ObjectiveTo observe the short-term intraocular pressure changes of the affected eye after the implantation of dexamethasone vitreous implant (Ozurdex), and indirectly understand the tightness of the scleral perforation of the 22G implant device.MethodsThis is a prospective cohort design clinical observational study. From January 2018 to January 2020, 90 eyes (90 patients) who underwent vitreous Ozurdex implantation in the Department of Ophthalmology of Beijing Hospital were included in the study. There were 52 males (52 eyes), and 38 females (38 eyes); they were 14-79 years old. Forty-three eyes (43 patients) had retinal vein occlusion with macular edema, 29 eyes (29 patients) had uveitis with or without macular edema, 18 eyes (18 patients) had diabetic macular edema. All eyes underwent standard scleral tunnel vitreous cavity implantation Ozurdex treatment. The intraocular pressure was measured with a non-contact pneumatic tonometer 10 min before implantation (baseline) and 10, 30 min and 2, 24 h after implantation. The difference were compared between the intraocular pressure at different time points after implantation and the baseline. Wilcoxon signed rank test was used to compare intraocular pressure between baseline and different time points after implantation.ResultsThe average baseline intraocular pressure of the affected eye was 14.85 [interquartile range (IQR): 11.60, 17.63] mmHg (1 mmHg=0.133 kPa). The average intraocular pressure at 10, 30 and 2, 24 hours after implantation were 11.90 (IQR: 8.95, 16.30), 13.75 (IQR: 9.95, 16.80), 13.60 (IQR: 10.95, 17.20), and 14.65 (IQR: 12.20, 17.50) mmHg. Compared with the baseline intraocular pressure, the intraocular pressure decreased at 10 and 30 minutes after implantation, the difference was statistically significant (P＜0.001, P=0.002); the intraocular pressure difference was not statistically significant at 2, 24 h after implantation (P=0.140, 0.280).ConclusionsThere is a statistically significant difference in intraocular pressure reduction compared with the baseline in 10 and 30 minutes after vitreous implantation of Ozurdex, and there is no statistically significant difference between 2, 24 hours. This suggests that the 22G scleral puncture port of the preinstalled implant device cannot be completely closed immediately, and short-term intraocular pressure monitoring after implantation should be appropriately strengthened.
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 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.
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.
At present, intravitreal injections of anti-VEGF agents is the main method for the treatment of macular edema secondary to retinal vein occlusion (RVO), which can significantly inhibit neovascularization, release macular edema and improve the vision of patients. However, VEGF is a survival factor of vascular endothelial cells, whether it can lead to the progress of retinal ischemia and it has an effect on retinal capillaries deserves our clinical attention. Most scholars currently think that the anti-VEGF agents will not aggravate the occlusion of retinal capillaries in the treatment of macular edema secondary to RVO from the aspects of the changes of perifoveal capillary arcade, the quantification of foveal avascular zone area, retinal nonperfusion area and retinal vascular density of the superficial and deep capillary plexus In addition, the changes of these indicators may be related to the number of times patients need treatment, visual prognosis and so on. In the future, with the gradual popularization of OCT angiography and the prolongation of the number and time of anti VEGF drug treatment, we look forward to the study of larger samples and longer follow-up time to further analyze the influence of the retinal capillary after anti-VEGF therapy in patients with macular edema associated with RVO.
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.
ObjectiveTo observe the short-term efficacy of sub-Tenon’s triamcinolone acetonide (TA) in the treatment of cystoid macular edema (CME) after cataract surgery.MethodsA retrospective study. From October 1, 2013 to October 1, 2018, 21 patients (21 eyes) with CME after cataract surgery diagnosed at The Affiliated Eye Hospital of Wenzhou Medical University were included in this study. All eyes underwent BCVA, intraocular pressure, frequency domain OCT examination. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity when recorded. A frequency domain OCT instrument was used to measure the foveal retinal thickness (CRT). Among 21 eyes of 21 patients, 9 eyes were male and 12 eyes were female; the average age was 66.38±10.88 years. The average logMAR BCVA was 0.46±0.23; the average CRT was 519.90±131.59 μm; the average intraocular pressure was 11.01±3.97 mmHg (1 mmHg=0.133 kPa). All eyes underwent a single treatment of 100 mg/ml TA suspension 0.4 ml (containing TA 40 mg) under Tenon's capsule. The average follow-up time after treatment was 32.86±20.2 days. The changes of BCVA, CRT and intraocular pressure were observed 1 month after treatment. The BCVA, CRT and intraocular pressure before and after treatment were compared by paired t test.ResultsOne month after treatment, the average logMAR BCVA, CRT, and intraocular pressure of the CME eyes were 0.29±0.22, 307.71±35.82 μm and 14.19±6.30 mmHg, respectively. Compared with those before treatment, the differences were statistically significant (t=5.252, 8.166, 4.128; P=0.000, 0.000, 0.001). Among 21 eyes, 13 eyes (61.90%) of the retinal cysts in the macular area completely disappeared; 8 eyes (38.1%) were still visible between the retinal layers. Three eyes with intraocular pressure over than 21 mmHg were treated with lowering intraocular pressure and returned to normal.ConclusionSub-Tenon’s capsular injection of TA to treat CME after cataract surgery can reduce CRT and improve vision in a short time.
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.
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 observe the effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema (DME).MethodsA prospective randomized controlled clinical study. From June 2016 to June 2017, 68 eyes of 68 patients with DME diagnosed in Central Theater Command General Hospital were enrolled in the study. The patients were randomly assigned to two different treatment groups: 36 eyes (36 patients) in the conbercept combined with 577 nm subthreshold micropulse lase group (combined treatment group) and 32 eyes (32 patients) in conbercept group (drug treatment group). All patients received three initial intravitreous injection of conbercept and re-treatment was performed according to the criteria which has been disigned before. BCVA was measured by ETDRS charts. The central macular thickness (CMT), total macular volume (TMV) were measured by Topcon 3D-OCT 2000. The BCVA, CMT and TMV in the combined treatment group and the drug treatment group were 57.9±12.4 letters, 427.8±129.4 μm, 10.14±1.50 mm3 and 59.0±16.0 letters, 441.0 ±135.7 μm, 10.43±2.10 mm3, respectively. There was no significant difference (t=0.321, 0.410, 0.641; P=0.749, 0.683, 0.524). The follow-up period was more than 12 months. The changes of BCVA, CMT and TMV were compared between the two groups. Comparison of BCVA, CMT, TMV before and after treatment in and between groups using repeated measures analysis of variance.ResultsThe average annual injection times was 5.8±1.9 in the combined treatment group and 8.5±2.4 in the drug treatment group. The difference was statistically significant (t=5.12, P=0.000). The BCVA in the 3rd, 6th, 9th and 12th month were 64.9±11.1, 65.6±10.5, 67.0±10.8, 66.6±10.7 letters and 65.7±15.8, 66.9±15.7, 66.4±13.0, 67.3±16.4 letters, respectively, and there were significant differences compared with BCVA before treatment (F=34.234, 10.137; P=0.000, 0.000). The CMT were 335.2±105.9, 352.6±106.6, 336.2±120.8, 305.9±97.0 μm and 323.9±92.8, 325.5±90.2, 327.6±108.2, 312.2±106.8 μm, respectively. The TMV were 9.20±1.08, 9.26±1.20, 9.20±1.63, 9.05±1.18 mm3 and 9.19±1.21, 9.35±1.69, 9.09±1.20, 8.92±1.10 mm3, respectively. Compared with the CMT (F=12.152, 12.917; P=0.000, 0.000) and TMV (F=11.198, 11.008; P=0.000, 0.000) before treatment, the differences were statistically significant.ConclusionConbercept combined with 577 nm subthreshold micropulse laser and conbercept can effectively reduce CMT, TMV and improve BCVA in patients with DME, but combination therapy can reduce the injection times of conbercept.