeks, 1month, 3 months and 6 months of treatment, all patients were examined with BCVA, ocular fundus, optical coherence tomography and micro-perimetry. These parameters were compared between the 2 groups. ResultsThe subretinal fluid of 39 eyes in the micro-pulse laser group and that of 3 eyes in the control group were absorbed completely. The cure rates in the micro-pulse laser group(61.9%) was higher than that in the control group (χ2=38.015, P < 0.01). In the micro-pulse laser group, the mean BCVA was 67.81±11.70 at baseline, which increased significantly to 75±9.91, 76.78±9.43, 78.56±8.57 and 78.52±8.60 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively. In the control group, that was 63.86±10.35, 64.20±11.43, 63.90±10.88, 64.55±11.04, 64.10±11.12 at baseline, 2 weeks, 1 month, 3 months, 6 months post-treatment respectively. The mean post-treatment BCVA at each time point were significantly higher in the micro-pulse laser group than that in the control group(P < 0.01). The mean CFT was(380.94±50.73) μm at baseline, which reduced to(268.44±44.20), (242.78±41.31), (235.46±38.44), (235.56±38.71) μm at 2 weeks, 1 month, 3 months and 6 months post-treatment respectively in the micro-pulse laser group. In the control group, that was (397.98±52.61), (334.55±59.15), (316.16±55.25), (314.47±53.27), (321.51±55.74) μm at baseline, 2 weeks, 1 month, 3 months, 6 months post-treatment respectively. The mean post-treatment CFT at each time point in the micro-pulse laser group were decreased significantly compared to that in the control group (P < 0.01). The mean central retinal sensitivity was (15.03±2.00) dB at baseline, which enhanced to (17.06±1.71), (17.37±1.61), (17.56±1.58), (17.48±1.53) dB at 2 weeks, 1 month, 3 months and 6 months post-treatment respectively in the micro-pulse laser group. In the control group, that was (14.54±2.22), (14.80±2.16), (14.88±2.09), (14.82±2.07), (14.69±2.11) dB at baseline, 2 weeks, 1 month, 3 months and 6 months post-treatment respectively. The mean central retinal sensitivity at each time point of post-treatment in the micro-pulse laser group were enhanced significantly compared to that in the controlled group(P < 0.01). ConclusionIn the treatment of acute CSC, micro-pulse laser can improve BCVA, reduce the mean CFT and improve the mean central retinal sensitivity. It is an effective and safe method to treat acute CSC.
Objective To analyze the efficacy and safety of Intra-arterial chemotherapy (IAC) as secondly treatment in children with retinoblastoma (RB). Methods 42 eyes of 34 consecutive RB patients were enrolled in the study after intravenous chemotherapy (IVC), including 26 males and 8 females. The average age is 14.1 months. 21 cases were bilateral and 7 cases were unilateral. A total of 42 eyes of 34 patients were classified according to the International Intraocular Retinoblastoma Classification（IIRC）as group B(n=1, 2.4%), group C (n=3, 7.1%), group D (n=32, 76.2%), or group E (n=6, 14.3%). Tumor recurrence and tumor enlargement after IVC were 4 and 10 eyes respectively, accounting for 9.0% and 24.0% respectively. Sequential treatment after IVC followed by IAC were 28 eyes, accounting for 67.0%. All treatment eyes received IAC combined with laser, cryotherapy and other eye local treatment. The IAC regimen adopted the combination and alternation administration mode, by the combination of melphalan and carboplatin or the combination of melphalan and topotecan. According to the tumor changes after IAC decide whether IAC again. If tumors increased, vitreous or subretinal implants increased will be termination of IAC and enucleation. The mean follow-up time was (21.4±3.7) months after the last IAC treatment and (6.2±2.9) months after enucleation. Ocular preservation rate and complication were evaluated. Results The average IAC procedures performed on 42 eyes were (4.0±0.9). An overall ocular preservation rate of 76.2% was observed during follow-up periods due to calcification or inactivation of tumors (32 eyes), including group B (n=1, 100%), group C (n=1, 33.3%), group D (n=27, 84.4%), group E (n=3, 50%). 10 eyes were enucleated. Among them, 2 eyes of the tumor did not shrink after IAC, tumor recurrence (n=3), vitreous hemorrhage (n=3), enophthalmos (n=1), vitreous disseminated (n=1). 34 cases of children, transient eyelid oedema were 18 cases, vitreous hemorrhage and bone marrow suppression (Ⅰ-Ⅳ) were 1, 22 casese respectively. Conclusions IAC as secondly treatment is safe and effective for RB patients, however, there is still tumor recurrence. No serious ocular local and systemic complications were observed.
Objective To evaluate the clinical efficacy of oral calcium dobesilate(CaD) on diabetic optic neuropathy (DON).Methods The clinical data of 235 eyes of 235 patients with DON diagnosed by examination of ocular fundus were retrospectively analyzed.The patients were divided into 3 groups according to the subtypes of DON: anterior ischemic optic neuropathy(AION)group(71 eyes of 71 patients), papilloedema group (71 eyes of 71 patients),and neovascularization of disc (NVD) group (93 eyes of 93 patients).The patients in each groups were randomly subdivided into CaD treating group and control group, in which the patients underwent oral administraion of CaD at a dose of 500 mg twice per day or Vit.E at a dose of 10 mg twice per day,respectively.The course of therapy was 6 months and consecutive 2 courses were performed with the 3-4 days interval between the courses; the courses lasted for 6 months.Several parameters (VFD/V),EA/d,NA/d,LA/d) were semiquantitative analyzed 2,4,6,8 months after initial treatment. Repeated ANOVA measures and t test were used as statistical methods.Results In CaD group,VFD/V (0.25plusmn;0.10),EA/d (0.94plusmn;0.53), and LA/d(1.83plusmn;1.12) 2 months after initial treatment was obviously better than the results before the treatment (0.49plusmn;0.13,1.57plusmn;0.71,3.42plusmn;1.88)(P＜0.001), respectively.VFD/V,EA/d and LA/d in CaD group 2,4,6,and 8 months after initial treatment significantly differed from which in the control group (P＜0.01). There was significant difference of VED/V,EA/d,and LA/d between the CaD and control group during the follow-up period (P＜0.01).At each time point in the followup period, there was no significant difference of NA/d among groups and between the treating and control group (P＞0.05).Conclusion Oral administration of CaD can rapidly and remarkably decrease the extent of visual field defect,relieve optic disc edema and lessen the leakage of NVD.
Objective To evaluated the efficacy of vitreoretinal surgery for X-linked retinoschisis (XLRS) and its complications. Methods Twentyone XLRS patients (27 eyes) with retinal detachment or vitreous hemorrhage who were treated by vitreoretinal surgery were enrolled in this study. There were microcystislike splitting in all the eyes. The mean visual acuity was 0.11±0.09 and the mean area of macular splitting was (1.09±0.56) mm2. Among the eyes, there were 12 eyes with rhegmatogenous retinal detachment, five eye with traction retinal detachment, six eyes with vitreous hemorrhage and four eyes with retinal detachment and vitreous hemorrhage. All the patients underwent a standard threeport pars plana vitrectomy. Internal limiting membrane peeling, laser photocoagulation, and C3F8 gas or silicone oil tamponade were carried out in different condition. The follow-up was 9-122 months (average 51 months). The preoperative visual acuity and anatomic structure of retina were observed. Results The mean visual acuity at last visit was increased to 0.26±0.15, the difference was significant (t=-6.320, P=0.000). It improved in 20 eyes (74.1%), remained unchanged in seven eyes (25.9%). The retina remained attached in 27 eyes. The mean area of macular splitting was decreased to (0.29±0.21) mm2, the difference was significant (t=10.358, P=0.000). The complications were found in four eyes (14.8%) which including two eyes with proliferative vitroretinopathy and traction retinal detachment six and eight months after surgery, one eye with cataract four months after surgery, and one eye with vitreous hemorrhage 15 months after surgery. The retina remained attached in these four eyes after reoperation. Conclusion Vitreoretinal surgery can significantly improve visual acuity, resume the anatomic structure of retina.