Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation（MLGP）to treat macular edema.Methods Consecutive 89 patients （109 eyes）diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving-0.8 (0.19plusmn;0.13)；the intraocular pressure（IOP）ranged from 7 mm Hg to 21 mm Hg（1 mm Hg=0.133 kPa）and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations，the central macular thickness was （570plusmn;182）mu;m；the average light sensitivity was （5.07plusmn;3.94） dB and the fixation percentage was 70.67% within 4 deg;area around the macular fovea. All the patients received IVTA treatment，39 patients（48 eyes）further received MLGP 1 month later (IVTAMLGP group). The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group. Best corrected visual acuity (BCVA),IOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months，the BCVA in IVTAMLGP and IVTA group was （0.41plusmn;0.20）、（0.24plusmn;0.19）respectively (P＜0.05)；the central macular thickness was （309plusmn;187） and （487plusmn;206） mu;m respectively（P＜0.05）；the mean light sensitivity of 4deg; central macular was （8.24plusmn;4.64）and（6.30plusmn;3.22）dB respectively（P＜0.05）；the fixation percentage was（87.01plusmn;19.70）% and（78.85plusmn;20.41）% respectively （P＜0.05）. During the followup recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTAMLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema.
ObjectiveTo evaluate the mid-term clinical and radiological results of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease in Chinese population.MethodsBetween April 2010 and June 2011, 25 patients with single-segmental degenerative cervical disc disease underwent DCI replacement. Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) and 36-Item Short Form Health Survey Questionnaires (SF-36) were used for evaluation of neurological function and pain severity, before and after operation, and during follow-up period. Radiographic evaluation included range of motion (ROM) of C2–7, surgical segments and adjacent level, intervertebral height of the surgical segments, migration, subsidence of the implant and heterotopic ossification (HO).ResultsThe mean follow-up period was 72.3 months (ranged from 68 to 78 months). The VAS, JOA, NDI, and SF-36 mental and physical component summaries improved significantly after surgery (P<0.05) and remained stable over the whole observation period. The ROM (flexion/extension) and intervertebral height at the level treated with DCI remained at the first 2 years and partly reduced at the final follow-up. ROM for C2–7 and adjacent levels maintained during the follow-up period. DCI subsidence was observed in 11 segements, and 9 segements appeared heterotopic ossification.ConclusionsClinical efficacy of DCI arthroplasty improves and maintaines during the mid-to-long period of follow-up. HO formation is a common phenomenon, leading a dramatic decrease of ROM at index level and recurrence of neurological symptoms. Rate of implant subsidence and migration is relatively high, leaving a potential risk of symptom at index level and adjacent segment degeneration. It suggests that for patients with degenerative cervical disc disease, total disc replacement or anterior cervical discectomy and fusion is still the first choice instead of DCI arthroplasty.
Objective To compare the efficacy of 23G and 20G vitrectomy for diabetic retinopathy. Methods Thirty-eight eyes of 33 patients with diabetic retinopathy who underwent primary vitrectomy were enrolled in this study. Twenty eyes of 18 patients underwent 23G microincision vitrectomy (23G group). Eighteen eyes of 15 patients underwent 20G vitrectomy (20G group). The followup ranged from 6 to 12 months. The surgical time, number of iatrogenic retinal tears, times of coagulation for hemorrhage, instrumental change for fibromembrane removal, intraocular pressure (IOP) at 1st, 2nd and 3rd days after surgery, postoperative complications, anatomic success rate, and best corrected visual acuity (BCVA) were observed. Results The mean surgical times were (63.5±21.7) and (83.9±27.5) minutes in 23G and 20G group which was a significant difference (t=2.55, P=0.02). The numbers of iatrogenic retinal tears were six and 14, while the mean times of coagulation were 71 and 104 in 23G and 20G group respectively. There were three and 12 eyes needing instrumental change for fibromembrane removal in 23G and 20G group with significant difference (χ2=10.58, P=0.001). At the 1st, 2nd and 3rd days after surgery, IOP were (10.2±2.0), (13.4±2.5), and (14.9±2.3) mm Hg (1 mm Hg=0.133 kPa) in 23G group, (16.5±2.9), (19.3±2.4), and (20.1±2.9) mm Hg in 20G group. Compared with each other, the differences were statistically significant (t=7.71, 7.41, 6.18; P＜0.01). There was one eye with intraocular hemorrhage, one eye with neovascular glaucoma (NVG), and one eye with retinal detachment (RD) in 23G group. There were two eyes with intraocular hemorrhage, two eyes with NVG, and one eye with RD in 20G group. Compared with each other, the differences were not statistically significant (χ2=0.49, 0.49, 0.01; P＞0.05). The anatomic success rates were 950% and 94.4% in 23G and 20G group without significant difference (χ2=0.01, P=0.94). There were no complications such as endophthalmitis or choroidal detachment. In 23G group, BCVA was ＜0.05 in one eye, 0.05 – 0.09 in five eyes, 0.1 -0.2 in 10 eyes, ≥0.3 in two eyes. In 20G group, BCVA was ＜0.05 in one eye, 0.05 - 0.09 in nine eyes, 0.1 -0.2 in six eyes, ≥0.3 in two eyes. Compared with each other, the differences were not statistically significant (χ2=2.70, P＞0.05). Conclusion 23G microincision vitrectomy is beneficial to shorten the operation time, reduce instrumental changes, decrease intraoperative complications, and enhance visual rehabilitation.
Objective To observe the therapeutic effects of transpupillary thermal therapy (TTT) on exudative agerelated macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV).Methods The clinical data of 44 eyes of 41 patients with exudative AMD diagnosed by fundus fluorescein angiography (FFA) who had undergone 810 nmdiode laser were retrospectively analyzed. In the 44 eyes of 41 patients, there were 26 eyes of 24 patients had occult CNV,12 eyes of 12 patients had classic CNV,and 5 eyes of 5 patients had small classic CNV. According to the focus sizes, the diameters of beam spot was 1.2-3.0 mm,the power of laser was 160-400 mW,and the duration was 60 s.The frequency of photocoagulation was once to thrice with the mean of 1.48.The followup duration was 3-24 months with the mean of 10.8 months.Visual acuity, haemorrhage in ocular fundus,absorption of exudation, and the closure of CNV were examined in the followup examination.Results A total of 42 eyes of 40 patients were examined at the last time in the followup duration,in which the visual acuity kept still or improved in 35 eyes of 33 patients (83.34%) and reduced in 7 eyes of 7 patients (16.67%). The results of OCT revealed that 1 and 3 months after the treatment and at the last time of followup duration, the decrease rate of exudative liquid at the macular area was 79.5%,86.4%,and 88.1%, respectively. Three months after the treatment,the macular volume decreased significantly than that before the treatment (P=0.01).The results of FFA demonstrated that at the last time in the folowup duration,the closure rate of occult CNV,classic CNV,and small classic CNV was 79.16%,46.15%,and 60%,respectively.The exudates increased in 6 eyes of 5 paitnets,including 5 eyes of 4 patients with classic CNV and 1 eye of 1 patient with small classic CNV.Conclusion TTT is effective for AMD accompanied with occult CNV,classic CNV, and small classic CNV.
ObjectiveTo evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Methods35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT. Best-corrected visual acuity(BCVA), central macular thickness (CMT) were measured before and after treatment (1, 3 and 6 months). The mean BCVA was 0.28±0.22, mean CMT was(384.5±85.0)μm. The situation of subretinal fluids (SRF) absorption was observed. ResultsIn 35 eyes, SRF of 29 eyes (82.9%) completely absorbed and 6 eyes (17.1%) not completely absorbed after one month of treatment. SRF of all eyes (100.0%) completely absorbed after three months of treatment. After 6 months of treatment, SRF of 3 eyes (8.6%) were recurrence, which might be completely absorbed when a half-dose maintenance therapy PDT was used again. The mean BCVA significantly improved to 0.14±0.13 at 1 months, 0.05±0.11 at 3 months and 0.05±0.12 at 6 months after PDT (t=5.410, 7.830, 7.758; P < 0.05). The mean CMT decreased to (224.3±61.4) μm at 1 months, (199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856, 11.781, 11.900; P < 0.05). The mean CMT of controlled 32 eyes after treatment was (198.5±33.9) μm, much lower than the fellow eyes(232.3±17.5) μm (t=-3.988, P < 0.05). ConclusionsHalf-dose verteporfin PDT was safe and effective in treating chronic CSC, but may cause thinning of CMT.
Objective To evaluate the visual function before and after photodynamic therapy(PDT) in patients with subfoveal choroidal neovascularization ( CNV) caused by age-related macular degeneration (AMD). Methods Twenty-five consecutive patients (34 eyes) treated with PDT (verteporfin) for subfoveal CNV in age-related macular degeneration diagnosed by fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Visual function including best corrected visual acuity, contrast sensitivity frequency, binocular function, confusion, stereo-vision, color vision, metamorphopsis and central scotoma were examed before photodynamic therapy and 1 week, 1 month, 3 month after photodynamic therapy. The follow-up time varied from 3 months to 2 years (mean 7.6 months). Results The changes of visual function at the 3rd month after photodynamic therapy revealed improving in 13 eyes (38.24%), without any change in 17 eyes (50.00%), and decreasing in 6 eyes (17.65%). Visual acuity with logMRA improved after photodynamic therapy, but without statistic difference. All spatial contrast sensitivity improved. Contrast sensitivity for spatial frequencies 5 cycles per degree (cpd) was better after photodynamic therapy with significant difference (P=0.045).Binocular function, fusion function, stereo function and color vision were slightly improved without statistic difference. Conclusion Damage of visual function in macular degeneration is many-sided. The treatment of PDT for exudative AMD can improve part visual function. (Chin J Ocul Fundus Dis，2004，20：289-291)
Objective To systematically review the treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients, and to provide evidence for treatment. Methods Databases including PubMed, Web of Science, ScienceDirect, CNKI, WanFang Data and VIP were electronically searched to collect literature related to MDR-TB from inception to April 28th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using R 4.0.5 software, subgroup and meta-regression analyses were performed based on sample size, survey time, etc. Results A total of 36 studies involving 7 981 patients were included. The results of meta-analysis showed that the overall treatment success rate of MDR-TB patients was 60% (95%CI 56% to 63%). The subgroup analysis showed that the treatment success rates of MDR-TB were 49% (95%CI 41% to 58%) from 1992 to 2010, 62% (95%CI 58% to 65%) from 2011 to 2015, and 62% (95%CI 55% to 68%) from 2016 to 2020; those with sample size above 100 and less than 100 were 60% (95%CI 55% to 65%) and 59% (95%CI 54% to 63%), respectively; those with average age above 45 and less than 45 were 58% (95%CI 51% to 65%) and 56% (95%CI 53% to 59%); those of MDR-TB were 63% (95%CI 57% to 68%) in central China, 63% (95%CI 52% to 73%) in the Northwest, 60% (95%CI 55% to 65%) in the Southeast, and 53% (95%CI 48% to 58%) in the Northeast. Conclusions The overall success rate of treatment for MDR-TB patients in China is low. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.