Diabetic macular edema (DME) is a common ocular complication of diabetes patients. It mainly involve macular which is closely related with visual function, thus DME is one of the major reasons causing visual impairment or blindness for diabetes patients. How to reduce the visual damage of DME is always a big challenge in the ophthalmic practice. In the past three decades, there are tremendous developments in DME treatments, from laser photocoagulation, antiinflammation drugs to antivascular endothelial growth factor therapy. However, the mechanism of DME development is not yet completely clear; every existing treatment has its own advantages and weaknesses. Therefore DME treatment still challenges us to explore further to reduce the DME damages.
ObjectiveTo observe the expression of inflammatory cytokines in diabetic rats received posterior sub-Tenon capsule injection of triamcinolone acetonide (TA) and pan-retinal photocoagulation. MethodsA total of 48 Brown Norway rats received intraperitoneal injection of streptozotocin to establish the diabetic model. Diabetic rats were randomly divided into experimental group (20 rats), control group (20 rats) and blank group (8 rats). 50 μl TA or saline was injected into the posterior sub-Tenon capsule immediately after the photocoagulation in the experimental group and the control group, respectively. The blank group received no treatment. The mRNA and protein expression level of retinal vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and tumor necrosis fator-α (TNF-α) were measured by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA) at 1, 3, 7 days after laser photocoagulation. ResultsThe mRNA and protein expression of VEGF, IL-6, TNF-α of the experimental group and control group were significantly higher than the blank group, the difference was statistically significant (P < 0.05). The mRNA and protein expression of VEGF, IL-6 and TNF-α of the experimental group were significantly lower than that of the control group. On day 1 after laser photocoagulation, the mRNA expression of VEGF was not statistically significant in the experimental group and control group (P > 0.05), the mRNA and protein expression of VEGF, IL-6, TNF-α of the two groups were statistically significant in the remaining observing time (P < 0.05). ConclusionPosterior sub-Tenon capsule injection of TA can effectively reduce retinal photocoagulation induced VEGF, IL-6, TNF-α expression.
ObjectiveTo observe the efficacy of phacoemulsification with intravitreal triamcinolone injection (IVTA) in diabetic patients with severe cataract and diabetic macular edema (DME). MethodsTwenty-one patients (25 eyes) with severe cataract and DME were enrolled in this retrospective study. Fifteen eyes underwent standard phacoemulsification and intraocular lens implantation with 4 mg IVTA at completion of surgery. Ten eyes underwent standard phacoemulsification and intraocular lens implantation. All the patients were followed up for best corrected visual acuity (BCVA), optical coherence tomography(OCT) and ophthalmological examination.Changes in logarithm of he minimal angel of resolution (logMAR) BCVA and central macular thickness (CMT) were evaluated preoperatively and 1 month, 3 months and 6 months postoperatively by repeated measures ANOVA. Correlations between logMAR BCVA and CMT preoperatively and postoperatively were analyzed by Pearson correlation analysis. Postoperative 6 months logMAR BCVA and affecting factors were evaluated by multivariate linear regression analysis. ResultsBoth groups showed significant improvements of logMAR BCVA after surgery (F=4.855, 6.235; P=0.037, 0.020). There were no statistical differences of logMAR BCVA improvement at different time points postoperatively (F=0.007, 0.006, 0.023; P=0.973, 0.938, 0.882). The CMT reductions in IVTA group at month 1 and month 3 postoperatively were statistically significant than the reductions in group without IVTA(F=10.449, 7.374; P=0.012, 0.026), and there was no statistical difference of CMT reduction at month 6 postoperatively between two groups(F=2.173; P=0.114). Correlation Coefficients between CMT and BCVA were not statistically significant preoperatively and 6 months postoperatively(r=0.279, 0.172; P=0.295, 0.574). Analysis of multiple linear regression showed that external limiting membrane status and duration of diabetes are factors affecting the visual recovery (β=0.577, -0.411; P=0.025, 0.030). ConclusionsPhacoemulsification with concurrent IVTA for treatment of patients with severe cataract and DME is effective in reducing edema. But IVTA does not further improve logMAR BCVA postoperatively.
Objective To investigate the effects of Atorvastatin calcium on the incidence of macular edema after phacoemulsification in diabetic patients. Methods Forty two eyes of 42 cataract patients with diabetes and hypercholesterolemia who underwent phacoemulsification surgery were divided into interventional group (23 patients) and non-interventional group (19 patients) by random number table methods. The blood glucose and pressure of patients in two groups was controlled strictly before and after surgery. 10 mg Atorvastatin calcium per day was delivered one day after cataract surgery for the patients of interventional group and used for 24 weeks. No lipid-lowing agent was provided to the patients of non-interventional group. The main outcome measures included the best corrected visual acuity (BCVA), central retina thickness (CRT), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C). No significant difference was shown in the BCVA, CRT, TC, LDL-C and HDL-C in two groups before phacoemulsification surgery (t=1.251, 1.257, 1.031, 1.042, 1.461; P > 0.05). At the end of the 24 weeks after surgery, the efficacy evaluation and comparative analysis were performed. The analysis included the BCVA, the incidence of macular edema, CRT, TC, LDL-C and HDL-C. Results The BCVA was no significantly different between two groups one day after surgery (t=1.523，P > 0.05). But 4, 12, 24 weeks after phacoemulsification surgery, the BCVA in interventional group was better than that in non-interventional group(t=3.920, 3.012, 7.025; P < 0.05). 24 weeks after the operation, macular edema was occurred in 2 eyes (8.69%) in interventional group and 4 eyes (21.05%) in non-interventional group. Significance difference was found between two groups (χ2=4.896，P < 0.05). There was no significance different of the CRT between two groups one day after operation (t=1.501，P > 0.05). Whereas, the significance difference of the CRT was occurred in two groups 4, 12, 24 weeks after surgery(t=4.673, 7.583, 9.035; P < 0.05). Comparing with that in non-interventional group, the level of TC (t=7.043, 7.930, 8.611)and LDL-C (t=9.374, 9.554, 10.856) in interventional group was significantly decreased 4 to 24 weeks after operation (P < 0.05). But no significance different of HDL-C was shown in two groups 4, 12 and 24 weeks after surgery (t=1.057, 1.127, 1.295; P > 0.05). Conclusion The treatment of Atorvastatin calcium effectively reduced the incidence rate of macular edema in hypercholesterolemia patients with good glycemic and hypertension control after phacoemulsification surgery.
ObjectiveTo compare the short-term efficacy of conbercept and ranibizumab for macular edema in central retinal vein occlusion (CRVO)and explore the relationship between the integrity of ellipsoidal zone and visual acuity. MethodsForty-four eyes of 44 patients with macular edema in CRVO were enrolled into this retrospective and comparative study. There were 15 eyes of 15 males, 29 eyes of 29 females; age ranged from 49-61 years old,with an average age of (54.65±3.10) years. All patients were examined with best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp, fundus photograph, fundus fluorescein angiography (FFA), optical coherence tomography(OCT). BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution acuity. Twenty-three eyes were intravitreal injected with conbercept 0.5 mg (group A) and 21 eyes were intravitreal injected with ranibizumab 0.5 mg (group B). There was no statistical difference of age (t=-1.41), gender (χ2= 0.55),the percentage of hypertension patients (χ2=0.27), average BCVA (t=-2.06), IOP (t=-2.52), central macular thickness (CMT) (t=-1.96), number of different integrity of ellipsoidal zone patients (χ2=1.00) and number of different types of macular edema patients (χ2=1.03) among the two groups (P > 0.05). The change in BCVA and CMT at 3, 6 months between the two groups were compared. The relationship between BCVA at 6 months and BCVA, CMT at baseline were explored. The relationship between three groups of ellipsoidal zone and BCVA at baseline were evaluated. The change of BCVA after treatment between the three groups of ellipsoidal zone were Compared. The number of intravitreal injections between two groups was compared. ResultsDuring the 3, 6 months after treatment, the mean BCVA were all improved with statistically difference in group A (t=5.13, 7.39; P < 0.05) and group B (t=6.60, 11.52; P < 0.05). There was no significant difference of BCVA at 3, 6 moths between group A and group B (t=-0.99, -0.40; P > 0.05). During the 3, 6 months after treatment, the mean CMT were all decreased with statistically difference in group A (t=11.58, 15.96; P < 0.05) and group B (t=18.77, 35.16; P < 0.05). There was no significant difference of CMT at 3, 6 months between group A and group B (t=-1.52, -1.63; P > 0.05). In both groups,BCVA at 6 months was related to BCVA at baseline (r= 0.44, 0.62; P < 0.05), but not related to CMT at baseline (r=0.19, 0.01; P > 0.05). In the two groups, BCVA at baseline was related to the integrity of ellipsoidal zone (r=0.97, 0.70; P < 0.05). There was statistical difference of the number of intravitreal injections in the two groups (t=-6.88, P < 0.05). There was no systemic or ocular serious side effects during the follow up. ConclusionsComparing to ranibizumab, conbercept has the same effective to the treatment of macular edema in CRVO, but the number of intravitreal injections is less. The integrity of ellipsoidal zone is related to BCVA.
ObjectiveTo investigate the effects of intravitreous injection of conbercept for macular edema secondary to retina1vein occlusion(RVO) during 6 months period. MethodsA retrospective clinical study. 34 patients (34 eyes) were included in this study,who were diagnosed with macular edema due to retinal vein occlusion by ophthalmologic examination, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography and other methods. The best corrected visual acuity (BCVA) was examined using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The average logMAR BCVA was 0.90±0.68, and the mean macular central retinal thickness (CMT) was (672.27±227.51) μm before treatment. All subjects received intravitreal injection of 0.5 mg conbercept (0.05 ml) at the first visit. Injections were repeated based on the visual acuity changes and the OCT findings. 34 eyes received 69 times of injection, the average number of injections was 2.03±1.03. BCVA, OCT were examined before and after treatment using the same method. BCVA and CMT changes, drugs and treatments associated cardiac and cerebral vascular accident, intraocular pressure elevation, retinal tears, retinal detachment, endophthalmitis and other complications after treatment were observed. Linear correlation analysis was used to analyze the correlation between prognosis BCVA and baseline BCVA, correlation between prognosis BCVA and baseline CMT, and also correlation between BCVA and CMT at different time points before and after treatment. ResultsAt 1 week and 1, 2,3, 6 months after treatment, the average logMAR BCVA was 0.65±0.61, 0.56±0.61, 0.46±0.55, 0.56±0.71, 0.44±0.48 respectively. During 1, 2, 3, 6 months after treatment, the mean logMAR BCVA were improved with statistically significant difference (Z=34.029, 47.294, 41.338, 43.603;P < 0.05), while 1 week after treatment showed no obvious improvement (Z=21.941,P > 0.05). At 1 week and 1, 2, 3, 6 months after treatment, the average CMT was (285.89±96.69), (256.65±143.39), (278.68±156.92), (290.11±188.17), (217.15±48.04) μm respectively. At 1 week and 1,2,3,6 months after treatment, the mean CMT were all decreased with statistically significant difference (Z=68.500, 98.735, 93.235, 91.132, 109.162; P < 0.05). There was a positive correlation between the prognosis visual acuity and preoperative visual acuity (r=0.682,P < 0.05). However,there was no correlation between the prognosis vision and the degree of macular edema before treatment (r=0.078,P > 0.05). Before and 3, 6 months after treatment, BCVA was negatively correlated with CMT (r=0.491, 0.416, 0.386; P < 0.05), while there was no correlation in other time points (r=0.145, 0.217, 0.177; P > 0.05). Systemic adverse reactions and persistent intraocular pressure elevation, iatrogenic cataract, retinal detachment, retinal tear, endophthalmitis and ocular complications were never found in the follow-up period. ConclusionIntravitreal conbercept is a safe and effective approach for RVO,which can significantly improve visual acuity and reduce CMT.
ObjectiveTo observe the short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide (PSTA) in the treatment of macular edema due to ischemic retinal vein occlusions (RVO). MethodsA retrospective clinical study. A total of 53 eyes of 53 patients with RVO macular edema diagnosed by fundus color photography, fundus fluorescein angiography and optical coherence tomography (OCT) were included in the study. The best corrected visual acuity (BCVA) was detected by the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by OCT. Among 53 eyes, there were 27 eyes with ischemic RVO macular edema (ischemic group) and 26 eyes with non-ischemic RVO macular edema (non-ischemic group). The mean logMAR BCVA was 0.82±0.37, mean CMT was (662.1±216.7) μm in ischemic group. The mean logMAR BCVA was 0.41±0.23, mean CMT was (548.0±161.9) μm. The differences of logMAR BCVA and CMT between the two groups were both statistically significant (t=4.745, 2.258; P<0.05). All eyes were treated with a single sub-Tenon injection of 0.4 ml triamcinolone acetonide suspension (100 mg/ml).The mean logMAR BCVA, CMT before and 1, 3 months after the treatment between the two groups were observed and compared. ResultsOn 1 and 3 months after treatment, the mean logMAR BCVA in the non-ischemic group (0.32±0.25 and 0.27±0.29) were improved compared with ischemic group (0.76±0.37 and 0.41±0.79), the difference was statistically significant (t=5.052, 5.240; P<0.05). The mean logMAR BCVA before and after treatment had no statistically significant difference in ischemic group (F=0.516, P>0.05), but had a statistically significant difference in non-ischemic group (F=7.685, P<0.05). On 1 and 3 months after treatment, the mean CMT in the ischemic group were (534.7±223.4), (470.8±234.7) μm, which were lower (127.4±28.28), (191.4±34.55) μm before treatment. In the non-ischemic group, the average CMT was (426.2±188.8), (371.3±200.6) μm, which were lower (103.1±33.1), (164.9±49.6) μm. There were statistically significant differences in the mean CMT between the ischemic group and the non-ischemic group (F=17.040, 10.360; P<0.05). In non-ischemic group, CMT had a bigger reduction compared to the the ischemic group (t=2.056, 2.103; P<0.05). The difference of CMT decrease value between two groups was not statistically significant (t=0.560, 0.441; P>0.05). On 1 month after the treatment, there were 3 and 5 eyes had a higher intraocular pressure than 21 mmHg (1 mmHg=0.133 kPa) in ischemic and non-ischemic group, respectively; but all of them returned to normal after drug treatment. There were no drugs and ocular injection related complications. ConclusionPSTA of ischemic RVO macular edema can lower the CMT in the short term, but can't significant improve the visual acuity.
Uveitic macular edema (UME) is a major reason of permanent visual loss. Early treatment is essential for achieving a good visual outcome, but some patients are resistant or nonresponsive to the treatment, which is called refractory UME (RUME). Intravitreous injection of glucocorticoids can improve the intraocular drug concentration and avoid systemic side effects. Immunosuppressive agents have a certain role in improving RUME by inhibiting immune cells through a variety of ways. Non-steroidal anti-inflammatory drugs, carbonic anhydrase inhibitors and new biological agents also can improve RUME outcome, but their effectiveness and safety need to be confirmed by large scale randomized clinical trials. Vitrectomy can improve RUME outcome but whether peeling of internal limiting membrane is necessary or not is still controversial. Peeling the inner limiting membrane can eliminate the potential incentive for macular edema and remove the barrier. But the process of stripping may injury the retinal neurepithelium. To eliminate edema and protect the visual function, we should analysis the causes of RUME and treat it individually.
Objective To evaluate the efficacy and safety of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO). Methods Thirty-nine patients (39 eyes) with ME secondary to RVO were enrolles in this study. Of the patients, 27 were male and 12 were female. The mean age was (41.9±16.3) years. The mean course of disease was (5.0±5.3) months. The best corrected visual acuity (BCVA), intraocular pressure and optical coherence tomography (OCT) were performed. BCVA was measured by Early Treatment Diabetic Retinopathy Study charts. Central macular thickness (CMT) was measured by OCT. The mean BCVA was (13.4±15.3) letters. The mean intraocular pressure (IOP) was (14.1±2.8) mmHg (1 mmHg=0.133 kPa). The mean CMT was (876.1±437.9) μm. Of the 39 eyes, 33 were central RVO, 6 were branch RVO. Patients were categorized into ischemic (18 eyes)/non-ischemic (21 eyes) groups and previous treatment (22 eyes)/treatment naïve (17 eyes) groups. All eyes underwent intravitreal 0.7 mg Ozurdex injections. BCVA, IOP and CMT were assessed at 1, 2, 3, 6, 9, 12 months after injection. Three months after injection, intravitreal injections of Ozurdex, triamcinolone acetonide or ranibizumab could be considered for patients with ME recurrence or poor treatment effects. Change of BCVA, IOP and CMT were evaluated with paired t test. The presence of ocular and systemic adverse events were assessed. Results BCVA, IOP significantly increased and CMT significantly decreased at 1 month after injection compared to baseline in all groups (t=3.70, 3.69, 4.32, 3.08, 4.25, 6.09, 6.25, 4.02, 5.49, 8.18, 6.54, 5.73; P＜0.05). Two months after injection, change of BCVA, IOP and CMT was most significant (t=4.93, 6.80, 6.71, 5.53, 4.97, 5.89, 5.13, 7.68, 7.31, 8.67, 8.31, 5.82; P＜0.05). Twelve months after injection, there was no statistical difference regarding BCVA of ischemic RVO group and previous treatment group, compared to baseline (t=1.86, 0.67; P＞0.05); BCVA of non-ischemic RVO group and treatment naïve group significantly increased compared to baseline (t=2.27, 2.30; P＜0.05); there was no statistical difference regarding IOP in all groups (t=0.30, 0.13, 0.64, 1.53; P＞0.05);however, CMT significantly decreased in all groups (t=4.60, 3.26, 3.00, 4.87; P＜0.05). Twenty-seven eyes (69.2%) experiences ME recurrence (4.5±1.5) months after injection. Most common side-effect was secondary glaucoma. 41.0% eyes had IOP more than 25 mmHg, most of which were lowered to normal range with use of topical IOP lowering drugs. Four eyes (10.3%) presented with significant cataract progression and needed surgical treatment, all were central RVO eyes. No serious ocular or systemic adverse events such as vitreous hemorrhage, retinal detachment or endophthalmitis were noted. Conclusions Intravitreal injection of Ozurdex for patients with ME secondary to RVO is effective in increasing BCVA and lowering CMT in the first few months. Significant treatment effect could be seen at 1 month after injection and was most significant at 2 months after injection. The long-term vision of eyes in non-ischemic RVO group and treatment naïve group are better. 69.2% eyes experience ME recurrence at 4 months after injection. Short term adverse events were mostly secondary glaucoma and long term adverse events are mostly cataract progression.
ObjectiveTo compare the one year efficacy of intravitreal injection with ranibizumb for macular edema (ME) secondary to ischemic and non-ischemic central retinal vein occlusion (CRVO).MethodsA total of 88 patients (88 eyes) with ME secondary to CRVO were enrolled in this retrospective study. The best corrected visual acuity (BCVA) was detected by the Early Treatment Diabetic Retinopathy Study Chart. The optical coherence tomography was used to measure the foveal retinal thickness (CRT) and macular edema volume. The patients were divided into non-ischemic group and ischemic group, 44 eyes of 44 patients in each group. There was no significant differences in age (t=0.650, P=0.517) and gender (χ2=0.436, P=0.509) between the two groups. Compared with the ischemic group, the CRT was significantly decreased in the non-ischemic group (t=−2.291, P=0.024), and the edema volume in the macular area was significantly reduced (t=−2.342, P=0.022). All eyes were treated with continuous intravitreal injection of ranibizumab three times, and repeated injections were performed as needed. The patients without obvious ME regression after treatment were combined with triamcinolone acetonide injection. The patients with peripheral retinal non-perfusion area were combined with peripheral retinal laser photocoagulation. The follow-up was 1 year. The number of injections was counted. The changes of BCVA, CRT and edema volume in the macular area were compared between the two groups.ResultsDuring the 1-year follow-up period, 88 eyes were injected 1 to 10 times, with the mean of 4.51±2.33. The number of injections in the ischemic group and non-ischemic group were 4.55±1.59 and 4.48±2.91, respectively. There was no significant difference in the average number of injections between the two groups (t=0.136, P=0.892). The number of acetonide injections and laser treatment in the ischemic group was significantly higher than that in the non-ischemic group (t=3.729, 9.512; P＜0.001). At the last follow-up, compared with the ischemic group, the BCVA was increased (t=8.128), the CRT was decreased (t=−7.029) and the edema volume in the macular area was decreased (t=−7.213) in the non-ischemic group (P＜0.001).ConclusionCompared with ME secondary to ischemic CRVO, intravitreal injection of ranibizumab for ME secondary to non-ischemic CRVO has the better outcome of vision improvement and edema regression as well as less frequent of acetonide injections and laser treatment.