Corticosteroids, anti-vascular endothelial growth factor, antibiotics and antiviral were the main 4 classes of drugs for intravitreal injection. Depending on the class and volume of medication, age and gender of patients, ocular axial lengths or vitreous humour reflux, intraocular pressure (IOP) can be elevated transiently or persistently after intravitreal injection. Transient IOP elevation occurred in 2 weeks after intravitreal injection, and can be reduced to normal level for most patients. Only a small portion of such patients have very high IOP and need intervention measures such as anterior chamber puncture or lowering intraocular pressure by drugs. Long term IOP elevation is refers to persistent IOP increase after 2 weeks after intravitreal injection, and cause optic nerve irreversible damage and decline in the visual function of patients. Thus drug or surgical intervention need to be considered for those patients with high and long period of elevated IOP. Large-scale multicenter clinical trials need to be performed to evaluate the roles of the drug and patients factors for IOP of post-intravitreal injection, and to determine if it is necessary and how to use methods reducing IOP before intravitreal injection.
Primary vitreoretinal lymphoma (PVRL) is a rare type of non-Hodgkin's lymphoma with poor prognosis and the optimal treatment has yet to be determined. Its treatment has evolved from enucleation to ocular radiotherapy, systemic chemotherapy and intravitreal chemotherapy. Radiotherapy can effectively eradicate tumor cells but ocular recurrences are common. Systemic chemotherapy has become the mainstream option but there are problems with only-partial response of PVRL and high rate of recurrence. Intravitreal chemotherapy, primarily used as adjunctive to systemic chemotherapy, has achieved high remission rate and low rate of recurrence as well as with limited ocular complications. The tumor cells were cleared and the visual function preserved. However, issues about the drug applied, treatment protocols and goals of intravitreal chemotherapy, whether for visual preservation or survival improvement, are worthy for further study.
Nowadays, one of the most challenging aspects of retinoblastoma (RB) therapy is how to control the resistant or recurrent viable vitreous seeds, for which intravenous chemotherapy appears to be ineffective. Recently, intravitreal chemotherapy offers another option to control advanced stage and vitreous seeds of RB, and may be a promising new approach to RB therapy. However, intravitreal injection for RB patients raises considerable controversy due to concerns of possible extraocular extension along the injection route, and should not replace the primary standard of care for bilateral RB or group E eyes of RB. Close follow-up and further studies are needed to determine appropriate indications, to determine the effective drugs and concentrations, to optimize RB therapy protocols and to investigate the relationship between long-term efficacy and toxicities.
ObjectiveTo explore safe dosage of single intravitreal injection of ganciclovir (IVG) in healthy rabit eyes, and to explore retinal toxicity of different dosage of ganciclovir after continues intravitreal injection into the vitreous cavity of healthy albino rabbit eyes. MethodsTen healthy New Zealand albino rabbits were divided into 5 groups with 2 rabbits in each group. Each group was injected with 1 mg/0.025 ml, 2 mg/0.025 ml, 5 mg/0.025 ml, 10 mg/0.025 ml ganciclovir or 0.025 ml saline (control group). After 1 week of intervention, rabbits were examined by ultra-wide-angle fundus photography, optical coherence tomography (OCT) and full field electroretinogram (ERG). The maximum mixed response of rod and cone cells (Max-R) was measured under dark adaption conditions, cone response (Cone-R) and 30 Hz flicker response (30 Hz-R) were measured under light adaption conditions. Twenty-four healthy New Zealand albino rabbits were randomly divided into a low-dose experimental group, a low-dose control group, a high-dose experimental group, and a high-dose control group, with 6 rabbits in each group, with the right eye as the experimental eye. The rabbits in the high-dose experimental group were continuously injected with ganciclovir 2 mg/0.025 ml, once a week, for a total of 4 times. The rabbits in the low-dose experimental group were injected with 1 mg/0.025 ml ganciclovir, the induction period was 2 times/week, a total of 4 times; the maintenance period was 1 time/week, a total of 2 times. The rabbits in the high-dose control group and the low-dose control group were injected with 0.025 ml normal saline into the vitreous cavity respectively. Full-field ERG examination was performed 1 day before each injection and 1 week after the last injection. Max-R was measured under dark-adapted conditions, and Cone-R and 30 Hz-R were measured under light-adapted conditions. OCT was recorded before the first injection and one week after the last injection. One week after the last injection, the experimental rabbits in each group were sacrificed for hematoxylin-eosin staining, and the retinal structure was observed under a light microscope. The comparison of a-wave and b-wave amplitude of Max-R, Cone-R and 30 Hz-R amplitude at different time was performed by two independent sample nonparametric test. ResultsThere were no abnormal results of fundus photography, OCT and ERG after single intravitral injection of 1 mg or 2 mg ganciclovir. One week after single 5 mg IVG, fundus photography of rabbits showed vascular occlusion and preretinal hemorrhage and ERG showed slight decrease of amplitude of Max-R, Cone-R and 30 Hz-R. One week after single 10 mg IVG, retinal necrosis and exudative changes were also observed. OCT showed edema and unclear retinal structure in the necrotic area. ERG showed significant decrease of amplitude of Max-R, Cone-R and 30 Hz-R. After continuous IVG in high dose and low-dose experimental group, the amplitude of Max-R a wave (Z=－0.160, 0.000) and b wave (Z=－0.321, 0.000), Cone-R a wave (Z=－0.641,－0.641) and b wave (Z=－0.321, －0.160), and 30 Hz-R (Z=－0.321,－0.160) showed no difference compared to control group. No histologic evidences of retinal microstructure abnormalities were found in both groups. OCT and fundus photography before and after the intervention did not show any difference, either. ConclusionThere was no retinal toxicity of continuous 1 mg or 2 mg IVG recorded in albino rabbits.
Objective To evaluate the safety and efficacy of dexamethasone intravitreal implant 0.7 mg (DEX) for treatment of macular edema associated with retinal vein occlusion (RVO). Methods This study was a six-month, randomized, double-masked, sham-controlled, multicenter, phase 3 clinical trial with a 2-month open-label study extension. Patients with branch or central RVO received DEX (n=129) or sham procedure (n=130) in the study eye at baseline; all patients who met re-treatment criteria received DEX at month 6. Efficacy measures included Early Treatment Diabetic Retinopathy Study (ETDRS), best-corrected visual acuity (BCVA), and central retinal thickness (CRT) on optical coherence tomography. Results Time to ≥15-letter BCVA improvement from baseline during the first 6 months (primary endpoint) was earlier with DEX than sham (P＜0.001). At month 2 (peak effect), the percentage of patients with ≥15-letter BCVA improvement from baseline was DEX: 34.9%, sham: 11.5%; mean BCVA change from baseline was DEX: 10.6±10.4 letters, sham: 1.7±12.3 letters; and mean CRT change from baseline was DEX: −407±212 μm, sham: −62±224 μm (all P＜0.001). Outcomes were better with DEX than sham in both branch and central RVO. The most common treatment-emergent adverse event was in-creased intraocular pressure (IOP). Increase sin IOP generally were controlled with topical medication. Mean IOP normalized by month 4, and no patient required incisional glaucoma surgery. Conclusions DEX had a favorable safety profile and provided clinically significant benefit in a Chinese patient population with RVO. Visual and anatomic outcomes were improved with DEX relative to sham for 3 - 4 months after a single implant.
ObjectiveTo observe the efficacy of parsplana vitrectomy (PPV) combined with 0.7 mg dexamethasone sustained-release Ozurdex intravitreal implantation in the treatment of children with ocular toxocariasis (OT). MethodsA retrospective clinical study. Fifty-three pediatric patients (53 eyes) diagnosed with OT and underwent PPV in Beijing Tongren Eye Center of Beijing Tongren hospital from March 2015 to December 2021 were included. There were 30 males and 23 females, with an average age of 7.07±3.45 (4-14) years; all were unilateral. Color Doppler imaging, fundus color photography, optical coherence tomography examinations were performed for patients who can cooperated with the examiners. Forty-three eyes were examined by best corrected visual acuity (BCVA); 47 eyes were examined by intraocular pressure; 29 eyes were examined by ultrasound biomicroscopy. According to the location of granuloma, OT was divided into posterior pole granulomatous type (posterior type), peripheral granulomatous type (peripheral type), and chronic endophthalmitis type. According to whether Ozurdex was implanted into the vitreous cavity after PPV, the children were divided into the oral glucocorticoid group after PPV (group A) and the PPV combined with vitreous cavity implantation of Ozurdex group (group B), 37 cases with 37 eyes and 16 cases with 16 eyes, respectively. There was no significant difference in age (t=0.432), sex composition ratio (χ2=0.117), BCVA (χ2=0.239), and clinical type (χ2=0.312) between the two groups (P＞0.05). The follow-up time after surgery was ≥5 months. The intraocular pressure at 1 week and 1, 3, and 6 months after surgery, the changes of BCVA and the occurrence of complications such as concurrent cataract and epimacular membrane were observed at the last follow-up, and the incidence of obesity in the children during the follow-up period was recorded. The measurement data between groups was compared by independent sample t test; the enumeration data was compared by χ2 test. ResultsOne month after the operation, the intraocular pressure of group A and group B were 15.17±6.21 and 25.28±10.38 mm Hg (1 mm Hg=0.133 kPa) respectively; the intraocular pressure of group B was significantly higher than that of group A, the difference was statistically significant (t=0.141, P=0.043). At the last follow-up, there was no significant difference in the percentage of visual acuity improvement between the two groups (χ2=0.315, P=0.053); there was no significant difference in the incidence of concurrent cataract and epimacular membrane (χ2=0.621, P＞0.05). Among the 37 cases in group A, 32 cases (86.5%, 32/37) developed obesity symptoms during the follow-up period. ConclusionPPV combined with intravitreal implantation of Ozurdex and oral glucocorticoid after PPV can effectively improve the visual acuity of the affected eye; the incidence of complications is similar, however, the incidence of obesity after oral glucocorticoid is higher.
ObjectiveTo investigate the clinical effects and influence factors of intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs in the treatment of idiopathic choroidal neovascularization (ICNV). MethodsThis retrospective study involved 27 patients (27 eyes) with ICNV from July 2012 to July 2015. Patients received intravitreal bevacizumab (1.25 mg), ranibizumab (0.05 mg), additional injection was provided if it was needed. The average follow-up time was 168 weeks. The recovery of best corrected visual acuity (BCVA) and central foveal retinal thickness (CRT) of the affected eye was observed. Follow up once a month after the initial treatment until the lesion was completely absorbed or scarred (the first follow-up period). Follow up every 12 weeks was performed to observe the recurrence of the lesions (the second stage of long-term follow-up). One month after the last injection of the first follow-up period, according to the regression of choroidal neovascularization (CNV), the affected eyes were divided into a significant improvement group (significant improvement group) and an insignificant improvement group (non-significant improvement group)), to analyze the effects of age, course of disease, type of drugs, number of injections, baseline BCVA and CRT on the regression of CNV lesions. According to the results of long-term follow-up, the eyes were divided into recurrence group and non-recurrence group, and the factors affecting the recurrence of CNV lesions were analyzed. Measurement data between groups was compared by using independent sample t test or non-parametric test; count data was compared by using χ2 test. Logistic regression analysis was used to analyze the factors affecting the regression and recurrence of the lesion. ResultsAt baseline and 1 month after the last injection in the first stage, the average BCVA of the eyes were 55.70±15.21 and 73.59±12.08 letters; CRT was 338.3±89.32 and 264.5±47.47 μm, respectively. The BCVA and CRT of the affected eyes were compared at the two time points, and the differences were statistically significant (Z= －3.886, －4.061; P＜0.001). The BCVA of the eyes in the significant improvement group and the insignificant improvement group were 65.38±17.27 and 51.63±12.61 letters, respectively; the difference between the two groups of BCVA was statistically significant (t=－2.316, P=0.029). The results of long-term follow-up showed that of the 27 eyes, 6 eyes had recurrence; the average recurrence time was 90.83±49.02 weeks. After another intravitreal injection of anti-VEGF drugs, the CNV lesions was resolved. The average injection times of the relapsed group and the non-relapsed group were 3.67±0.816 and 2.24±0.768, respectively. The average injection times of the relapsed group was significantly higher than that of the non-relapsed group, and the difference was statistically significant (Z=－3.253, P＜0.001). There was no statistically significant difference between the two groups of eyes at baseline and CRT at the last follow-up (Z=－1.342,－1.313; P=0.195, 0.195). ConclusionIntravitreal injection of anti-VEGF drugs can effectively increase the regression rate of BCVA and CNV lesions in ICNV eyes; high baseline visual acuity indicates better CNV lesion regression after treatment. Relapsed patients can be effectively improved after re-treatment with anti-VEGF drugs, and CNV recurrence has no significant effect on the final prognosis.
ObjectiveTo observe the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and vitreous injection of mouse never growth factor (mNGF) in the high myopia macular hole (HMMH). MethodsA prospective study. Thirty-one patients (33 eyes) with HMMH diagnosed in Affiliated Eye Hospital of Nanchang University from August 2020 and February 2021 were selected. Before surgery, all included patients were subjected to a complete ophthalmologic evaluation including best corrected visual acuity (BCVA), optical coherence tomography (OCT), macular microperimetry and axial length measurement. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of minimum resolution angle (logMAR) visual acuity during statistics. The included subjects were accepted the treatment of PPV combined with ILM peeling and vitreous injection of mNGF (combined group) or PPV united with ILM peeling (simple group), 15 cases with 16 eyes, 16 cases with 17 eyes, respectively. There were no significant differences in logMAR BCVA (t=0.836), macular hole (MH) diameter (t=0.657), visual acuity (VA) (t=0.176), the missing length of external limting membrane (ELM) and ellipsoid zone (EZ) (t=1.255, 0.966) between two groups (P＞0.05). The follow-up time was at least 6 months. The BCVA, closure rate of MH, integrity of ELM and EZ and recovery of VA in macular area were compared and observed between the two groups after surgery. The logMAR BCVA, VA, the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group. Fisher test was performed for comparison of count data. ResultsSix months after surgery, MH closure rates in the simple group and the combined group were 88.24% (15/17) and 93.75% (15/16), respectively, with no significant difference (P=0.523). At 3 and 6 months after surgery, the integrity recovery of ELM in the combined group was better than that in the simple group, and the difference was statistically significant (t=2.282, 3.101; P＜0.05). At 1, 3 and 6 months after surgery, EZ deletion length in the combined group was lower than that in the simple group, and the difference was statistically significant (t=1.815, 2.302, 2.784; P＜0.05). Compared with 1 week after surgery, VA in macular area of the combined group increased at 1, 3 and 6 months, and the difference was statistically significant (P=0.007, ＜0.001, ＜0.001). At 3 and 6 months after surgery, VA in macular area of affected eyes in the combined group was higher than that in the simple group, and the difference was statistically significant (t=1.897, 2.250; P＜0.05). There was an interaction effect between the surgical method and the follow-up time. The postoperative time was prolonged, and the VA in macular area was decreased in the simple group and increased in the combined group, with statistical significance (F=12.963, P＜0.001). The BCVA and BCVA changes in the two groups increased with the extension of postoperative time. The improvement of BCVA and the difference of BCVA changes in the combined group were significantly higher than those in the simple group at different time points after surgery, with statistically significant differences (F=12.374, 21.807, 5.695, 4.095; P＜0.05). ConclusionPPV combined with ILM peeling and vitreous injection of mNGF is more effective than PPV with ILM peeling for HMMH, improving both anatomical and functional outcomes.
ObjectiveTo observe the ocular clinical features and efficacy of young infants with incontinentia pigmenti (IP). MethodsA retrospective study. Clinical data of 18 young infants with IP aged 0-3 months in the Department of Ophthalmology of Henan Children's Hospital from October 2017 to February 2019 were collected in this study. All patients were underwent fundus examination under topical anesthesia or general anesthesia. Among them, 9 cases were underwent genetic testing. Patients were determined whether to treated with retinal laser photocoagulation (LIO) or intravitreal conbercept (IVC, 0.25 mg/0.025 ml) according to the condition of eyes. The followed-up time ranged from 4months to 43 months. The ocular clinical features and treatment were observed. ResultsThere were 1 male and 17 females of the 18 patients. The age of first visit were 1.2±1.0 months (2 d-3 months). All cases had typical skin lesions, 4 cases had neurological symptoms, 10 cases had tooth abnormalities, and 4 cases had cicatricial alopecia. Among the 9 cases that were underwent genetic testing, 5 cases were deleted in exons 4-10 of the IKBKG gene and 1case were a heterozygous mutation c.1124delT in exon 9 of the IKBKG gene. Among the 36 eyes, 21 eyes of 13 cases with incontinentia pigmenti-associated ocular diseases were all retinopathy (58.3%,21/36). Retinopathy of 9 cases were asymmetrical (69.2%,9/13). Among the 21 eyes, 3 eyes were simple retinal pigment abnormalities (14.3%,3/21) and 18 cases had retinal vascular lesion (85.7%, 18/21). Among the 36 eyes, 8 eyes were treated; 4 eyes were underwent LIO; 3 eyes were treated with IVC; 1 eye was treated with LIO combined with IVC. They were all improved significantly after the operation without serious complications. 1 eye with retinal detachment did not undergo surgical treatment due to guardian reasons. Perceptual exotropia and eyeball atrophy was found during the follow-up. ConclusionsThe onset of IP-related ocular anomalies is early. The early anomalies were mainly retinal vascular abnormalities. Treatment in early time is effective.
ObjectiveTo evaluate the efficacy of intravitreal injection (IVI) of expansile gas alone to treat idiopathic full-thickness macular hole (FTMH).MethodsThis is a prospective interventional case series. Twenty FTMH patients (26 eyes) who underwent IVI with expansile gas alone were enrolled in this study. There were 5 males (5 eyes) and 21 females (21 eyes), with the mean age of (59±12) years. All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus color photography and three-dimensional optical coherence tomography (OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. The diameters of macular holes and the interface between vitreous and macular were observed by OCT (Topcon, OCT-2000). Based on the diameter, the holes were classified as small FTMH (equal or lesser than 250 μm), medium FTMH (more than 250 μm but equal or lesser than 400 μm) and large FTMH (more than 400 μm). The mean BCVA was 0.85±0.29. There were 7, 10 and 9 eyes with small, medium and large FTMH. There were 10 eyes with vitreous- macular traction (VMT). All the eyes received IVI of 0.2 ml C3F8 followed facedown positioning for 7-14 days. The follow-up ranged from 1 to 23 months. The BCVA, FTMH closure and complications were observed. If holes failed to close at 1 month after IVI, vitrectomy combined with internal limiting membrane (ILM) peeling and C3F8 tamponade would be performed for these eyes.ResultsFTMHs was able to close in 17/26 eyes (65.4%) had hole closure, failed to close in 9 /26 eyes (34.6%). All 10 eyes with VMT achieved vitreous-macula separation after IVI of gas. The eyes failed in the closure initially with IVI of gas alone, all succeed with hole closure after vitrectomy combined with ILM peeling and C3F8 tamponade. The closure rate of small (6 eyes), medium (8 eyes) and large FTMH (3 eyes) was 85.7%, 80.0% and 33.3% respectively. The diameter of FTMHs in holes-closure eyes and failed-closure eyes was (307.8±122.8), (431.6±128.4) μm respectively, the difference was significant (t=−2.407, P=0.024). VMT was found in 6 eyes and 4 eyes in holes-closure group and failed-closure group, respectively, the difference was significant (t=−2.196, P=0.038). The mean preoperative BCVA was 0.51±0.36. There was a significant difference between pre-and postoperative BCVA (t=4.758, P＜0.05). Two eyes developed local retinal detachment, which achieved hole closure and retinal reattachment after vitrectomy.ConclusionIVI of expansile gas alone is an effective way in treating FTMH with a diameter smaller than 400 μm and with VMT before surgery.