Objective To evaluate the effectiveness of repeated intravitreal conbercept injection in patients with macular edema (ME) of retinal vein occlusion (RVO), guided by optic coherence tomography (OCT). Methods It is a retrospective case study. Forty patients (40 eyes) diagnosed as ME secondary to RVO were enrolled in this study. There were 19 males (19 eyes) and 21 females (21 eyes), with the mean age of (53.58±13.19) years and the mean course of 1.5 months. The best corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus fluorescein angiography (FFA) and OCT were performed. The mean baseline of BCVA, central macular thickness (CMT) were 0.25±0.18 and (509.48±170.13) μm respectively. All the patients were treated with 10.00 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg). Follow-up of these patients was 1 to 6 months after treatments, the BCVA, fundus manifestations, OCT were retrospectively observed by every month, the FFA was retrospectively observed by every 3 months. When there was retinal edema or CMT ≥50 μm by OCT during follow-up, those patients were retreated with intravitreal conbercept injection. The changes of the BCVA, CMT were evaluated before and after treatment. Meanwhile, complications in eyes related to medicine and treatment methods were evaluated too. Results At the 6 months, the BCVA was improved (increase≥2 lines) in 25 eyes (62.50%), stabilized (±1 line) in 13 eyes (32.50%) and decreased 2 lines in 2 eyes (5.00%). Retinal hemorrhage and exudates were absorbed in most patients. FFA showed no fluorescein leakage in 11 eyes (27.50%), minor fluorescein leakage in 26 eyes (65.00%), and retinal capillary non-perfusion in 3 eyes (7.50%). OCT showed absorption of the subretinal fluid. The mean CMT were (235.20±100.44) μm at 6 months. Intravitreal injection of conbercept was applied for 4 times in 8 eyes (20.00%), 3 times for 18 eyes (45.00%), and 2 times for 14 eyes (35.00%). The mean number of intravitreal injection was 2.85 times. There were no ocular or systemic adverse events observed in all patients. Conclusion Intravitreal conbercept injection is an efficacy and safe treatment for the patients with ME of RVO guided by OCT. It can stabilize and improve the visual acuity.
Objective To evaluate the therapeutic effect of laser-induced chorioretinal venous anastomosis on macular edema of non-ischemic retinal vein occlusion. Methods Thirty-seven eyes of 37 cases of non-ischemic retinal vein occlusion received the treatment of laserinduced chorioretinal venous anastomosis and were followed up for 6～12 months. All affected eyes underwent the clinical examinations of visual acuity, ocular fundus photography, fundus fluoreceine angoigraphy (FFA) and light sensitivity of central 5 degree of the retina, and the pre- and post-operative clinical materials were analyzed. Results Successful chorioretinal venous anastomosis was formed in 18 eyes (48.6%) within 2 months after laser photocoaglation, with the mean best improved corrected visual acuity of (4.25±0.46) lines, while the mean best corrected visual acuity of the other 19 eyes with unsuccessful anastomosis decreased (0.20±0.54) lines（P＜0.001）. The light sensitivity of central 5 degree of the 18 eyes with successful anastomosis improved（P＜0.001）, with resolution of macular edema in 16 eyes, although cystoid macular edema in 2 eyes remained no change. The light sensitivity of central 5 degree of the 19 eyes with unsuccessful anastomosis have decreased（P＜0.05）, with aggrevation of the macular edema. Conclusion Successful laser-induced chorioretinal anastomosis can resolute the macular edema caused by retinal vein occlusion, especially for diffused macular edema caused by early retinal vein occlusion. (Chin J Ocul Fundus Dis,2002,18:10-12)
Retinal vein occlusion (RVO) is the second visual threatening retinal disorders followed by diabetic retinopathy in the elderly. In the past decades, increasing knowledge of the natural history, aetiology and risk factors, medical management investigation, together with the support of high level evidence-based medical evidence and the results of real-world clinical trials play key roles in guiding the clinical practice. However, without understanding the pathogenesis and pathogeny of the disease, it is difficult to implement a comprehensive, precise and personalized treatment strategy for the RVO patients. It is of significance in the clinic to discuss the pathological process of RVO, analyze the etiological characteristics of the disease, reveal the clinical outcomes, which aim to facility the optimal treatment and follow-up procedure for the patients.
Macular edema is a common cause of visual loss in patients with retinal vascular diseases represented by diabetic retinopathy and retinal vein occlusion. Laser photocoagulation has been the main treatment for this kind of diseases for decades. With the advent of antagonist of vascular endothelial growth factor and dexamethasone implant, diabetic macular edema and macular edema secondary to retinal vein occlusion have been well controlled; the use of laser therapy is decreasing. However, considering possible risks and complications, lack of extended inspection of efficacy and safety of intravitreal pharmacotherapy, laser therapy cannot be replaced by now. Therefore, the efficacy and safety of laser therapy will improve by sober realization of role of photocoagulation and proper selection of treatment indication.
Objective The present study focus on the macular branch retinal vein occlusion (MBRVO) with and without laser treatment,and evaluate prospectively whether laser treatment is useful in improving the visual acuity and reducing the macular edema. At the same time to learn the difference of macular light sensitivity before and after laser treatment.Methods Forty-five eyes of forty-five patients with MBRVO and macular edema were randomized to laser treatment and no laser treatment. Follow up examinations were performed every 3 months. We compared the difference of visual improvement, resolution of macular edema between the two groups. The central 30°visual field of 20 patients with MBRVO were examined at pretreatment and 3 months after laser treatment. A comparison of light sensitivity at fovea ，central 10°and 11~30°eccentricity were done between before and after laser treatment. Results Comparison of visual improvement and resolution of macular edema showed a statistical difference between laser treatment and no laser treatment. The mean reduction of macular light sensitivity at the fovea and 11~30°3 months after the treatment has no statistical difference between before and after treatment (Pgt;0.05). But the mean light sensitivity at central 10°eccentricity were significantly decreased 3 months after photocoagulation (Plt;0.05).Conclusion The laser treatment might promote or accelerate visual acuity recovery and reduce the macular edema. There is no significant difference about the efficiency on macular function after laser treatment.(Chin J Ocul Fundus Dis，2003，19：201-268)
ObjectivesTo evaluate the therapeutic effect of argon laser photocoagulation combined with intravitreous injection of triamcinolone acetonide (TA) on ischemic central retinal vein occlusion (CRVO).MethodsArgon laser photocoagulation combined with intravitreous injection of TA was performed on 17 patients (17 eyes) with CRVO between December 2003 and July 2004.ResultsDuring the follow-up of 4-10 months, the visual acuity improved in 16 patients, including alleviated or even disappeared cystoid macular edema (CME) in 5, and recurred macular edema in 5 with decreased visual acuity after 3 months. Six patients had increased ocular pressure after intra-ocular injection which alleviated after treated suitably. No neovascularization in angle or secondary neovascular glaucoma was found.ConclusionArgon laser photocoagulation combined with intravitreous injection of TA may improve the visual acuity and reduce complications in ischemic CRVO, though macular edema may recur in some cases. (Chin J Ocul Fundus Dis, 2005,21:224-225)
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 study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study. Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female. The average age was (51.25±12.24) years and the course was 5–17 days. All patients were given best corrected visual acuity (BCVA), intraocular pressure, slit lamp with preset lens, fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination. The patients were divided into conbercept and laser group (group Ⅰ), laser group (group Ⅱ) and conbercept group (group Ⅲ), with 30 eyes in each group. The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072, 0.286;P=0.930, 0.752). Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg), and macular grid pattern photocoagulation 3 days later. Group Ⅱ patients were given macular grid pattern photocoagulation. Times of injection between group Ⅰ and Ⅲ, laser energy between group Ⅰ and Ⅱ, changes of BCVA and CMT among 3 groups at 1 week, 1 month, 3 months and 6 months after treatment were compared. Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20±0.41) and (2.23±1.04) times respectively, and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections. The difference of injection times between two groups was significant (P＜0.001). Patients in group Ⅱ had received photocoagulation (1.43±0.63) times, 9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation. The average laser energy was (96.05±2.34) μV in group Ⅰ and (117.41±6.85) μV in group Ⅱ, the difference was statistical significant (P=0.003). BCVA improved in all three groups at last follow-up. However, the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607, –4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=–0.802,P=0.429). The mean CMT reduced in all three groups after treating for 1 week and 1 month, comparing that before treatment (t=–11.855, –10.620, –10.254;P＜0.001). There was no statistical difference of CMT between group Ⅰand Ⅲ at each follow up (t=0.404, 1.723, –1.819, –1.755;P=0.689, 0.096, 0.079, 0.900). CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=–4.621, –3.230;P＜0.001, 0.003). The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month, but the difference was not statistically significant (t=1.995,P=0.056). All patients had no treatment-related complications, such as endophthalmitis, rubeosis iridis and retinal detachment. Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO. Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.
Objective lt;brgt;To inspect the rate of success of anastomosis and tissue damage with different power levels of photocoagulation in the treatment of experimental branch retinal vein occlusion (BRVO) by laser induced chorioretinal venous anastomosis. lt;brgt;Methods lt;brgt;Forty pigmented rabbits (80 eyes) were divided into four groups in random, and 10 (20 eyes) in each. Chroioretinal venous anastomosis was attempted to create using the krypton red laser with 4 different power levels (group A: 400 mW,group B: 600 mW,group C: 800 mW,group D: 1000 mW) in these animals in which BRVO had previously been created photodynamically. Fundus photography and fundus fluorescein angiography were performed at various times after the treatment and histological examination was taken at the end of the study. lt;brgt;Results lt;brgt;The model of BRVO was successfully set up. At the lowest power of 400 mW there was an absence of anastomosis formation and the damage to the retina and choroid was mild, Bruch′s membrane showed no evidence of rupture. At the power levels of 600 mW and 800 mW an anastomosis formed in 15% and 55% respectively and the damage was medium in degree. At the highest power level of 1 000 mW a 80% rate of success was obtained, however, the damage to the retina and choroid tended to be severe.The difference of the rate of success of anastomosis between different groups was highly significant (P=0.001), the difference between group B and group C was also highly significant (PBC=0.008), and the difference between group A and group B, group C and group D was not significant (PAB=0.072、PCD=0.091). lt;brgt; lt;brgt;Conclusion lt;brgt;The optimal power level of krypton red laser induced chorioretinal venous anastomosis is 800 mW, 0.1 s, 50 μm in our study. lt;brgt; lt;brgt;(Chin J Ocul Fundus Dis,2002,18:13-16)
Objective To investigate the efficacy and the safety of external therapy of ultrasound (ETUS) enhancing thrombolysis on the experimental retinal vein occlusion. Methods The effect of ETUS enhanced thrombolysis and the impact of ultrasound energy and exposure were investigated respectively after both eyes of 51 rabbits with retinal branch vein occlusion created by photodynamic initiated thrombosis were divided into 4 groups. The first 2 groups are the ETUS groups, including one group (15 rabbits) underwent intravenous injection with urokinase (UK) (1700-2200 UK dissolved into 20 ml normal saline), and other group (12 rabbits) underwent intravenous injection with normal saline. In these 2 groups, each rabbit received ETUS treatment (1.0 W/cm2, 20 min) in one eye and the fellow eye did not which was as the control. The latter 2 groups are the energy and duration of ultrasound groups, and 12 rabbits in each group underwent ETUS with the energy of 0.7 and 1.0 W/cm2 respectively. Each of the 2 groups was divided into 3 subgroups (8 rabbits in each) according to the radiated durations (8, 14, and 20 minutes). All of the eyes except the control ones underwent ETUS with 1 MHz ultrasound and 100 Hz pulsed ultrasound once a day for 3 days. Fundus fluorescein angiography (FFA) was used to detect the vascular condition 4 days after ETUS, and at the 15th day, retinal light microscopy and electron microscopy were performed. Results The vascular recanalization rate in ETUS+UK treatment group was 66.7%, which is obviously higher than which in single UK group (20.0%, P=0.025), normal saline group (8.3%, P=0.005), and ETUS+ normal saline group (8.3%, P=0.005). The vascular recanalization rates in groups with different energy of ultrasound increased obviously as the radiated durations increased (P=0.006, 0.001), while no apparent effect of energy of ultrasound on the vascular recanalization rate was found in the groups with different radiated duration (Pgt;0.05). The eyes which had undergone ETUS treatment had retinal tissue damage and ultrastructure changes of the retinal ganglion cells (RGC), and deteriorated as the radiated duration increased. Conclusion ETUS may enhance the thrombolysis induced by urokinase in experimental retinal vein occlusion. Simultaneously, ETUS can lead to the damage of retinal tissue and changes of the ultrastructure of RGC. (Chin J Ocul Fundus Dis, 2007, 23: 166-169)