Anatomical and functional changes after dexamethasone implant and ranibizumab in diabetic macular edema: a retrospective cohort study

AIM: To investigate the efficacy and safety of ranibizumab (RZB group) and dexamethasone implant (DEX group) intravitreal treatments in patients with treatment-naïve center involved diabetic macular edema (DME) by means of functional and morphological assessments. METHODS: This retrospective cohort study included 50 eyes of 50 patients with DME treated either with RBZ or DEX. Best-corrected visual acuity (BCVA) and microperimetry were evaluated at baseline and during a 6-month follow-up. In addition, central macular thickness (CMT) by means of structural optical coherence tomography (OCT) and retinal capillary plexus density and choriocapillary density by means of OCT angiography were assessed in all cases. RESULTS: Functional and morphological parameters significantly improved during the study period in both groups. BCVA improved significantly in both groups with a greater increase in the DEX group compared to the RBZ group (P=0.030). Microperimetry significantly differed during follow-up between the two treatments (P=0.031). In both groups CMT significantly decreased (P<0.001) without statistically significant differences between the two groups. A statistically significant increase of deep capillary plexus density was detected in both groups at 30d after therapy. The retreatment rate was 0.70±0.10 and 0.65±0.10 in the RBZ group and 0.65±0.10 and 0.50±0.11 in DEX group at 120 and 180d respectively. Two out of 25 patients in DEX group showed intraocular pressure increase requiring hypotonic eye drops. CONCLUSION: Both treatments are very effective for DME treatment during 6mo of follow-up with a lower retreatment rate in DEX group.     

Intravitreal Bevacizumab and Ranibizumab in the Treatment of Acute Central Serous Chorioretihopathy: A Single Center Retrospective Study

Objectives: To evaluate and compare the anatomical and functional outcomes of patients with acute central serous chorioretinopathy (CSC) who did not receive any intervention or treatment with intravitreal bevacizumab or ranibizumab. Methods: A single-center retrospective comparative study. Seventy eyes of 70 patients were recruited for the study; 27 patients were only observed without any medication or intervention (observation group), 23 were treated with intravitreal bevacizumab (IVB group), and the remaining 20 were treated with intavitreal ranibizumab (IVR group). The best-corrected visual acuity (BCVA) and central macular thickness (CMT) obtained by spectral-domain optical coherence tomography were compared between the groups. Results: There were no significant differences between the groups with regard to age, sex, and follow-up periods (p>0.05). The mean time from baseline to initial complete resolution of subretinal fluid was 3.52±1.64 months in the observation group, 1.19±0.60 months in the IVB group, and 1.11±0.47 months in the IVR group; the resolution time was significantly longer in the observation group (p<0.001). While the CMT was significantly thicker in the observation group when compared to the IVB and IVR groups in the first month (p=0.001), it was similar between the groups in the third, sixth, and twelfth months (p>0.05). Additionally, pairwise comparisons of the IVB and IVR groups revealed that there were no significant differences between these groups regarding CMT at any follow-up time (p>0.05). Conclusions: Compared with observation alone, neither IVB nor IVR had a positive effect in terms of anatomical and functional outcomes for acute CSC. Although the resolution time of SRF is shorter by using ranibizumab, both the ranibizumab and bevacizumab could be effective in achieving rapid resolution of serous detachment in patients with acute CSC.     

Vascular endothelial growth factor and its inhibitor in age-related macular degeneration

Intraocular angiogenesis is considered the leading cause for severe loss of vision, and contributes to many ocular diseases such as neovascular age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity, the main causes of blindness in developed countries.¹ An enormous body of work has demonstrated that vascular endothelial growth factor (VEGF) plays a prominent role as mediator in the procedure of pathological angiogenesis. This makes VEGF a potential target for the medical therapies of retinal angiogenesis and some clinical trials have proved the efficacy of anti-VEGF strategies. This review evaluates the role of VEGF in the pathogenesis of age-related macular degeneration and provides an overview of recent developments in therapeutic modalities.     

Complications of dexamethasone implants: risk factors, prevention, and clinical management

AIM: To analyze the crosslinking (CXL) effects in pediatric keratoconus, and to identify the patients’ corneal characteristics whose pachymetry could not be adequately evaluated by Scheimpflug method after procedure. METHODS: Consecutive pediatric patients with progressive keratoconus underwent CXL were included. Best-corrected visual acuity (BCVA) and spheric equivalent (SE) were measured before and after CXL. After CXL, groups 1 and 2 were divided based on the posterior surface Pentacam quality specifications (QS): “OK” (Group 1) and “not OK” (Group 2). The mean (RmF and RmB) and minimum (RminF and RminB) radius of curvatures of the anterior and posterior corneal surfaces, and the thinnest pachymetry (Pmin) were measured preoperatively at 3, 6, 12, 24, and 36 mo. Haze was annotated. RESULTS: Twenty-six patients (14 men, mean age 14±1.8y) and median Kmax of 59.9 D initially and 61.4 D preoperatively were treated. BCVA and SE were not different before and 24mo after CXL. RmF and RmB were steeper and Pmin was thinner pre-surgically. Group 2, in which pachymetric changes could not be adequately evaluated after surgery, presented with significant RmF flattening, a shift to hyperopia, and more haze after CXL. CONCLUSION: Patients whose pachymetry could not be adequately evaluated after CXL had steeper and thinner corneas before surgery. The predictive factors for impaired QS after CXL are RmF, RmB, and Pmin. In advanced keratoconus, alternative methods to analyze pachymetry and the posterior surface should be considered.     

Treatment of pigment epithelial detachments due to age-related macular degeneration with intra-ocular C3F8 injection*

Purpose: To flatten pigment epithelial detachments (PED) cue to age-related macular degeneration in an attempt to visualize the underlying choroidal neovascularization by fluorescein angiography (FA) and reveal a treatment target. Methods: Nine patients with PED received intravitreal gas injections via the pars plana and postured face down. Fluorescein angiograms were obtained before and after gas injection. In two patients, retinal scotopic sensitivity was also measured. Results: Eight patients demonstrated change in the shape and size of the PED following gas injection. Four patients showed a better delineation of underlying structures on FA. Three patients had focal laser treatment to the newly visible choroidal neovascular complex, but this was successful in only one patient with flattening of the PED. Conclusion: Pigment epithelial detachments can be modified by intravitreal gas injection in some patients, but this treatment did not have a major impact on overall outcome or management.     

抗血管内皮生长因子药物在新生血管性青光眼治疗中的应用

新生血管性青光眼( neovascular glaucoma,NVG)是一种难治性青光眼,其病因主要由各类眼病造成视网膜缺血缺氧,导致VEGF生成增多有关。近年来,抗VEGF药作为NVG治疗方法之一,已成为当前研究热点,为NVG治疗开辟了新道路。随着抗 VEGF 药物在眼科的广泛应用, NVG的治疗已进入了新的领域。本文结合目前国内外抗VFGF药物在NVG治疗中的应用加以综述,旨在为NVG的临床治疗方案提供参考。     

酒精中毒致视网膜色素上皮损伤观察

目的 观察急慢笥酒精中毒后视网膜色素上皮损伤情况。方法 对９例（１８眼）急慢性酒精中毒患者进行了眼底荧光血管造影（ＦＦＡ）及视觉电生理（ＥＲＧ,ＶＥＰ）检查。结果 ２例（４眼）急性酒精中毒者经药物治疗后视力完全恢复,１例（２眼０ＦＦＡ见双眼底视网膜色素上皮弥漫性损伤。慢性酒精中毒６例１２眼经药物后ＦＦＡ为双眼底视风纱上皮炎改变,ＥＲＧ,ＶＥＰ无好转。结论 急性酒精中毒引起的眼部改变大多时恢复,慢性     

Unilateral Acute Idiopathic Maculopathy

Purpose: To discuss the fluorescein angiographic features and diagnosis as well as differential diagnosis.Methods : In our hospital, we have found three cases of UAIM, one of them has eccentric maculopathy, another has papillitis, and the third associates with pregnancy. Each has characteristic clinical findings. We have made the diagnosis base on ophthalmoscopy and fluorescein angiography (FA).Results: Three patients with UAIM have been experienced sudden unilateral decreased visual acuity. The significant changes on fundus are retinal pigment epithelium (RPE) thickening with neurosensory retinal detachment with in the macular area. FA showed early patchy hypofluorescence and hyperfluorescence at the level of the RPE.' Bull' s eye appearance may occur in the macular area after the acute stage of the disease. The clinical findings are similar to what the foreign report described. But there were no previous reports in China. Conclusion : We can establish the diagnosis on the base of clinical and fundus f     

Descending doses of intravitreal bevacizumab for the regression of diabetic neovascularization

Purpose: To report short‐term regression of neovascularization after varying intravitreal doses of bevacizumab (Avastin^®; Genentech, San Francisco, California, USA) in patients with proliferative diabetic retinopathy (PDR). Methods: Eighty eyes from 76 patients with active neovascularization of the disc (NVD) or elsewhere (NVE) caused by PDR were divided into four groups and treated with a single intravitreal bevacizumab (IVB) injection of 1.25 mg, 600 μg, 300 μg or 150 μg, respectively. All patients underwent ophthalmoscopic examination and fluorescein angiography at baseline, 1 week, 1 month and 2 months later. Results: No significant ocular or systemic adverse events were observed. In all patients with NVD or NVE, complete resolution of leakage was recorded within the first week or the first month of the injection. Even with the lowest dose (150 μg), regression of neovascularization appeared as early as the first week and lasted for over a month. Recurrence of fluorescein leakage was observed in all groups after the first month and did not correlate with the extent of neovascularization or IVB dose. Conclusion: Short‐term results suggest that IVB given below the standard dosage (150–300 μg compared to 1.25 mg) can lead to the achievement of complete regression of diabetic retinal neovascularization within 30–45 days of injection.     

大泡状视网膜脱离误诊及分析

探讨减少大泡状视网膜脱离误诊的方法。方法通过对６６例１０眼误诊病例,从误诊原因,病因,疾病特点,特别是眼底荧光血管造影表现等方面进行讨论,并与类似疾病比较。结果大泡状视网膜脱离有其特殊的临床表现和ＦＦＡ表现。结论ＦＦＡ是诊断大泡状视网膜脱离及鉴别其它眼病的必要手段。     

Prepapillary Vascular Loops

Twenty-one eyes in eighteen patients with prepapillary vascular loops were studied. Fluorescein angiography demonstrated 20 of the loops to be arterial and one to be venous. The wide range of clinical and angiographic variations of prepapillary loops are described. Cilioretinal arteries were seen in 16 of 21 eyes with loops and occasionally provided a major portion of the blood supply to the retina. In addition to the previously described complications of vitreous hemorrhage and branch retinal artery obstruction in eyes with a prepapillary arterial loop, hyphema and amaurosis fugax were notable new associations.     

Peripapillary and macular vascular densities in healthy, ocular hypertensive, and different stages of glaucomatous eyes

AIM: To investigate vascular changes in different stages of glaucoma and to evaluate the role of optical coherence tomography angiography (OCTA) in the early diagnosis of glaucoma. METHODS: Glaucoma patients and healthy controls (n=29 eyes) were investigated in this cross-sectional comparative study. Glaucoma patients were grouped as ocular hypertension (n=44 eyes), preperimetric glaucoma (PPG; n=32 eyes), early glaucoma (EG; n=35 eyes), moderate stage glaucoma (MG; n=36 eyes), and advanced glaucoma (AG; n=35 eyes). Peripapillary and macular vascular densities (VDs) of all participants were compared and correlations of VDs and retinal nerve fiber layer thickness (RNFLT), ganglion cell analysis (GCA), and visual field (VF) tests were evaluated. Area under the receiver operation characteristic curves (AUC) of the peripapillary and macular VD parameters were obtained. RESULTS: VD values ​​decreased with the progression of glaucoma. Most peripapillary and macular VD parameters of PPG and EG groups were lower than healthy controls (P<0.001). There was no significant difference in RNFLT between the PPG and EG groups, but most peripapillary and macular VDs were found to be lower in EG group than in PPG group (P<0.05). In most disease group, VDs were significantly correlated with OCT parameters (P<0.001) and VF index (P<0.05). There were no significant correlations between VF and RNFLT indices in the AG group, but significant correlations were found between VF and VD values (P<0.05). AUC for discriminating between healthy and glaucomatous eyes were highest in whole image peripapillary VD (AUC: 0.865, 0.929, and 0.986, respectively in EG, MG, and AG groups). CONCLUSION: OCTA can be used in the early diagnosis of glaucoma and can be useful in follow-up of the advanced disease. In cases where limitations or suspicions in structural and functional tests are present, OCTA can be used as a supportive diagnostic test, both in EG and AG.     

Role of daunorubicin in inhibiting proliferative vitreoretinopathy after retinal detachment surgery

Purpose : To study the role of daunorubicin in inhibiting pro­liferative vitreoretinopathy after retinal detachment surgery. Method: Thirty eyes of 30 patients with a primary rhegmato­genous retinal detachment and proliferative vitreoretin­opathy of stage D1 or more advanced were included in the study. The eyes were randomly assigned to either the experimental or the control group. The eyes in the experimental group received an intravitreal injection of dauno­rubicin (5 µg) before conclusion of the vitrectomy. The main outcome measures evaluated were: retinal attachment, vitreous activity and visual acuity at 3 months after surgery. Results: Complete retinal attachment was achieved in 13 eyes (86.6%) in the daunorubicin group and 10 eyes (66.6%) in the control group, at 3 months. Nine patients (60%) in the daunorubicin group and five patients (33.3%) in the control group had a best‐corrected visual acuity of ≥3/60 at 3 months of follow up. There was a statistically significant reduction in vitreous reaction at all times during the postoperative period in the daunorubicin group. Conclusion: Daunorubicin may be a useful drug in inhibiting proliferative vitreoretinopathy after surgery for primary rhegmatogenous retinal detachment.     

MPPE的荧光素和吲哚青绿眼底血管造影的临床特征及意义

目的:观察多发性后极部色素上皮病变(multifocalposterior pigment epitheliopathy,MPPE)的荧光素眼底血管造影(fundus fluorescein angiography,FFA)和吲哚青绿眼底血管造影(indocyanine green angiography,ICGA)特征及其临床意义。方法:回顾性分析2007-01/2009-04期间在我院就诊的35例51眼MPPE患者的临床资料。所有患者都接受了常规视力、裂隙灯、直/间接眼底镜检查,同时行眼底彩色照相和德国海德堡共焦激光视网膜仪(HRA-2)的同步FFA和ICGA检查。结果:多灶性视网膜色素上皮(RPE)渗漏和脉络膜血管循环障碍(包括脉络膜血管充盈延迟以及脉络膜血管的扩张渗漏)是活动期MPPE患者在FFA和ICGA检查中的主要特征性改变。由于长期大量的RPE渗漏,部分患者会继发渗出性视网膜脱离,其中小部分在FFA检查中还有视网膜小血管普遍渗漏、视网膜无灌注区及新生血管形成、晚期视盘强荧光着色等慢性葡萄膜炎的改变。静止期MPPE患者在FFA和ICGA中的荧光改变则主要为RPE和脉络膜毛细血管的萎缩,而脉络膜血管充盈迟缓和血管扩张等循环异常变化基本消失。结论:MPPE有类似CSC的FFA和ICGA改变,但程度更重;其中部分患者还可伴有类似慢性葡萄膜炎的改变。MPPE的ICGA后期像中的暗黑色低红外荧光灶有助于我们判断患者病情的预后。     

OCTA评价康柏西普治疗湿性年龄相关性黄斑变性的疗效

目的：以光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)评价玻璃体腔注射康柏西普治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)的临床疗效。

方法：收集芜湖市眼科医院2016-12/2017-11收治的18例20眼确诊为wAMD的患者,给予玻璃体腔注射康柏西普注射治疗,随访记录治疗1mo后最佳矫正视力(best corrected visual acuity,BCVA),OCTA检查视网膜黄斑中心凹厚度(foveal macular thickness,FMT)、黄斑中心凹旁厚度(parafoveal macular thickness,PMT)、脉络膜新生血管(choroidal neovascularization,CNV)面积,以及中心凹和中心凹旁浅层血管密度。比较治疗前后各指标的变化。

结果：患者18例20眼经玻璃体腔注射康柏西普治疗1mo后,平均BCVA较术前提高,差异有统计学意义(P<0.05),平均FMT、PMT、CNV面积及中心凹浅层血流密度与治疗前相比明显下降,差异有统计学意义(P<0.05),中心凹旁浅层血流密度较术前减少,但差异无统计学意义(P>0.05)。

结论：玻璃体腔注射康柏西普治疗wAMD是安全有效的,同时发现玻璃体腔注射康柏西普能改变视网膜脉络膜自身血管结构。OCTA用于评价康柏西普治疗wAMD的临床疗效更安全,更客观。     

曲安奈德溶媒视网膜毒性的形态学研究

目的探讨两种商用曲安奈德(TA)溶媒的视网膜毒性及其与剂量的关系。方法用梯度离心法从两种TA注射液提取高纯度溶媒A、溶媒B。36只新西兰白兔右眼玻璃体内分别注入0.1mL和0.2mL溶媒A、溶媒B及平衡盐溶液。术前、术后定时行眼前节、检眼镜检查及眼底照相;荧光素眼底血管造影(FFA)观察血管病变;光镜、透射电镜观察视网膜结构。结果眼底和FFA检查显示溶媒B引起视网膜血管损害和有髓神经纤维水肿。两种溶媒均引起视网膜结构及光感受器超微结构损害,且随剂量增加而加重;溶媒B引起的损害较溶媒A更显著。结论两种溶媒可引起无色素兔眼不同程度的视网膜损害,并随剂量增加而加重。     

Indocyanine green angiography pattern of congenital grouped albinotic retinal pigment epithelial spots

Congenital grouped albinotic retinal pigment epithelial spots (CGARPES) is a rare retinal pigment epithelium disease with multiple, white spots, generally involving the peripheral retina, with variable angiographic pattern. A 46-year-old male affected by CGARPES underwent fluorescein angiography and indocyanine green videoangiography. Fluorescein angiography demonstrated an early hyperfluorescence of the spots. A peculiar pattern was revealed by indocyanine green videoangiography. Indeed, during the early phases the spots were either not detectable on the choroidal background, or presented slightly hypofluorescent, whereas during the intermediate and the late phases some spots became progressively hyperfluorecent. The angiographic behavior on indocyanine green may be explained considering a gradual staining of the lesions, with a progressive binding between the indocyanine green molecule and the abnormal retinal pigment epithelium material.     

Cyclosporine玻璃体腔内注射对异种视网膜色素上皮移植的排异抑制作用

目的 观察兔眼视网膜下腔植入人胚眼视网膜色素上皮（retinal pigment epithe-lium,RPE）后不同时期的眼底和组织学改变。研究环胞菌素A（Cyclosporines,CsA）玻璃体腔内注射能否抑制人胚眼RPE在兔眼视网膜下腔中诱导的异种移植排异反应。方法 人胚眼色素上皮片和浓缩色素上皮细胞悬液植入36只兔眼的视网膜下腔,其中16眼为对照组,用于观察排异的自然转规。分别7d(8眼）和30d(8眼）后获取组织标本。另20眼为实验组。RPE移植后,每周一次玻璃体腔内注射CsA 1mg(12眼）或CsA0.1mg(8眼）。视网膜和视神经的毒性反应使用ERG进行检查。结果 人胚眼RPE片和浓缩的RPE细胞均能在视网膜下腔短期存活。移植的RPE与视细胞结合良好并显示吞噬功能。排异反应发生时间约在术后10～30d。对照组中7d的排异发生率为0/8;30d排异发生率为7/8。排异发生后荧光造影中移植区为高荧光区,组织切片中显示有大量的组织细胞积聚。CsA1mg组30d排异发生率为0/12,0.1mg组为5/8。ERG波幅的下降与CsA剂量和注射次数呈正相关。结论 异种RPE视网膜下腔移植在无免疫抑制剂的条件下,只能短期存活。CsA玻璃体腔中注射能抑制异种RPE移植的排异反应但易引起明显的视网膜毒性反应。     

反义RNA抑制人视网膜色素上皮细胞VEGF分泌的研究

目的　探索应用血管内皮生长因子 (VEGF12 1)的反义RNA抑制人视网膜色素上皮细胞 (RPE)VEGF表达的可行性。方法　构建编码反义hVEGF12 1真核表达质粒 ,转入人RPE细胞。将稳定表达外源基因的细胞分别置于大气氧环境 ( 2 1%O2 )或缺氧环境 ( 1%O2 )中培养 ,以空白细胞为对照 ,18h后收集上清液 ,ELISA测定其中VEGF的浓度 ,将此上清液加入人脐静脉血管内皮细胞 (HUVEC) ,观察其对细胞生长的影响。结果　反义VEGF转染能使RPE细胞VEGF的分泌量降低 62 7%。缺氧条件下 ,RPE细胞大量分泌VEGF ,18h时细胞培养上清液能刺激HUVEC细胞增殖 18 4% (P <0 0 1)。同样状态下 ,转染反义VEGF的RPE细胞培养上清液则无明显促内皮细胞生长作用 (P >0 0 1)。结论　本实验构建的反义VEGF12 1质粒能通过下调RPE细胞VEGF的蛋白分泌水平 ,有效抑制缺氧情况下该细胞上清液对血管内皮细胞的生长刺激作用