Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors

AIM: To document the indications, safety and possible complications of bilateral same-session intravitreal anti-vascular endothelial growth factor (VEGF) injections performed in the ophthalmic operating room.METHODS:A retrospective case series study. Consecutive records of seventy four patients receiving simultaneous bilateral intravitreal injections of either ranibizumab or bevacizumab, between September 2010 and September 2013, were reviewed and the outcomes were assessed. Data collected included number of injections, indications for injections, pre-injection and post-injection visual acuity (VA), pre-injection and post-injection intraocular pressure and ocular and systemic complications/complaints after each injection.RESULTS: A total of 342 injections were administered to 74 patients, with a mean of 4.62 injections per patient. Seventy-three patients received bevacizumab (Avastin; Genentech Inc., South San Francisco, California, USA) alone, and only one patient received both bevacizumab and ranibizumab (Lucentis; Genentech Inc.) distributed between the injections. Pre- and post-injection VA follow-up measurements were available for 65 patients. Mean follow up period was 22mo. The indications for initiating therapy were choroidal neovascular membrane from age-related macular degeneration (3 patients) and diabetic macular edema (71 patients). The mean Snellen VA before each injection was 6/22. The next post-injection follow-up mean Snellen VA was 6/20. One patient had a painful, culture-positive endophthalmitis in one eye 3d after bilateral bevacizumab. Another patient had a painless subconjunctival hemorrhage in one eye. No other ocular or systemic adverse side effects/complaints have been registered in this study group.CONCLUSION:Bilateral same-session intravitreal injections using a separate povidone-iodine preparation, speculum, needle, and syringe for each eye are well-tolerated. None of the subjects in this study requested to switch to alternating unilateral injections. Proper patient counseling as to the risk of complications with this procedure is necessary.     

抗血管内皮生长因子治疗对黄斑水肿患者脉络膜厚度的影响

目的 利用相干光断层扫描加强深度扫描模式（enhanced depth imaging-optical coherence tomography,EDI-OCT）评估玻璃体注射抗血管内皮生长因子（vascular endothelial growth factor, VEGF）药物治疗因糖尿病视网膜病变引起的黄斑水肿（diabetic macular edema, DME）和视网膜静脉阻塞继发的黄斑水肿（retinal vein occlusion-macular edema, RVO-ME）后黄斑中心凹下脉络膜厚度（subfoveal choroidal thickness,SFCT）的变化。设计 回顾性病例系列。研究对象 选取 2014年12月至2018年11月在江南大学附属医院眼科接受玻璃体抗VEGF药物注射术的DME者13眼和RVO-ME者15眼。方法 采用EDI-OCT测量术前和术后1、3、6个月的SFCT,评估玻璃体注射抗VEGF药物治疗DME与RVO-ME后SFCT的变化。主要指标 SFCT。结果 DME组术后1、3、6个月的SFCT值分别为（224.85±50.03）μm、（215.62±47.70）μm、（207.54±46.85）μm,均较术前[（244.54±53.62）μm]减小（P=0.0004,0.0002,0.0001）;术后3、6个月的SFCT值较术后1个月减小（P=0.003,0.001）;术后6个月的SFCT值较术后3个月减小（P=0.026）。RVO-ME组术后1、3、6个月的SFCT值分别为（260.67±42.29）μm、（254.33±40.54）μm、（239.73±37.08）μm均较术前[（288.13±49.26）μm]减小（P=0.0003,0.0002,0.0002）;术后3个月的SFCT值较术后1个月减小（P=0.599）;术后6个月的SFCT值较术后1、3个月减小（P=0.0002,0.0003）。结论 玻璃体注射抗VEGF药物治疗DME与RVO-ME后SFCT明显减小,动态监测SFCT值对发现病情变化有一定的参考价值。     

玻璃体腔注射康柏西普治疗不同类型视网膜静脉阻塞伴黄斑水肿的疗效

目的：观察玻璃体腔内注射康柏西普治疗不同类型视网膜静脉阻塞(RVO)伴黄斑水肿的临床疗效。

方法：回顾性研究。纳入79例79眼不同类型视网膜静脉阻塞伴黄斑水肿患者[视网膜分支静脉阻塞(BRVO)54眼,非缺血型视网膜中央静脉阻塞(non-iCRVO)16眼,缺血型视网膜中央静脉阻塞(iCRVO)9眼],采用3+PRN方案治疗,随访6mo,记录基线、治疗后1d,1、2、3、4、5、6mo的最佳矫正视力(BCVA,LogMAR)、黄斑中心凹视网膜厚度(CMT)等变化。

结果：三种不同类型RVO治疗后6mo BCVA均较基线提高(0.22±0.23 vs 0.70±0.32; 0.24±0.19 vs 0.73±0.27; 1.20±0.37 vs 1.92±0.23; 均P<0.05),OCT显示黄斑CMT明显降低(199±27 vs 422±162μm; 195±16 vs 550±158μm; 231±55 vs 583±152μm; 均P<0.05)。三种不同类型RVO在不同就诊时间组内治疗后各时间CMT均较基线下降(P<0.05),不同就诊时间组间CMT均无差异(P>0.05)。BRVO、non-iCRVO患者在不同就诊时间组内治疗后BCVA均较基线改善(P<0.05),iCRVO患者>90d组视力几乎无提升。

结论：玻璃体腔内注射康柏西普可以有效治疗RVO引起的黄斑水肿。对于RVO患者,早期及时的进行抗血管内皮生长因子(VEGF)治疗,有助于其远期视力的提高并维持稳定; 延迟抗VEGF药物治疗可能会降低其视力提升的空间。     

Impact of COVID-19-related lifestyle changes on diabetic macular edema

AIM: To assess diabetic macular edema (DME) progression during the early phases of the COVID-19 pandemic, when severe societal restrictions raised the concern of possible deterioration of health in patients with systemic conditions, particularly those requiring frequent office visits. METHODS: This is a multicenter retrospective chart review of 370 patients (724 eyes) with an established diagnosis of DME seen on 3 separate visits between January 2019 and July 2021. Period 1 was January 2019 to February 2020 (considered pre-COVID-19), period 2 was March 2020 to December 2020 (considered the height of the pandemic; highest level of pandemic-related clinical and societal regulations) and period 3 was January 2021 to July 2021 (re-adjustment to the new “pandemic norms”). Main outcome measures included visual acuity, body mass index (BMI), blood pressure (BP), hemoglobin A1c (HbA1c), macular thickness, patient adherence to scheduled ophthalmology visits, and DME treatment(s) received at each visit. To facilitate measurement of macular thickness, each macula was divided into 9 Early Treatment Diabetic Retinopathy Study (ETDRS)-defined macular sectors as measured by OCT imaging. RESULTS: There was no change of BMI, systolic BP, and diastolic BP between any of the time periods. HbA1c showed a very small increase from period 1 (7.6%) to period 2 (7.8%, P=0.015) and decreased back to 7.6% at period 3 (P=0.12). Macular thickness decreased for 100% of macular regions. The central macular thickness decreased across all 3 periods from 329.5 to 316.6 μm (P=0.0045). After analysis of multiple variables including HbA1c, BMI, adherence to scheduled appointments, different clinic centers, and treatment interventions, there was no easily identifiable subgroup of patients that experienced the increase in DME. CONCLUSION: DME doesn’t worsen during the COVID-19 pandemic, instead sustaining a very small but statistically significant improvement. While identifying a mechanism behind our findings is beyond the scope of this study, potential explanations may include a delay in retinal changes beyond our study period, an unexpected increase in treatment frequency despite pandemic restrictions, and an unanticipated pandemic-related improvement in some lifestyle factors that may have had a positive impact on DME.     

Comparison of intravitreal anti-vascular endothelial growth factor agents and treatment results in Irvine-Gass syndrome

AIM: To investigate the alleviation of scutellarein (SN) against inner blood-retina-barrier (iBRB) dysfunction in vitro mediated by hyperglycemia-stimulated microglia cells and the engaged mechanism. METHODS: Microglia BV2 cells were treated with D-glucose (25 mmol/L) for the indicated times, and 25 mmol/L mannitol was used as an isotonic contrast. Real-time PCR and Western-blot assay were used to detect cellular mRNA and protein expression. Immunofluorescence staining assay was performed. The dysfunction of iBRB in vitro was detected by using transendothelial electrical resistance (TEER) and fluorescein isothiocyanate (FITC)-conjugated dextran cell permeability assay. RESULTS: SN decreased the activation of microglia BV2 cells, reduced the phosphorylation of extracellular regulated protein kinase (ERK)1/2, the nuclear accumulation of nuclear factor kB (NFkB) and the increased expression of pro-inflammatory cytokines including tumor necrosis factor a (TNFa), interleukin (IL)-6 and IL-1b induced by D-glucose (25 mmol/L) in BV2 cells. The results of TEER and FITC-conjugated dextran cell permeability assay showed that SN attenuated iBRB dysfunction in human retinal endothelial cells (HRECs) or choroid-retinal endothelial RF/6A cells when those cells were treated with TNFa, IL-1b or IL-6, or co-cultured with D-glucose-stimulated microglia cells. Moreover, SN restored the reduced protein expression of tight junctions (TJs) in TNFa-treated HRECs and RF/6A cells. CONCLUSIONS: SN alleviated iBRB dysfunction via directly inhibiting retinal endothelial injury caused by pro-inflammatory cytokines including TNFa, IL-1b or IL-6. SN also reduced the release of TNFa, IL-1b and IL-6 from microglia cells by abrogating hyperglycemia-mediated the activation of microglia cells.     

玻璃体黄斑粘连对抗VEGF药物治疗视网膜分支静脉阻塞疗效的影响

目的：探讨玻璃体黄斑粘连(VMA)对视网膜分支静脉阻塞(BRVO)患者抗VEGF治疗的影响。

方法：回顾性病例研究。选取2017-01/2019-05在我院眼科接受玻璃体腔注射康柏西普治疗的BRVO伴黄斑水肿患者110例110眼,根据初诊时OCT特征,将纳入患者分为存在VMA组(VMA+组,34眼)和无VMA组(VMA-组,76眼)。首次注药后至少定期随访6mo,记录注射次数,检测两组患者最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT),根据OCT扫描结果评估玻璃体黄斑粘附状态及黄斑部玻璃体后脱离(PVD)发生情况。

结果：随访至首次注药后6mo,VMA+组和VMA-组患者平均玻璃体腔注射次数无差异(2.91±1.05次 vs 3.08±1.22次,P=0.915)。首次注药后第6mo时,两组患者BCVA和CMT均显著改善,且VMA+组患者BCVA较VMA-组患者增益更明显\〖-0.20(-0.33,-0.10)LogMAR vs-0.20(-0.30,-0.10)LogMAR,P=0.041\〗,但两组患者CMT变化值无差异(P=0.914)。随访期间,VMA+组患者中3眼基线时为局灶性VMA的患眼均发生黄斑部PVD(100.0%),基线时为广泛性VMA的患者31眼中5眼发生了黄斑部PVD(16.1%),局灶性粘连较广泛性粘连的患者更易发生黄斑部PVD(P=0.009)。

结论：BRVO患者合并VMA时抗VEGF治疗后视力改善的潜力更大,故VMA的存在不妨碍抗VEGF治疗BRVO的疗效。     

Retinal vasoocclusive spectrum following COVID-19

The coagulation abnormalities and thromboembolic complications of coronavirus 2 (SARS-CoV-2) are now a well-established fact. The hypercoagulable state, the tendency for thromboembolism, and a cytokine surge state have been the exclusive reasons for multiorgan failure and other morbidities that have been regularly reported in COVID-19 patients. Ocular involvement in patients with active disease and those who have recovered is uncommon but not rare. We report a case series of four patients with CRVO, BRVO, CRAO, and vitreous hemorrhage in patients with proven COVID-19 infection and no other systemic ailments. The case series also tries to correlate the elevated D-dimer values, which signify a plausible prothrombotic state with the vaso-occlusive phenomenon in the retina leading to significant visual morbidity.     

玻璃体注射雷珠单抗治疗老年性黄斑变性黄斑水肿与视网膜静脉阻塞性黄斑水肿的短期疗效观察

目的 观察玻璃体注射雷珠单抗治疗老年黄斑变性黄斑水肿（AMD-ME）与视网膜静脉阻塞性黄斑水肿（RVO-ME）的短期临床效果。设计 回顾性病例系列。研究对象 2015年10月至2016年7月确诊为AMD-ME 及RVO-ME 的患者共30例（30眼）,各15例（15眼）。方法 患眼接受玻璃体注射雷珠单抗（0.5 mg/0.05 ml）治疗,采用1+PRN的注射方法,比较治疗前和治疗后 1 天、1个月最佳矫正视力（BCVA）、眼压（IOP）、黄斑中心凹视网膜厚度（CMT）、注射后消除的水肿高度,评价每次随访时检查结果。主要指标 BCVA、CMT、消除的水肿高度、IOP。结果 AMD-ME组及RVO-ME 组注射雷珠单抗后1天、1个月的BCVA均较术前提高（P=0.000、0.000）。AMD-ME组 及RVO-ME 组每次治疗前和治疗后1个月CMT厚度均降低（P＝0.000、0.000）。治疗过程中患者眼压与治疗前比较并无明显变化 （P=0.096、0.066、0.213、0.088、0.240、0.337）。结论 玻璃体注射雷珠单抗治疗 AMD-ME 及 RVO-ME 在短期内均可减轻黄斑水肿和改善视力,两者治疗效果无明显差异。（眼科, 2017, 26： 120-124）     

RVO黄斑水肿患者雷珠单抗治疗后脉络膜厚度的变化

目的：观察视网膜静脉阻塞( retinal vein occlusion,RVO)黄斑水肿患者雷珠单抗治疗后脉络膜厚度的变化。
　　方法：RVO黄斑水肿患者36例36眼行雷珠单抗3+prn次玻璃体腔注射治疗。随访1a,观察患眼及对侧眼治疗前和治疗后中心凹下脉络膜厚度的变化。
　　结果：治疗前、治疗后1,6,12 mo时患眼平均中心凹下脉络膜厚度( Subfoveal choroidal thickness,SFCT)分别为246.7±115.0,220.5±102.0,198.3±114.0,212.6±96.0μm,差异有统计学意义(P<0.05)。对侧眼平均SFCT分别为229.4±108.0,226.3±107.0,228.6±127.0,223.6±101.0μm,对侧眼治疗前后中心凹下脉络膜厚度的变化无差异。
　　结论：RVO黄斑水肿患者雷珠单抗治疗后中心凹下脉络膜厚度明显降低。雷珠单抗玻璃体腔注射治疗可能影响脉络膜血流状态。     

The economic implications of the use of anti-vascular endothelial growth factor drugs in age-related macular degeneration

Age-related macular degeneration (ARMD) is the most common cause for visual impairment in the elderly in western countries. Recently several anti-vascular endothelial growth factor (VEGF) drugs like pegaptanib sodium (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin) are available for use in the management of wet ARMD. A major limitation of these drugs is that they require multiple intravitreal injections, every 4 to 6 weeks interval for a period of 2 years. Moreover, most of these drugs are too expensive for the general masses to afford in developing nations. Avastin, though used "off-label", offers a comparable result at affordable cost, however, long term results are awaited. The drug industry should review the entire pricing policy of these drugs in developing countries like India, and develop affordable alternative compounds. The article reviews the economic burden and affordability issues of these Anti-VEGF drugs in ARMD.     

抗VEGF治疗对不同类型DME患者黄斑中心凹无血管区的影响

目的 基于糖尿病性黄斑水肿(DME)的不同影像类型,采用OCTA探讨DME患者抗血管内皮生长因子(VEGF)治疗前后黄斑中心凹无血管区(FAZ)结构的变化。方法 回顾性分析2019年10月至2021年10月来我院就诊的经3+PRN抗VEGF治疗的51例62眼DME患者资料。根据黄斑水肿类型分为弥漫增厚型DME(DRT-DME)组30例(36眼)和黄斑囊样水肿型DME(CME-DME)组21例(26眼)。分别收集两组患者抗VEGF治疗前、治疗后3个月及治疗后6个月的临床资料和OCTA指标,包括最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)、FAZ面积、黄斑中心凹旁300μm范围内的视网膜血流密度(FD)和FAZ非圆度指数(AI),并对其进行比较分析。对CME-DME组患者抗VEGF治疗前后OCTA指标差值(治疗前与治疗后6个月差值)之间的相关性采用Spearman相关性分析。结果 与治疗前相比,DRT-DME组患者治疗后3个月和治疗后6个月各方位的CRT均下降、BCVA均改善(均为P<0.05),但FAZ面积、FD和AI的差异均无统计学意义(均为P>0.05)。与治...     

The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review

The acute and chronic effects of repeated intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients who are at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well tolerated. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive. Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension after each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection, and preexisting glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss. While definitive evidence of damage to the retinal nerve fiber layer is lacking, patients receiving repeated injections should be monitored for ocular hypertension and patients in whom sustained ocular hypertension subsequently developed should be periodically monitored for glaucomatous changes with optic nerve optical coherence tomography and static visual fields.     

玻璃体腔首次注射Ranibizumab治疗视网膜静脉阻塞继发黄斑水肿

目的：观察玻璃体腔首次注射ranibizumab(雷珠单抗)治疗视网膜静脉阻塞继发黄斑水肿的疗效。

方法：分析2014-06/12我院确诊为视网膜静脉阻塞伴有黄斑水肿39例39眼患者资料,患眼给予玻璃体腔注射0.05mL ranibizumab,于注射后2d,2、4wk复查最佳矫正视力(BCVA)、黄斑中心厚度(CMT)、黄斑区平均厚度(CAT)。

结果：治疗前BCVA(LogMAR值)为0.82±0.45,CMT为 541±136μm,CAT为382±107μm。玻璃体腔内首次注射ranibizumab后平均BCVA在治疗后2d,2、4wk后分别为0.56±0.35、0.48±0.39、0.51±0.44,与治疗前比较明显提高(P<0.01)。平均CMT在治疗后2d,2、4wk后分别为372±86、281±74、286±97μm(P<0.01)。平均CAT在治疗后2d,2、4wk后分别为331±46、312±54、319±68μm(P<0.01),与治疗前比较得到了明显降低。

结论：玻璃体腔首次注射ranibizumab 能够改善视网膜静脉阻塞继发黄斑水肿,提高视力,短期疗效明确,但远期疗效仍有待观察。     

Intravitreal anti-vascular endothelial growth factor with and without topical non-steroidal anti-inflammatory in centre-involving diabetic macular edema

Purpose:Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the mainstay in the management of center-involving diabetic macular edema (CI-DME). Topical nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to treat CI-DME as well. Whether there is any benefit of using both together has not been explored. The aim of this study was to compare visual acuity and OCT outcomes in patients with CI-DME who receive intravitreal anti-VEGF with and without topical NSAIDs in CI-DME.Methods:This was A retrospective observational study in two centers in India. The study compared visual and OCT parameters of patients with CI-DME treated with intravitreal anti-VEGF monotherapy (group 1, N = 100) versus intravitreal anti-VEGF therapy with topical NSAIDs (group 2, N = 50) over 1-year follow-up. Continuous and categorical parameters were compared using parametric and nonparametric tests, respectively.Results:Over the 1-year follow-up, group 2 received more mean number of intravitreal injections (group 1: 2.26 ± 1.71 vs. group 2: 3.74 ± 2.42; P < 0.0001). There were no differences between the groups in visual acuity and OCT thickness at 1-year follow-up.Conclusion:Combination therapy of topical NSAIDs with intravitreal anti-VEGF did not show any beneficial effects in terms of visual outcomes, reduction in central subfoveal thickness, or reduction in the mean number of injections in our study.     

玻璃体腔内注射康柏西普治疗视网膜静脉阻塞继发黄斑水肿

目的：观察玻璃体腔内注射康柏西普治疗视网膜静脉阻塞( retinal vein occlusion,RVO)继发黄斑水肿的临床效果及安全性。方法：回顾性观察我院2016-01/03间收治的RVO继发黄斑水肿的患者22例22眼,3 mo内给予3次玻璃体腔内注射康柏西普0.05mL(0.5mg),比较治疗前后患者的视力变化情况,光学相干断层扫描( OCT )检查,眼底荧光造影( FFA)及眼底出血吸收情况。结果：所选患者玻璃体内注射康柏西普在1wk,1、2、3mo后平均视力均有不同程度的提高,差异有统计学意义(P<0.05)。 OCT图像显示黄斑中心凹视网膜厚度明显变薄,与治疗前相比差异具有统计学意义(P<0.05)。治疗后3 mo检查FFA显示视网膜渗漏明显减轻,眼底出血明显吸收。结论：玻璃体腔内注射抗VEGF药物康柏西普治疗RVO继发的黄斑水肿疗效肯定,但远期疗效及注射药物的频率尚需进一步观察与探讨。     

Efficacy and retention times of intravitreal triamcinolone acetonide for macular edema

Purpose To evaluate the retention of intravitreal triamcinolone acetonide (TA) particles and the efficacy of TA therapy for patients with cystoid macular edema in branch retinal vein occlusion (BRVO) or diabetic macular edema (DME). We monitored the TA particles until absorption from the vitreous cavity was complete. The correlation between the intravitreal retention time of TA and its efficacy was evaluated based on central macular thickness (CMT). Results The intravitreal TA retention time was a mean 141.8 ± 139.6 days in BRVO patients and 114.5 ± 59.6 days in DME patients. Patient age and retention time were negatively correlated (r = −0.46; P = 0.013). At 6 months posttreatment the mean CMT decreased from 544.1 ± 143.7 to 322.4 ± 131.9 μm in BRVO patients and from 454.5 ± 119.0 to 371.2 ± 209.4 μm in DME patients. Retention time and CMT reduction were positively correlated in BRVO patient (r = 0.56, P = 0.02) but not in DME patients (P = 0.06). Conclusions Intravitreal TA reduced the CMT in BRVO and DME patients over 6 months. The retention time was longer in younger individuals. The efficacy of the therapy depended on the intravitreal TA retention time observed clinically in BRVO patients. Biomicroscopic examination of intravitreal TA is useful for evaluation of its efficacy.     

Retinal venous occlusion in a child following Corbevax COVID-19 vaccination

A 13-year-old boy developed painless diminution of vision in left eye 15 days after taking first dose of coronavirus disease 2019 (COVID-19) vaccine (Corbevax). Fundus and fluorescein angiography revealed central retinal vein occlusion in the left eye. Blood investigations were noncontributory. He was administered three doses of pulse corticosteroids followed by a tapering dose of oral corticosteroids. Retinal vascular occlusion can occur following COVID-19 vaccination in children, and early and aggressive systemic anti-inflammatory therapy can be helpful.     

Comparison of anti-vascular endothelial growth factors, laser treatments and a combination of the both for treatment of central retinal vein occlusion

AIM: To compare changes in visual acuity and macular edema in patients with central retinal vein occlusion (CRVO) treated with intravitreal injections of bevacizumab, macular grid photocoagulation combined with pan retinal photocoagulation (PRP), or both (bevacizumab+grid+PRP). METHODS: Our study is a retrospective cohort clinical study that examined patients that suffered from ischemic CRVO with macular edema. Study inclusion criteria were ischemic CRVO with macula edema and the availability of complete medical records for at least 12mo after treatment. Excluded were patients with diabetes or any other retinal disease. We reviewed the medical records of patients treated in one ophthalmology department-comparing changes in visual acuity and macular edema in patients treated with intravitreal injections of bevacizumab vs those that were treated with macular grid photocoagulation and PRP or both. The main outcome measures were the differences in best corrected visual acuity (BCVA) and in macular thickness, as assessed by optical coherence tomography, between the enrollment and the final follow up visits. RESULTS: Sixty-five patients met inclusion criteria. There were no statistically significant differences among the three groups in the mean changes in macular thickness as measured by ocular coherence tomography (131.5±41.2, 108.6±29.2, and 121.1±121.1, P=0.110), or in visual acuity (0.128±0.077, 0.088±0.057, and 0.095±0.065), for intravitreal injections, macular grid photocoagulation+PRP and a combination of the treatments, respectively, P=0.111. The proportions of patients with macular edema after treatment were: 26.1%, 28.6%, and 14.3%, respectively, P=0.499. CONCLUSION: Similar benefit was observed for intravitreal injections, laser photocoagulation, or a combined regimen in the treatment of CRVO. A non-statistically significant trend for reduction in macular edema was observed following combined treatment.     

Abrupt visual loss during anti-vascular endothelial growth factor treatment for type 3 neovascularization

AIM: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor (VEGF) treatment for type 3 neovascularization. METHODS: This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity (BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss. RESULTS: The mean follow-up period was 42.4±18.9mo after diagnosis, and abrupt visual loss was noted in 22 eyes (16.1%) at a mean of 19.6±13.9mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes (50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes (36.4%), and tears in the retinal pigment epithelium in 3 eyes (13.6%). The logarithm of minimum angle of resolution (logMAR) mean BCVA at the final follow-up was 2.07±0.67 (Snellen equivalents: 20/2349) and 1.00±0.55 (20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss (P<0.001). CONCLUSION: Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.