Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study. Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female. The average age was (51.25±12.24) years and the course was 5–17 days. All patients were given best corrected visual acuity (BCVA), intraocular pressure, slit lamp with preset lens, fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination. The patients were divided into conbercept and laser group (group Ⅰ), laser group (group Ⅱ) and conbercept group (group Ⅲ), with 30 eyes in each group. The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072, 0.286;P=0.930, 0.752). Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg), and macular grid pattern photocoagulation 3 days later. Group Ⅱ patients were given macular grid pattern photocoagulation. Times of injection between group Ⅰ and Ⅲ, laser energy between group Ⅰ and Ⅱ, changes of BCVA and CMT among 3 groups at 1 week, 1 month, 3 months and 6 months after treatment were compared. Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20±0.41) and (2.23±1.04) times respectively, and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections. The difference of injection times between two groups was significant (P＜0.001). Patients in group Ⅱ had received photocoagulation (1.43±0.63) times, 9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation. The average laser energy was (96.05±2.34) μV in group Ⅰ and (117.41±6.85) μV in group Ⅱ, the difference was statistical significant (P=0.003). BCVA improved in all three groups at last follow-up. However, the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607, –4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=–0.802,P=0.429). The mean CMT reduced in all three groups after treating for 1 week and 1 month, comparing that before treatment (t=–11.855, –10.620, –10.254;P＜0.001). There was no statistical difference of CMT between group Ⅰand Ⅲ at each follow up (t=0.404, 1.723, –1.819, –1.755;P=0.689, 0.096, 0.079, 0.900). CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=–4.621, –3.230;P＜0.001, 0.003). The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month, but the difference was not statistically significant (t=1.995,P=0.056). All patients had no treatment-related complications, such as endophthalmitis, rubeosis iridis and retinal detachment. Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO. Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.
Objective The present study focus on the macular branch retinal vein occlusion (MBRVO) with and without laser treatment,and evaluate prospectively whether laser treatment is useful in improving the visual acuity and reducing the macular edema. At the same time to learn the difference of macular light sensitivity before and after laser treatment.Methods Forty-five eyes of forty-five patients with MBRVO and macular edema were randomized to laser treatment and no laser treatment. Follow up examinations were performed every 3 months. We compared the difference of visual improvement, resolution of macular edema between the two groups. The central 30°visual field of 20 patients with MBRVO were examined at pretreatment and 3 months after laser treatment. A comparison of light sensitivity at fovea ，central 10°and 11~30°eccentricity were done between before and after laser treatment. Results Comparison of visual improvement and resolution of macular edema showed a statistical difference between laser treatment and no laser treatment. The mean reduction of macular light sensitivity at the fovea and 11~30°3 months after the treatment has no statistical difference between before and after treatment (Pgt;0.05). But the mean light sensitivity at central 10°eccentricity were significantly decreased 3 months after photocoagulation (Plt;0.05).Conclusion The laser treatment might promote or accelerate visual acuity recovery and reduce the macular edema. There is no significant difference about the efficiency on macular function after laser treatment.(Chin J Ocul Fundus Dis，2003，19：201-268)
ObjectiveTo investigate the effects and safety of intravitreous injection of Conbercept combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion. MethodsAll subjects were assigned randomly to 3 groups:intravitreal Conbercept combined with laser photocoagulation group (CL group), intravitreal triamcinolone combined with laser photocoagulation group (TL group), and photocoagulation group (L group). The best-corrected visual acuity (BCVA), central macular thickness (CMT), fundus oculi and fundus fluorescein angiography (FFA), intraocular pressure (IOP), slit lamp were observed before and 1 day, 1 week, 1 month, 3 months after treatment. The changes of post-treatment BCVA and CMT in pre-therapy and post-treatment were compared, and related complications were recorded. ResultsThere were significant differences of BCVA (χ2=9.754, 12.430, 17.424, 13.189) and CMT (F=10.614, 4.099, 4.927, 8.99) between 3 groups in post-treatment 1 day, 1 week, 1 month and 3 months. The numbers of subjects of improving and stabilizing BCVA in CL group were remarkably more than that in L group in every post-treatment follow-up time (P < 0.01), whereas the CMTs in CL group were significantly less than that in L group in every post-treatment follow-up time (P < 0.05). The CMTs in post-treatment 1 day, 1 week, 1 month, 3 months were thinner than that in pretreatment in CL group and TL group (P < 0.05). Meanwhile, there was no significant difference (P > 0.05)between any two CMTs in post-treatment 1 day, 1 week, 1 month and 3 months in CL group. Yet, the CMT in post-treatment 3 months was thicker than those in post-treatment 1 day, 1 week and 1 month in TL group(P < 0.05). And there was no significant difference(P > 0.05)between any two CMTs in post-treatment 1 day, 1 week and 1 month in TL group. There was no conspicuous difference in CMTs(P > 0.05)between in CL group and in TL group in every viewing time, except for that in post-treatment 3 months(P < 0.05). There was only 1 case of intraocular hypertension in post-treatment in TL group. ConclusionsIntravitreous injection of Conbercept combined with laser photocoagulation for macular edema secondary to BRVO is effective, safe, and superior to laser photocoagulation only. Also it had a longer effective duration and less complications than intravitreal triamcinolone combined with laser photocoagulation.
Pharmaceutical therapy, including anti-vascular endothelial growth factor treatment and intravitreal corticosteroids, is the most common treatment for branch retinal vein occlusion (BRVO) and its complications, however there are confusing ideas about the protocol, patient selection, timing and endpoint of this treatment. The disease is easy to relapse with these drugs therapy. Collateral vessel formation was found in patients receiving intravitreal injection of ranibizumab or triamcinolone for BRVO and secondary macular edema. The mechanism of collateral vessel formation has not been carefully investigated. In the past thrombolysis, arteriovenous fasciostomy and laser choroidal retinal vascular anastomosis were used to reconstruct the retinal circulation, but their rationality, effectiveness and safety need to be further were studied. In recent years, because of the key technology is still immature, the artificial vascular bypass surgery experiment is not yet practical, but provides us a new idea worth looking forward to for the treatment of BRVO.
Objective To observe the clinical features and outcomes of vitrectomy for diabetic retinopathy (DR) with central retinal vein occlusion (CRVO) in type 2 diabetes mellitus (T2DM). Methods A total of 192 patients (241 eyes) with proliferative DR (PDR) who underwent vitrectomy were enrolled in this study. All the patients were diagnosed as vitreous hemorrhage (VH) because of suddenly decreased vision. There were 93 eyes with tractional retinal detachment (TRD) and six eyes with neovascularization of iris (NVI). The patients were divided into PDR with CRVO group (group A, 41 eyes) and PDR group (group B, 200 eyes) according to the results of fundus examination. All patients received vitrectomy with silicone oil and C3F8 gas tamponade. There were 138 eyes with silicone oil tamponade which including 30 eyes in group A and 108 eyes in group B. The difference of number in silicone oil-filled eyes in two groups was statistically significant (chi;2=5.110,P＜0.05). There were 38 eyes with C3F8 gas tamponade which including six eyes in group A and 32 eyes in group B. There was no difference in C3F8 gas-filled eyes numbers in two groups (chi;2=0.048, P＞0.05). The follow-up ranged from one to 60 months, with the mean of (28.69plusmn;17.28) months. The corrected vision, retinal reattachment, persisting macular edema (ME), neovascular glaucoma (NVG) and repeated VH after surgery were comparatively analyzed. Results Of 241 eyes, there were 41 eyes (17.0%) with CRVO. Before surgery, the differences of corrected vision (Z=-0.138), intraocular pressure (t=0.966), whether there was TRD or not (chi;2=0.412), whether underwent panretinal photocoagulation or not (chi;2=1.416) were not statistically significant (P＞0.05), but the difference of whether NVI were present or not was statistically significant (chi;2=31.724,P＜0.05) between two groups. After surgery, the corrected vision improved in both two groups (Z=2.319, 4.589; P＜0.05). There was no difference of corrected vision after surgery between two groups (Z=0.782,P＞0.05). Postoperative complications occurred in 94 eyes, including 26 eyes in group A and 68 eyes in group B. The differences of incidence of reoperation (chi;2=0.498), retinal reattachment (chi;2=0.818), persisting ME (chi;2=2.722) between two groups after surgery were not statistically significant (P＞0.05). The incidence of repeated VH (chi;2=5.737) and NVG (chi;2=6.604) in group A were higher than those in group B (P＜0.05). Conclusions CRVO is commonly found to coexist with DR in T2DM patients with VH. Combined with CRVO patients are more likely to suffer NVI. Vitrectomy can improve the visual function in PDR with CRVO patients.
Objective To investigate the efficacy and the safety of external therapy of ultrasound (ETUS) enhancing thrombolysis on the experimental retinal vein occlusion. Methods The effect of ETUS enhanced thrombolysis and the impact of ultrasound energy and exposure were investigated respectively after both eyes of 51 rabbits with retinal branch vein occlusion created by photodynamic initiated thrombosis were divided into 4 groups. The first 2 groups are the ETUS groups, including one group (15 rabbits) underwent intravenous injection with urokinase (UK) (1700-2200 UK dissolved into 20 ml normal saline), and other group (12 rabbits) underwent intravenous injection with normal saline. In these 2 groups, each rabbit received ETUS treatment (1.0 W/cm2, 20 min) in one eye and the fellow eye did not which was as the control. The latter 2 groups are the energy and duration of ultrasound groups, and 12 rabbits in each group underwent ETUS with the energy of 0.7 and 1.0 W/cm2 respectively. Each of the 2 groups was divided into 3 subgroups (8 rabbits in each) according to the radiated durations (8, 14, and 20 minutes). All of the eyes except the control ones underwent ETUS with 1 MHz ultrasound and 100 Hz pulsed ultrasound once a day for 3 days. Fundus fluorescein angiography (FFA) was used to detect the vascular condition 4 days after ETUS, and at the 15th day, retinal light microscopy and electron microscopy were performed. Results The vascular recanalization rate in ETUS+UK treatment group was 66.7%, which is obviously higher than which in single UK group (20.0%, P=0.025), normal saline group (8.3%, P=0.005), and ETUS+ normal saline group (8.3%, P=0.005). The vascular recanalization rates in groups with different energy of ultrasound increased obviously as the radiated durations increased (P=0.006, 0.001), while no apparent effect of energy of ultrasound on the vascular recanalization rate was found in the groups with different radiated duration (Pgt;0.05). The eyes which had undergone ETUS treatment had retinal tissue damage and ultrastructure changes of the retinal ganglion cells (RGC), and deteriorated as the radiated duration increased. Conclusion ETUS may enhance the thrombolysis induced by urokinase in experimental retinal vein occlusion. Simultaneously, ETUS can lead to the damage of retinal tissue and changes of the ultrastructure of RGC. (Chin J Ocul Fundus Dis, 2007, 23: 166-169)