ObjectiveTo investigate the efficacy and safety of intravitreal ranibizumab and (or) triamcinolone combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion (BRVO) during one year period. MethodsThe data of 31 eyes from 31 consecutive patients with macular edema secondary to BRVO during one year follow-up visit were retrospectively analyzed. Mean best corrected visual acuity (BCVA) logMAR was (0.74±0.36) and mean central retinal thickness (CRT) was (484.48±164.81)μm at baseline. All patients received standardized clinical comprehensive examinations including vision, intraocular pressure and optical coherence tomography for diagnosis before treatment. All patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml) at first visit. The continue PRN treatment were based on the visual acuity changes and the optical coherence tomography findings. Eyes received combined triamcinolone acetonide 0.05 ml (40 mg/ml) and ranibizumab for macular edema recurrence after two injections of ranibizumab and received laser photocoagulation during 10-14 days after third injections of ranibizumab. Mean injection of ranibizumab was 3.52±2.01, 15 eyes with triamcinolone acetonide (0.84±1.21), 21 eyes with laser photocoagulation (0.97±0.95) and 12 eyes with three treatment. Compared the visual acuities and CRTs of the first and the last visits by statistical analysis. ResultsMean visual acuity improved significantly to 0.42±0.33 logMAR (t=6.611, P=0.000). Mean improvement of visual acuity was 2.90±3.07 lines. A gain of three or more logarithmic lines was evaluated in 20/31 eyes (64.52%) at the last visit. Mean CRT was (326.19±117.80)μm (t=4.514, P=0.000).Mean reduction of CRT was (333.58±134.17)μm. A decrease of 100μm of CRT was evaluated in 17/31 eyes (54.84%). No severe ocular and systematic side effect was found. ConclusionThe efficacy and safety of intravitreal ranibizumab and (or) triamcinolone combined with laser photocoagulation for macular edema secondary to BRVO were assured.
Objective To observe the short-term effect of changing the sequence of PRP and MLP on the pre-proliferative or proliferative diabetic retinopathy patients with clinical significant macular edema (CSEM). Methods Sixty-three consecutive pre-proliferative or proliferative diabetic retinopathy outpatients (103 eyes) with clinical significant macular edema were selected and divided into two groups: 54 eyes in patients of group A accepted MLP one month prior to PRP and 49 eyes in patients of group B accepted the photocoagulative therapies in a contrary sequence. All the patients were followed up for 3 to 13 months and visual acuity. Light sensitivity of 5deg;macular threshold, and FFA were performed pre- and post-photocoagution. Results The improvement of visual acuity was found to be better in group A than that of group B (Plt;0.01) 2 months after the therapy, since then, there was no significant defference (Pgt;0.05) in both groups. Three and 4 months after the treatment, there was no significant difference in change of light sensitivity of 5deg;macular threshold in both groups. The macular leakages of 59 eyes, 32 ingroup A and 27 in group B, were well controlled. Conclusion Among the pre-proliferative or proliferative diabetic retinopathy patients with CSEM, visual acuity of those who accept MLP prior to PRP more rapidly than those who accept contrary sequence of photocoagulation, but the changing of therapeutic sequence might have no dramatic influence on light sensilivity of 5deg;macular threshold. (Chin J Ocul Fundus Dis,2000,16:150-152)
Objective To evaluate the practicability and safety of 25-gauge (25G) transconjunctival sutureless vitrectomy system (TSV25G) and describe the preliminary experience. Methods Eighteen patients underwent TSV25G. The time of procedures of setting-up the three-port cannulae and closing the cuts were recorded. The pre- and post-operative ocular tension, visual acuity and complications were observed. Results The average time of setting-up the three-port cannulae and closing the cuts was 1 minutes 24 seconds and 32 seconds, respectively. The average preoperative ocular tension was 16.3 mm Hg（1 mm Hg=0.133 kPa）; the average postoperative ocular tension at the first day, first week, and first month was 13.0, 15.9, and 16.4 mm Hg, respectively. The visual acuity before and one month after operation the was HM/ 20 cm～0.2 and HM/50 cm～0.6, respectively. No postoperative complication was found. Conclusion TSV25G may simplify the operation, minimize the surgical induced trauma, and decrease the operating time and the postoperative inflammatory response. (Chin J Ocul Fundus Dis，2004，20：139-141)
Thanks to the treatment of retinoblastoma (RB) having improved significantly in recent years, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum mortality. RB therapy is a long-term systemic treatment in clinical practice. Although there are many treatment options for RB therapy, such as cryotherapy, photocoagulation, systemic chemotherapy, enucleation and ophthalmic chemotherapy, it is recommended to consider in accordance with the following key points in gaining a reasonable treatment strategies: to make sure that RB is an intraocular period; to determine whether the intraocular RB to be treated with eye preservation or enucleation; what is the case of eye preservation therapy combined with chemotherapy and how to arrange the follow-up of RB patients. It's more complicated to choice the therapeutic measures for RB in clinical practice. So, the patient's condition, economic capability and medical condition should be evaluated comprehensively. The principle of RB treatment should be followed, which is protecting eyeball and visual function without life damage.
Up-regulation of vascular endothelial growth factor (VEGF) is demonstrated to be a key role in formation process of intraocular neovascularization. Anti-VEGF treatment is the breakthrough of intraocular neovascular diseases therapy. Intrav itreal injection of antineovascularization drug looks to be an effective method on ocular neovascular diseases which with the advantages of good biocompatibility, low prices and longer intravitreal half-time etc. However, at present, it lack of multi-center study; the long-term efficacy and the systematic safety needs the further clinical verification. Various types of CNV showed the different therapeutic reactions to either PDT or Anti-VEGF agent, the treatment methods for exudative AMD include laser, PDT, and drug like Triamcinolone Acetonide，several anti-VEGF preparations. Therefore, understanding the pathogenesis of neovascular AMD and choosing a reasonable therapeutic methods are necessary. We should try to explore a safe, effective, economic, new approach. （Chin J Ocul Fundus Dis，2008，24：157-159）
Objective To investigate the early influences of laser photocoagulation on retinal function in diabetic retinopathy(DR)． Methods The multifocal electroretinograms (MERG) of 30 eyes with DR (phase Ⅲ～Ⅳ) were tested with visual evoked response image system IV b efore,and the 3rd day and the 7th day after laser photocoagulation． Results Three days after photocoagulation, the latency of N1 prolonged in the central macula 5deg; area and superionasal quadrant．Th e response densities of N1,P1 and N2 markedly reduced, and most significant changes occurred in the central macula 5deg; area and then in the central 10deg;area． There were also differences in the changes of the amplitude of N1 and P1 in diff erent quadrants ．The changes of visual acuity were positively related to the de crease of amplitudes of N1,P1 and N2 in the macula． Conclusion The reduction of response densities in MERG reveals functional damage in diabetic retina occurring early after photocoagulation．The functional damage in macula induced indirectly by photocoagulation may explain the reduction of visual acuity after panretinal photocoagulation in some degree． (Chin J Ocul Fundus Dis, 2001,17:181-183)
Objective To observe the effect of macular retinal thickness (CMT) on the long-term visual prognosis after intravitreal injection of Conbercept combined with retinal laser photocoagulation for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods A retrospective non randomized controlled study. Forty-one patients (41 eyes) of ischemic BRVO secondary ME were included in the study. Among them, there were 23 males (23 eyes) and 18 females (18 eyes). The average age was (56.49±8.94) years. The best corrected visual acuity (BCVA) and optical coherence tomography were performed. The mean logMAR BCVA was 0.82±0.41, and the mean CMT was (512.61±185.32) μm. According to the CMT reduction value at 1 month after treatment, the eyes were divided into no response group and response group, each has 15 patients of 15 eyes and 26 patients of 26 eyes respectively. The age and sex composition of the two groups were not statistically significant (t=−0.298, −1.708; P=0.767, 0.096), and the difference of frequency of injection was statistically significant (t=3.589, P=0.010), and there was no statistical difference between the patients with logMAR BCVA and CMT (t=2.056, −1.876; P=0.460, 0.070). The average follow-up was 8 months. The logMAR BCVA on 6 months after treatment was defined as long term vision. The changes of long term vision and CMT on 1 and 6 months of two groups after treatment were observed. Pearson correlation analysis showed that the correlation between long-term vision and age, logMAR BCVA before treatment, CMT before treatment, frequency of injection, and CMT value decreased 1 month after treatment. The correlation of long-term visual acuity with age, sex, logMAR BCVA before treatment, CMT before treatment, number of drugs before treatment, CMT reduction at 1 month after treatment, integrity of ellipsoid band and integrity of external membrane (ELM) were analyzed by multiple regression analysis. Results On 1 month after treatment, the CMT of the eyes was lower than that before treatment (231.48±177.99) μm, and the average integrity of ELM and ellipsoid were 0.56±0.50 and 0.41±0.50 respectively. On 6 months after treatment, the average logMAR BVCA of the eyes was 0.48±0.34. The results of Pearson correlation analysis showed that the long-term vision was positively correlated with the logMAR BCVA before treatment and the number of CMT reduction and the number of drug injection at 1 month after treatment (P＜0.05); there was no correlation with age and CMT before treatment (P＞0.05). The results of multiple regression analysis showed that the long-term vision was associated with logMAR BVCA before treatment, CMT reduction, ELM integrity, and the number of times of injection (P＜0.05), and no correlation with age, sex, CMT before treatment and the integrity of the ellipsoid (P＞0.05). On the 6 months after treatment, the logMAR BCVA in the non-response group and the response group were 0.86±0.23 and 0.26±0.14, and the average CMT was respectively (398.93±104.87) and (255.15±55.18) μm, and the average injection times were respectively (2.53±1.46) and (1.31±0.74) times. The average logMAR BCVA, CMT and injection times of the two groups were statistically significant (t=10.293, 5.773, 3.589; P=0.000, 0.000, 0.001). No complications related to drug or intravitreal injection occurred in all patients. Conclusion The long-term vision of ME secondary to BRVO after intravitreal injection of Conbercept combined with retinal laser photocoagulation was associated with the decrease of CMT and the integrity of the ELM after 1 month of treatment, no correlation was found between CMT and ellipsoid integrity before treatment.
Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR). Methods A prospective clinical studies. Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No. 306 Hospital of PLA during January 2014 and December 2015 were included in this study. Among them, 21 eyes of NPDR and 20 eyes of PDR; 13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group). All eyes underwent best corrected visual acuity (BCVA), fundus color photography, fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations. The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field). The BCVA of DR eyes was 0.81±0.28; the VFI and MD values were (89.8±8.4)% and −7.5±3.85 dB, respectively. The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27, the VFI were (90.86±7.86)% and (87.46±9.41)%, the MD values were −6.86±3.43 and 8.87±4.48 dB. PRP was performed on eyes using 577 nm krypton laser. The changes of VFI, MD and BCVA were observed at 1, 3, and 6 months after treatment. Results Compared with before treatment, the VFI of DR eyes decreased by 12.0%, 12.3% and 14.8% (t=7.423, 4.549, 4.79; P＜0.001); the MD values were increased by −4.55, −4.75, 6.07 dB (t=−8.221, −5.313, −5.383; P＜0.001) at 1, 3 and 6 months after treatment, the differences were statistically significant. There was no difference on VFI (t=1.090, −0.486; P＞0.05) and MD value (t=−0.560, −0.337; P＞0.05) at different time points after treatment. Compared with before treatment, the BCVA was significantly decreased in DR eyes at 1 month after treatment, the difference was statistically significant (t=2.871, P＜0.05). Before and after treatment, the BCVA of the DME group was lower than that of the non-DME group, the difference were statistically significant (t=4.560, 2.848, 3.608, 5.694; P＜0.001); but there was no differences on the VFI (t=1.209, 0.449, 0.922, 0.271; P＞0.05) and MD values (t=1.582, 0.776, 0.927, 1.098; P＞0.05) between the two groups. Conclusion The range of 30° visual field loss is about 12%-14.8% after 577 nm krypton laser PRP for DR. VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.
ObjectiveTo observe the efficacy of pars plana vitrectomy (PPV) combined with endoscopic cyclophotocoagulation (ECP) for refractory glaucoma. MethodsTwenty-eight patients (30 eyes) diagnosed with refractory glaucoma were enrolled in this study. The intraocular pressure was ranged from 28 to 55 mmHg (1 mmHg=0.133 kPa), with the mean of (46.3±10.3) mmHg. There were 24 eyes with initial visual acuity <0.05, 1 eye with 0.05-0.08 initial visual acuity and 5 eyes with ≥0.1 initial visual acuity. The mean number of intraocular pressure-decreased drugs was 4. All the eyes underwent PPV combined with ECP. The cyclophotocoagulation ranged from 90°-360°, with the mean of (232.5±77.6)°. The cyclophotocoagulation was <180° in 4 eyes, 180°-270° in 6 eyes, >270° in 20 eyes. The follow-up ranged from 12 to 20 months, with the mean of 15.2 months. The intraocular pressure, vision and the mean number of intraocular pressure-decreased drugs before and after surgery were comparatively observed. The relationship between cyclophotocoagulation area and postoperative intraocular pressure was analyzed. ResultsAt the final follow-up, the intraocular pressure ranged from 12 to 36 mmHg, with the mean of (18.5±4.4) mmHg, which decreased 49.4% compared with preoperative intraocular pressure (t=15.537, P<0.01). Among 30 eyes, the intraocular pressure was ≤21 mmHg without any intraocular pressure-decreased drugs in 24 eyes (80.0%), 1 eye (3.3%) with ≤21 mmHg who treatment by local intraocular pressure-decreased drugs, lose control of intraocular pressure in 5 eyes (16.7%). The vision was <0.05 in 15 eyes, 0.05-0.08 in 3 eyes and ≥0.1 in 12 eyes. The difference of vision distribution before and after surgery was not significant (χ2=6.197, P>0.05). Compared with preoperative vision, the postoperative vision was improved in 8 eyes (26.7%), stabled in 15 eyes (50.0%), decreased in 7 eyes (23.3%). The mean number of intraocular pressure-decreased drugs was reduced from 4 to 1 (t=8.402, P<0.01).The cyclophotocoagulation area was positive related to postoperative intraocular pressure (r=4.160, P<0.05). There were no ocular and systemic complications during and after surgery except slight inflammation. ConclusionPPV combined with ECP for refractory glaucoma can reduce intraocular pressure, stabilize or improve the visual acuity.
PURPOSE:To evaluate the therapeutic effect of argon laser photocoagulation on choroidal osteoma. METHODS:Six cases (7 eyes)of choroidal osleoma were treated with argon laser photoeoagulation. The pre and postoperative visual aeuity,fundus appearance and fundus fluorescein anglography(FFA)were observed. The average period of follow up was 23 months. RESULT:The visual acuity of all patients was unchanged. Choroidal osteomas in 3 patlents ( 3 eyes)were flattened. The EFA showed that choroidal vaseulature disappeared in one eye. CONCLUSION :Multiple sessions of photocoagulation may cause decalcification of choroidal ostema and ]imitation of growth of the tumors awing to destroying the choroid blood vessel by pholoeoagulation in the area of tumor and around it. （Chin J Ocul Fundus Dis,1997,13: 204-206）