Objective To observe the inhibitory effects and characteristics of intravitreal injection with bevacizumab on laser induced choroidal neovascularization (CNV).Methods Twelve male brown norway（BN）rats were divided into the bevacizumab group and control group with six rats in each group. One eye of rats were received a series of 8 diode laser esions around optic disc to induce CNV,then the rats in bevacizumab group and control group underwent intravitreal injection with 2 mu;l bevacizumab and ringer's lactate.On days 7,14,and 21，the morphology and leakage of CNV were observed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA).On day 21 after photocoagulation,the photocoagulated eyes were enucleated and processed for histopathologic examination, including hematoxylin and eosin (Hamp;E) staining and immunohistochemistry staining for vascular endothelial growth factor（VEGF）.Results On day 7 after photocoagulation,ICGA showed that CNV developed in the bevacizumab group and the control group. FFA showed that leakage intensity in the bevacizumab group was significantly lower than that in the control group，but the bevacizumab group gradually increased over time. The mean thickness of CNV significantly decreased in the bevacizumab group.The CNV in the bevacizumab group were negative for VEGF according to the result of immmuohistochemistry staining.Conclusions Early intravitreal injection with 2 mu;l bevacizumab can reduce the thickness of CNV and inhibit the leakage of CNV. However, bevacizumab could neither block the formation of CNV, nor suppress the permeability permanently. Combined other therapies with bevacizumab may be more potential to treat CNV effectively.
ObjectiveTo evaluate the 3-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). MethodsThis is a retrospective, uncontrolled case series study. Thirty-two eyes of 29 patients with PCV were enrolled. All patients were primarily treated with the first conventional PDT. For the eye with active polypoida, residual or exudative lesions in 6 month after PDT, PDT combined with intravitreal anti vascular endothelial growth factor (VEGF)or simple vitreous injection of anti VEGF therapy were used. All the patients were followed up for at least 3 years with the mean follow-up duration of 43.64±10.84 months. The best-corrected visual acuity (BCVA) in 1, 3, 6, 12, 24 and 36 months after the primary PDT, PCV recurrence rates and number of treatments were followed and analyzed. The BCVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. ResultsDuring the 1, 3, 6, 12 months after the primary PDT, the mean BCVA were all improved with statistically significant difference(t=2.27, 4.57, 3.77, 2.37; P<0.05). During the 24 and 36 months after PDT, the mean BCVA was decreased without statistically significant difference(t=-1.29, -0.81; P>0.05). On the final evaluation at 36 months, the mean BCVA was improved in 6 eyes(18.75%), stable in 14 eyes(43.75%), and decreased in 12 eyes(37.50%). During the follow-up time, recurrence of PCV in 24 eyes (75.00%), no recurrence in 8 eyes (25.00%). There was 1 recurrence in 12 eyes (50.00%), 2 recurrences in 9 eyes (37.50%), 3 recurrences in 3 eyes (12.50%). Initial recurrences were noted in 4 eyes (16.67%) within 12 months of baseline PDT treatment; in 11 eyes (45.83%) between 13 and 24 months; in 9 eyes (37.50%) between 25 and 36 months. The mean number of PDT and anti-VEGF was 1.86±1.04 and 4.95±3.92 in all patients, respectively. ConclusionThe 3-year efficacy of PDT in patients with PCV was poor with low improvement of visual acuity and high recurrence rate of PCV.
ObjectiveTo observe the efficacy and safety of combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity (AP-ROP). MethodsMedical records of 70 eyes of 35 premature infants with a primary diagnosis of AP-ROP in our clinic were reviewed and analyzed retrospectively. All the lesions were located in posterior zone, with 42 eyes in zone 1 and 28 eyes in zone 2. Forty-six eyes had iris neovascularization, while 19 eyes combined with vitreous hemorrhage. All participants underwent intravitreal injection of ranibizumab as the primary treatment within 12 hours after diagnosis of AP-ROP. The systemic and ocular adverse effects were observed. The change of retinal vascular tortuosity and dilatation before and after the intravitreal injection of ranibizumab was observed one week after injection. Laser photocoagulation was used as adjuvant therapy if the plus disease persisted more than two weeks or new-onset ridge occurred after injection. The mean time interval between injection and laser therapy was (5.1±2.6) weeks (range, 1-10 weeks). Follow-up ranged from 6 to 18 months, with a mean of (10.3±3.9) months. The anatomical results and complications were evaluated after treatment. The eyes that progressed to stage 4 or 5 during the follow-ups were underwent lens-sparing vitrectomy or lensectomy combined with vitrectomy. ResultsNo major systemic or ocular complications were observed. Preretinal hemorrhages were found in 12 eyes of 8 patients (17.1%), but they were absorbed spontaneously during the follow-ups. All lens remained transparent and no iatrogenic retinal hole was occurred during the follow-ups. After the injection, the regression of iris neovascularization was observed in 46 eyes within one week, vitreous hemorrhage absorbed significantly in 16 eyes (84.2%), and plus disease disappeared completely within one week in 61 eyes (87.1%). 59 eyes (84.3%) demonstrated vascularization toward the peripheral retina after treatment. 32 out of 42 eyes (76.2%) with zone 1 demonstrated vascularization toward to zone 2, while 24 out of 28 eyes (85.7%) with zone 2 demonstrated vascularization toward to the junction of zone 2 and 3. After intravitreal injection of ranibizumab combined with laser photocoagulation, 62 of 70 eyes (88.6%) had retinal vascular ridge and plus disease regression. However, 8 eyes of 6 patients (11.4%) showed significant fibrovascular proliferation and progressed to retinal detachment after the combination treatment of intravitreal ranibizumab injection and laser photocoagulation. Four eyes underwent lens-sparing vitrectomy, while the other 4 eyes underwent vitrectomy combined with lensectomy. Five eyes achieved totally retinal reattachment after surgery, while 3 eyes achieved partially retinal reattachment. ConclusionThe combination of intravitreal injection of ranibizumab and laser photocoagulation is safe and effective in the treatment of AP-ROP.
ObjectiveTo observe the efficacy of intravitreal injection of ranibizumab (IVR) and combined treatment for severe Coats disease. MethodsNineteen Coats disease patients (24 eyes) were enrolled in this retrospective non-comparative interventional clinical study. The patients included 17 males and 2 females. The age was ranged from 1 to 42 years old, with an average of (13.05±6.78) years. The patients included 15 children (age ≤14 years old) and 4 adults (age ≥18 years old). There were 13 patients with 3a stage and 6 patients with 3b stage. The treatment methods including IVR only, IVR combined with cryotherapy, IVR combined with cryotherapy and sclerotomy to drain subretinal fluid, IVR combined with vitrectomy. Treatments were repeated if it was necessary at the first day, the first week and the first month after injection. The interval between treatments was ≥1 month. Eleven patients (57.9%) underwent one treatment, 3 patients (15.8%) underwent 2 treatments, 3 patients (15.8%) underwent 3 treatments, 2 patients (10.5%) underwent 4 treatments. The treatment frequency including 22 times of IVR only, 6 times of IVR combined with cryotherapy, 5 times of IVR combined with cryotherapy and sclerotomy to drain subretinal fluid, 1 time of IVR combined with vitrectomy. The follow-up period was ranged from 6 to 36 months, with an average of (19.11±7.05) months. Visual acuity, retinal reattachment and ocular adverse events were observed. ResultsThree children (15.8%) were failing to test the visual acuity. Visual acuity was improved in 2 patients (10.5%), stable in 13 patients (68.4%) and decreased in 1 patient (5.3%). Three patients (15.8%) achieved totally retinal reattachment after treatment, while 16 patients (84.2%) achieved partially retinal reattachment. One patient had vitreous hemorrhage. One patient had neovascular glaucoma. ConclusionIVR and combined treatment were effective for severe Coats disease.
ObjectiveTo observe the efficacy of intravitreal injection of ranibizumab (IVR) for retinal angiomatous proliferation (RAP). MethodsEleven patients (14 eyes) with RAP were enrolled in this retrospective clinical study. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), and maximum retinal thickness (MRT) were detected by examination of visual acuity and optical coherence tomography (OCT). The average BCVA was 0.17±0.21, CRT was (382.71±219.07) μm, MRT was (746.36±268.29) μm. All eyes received 0.5 mg (0.05 ml) ranibizumab injection. Follow-up visits were performed monthly after injection. The mean follow-up time was (15.38±13.64) month. Injections were repeated if the eyes with retinal edema. The mean number of repetitive IVR was (3.7±1.0) times/eye (from 1 to 10 times). Changes in BCVA, CRT, MRT and complications were observed at the last follow up. ResultsAt the last follow-up, the mean BCVA was 0.28±0.26 (from 0.01 to 1.0). Of 14 eyes, visual acuity improved in 11 eyes, not changed in 2 eyes and decreased in 1 eye. The difference of BCVA was significant between before and after the treatment (t=3.167,P=0.007). The mean CRT was (166.14±52.79) μm, which was less than that of pre-treatment values (t=3.737,P=0.002). The mean MRT was (360.43±102.19) μm, which was less than that of pre-treatment values (t=6.106,P=0.000). No ocular or systemic adverse effects occurred. ConclusionIVR is an efficient and safe treatment for RAP, with visual acuity improvement, decrease of CRT and MRT.
ObjectiveTo observe the concentration of the inflammatory cytokines in vitreous of severe proliferative diabetic retinopathy (PDR) after intravitreal ranibizumab injection (IVR). MethodsA total of 80 PDR patients (80 eyes) were enrolled in this study. The patients were randomly divided into vitrectomy group (group A) and IVR combined with vitrectomy group (group B), 40 eyes in each group. The differences of sex (χ2=0.05), age (t=0.59), duration of diabetes (t=0.36), HbA1c (t=0.13) and intraocular pressure (F=0.81) between two groups were not significant (P>0.05). The eyes in group B received 0.5 mg (0.05 ml) ranibizumab injection at 7 days before operation. The vitreous samples (0.4 ml) were obtained before operation. The concentration of vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-8, intercellular adhesion molecule-1 (ICAM-1) and connective tissue growth factor (CTGF) were measured by enzyme-linked immunosorbent assays. ResultsThe concentration of VEGF and ICAM-1 were (10.70±3.60), (224.64±90.32) pg/L in group B and (72.38±23.59), (665.61±203.34) pg/L in group A. The differences of VEGF and ICAM-1 concentration between two groups was significant (t=16.34, 12.53; P<0.001). The concentration of IL-6 and IL-8 were (210.64±80.27), (156.00±57.74) pg/L in group B and (45.78±33.82), (41.07±13.82) pg/L in group A. The differences of IL-6 and IL-8 concentration between two groups was significant (t=11.97, 12.24; P<0.001). There was no difference of CTGF concentration between two groups (t=1.39, P=0.17). The CTGF/VEGF in group B was higher than that in group A (t=14.75, P<0.001). ConclusionsOne week after IVR, the concentration of VEGF and ICAM-1 are decreased, while IL-6 and IL-8 increased. There is no obvious change in CTGF, but CTGF/VEGF is increased.
ObjectiveTo further compare the effect of intravitreal injection of bevacizumab (IVB) and photodynamic therapy (PDT) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia by meta-analysis. MethodsPertinent publications were identified through systemic searches of PubMed, EMBASE and the Cochrance Controlled Trials Register. All clinical comparative studies of IVB or PDT as initial treatment for CNV secondary to pathologic myopia were included. Meta analysis of these clinical trials was performed to analyze the effect of IVB and PDT for CNV secondary to pathologic myopia. Measurements included best corrected visual acuity (BCVA) and central foveal thickness (CFT). ResultsA total of 6 comparative studies involving 351 eyes were included. There were 196 eyes in IVB group and 215 eyes in PDT group. Funnel plots, Egger linear regression and Begg method did not show publication bias. Compared with PDT group, at 3, 6 and 12 months after IVB treatment, BCVA significantly increased . However, change of CFT at 3, 6 and 12 months did not vary significantly between IVB group and PDT group (3 months: WMD=-22.49, 95% CI=-93.49 to 48.52, P=0.53; 6 months: WMD=-17.34, 95% CI=-56.00 to 21.31, P=0.38; 12 months: WMD=-5.32, 95% CI=-56.37 to 45.74, P=0.84). ConclusionPatients with CNV secondary to pathologic myopia experienced a significant benefit of visual improvement after IVB, but reduction in CFT after the IVB or PDT did not vary significantly.
Choroidal neovascularization (CNV) is the key characteristic of neovascular age-related macular degeneration (nAMD), and the effective therapy is intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents based on clinical and basic research. In the meantime the challenge is how to further improve the inhibiting effect for CNV and visual function of anti-VEGF treatment on nAMD. The new strategy and drug delivery devices for anti-VEGF treatment will optimize the clinical scheme. From bench to bedside, the research on targeted treatment of angiogenesis brings the bloom of nAMD medical therapy.
ObjectiveTo observe the effect of microincision vitrectomy assisted with intravitreaI injection of ranibizumab (IVR) in proliferative diabetic retinopathy (PDR) treatment. MethodsThis is a prospective, randomized, and comparative case series study. A total of 92 patients (92 eyes) with PDR were recruited to have microincision vitrectomy with (combined group) or without (PPV group) IVR. There are 48 eyes in the combined group and 44 eyes in the PPV group. The average operation time, iatrogenic breaks, the use of tamponade and electric coagulation, postoperative bleeding and best corrected visual acuity were comparatively analyzed among the two groups.The mean follow-up was (14.3±5.2) months. ResultsThe average operation time was (59.4±18.5) min in the combined group and (74.6±16.2) min in the PPV group. The rate of silicone oil tamponade (χ2=4.619), inert gas tamponade (χ2=4.290), electric coagulation (χ2=8.039) and iatrogenic breaks (χ2=4.330) in the combined group were significantly decreased compared with PPV group(P<0.05). The mean logMAR BCVA was 0.83±0.44 in the combined group and 1.37±0.53 in the PPV group, which significantly improved from preoperatively (t=3.257, 3.012; P<0.05). The rate of BCVA improvement in the combined group was significantly higher than that in the PPV group (t=2.972, P<0.05). The incidence of the recurrent vitreous hemorrhage was 2.1% in the combined group and 9.1% in the PPV group (χ2=6.741, P<0.05). There was no severe complication associated with surgery, such as choroidal detachment, retinal detachment and endophthal-mitis. ConclusionIVR before the microincision vitrectomy can shorten the operation time, reduce the use of electric coagulation and intraocular tamponade, and improve visual acuity for PDR patients.