Bevacizumab in age‐related macular degeneration: a randomized controlled trial on the effect of injections every 4 weeks, 6 weeks and 8 weeks

Purpose: Several clinical trials have established the efficacy of ranibizumab therapy administered every 4 weeks to treat exudative age‐related macular degeneration (ARMD). Bevacizumab appears to be a cost‐effective alternative to ranibizumab, although an optimal injection schedule has not yet been determined. In this study, we set out to determine whether bevacizumab treatment in exudative ARMD every 6 or 8 weeks is non‐inferior to bevacizumab treatment every 4 weeks. Methods: A total of 191 patients with exudative ARMD were randomly assigned to a 1‐year continuous regimen of intravitreal bevacizumab every 4 (n = 64), 6 (n = 63) or 8 weeks (n = 64). The primary outcome was visual acuity change after 1 year of treatment. Results: In all three treatment groups, visual acuity improved between baseline and 1 year. There was no statistically significant difference in the mean change of visual acuity score at 1 year for bevacizumab administered every 4 (1.96 ± 13.70), 6 (1.60 ± 10.98) or 8 weeks (5.98 ± 8.88). Reduction in central retinal thickness was observed in all three study groups. At 1 year, the mean decrease in central foveal thickness ranged from 86 ± 97 μm in the every 6 weeks group to 109 ± 90 μm in the group every 8 weeks group (p = 0.30). Conclusion: At 1 year, bevacizumab administered every 6 or 8 weeks was not inferior to therapy administered every 4 weeks.     

玻璃体腔注射雷珠单抗和康柏西普治疗渗出型年龄相关性黄斑变性疗效比较

目的：探讨玻璃体腔注射雷珠单抗和康柏西普治疗渗出型年龄相关性黄斑变性(ARMD)疗效,并分析对患者最佳矫正视力(BCVA)、中心凹视网膜厚度(CRT)和并发症的影响。

方法：回顾性分析。收集2017-01/2020-01我院收治的渗出型ARMD患者60例60眼临床资料,按治疗药物不同分为玻璃体腔注射雷珠单抗组30眼和玻璃体腔注射康柏西普组30眼。比较两组患者治疗前,治疗1、2、3mo时患者BCVA、CRT、脉络膜新生血管变化和并发症发生情况。

结果：治疗后1、2、3mo,两组患者BCVA(LogMAR)较治疗前显著改善(P<0.05),CRT较治疗前显著降低(P<0.05),且玻璃体腔注射康柏西普组治疗1、2、3mo的CRT显著低于玻璃体腔注射雷珠单抗组(P<0.05); 两组脉络膜新生血管恢复情况和并发症发生情况比较无明显差异(P>0.05)。

结论：玻璃体腔注射雷珠单抗和康柏西普治疗渗出型ARMD均可取得较好的疗效,二者在改善视力方面无明显差异,但康柏西普治疗渗出型ARMD在降低CRT方面更具有明显优势。     

Efficacy of intravitreal bevacizumab (Avastin®) therapy for early and advanced neovascular age‐related macular degeneration

Purpose: To evaluate the safety and efficacy of intravitreal bevacizumab therapy for early and advanced neovascular age‐related macular degeneration (ARMD). Methods: A consecutive series of eyes with neovascular ARMD treated with monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml) as long as there was evidence of activity on fluorescein angiography (FA) and optical coherence tomography (OCT) was included and observed for 6 months. For further analysis they were assigned to either an early (untreated/newly diagnosed) or an advanced (predominantly fibrotic/pre‐treated) ARMD group. We examined distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and central retinal thickness with OCT, as well as lesion size and safety aspects. Results: Forty‐four patients (44 eyes) were enrolled (21 early lesions, 23 advanced lesions). Mean VA changed from 0.74 logMAR at baseline to 0.68 logMAR at month 6 (P = 0.01). Improvement in VA was statistically significant only in eyes with early lesions (n = 21) from month 1 (P = 0.015) up to month 6 (P = 0.03). The changes in central retinal thickness (CRT) (P < 0.001) and total lesion size (P < 0.001) were significant in both groups (early and advanced) at all time‐points during follow‐up. No significant ocular or systemic adverse effects were observed. Conclusion: Intravitreal bevacizumab was tolerated well by our patients and we did not identify any apparent short‐term safety concerns. We observed stabilization in VA overall, with significant improvement in the early lesion group.     

Plasma malondialdehyde and nitric oxide levels in age related macular degeneration

AIMS: To evaluate alteration of plasma malondialdehyde (MDA) and nitric oxide (NO) levels in patients with exudative age related macular degeneration (ARMD). METHODS: Plasma nitrite plus nitrate concentrations as an index of plasma NO levels and plasma MDA level as a marker of lipid peroxidation were measured in patients with exudative ARMD and age and sex matched healthy subjects. RESULTS: Significantly higher MDA and lower NO levels were detected in plasma of patients with ARMD compared with their controls (p=0.01, p=0.001, respectively). CONCLUSION: The results may support involvement of oxidative damage and vascular theory in the pathogenesis of ARMD as part of the ageing process.     

Plasma homocysteine and total thiol content in patients with exudative age-related macular degeneration

PURPOSE: Exudative age-related macular degeneration (ARMD) is one of the debilitating ocular complications, which results in permanent blindness. Elevated homocysteine (Hcys) levels have been associated in the development of several vascular diseases. Vascular and oxidative stress theories have been implicated for the development of choroidal neovascularization in exudative ARMD. The aim of the present study was to investigate the possible role of plasma Hcys and thiol content (tSH) as a risk factor for the development of exudative ARMD. METHOD: A total of 16 patients with exudative ARMD and 20 age-matched controls were recruited for the study. Plasma Hcys levels were analysed using Reverse Phase High Performance Liquid Chromatography. Plasma glutathione (GSH) content was determined using o-phthalaldehyde (OPA) derivatization and subsequent detection by fluorimeter. Plasma tSH levels were determined by using thiol-specific reagent dithionitrobenzoic acid (DTNB) spectrophotometrically. RESULTS: Plasma Hcys levels in exudative ARMD were elevated three-fold (18+/-5.0 microM) when compared to healthy controls (6.7+/-1.8 microM). There was a two-fold decrease in the GSH and tSH in exudative ARMD when compared with controls. Negative correlation was observed between diminished tSH and Hcys levels (r=-0.4837, P=0.05). Similarly plasma Hcys levels negatively correlated with GSH content (r=-0.6620, P<0.05). CONCLUSION: Results from our present study revealed that there is an elevated Hcys level and diminished thiol pool content in exudative ARMD that are significant.     

玻璃体腔注射康柏西普治疗渗出性年龄相关性黄斑变性

目的：观察玻璃体腔注射康柏西普治疗渗出性年龄相关性黄斑变性(age-related macular degeneration,ARMD)的临床疗效。

方法：回顾性研究我院2015-07/2016-01确诊的渗出性ARMD患者45例45眼,采取每月1次玻璃体腔注射康柏西普(0.5mg/0.05mL),连续治疗3mo,之后按需给药(3+PRN),随访2a。分别观察治疗前和治疗后最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹厚度(central macular thickness,CMT)变化情况。

结果：治疗后第1、2、3mo,1、2a后的BCVA较治疗前显著提高,差异有统计学意义(t=5.208、5.111、4.323、4.701、5.156,P<0.05),CMT较治疗前显著减低,差异有统计学意义(t=3.807、4.556、2.841、2.707、3.145,P<0.05)。

结论：康柏西普眼用注射液3+PRN方案治疗渗出性ARMD可以有效提高视力、减轻黄斑水肿。     

Intravitreal triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema

Background: To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema. Design: Prospective, non‐randomized, masked, interventional case series. Participants: Twenty‐four eyes of 24 subjects with centre‐involved diabetic macular oedema extending over two disc‐areas with predominant cystic changes on spectral domain optical coherence tomography were selected. Methods: Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide. Main Outcome Measures: Change in central macular volume on spectral domain optical coherence tomography and best‐corrected visual acuity were measured at 6‐week follow‐up. Results: Baseline data were matched in both groups. Post‐injection central macular volume (7.46 ± 0.73 mm³) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre‐injection central macular volume (9.11 ± 1.0 mm³) or when compared with the post‐injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm³). However, post‐injection best‐corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best‐corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre‐injection central macular volume (r = 0.55, P = 0.005). Conclusions: Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best‐corrected visual acuity.     

Intravitreal bevacizumab (Avastin®) for neovascular age‐related macular degeneration in treatment‐naive patients

Purpose: To report the effects of intravitreal bevacizumab (Avastin^®) in treatment‐naive patients with exudative age‐related macular degeneration (ARMD) assessed by visual acuity (VA), optical coherence tomography (OCT) and contrast sensitivity. Methods: A prospective, uncontrolled, pilot study of 26 eyes of 26 patients, all previously treatment‐naive to photodynamic therapy, argon laser or anti‐vascular endothelial growth factor (VEGF), were treated with one or more intravitreal injections of 1.25 mg bevacizumab. Of the 26 patients, 15 (57.7%) had occult choroidal neovascularization (CNV), 6 (23.1%) had predominantly classic CNV and 5 (19.2%) had minimally classic CNV. Ophthalmic outcome measures included changes in standardized Early Treatment Diabetic Research Study (ETDRS) VA, contrast sensitivity and OCT. The patients were examined at baseline and 1 week, 6 weeks, 3 months and 6 months after the first injection. Re‐treatment was given on an ‘as needed’ basis. Results: Twenty‐four eyes of 24 patients completed 6 months of follow‐up. Two patients chose to discontinue the study. Mean ETDRS VA score improved from 55 letters at baseline to 60 letters at 1 week (P < 0.01) and to 61 letters at 6 weeks (P < 0.01). No significant improvement in VA from baseline was found after 3 and 6 months. Patients with pigment epithelial detachment (PED) had a significantly worse outcome in VA at 6 months. Contrast sensitivity improved from baseline to 3 or 6 months, but this improvement was not statistically significant. Mean macular thickness decreased significantly from baseline to all follow‐up examinations (P < 0.01). Conclusion: Mean ETDRS VA improved significantly after 1 and 6 weeks; thereafter, it remained stable throughout the study period. Macular thickness improved significantly at all time points. The results indicate that 1.25 mg intravitreal bevacizumab is associated with functional as well as morphological improvement among treatment‐naive ARMD patients.     

One year follow up of macular translocation with 360 degree retinotomy in patients with age related macular degeneration

AIM: To evaluate the benefits of macular translocation with 360 degree retinotomy in patients with exudative age related macular degeneration (ARMD). METHODS: A consecutive interventional case series was performed on patients who underwent macular translocation between June 1997 and January 2000 at the department of ophthalmology, University of Aachen, Germany. A retrospective pilot study was set up with a minimum follow up of 12 months in 39 consecutive patients with subfoveal choroidal neovascularisation secondary to ARMD. The surgical technique included pars plana vitrectomy, induction of retinal detachment, 360 degree retinotomy, removal of the choroidal neovascular membranes (CNVM), macular translocation, peripheral laser retinopexy, and silicone oil endotamponade. RESULTS: 18 patients showed predominantly occult CNVM, six patients had predominantly classic CNVM, and 15 showed subretinal haemorrhage. At the 12 month follow up 13 patients (33%) showed an improvement in visual acuity of more than three lines (logMAR scale), 18 patients (46%) retained stable visual acuity with a change of equal or less than three lines (logMAR scale), and eight patients (21%) showed a decrease in visual acuity of more than three lines (logMAR scale). Recurrence of CNVM was observed in three (8%) eyes at 5-11 months postoperatively. Other complications included proliferative vitreoretinopathy with retinal detachment (n=10), peripheral epiretinal membranes (n=9), macular pucker (n=2), corneal decompensation (n=2), and hypotony (n=11). 18 patients (46%) complained about persistent diplopia. CONCLUSION: Macular translocation surgery is able to maintain or improve distant vision in the majority of patients with exudative ARMD. Proliferative vitreoretinopathy and diplopia are the two major complications. A prospective randomised controlled trial comparing macular translocation with observation for patients with the occult form of exudative ARMD may be justified.     

玻璃体腔注射康柏西普治疗湿性年龄相关性黄斑变性的早期mfERG变化

目的：利用多焦视网膜电图(mfERG)评价玻璃体腔注射康柏西普的湿性年龄相关性黄斑变性(age-related macular degeneration,ARMD)患者视网膜功能的早期变化。

方法：经眼底荧光血管造影确诊为湿性ARMD患者接受玻璃体腔注射康柏西普眼用注射液(0.05mL/0.5mg),记录注射前及注射后1mo的最佳矫正视力及mfERG各环N1、P1波潜伏期及P1波振幅密度。

结果：共20例20眼患者纳入研究,平均LogMAR视力从注射前0.80±0.48提高到注射后0.65±0.50(P<0.001),环1平均振幅密度从注射前39.59±16.60nV/deg²提高到注射后的53.81±20.41nV/deg²(P=0.006),振幅密度的改变与视力的改变呈正相关(r=-0.776,P<0.001)。

结论：对于湿性ARMD患者玻璃体腔注射康柏西普短期内能改善黄斑中心凹的功能。     

Perfluorohexyloctane endotamponade for treatment of subfoveal hemorrhage

PURPOSE: To report on the use of perfluorohexyloctane as a heavy liquid to temporarily tamponade the fovea for the prevention of recurrent massive subfoveal hemorrhage in patients with exudative age-related macular degeneration (ARMD). METHODS: The case series comprised seven patients with acute massive subfoveal hemorrhage due to exudative ARMD. The patients underwent pars plana vitrectomy, drainage of the subretinal blood, and foveal endotamponade with perfluorohexyloctane. The perfluorohexyloctane was removed 80.4 +/- 38.1 days (median 98 days; range 22-118 days) after the primary surgery in a second pars plana intervention. RESULTS: In six patients (85.7%) the subretinal hemorrhage removed during the first pars plana vitrectomy did not recur after removal of perfluorohexyloctane. In the seventh, however, a subretinal hemorrhage re-developed five days after release of perfluorohexyloctane. No large epiretinal membranes were observed. In six eyes (85.7%), the retina remained attached after removal of perfluorohexyloctane but in one eye proliferative vitreoretinopathy developed, with central retinal detachment. After the first pars plana vitrectomy, visual acuity increased slightly but not significantly (p = 0.25), from 0.03 +/- 0.03 to 0.05 +/- 0.07. Intraocular pressure rose from 15.0 +/- 1.9 mm Hg to 24.9 +/- 16.9 mm Hg. After a follow-up of 69.7 +/- 121.0 days after removal of the perfluorohexyloctane, final visual acuity was 0.02 +/- 0.04. CONCLUSIONS: Perfluorohexyloctane may be a useful additional tool for preventing the recurrence of subfoveal re-bleeding in exudative ARMD.     

OCTA观察早期ARMD患者黄斑区血流密度及形态结构的变化

目的：应用光相干断层扫描血管成像(OCTA)观察早期年龄相关性黄斑变性(ARMD)患者黄斑区血流密度和形态学结构的改变。

方法：本研究为病例回顾性研究,纳入2018-02于我院眼科被初次明确诊断为单眼湿性年龄相关性黄斑变性(wARMD)且另一眼为早期ARMD患者的35例35眼,并纳入与试验组年龄相匹配的健康眼35例。所有患者早期ARMD眼于初诊时及2a后均行OCTA检查,观察黄斑区3mm×3mm范围内浅层、深层视网膜及脉络膜毛细血管层血流密度,黄斑中心凹面积、周长及非圆指数,及黄斑区全层、内层、外层视网膜和光感受器与Bruch膜之间(ISOS-BRM)厚度变化。

结果：与正常人相比,早期ARMD患者黄斑区3mm×3mm范围内浅层、深层视网膜及脉络膜毛细血管层血流密度降低(P<0.05),黄斑区全层及内层视网膜厚度降低(P<0.05),而ISOS-BRM厚度有增加的趋势(P=0.37),黄斑中心凹无血管区面积、周长及非圆指数无明显变化(P>0.05); 初次诊断2a后早期ARMD患者深层视网膜及脉络膜毛细血管层血流密度较前进一步降低(P<0.05),外层视网膜厚度较前增加(P=0.02),ISOS-BRM厚度较前进一步有增加的表现(P=0.18),黄斑中心凹无血管区面积、周长及非圆指数较前无明显变化(P>0.05)。此外初次诊断及2a后早期ARMD患者脉络膜毛细血管层血流密度与黄斑区视网膜浅层及深层血流密度均呈正相关(初次诊断组：r_浅层=0.407,r_深层=0.56,均P<0.05; 2a后组：r_浅层=0.57,r_深层=0.628,均P<0.05)。

结论：早期ARMD患者黄斑区浅层、深层视网膜及脉络膜毛细血管层血流密度和内层视网膜厚度较正常人均降低,这对ARMD的早期发现和及早干预具有临床参考意义。     

Nonmydriatic Retinal Photography in Screening for Diabetic Retinopathy

Several recent reports have described stabilization of visual acuity and regression of subfoveal neovascular membranes in response to modest doses of ionizing radiation in patients with the exudative form of age related macular degeneration (ARMD). This paper provides a concise review of clinical radiation therapy and surveys the published literature regarding the use of ionizing radiation to test ARMD.     

Discriminative power of reading tests to differentiate visual impairment caused by cataract and age-related macular degeneration

PURPOSE: To determine whether preoperative reading tests can be used for differentiating visual impairments with regard to the diagnosis of cataract and age-related macular degeneration (ARMD). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Reading performance of patients with nuclear cataract, posterior subcapsular cataract, and ARMD were evaluated with respect to reading acuity, maximum reading speed, and critical print size; normal-sighted participants were tested as controls. A multivariate discriminant analysis of the 4 groups (100 eyes of 100 participants) was performed to evaluate how many patients could be correctly diagnosed by significant differences in the tested reading parameters. Subsequently, the nuclear cataract and posterior subcapsular cataract patients were compared with cataract patients with coexisting ARMD. RESULTS: Distance visual acuity was comparable in the nuclear cataract, posterior subcapsular cataract, and ARMD groups (P>.05). Reading acuity was significantly reduced in posterior subcapsular cataract and ARMD patients compared with nuclear cataract patients and controls (P<.0001). No significant difference in maximum reading speed was found between the nuclear cataract patients and the controls (P = .07), whereas the maximum reading speed of the posterior subcapsular cataract and ARMD patients was significantly reduced (P<.0001). In the discriminant analysis, it was possible to assign the correct diagnosis to 72% of the nuclear cataract patients, 76% of the posterior subcapsular cataract patients, 72% of the ARMD patients, and 92% of the controls. Comparing the reading performance of nuclear cataract and posterior subcapsular cataract patients and cataract patients with coexisting ARMD showed that reading performance was significantly impaired in the comorbid patients (nuclear cataract and ARMD, P<.001; posterior subcapsular cataract and ARMD, P<.05). CONCLUSION: The high discriminant accuracy shows that this standardized reading test system is a valuable diagnostic tool for evaluating functional visual impairments when distance visual acuity alone cannot elucidate the origin of functional impairment. Considering the significant discrepancies in reading performance among patients with nuclear cataract, posterior subcapsular cataract, and ARMD, reading tests may relevantly improve the clinical evaluation of patients with visual loss, even of patients with ocular comorbidity.     

Fourier analysis of digital retinal images in estimation of cataract severity

Purpose: To evaluate the efficacy of Fourier analysis of digital retinal images in grading cataract severity. Methods: A total of 330 eyes from 165 patients were divided into 287 phakic and 43 pseudophakic eyes. All patients underwent clinical examination, colour fundus photography and photoscreening. Phakic eyes were classified into 232 cataractous and 55 control eyes using the Lens Opacity Classification System (LOCS III). Assessment was repeated at 6 weeks postoperatively for 157 eyes in the cataractous group and in 24 pseudophakic eyes. The predictive value in assessing cataract severity using discrete Fourier transforms in fundus image analysis was compared with LogMAR visual acuity and LOCS III grading. Results: The mean age of the population was 71.7 years ± 13.4 (range 19–92) there were 70 (42.4%) males and 95 (57.6%) females. The mean LogMAR visual acuity was 0.44 ± 0.41 (range ?0.2 to 1.4). In the cataract group there were 232 eyes (80.8%), the mean age was 75.5 years ± 9.3 (range 21–92). Fourier analysis of retinal images showed a moderate correlation with LOCS III (R² = 0.59) in grading cataract severity and demonstrated a comparable correlation with visual acuity (R² = 0.39) as LOCS III (R² = 0.44). As with LOCS III score the Fourier value had a poor correlation with visual acuity in clear (R² = 0.05) and pseudophakic lenses (R² = 0.07). Conclusion: Fourier analysis is a useful automated method in grading of cataract severity for both pure and mixed types of cataract; however, similar to many objective systems it cannot determine the anatomic type of cataract.     

渗出性年龄相关性黄斑变性患者玻璃体液中VEGF的改变及与炎症的关系

目的：研究血管内皮生长因子(vascular endothelial growth factor,VEGF)在渗出性年龄相关性黄斑变性(age-related macular degeneration,ARMD)患者玻璃体液中的改变及与炎症的关系。

方法：纳入2016-09/2017-09于我院就诊的渗出性ARMD患者61例61眼作为观察组,另纳入特发性黄斑裂孔(idiopathic macular hole,IMH)患者25例25眼作为对照组。抽取两组患者玻璃体液0.5mL,检测VEGF、白介素-10(IL-10)及白介素-6(IL-6)的水平,并分析VEGF与炎症介质的关系。

结果：观察组患者玻璃体液内VEGF及IL-6水平均显著高于对照组患者(t=32.530、8.443,均P<0.01)。两组患者玻璃体液IL-10水平比较,差异无统计学意义(P>0.05)。ROC曲线分析显示,以460.6pg/mL为截点值,VEGF鉴别ARMD和IMH的敏感性为84.00%,特异性为93.44%,曲线下面积为0.879,优于IL-6。观察组患者玻璃体液VEGF水平与IL-6呈显著正相关关系(r=0.787,P<0.01)。

结论：渗出性ARMD患者玻璃体内VEGF水平显著升高,并与炎症呈正相关,且VEGF水平对于鉴别IMH有一定价值。     

SCARB1 rs5888 is associated with the risk of age-related macular degeneration susceptibility and an impaired macular area

Background: Age-related macular degeneration (ARMD), a progressive retinal disease, is responsible for an impaired central vision in about 180 million people worldwide. Current options for ARMD prevention and treatment are limited due to an incomplete understanding of disease etiopathogenesis. We aimed to test the hypothesis that the single nucleotide polymorphism rs5888 of SCARB1 gene reflecting lipid and antioxidant micronutrient metabolism pathways is associated with ARMD susceptibility and to evaluate if there is any relation between SCARB1 rs5888 and the macular lesion area.

Materials and methods: The prospective case-control study included patients with ARMD (n = 215) and the reference group (n = 238) drawn from a random sample of the Lithuanian population (n = 1436). The genotyping test of SCARB1 rs5888 was carried out using the real-time polymerase chain reaction method.

Results: Regression analysis adjusted by gender and age demonstrated that SCARB1 rs5888 TT genotype significantly decreased the odds for ARMD development (OR: 0.61, 95%; CI: 0.380–0.981, p = 0.04). A smoking habit and leading an outdoor life are associated with larger macular lesion areas in ARMD patients (0.54 (0.00–39.06) vs. 3.09 (0.02–19.30) and 0.27 (0.00–34.57) vs. 0.75 (0.00–39.06), respectively). In late stage ARMD subjects with CT genotype, the macular lesion area was larger than in TT carriers (7.64 (0.49–39.06) mm² vs. 5.02 (0.03–37.06) mm², p = 0.006).

Conclusions: SCARB1 rs5888 and environmental oxidative stress have a prominent role in ARMD susceptibility, early ARMD progression to advanced stage disease and even in the outcome of the disease—an area of macular lesion.     

可调节人工晶状体植入术后的视觉质量及拟调节力

目的:研究Tetraflex可调节人工晶状体(IOL)植入术后视力、调节幅度、对比敏感度及主观视觉功能的临床应用效果。方法:病例对照研究。选择2010-03/2012-12在我院接受白内障超声乳化摘除联合囊袋内IOL植入术的白内障患者48例72眼,其中23例35眼植入Tetraflex可调节IOL(Tetraflex组),25例37眼植入AcrySof SA60AT单焦点IOL(SA60AT组),对比研究两组患者术后1,3,6mo裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、最佳矫正远视力下近视力、拟调节力、脱镜率以及患者满意度情况,采用主观移近法测量调节力。采用SPSS13.0统计软件包进行统计学处理。结果:术后随访期间,两组患者的裸眼远视力、最佳矫正近视力和最佳矫正远视力差异无统计学意义(P>0.05);Tetraflex组患者的裸眼近视力和最佳矫正远视力下近视力与单焦组比较差异有统计学意义(P<0.05)。术后Tetraflex组拟调节力均高于SA60AT组(P<0.05),于术后6mo Tetraflex组拟调节力有所下降,与1,3mo比较差异均有统计学意义(P<0.05),两组间对比敏感度差异无统计学意义。脱镜率及和主观视功能满意度,Tetraflex可调节IOL组均明显优于单焦组,差异有统计学意义(P<0.05)。结论:可调节IOL可提供较好的远近视力,增加拟调节力,有效降低患者术后对老视镜的依赖,改善主观视功能。但其拟调节力仍需要进一步的研究。     

Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion

Purpose: To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO). Methods: Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best‐corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired‐t test. Side‐effects were monitored. Results: BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow‐up, BCVA and CFT were significantly different compared to pre‐injection values in the same group (P = 0.032, 0.049 in the initial‐injection group and P = 0.001, 0.008 in the repeat‐injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time‐point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post‐injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study. Conclusion: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.     

Visual acuity outcomes in ranibizumab-treated neovascular age-related macular degeneration; stratified by baseline vision

Background: Ranibizumab (Lucentis, Novartis, Basel, Switzerland) is currently indicated for use in neovascular age‐related macular degeneration (NVAMD). This study assessed the real‐life outcomes based on baseline visual acuity when treated with intravitreal ranibizumab on a three + pro re nata (PRN) dosing schedule for NVAMD. Design: This retrospective chart‐review was conducted at King's College Hospital. The patients were stratified into three groups based on baseline Early treatment diabetic retinopathy study (ETDRS) letters: 27 with poor visual acuity (24–34 letters), 33 with intermediate visual acuity (35–54 letters) and 27 with good visual acuity (≥=55 letters). Methods: All patients received a three + PRN dosing schedule of ranibizumab injections (0.5 mg per 0.05 mL) based on changes in visual acuity and macular thickness on optical coherence tomography (OCT) and all patients completed 12‐month follow up. Main Outcome Measures: The mean change in visual acuity at 12 months in the three groups. Results: Mean gain in ETDRS letters at 12 months was +14.00 (P < 0.0001), +7.10 (P = 0.012) and +2.85 (P = 0.19), and mean number of injections was 5.30, 6.12 and 5.70 in the poor, intermediate and good baseline vision group, respectively, over the 12‐ month follow‐up period. Conclusions: Poor baseline visual acuity (24–34 ETDRS letters) is a predictor of maximum gain in visual acuity. However, eyes with better baseline visual acuity (55 letters) had a better final visual acuity.