Retinal vein occlusion (RVO) is a closely related disease of ophthalmology and systemic diseases. The Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China (consensus) emphasizes that etiological diagnosis and treatment should be paid primary attention to, and etiological exploration should be placed in an important position in the diagnosis and treatment path. In addition to etiological treatment, the consensus emphasizes that clinical attention should be paid to the management of anterior segment neovascularization, neovascular glaucoma and macular edema. Especially for patients with short course of central retinal vein occlusion, the occurrence of 100-day glaucoma should be vigilant, and active anti-vascular endothelial growth factor (VEGF) drugs, laser photocoagulation and intraocular pressure treatment should be taken. For the treatment of macular edema, the consensus points out that anti-VEGF drugs and intraocular glucocorticoid sustained-release agents are effective, but the latter should be used cautiously to avoid problems such as high intraocular pressure glaucoma and accelerated cataract formation. For deficient RVO, the consensus defines its concept, defines the time point of treatment when combined with macular edema, and clarifies the applicable conditions of laser therapy.
Purpose To evaluate the efficacy of vitreous surgery and endolaser in a series of patients with retinal vein occlusion(RVO)with vitreous hemorrhage,neovascular membranes(NVM) and/or traction retinal detachment(TRD). Methods Clinical records were reviewed on 37 consecutive patients(38 eyes)who underwent vitreous surgery and endolaser for RVO with persistent vitreous hemorrhage,NVM and/or TRD.There were 19 patients(20 eyes)with retinal branch vein occlusion (BRVO)and 18 patients(18 eyes)with central retinal vein occlusion(CRVO). Results NVM and TRD were confirmed during operation in 27 and 23 eyes,respectively.Visual acuity improved postoperatively in 34 eyes(89.5%)including 22 eyes with 0.1 or better vision,and 4 eyes remained unchanged.CRVO group had longer history and less visual improvement after surgery. Conclusions Vitreous surgery and endolaser photocoagulation can improve the outcome in the majority of patients with RVO with vitreous hemorrage,NVM and/or TRD. (Chin J Ocul Fundus Dis,1998,14:3-6)
目的 研究巩膜外垫压手术联合视网膜激光光凝对硅油眼视网膜脱离的治疗效果。 方法 回顾性分析2009年1月－2012年1月，用巩膜外垫压联合视网膜光凝手术治疗36例硅油眼视网膜脱离的视网膜复位效果。 结果 全部患者均顺利完成巩膜外垫压手术及随后的视网膜激光光凝，行巩膜外放液5只眼，手术中未发生视网膜嵌顿、眼内出血和眼压显著升高等并发症；手术后1周视网膜复位21只眼（58.33%），剩下15只眼1个月后复位7只眼（19.44%），视网膜脱离总复位率为28只眼（77.77%）；未复位8只眼（22.23%），改用玻璃体切割手术方式，视网膜成功复位；6个月后取出硅油，随访6个月视网膜无脱离或者脱离范围增加；手术后眼压≥30 mm Hg （1 mm Hg=0.133 kPa）3只眼，≥20 mm Hg 7只眼，对症治疗1周后眼压均恢复到正常范围。 结论 巩膜外垫压联合视网膜激光光凝治疗硅油眼视网膜脱离，手术简单，复位率高，可为硅油眼视网膜脱离首选手术方式，对于巩膜外垫压手术失败和复杂的硅油眼视网膜脱离，应当选择玻璃体切割手术方式。
ObjectiveTo evaluate the effects of Fufang Xueshuantong combined with laser photocoagulation versus laser photocoagulation alone in the treatment of diabetic retinopathy (DR). MethodThe Web of Science, Medline, Embase, the Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, VIP and Wanfang databases were searched from their establishment until June 2015. We used the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trails. RevMan 5.2 software was used for the analysis. ResultsEight studies were included. The results of Meta-analysis demonstrated that Fufang Xueshuantong combined with laser photocoagulation was superior to laser photocoagulation alone in the effective rate of visual acuity[RR=1.19, 95%CI (1.12, 1.26), P<0.000 01], fundus[RR=1.34, 95%CI (1.18, 1.52), P<0.000 01], and elimination rate of macular edema[RR=1.29,95%CI(1.09,1.54),P=0.004]. ConclusionsFufang Xueshuantong combined with laser photocoagulation is effective for DR. However, due to the limited quantity and quality of the included studies, the results suggest that larger-scale trials are needed.
Diabetic macular edema (DME) is the most threatening complication of diabetic retinopathy that affects visual function, which is characterized by intractability and recurrent attacks. Currently, the clinical routine treatments for DME mainly include intravitreal injection, grid laser photocoagulation in the macular area, subthreshold micropulse laser, periocular corticosteroid injection, and vitrectomy. Although conventional treatments are effective for some patients, persistent, refractory, and recurrent DME remains a clinical challenge that needs to be urgently addressed. In recent years, clinical studies have found that certain combination therapies are superior to monotherapy, which can not only restore the anatomical structure of the macular area and effectively reduce macular edema but also improve visual function to some extent while reducing the number of treatments and the overall cost. This makes up for the shortcomings of single treatment modalities and is highly anticipated in the clinical setting. However, the application of combination therapy in clinical practice is relatively short, and its safety and long-term effectiveness need further exploration. Currently, new drugs, new formulations, and new therapeutic targets are still under research and development to address different mechanisms of DME occurrence and development, such as anti-vascular endothelial growth factor agents designed to anchor repetitive sequence proteins with stronger inhibition of vascular leakage, multiple growth factor inhibitors, anti-inflammatory agents, and stem cell therapy. With the continuous improvement of the combination application of existing drugs and treatments and the development of new drugs and treatment technologies, personalized treatment for DME will become possible.
The effect and opportunity of argon laser photocoagulation for the retinal neovascularization in branch retinal vein occlusion in 30 patients were investigated with a control group of 34 patients received nonlaser but routine treatment. The results of the therapeutic effect demonstrated that the neovascularization disappeared completely in 23 cases and became smaller in 7 cases after laser photocoagulation. The incidnce of vitreous hemorrhage in laser group was 43.3% before laser treatment and none after treatment in the duration of observation,and 70.6% in control group. The progression of visual acuity after treatment in laser group was much better than in control group(P＜0. 005)at the time of the latest examination. We found the therapeutic effect was relation to the area, location of the neovascularization in retina,as well as whether the new vessels protruding into vitreous or not. （Chin J Ocul Fundus Dis,1994,10:195-198）
Objective To evaluate the single-use of laser photocoagulation (LP) and the combined-use of laser photocoagulation plus intravitreal triamcinolone (LP+IVTA) for diabetic macular edema (DME) in terms of clinical therapeutic effect and safety. Methods Such databases as The Cochrane Library, Medline, Embase, CBM, CNKI and Wanfang Data were searched from the date of their establishment to September 2011, and the references of all included studies were also traced, so as to identify the randomized controlled trials (RCTs) on LP vs. LP+IVTA for DME. The quality assessment and data extraction were conducted in accordance with the Cochrane Handbook 5.0 by two reviewers independently, and then Meta-analyses were conducted using RevMan 5.0 software. Results Ten RCTs involving 525 ill eyes were included, and all of them were classified as Grade B in methodological quality. Results of meta-analysis showed that: at the end of follow-up, there were significant differences between the LP+IVTA group and the LP group in the best corrected visual acuity (BCVA) (RR=–0.14, 95%CI –0.20 to –0.08, Plt;0.000 01), and the central macular thickness (CMT) (RR=–56.78, 95%CI –84.03 to –29.54, Plt;0.000 1). In comparison with the LP group, there were more people in the LP+IVTA group who needed to be treated for their elevated intraocular pressure and to have surgery for the progression of cataract. But no significant difference was found between the two groups in vitreous hemorrhage, retinal detachment, retinal vein occlusion and macular epiretinal membrane. Conclusion Current evidence of clinical research shows that the LP+IVTA is superior to LP in reducing macular edema and improving vision in the treatment of diabetic macular edema, but it may also result in a high incidence of elevated intraocular pressure and cataract. Because the methodological quality limitation of included studies may affect the authenticity of outcomes, this conclusion has to be further proved by more high-quality and large-scale clinical trials.
Objective To observe the effect of laser photocoagulation of the peripheral retinal holes and/or degeneration in high myopia. Methods Full fundus examination for high myopic patients was made before keratorefractive surgery with binocular indirect ophthalmoscopy.Peripheral holes,degeneration and vitreous traction were found in 206 eyes of 135 patients,and all of them were treated with laser photocoagulation. Results No retinal detachment occurred after keratorefrative operation within 1 year follows up. Conclusions Retinal laser photocoagulation is an effective and safety method before keratorefractive operation for prevention of the retinal detachment in high myopia at least in short-term observation. (Chin J Ocul Fundus Dis, 1999, 15: 135-136)