Comparison of intravitreal injection of bevacizumab and triamcinolone acetonide in the treatment of uveitic macular edema

Background: Cystoid Macular Edema (CME) is one of the most common and sight threatening complications of uveitis. Intravitreal injection of corticosteroids and Anti-VEGF are two routine options for treatment. Objective: To compare the effects of intravitreal injections of Bevacizumab and Triamcinolone Acetonide for the treatment of persistent macular edema in non-infectious uveitis. Methods: In a randomized clinical trial, sixty eyes of 55 patients were enrolled in the study. Patients were divided into two groups with randomized digits table. 29 eyes received 4 mg of intravitreal triamcinolone acetonide, and 31 eyes received 1.25 mg of intravitreal bevacizumab. Two main outcome measures were changes in visual acuity, measured with logarithm of minimal angle of resolution, and central macular thickness, measured with optical coherence tomography. Results: The mean follow-up was 25.3 weeks. The best visual acuities were achieved 6 months after injection in both groups. Improvement in visual acuity at 6 months was achieved in 28/29 (96%) of eyes in Triamcinolone group and in 26/31 (83%) eyes in Bevacizumab group (p=0.196). None of the eyes showed worsening of visual acuity after 6 months. Mean of central macular thickness in the pre-injection time for intravitreal triamcinolone acetonide (IVTA) group was 295.62 μ, and 309.87 μ in intravitreal bevacizumab (IVB) group, which were decreased after six months to 199.27 μ and 221.06 μ, respectively (p<0.001). Conclusion: This study shows that IVT and IVB are both effective in improving vision in uveitic CME. Although effects of triamcinolone on Central Macular Thickness (CMT) are more apparent, this superiority is not seen on Best Corrected Visual Acuity (BCVA).     

Posterior subtenon and intravitreal triamcinolone acetonide for diabetic macular edema

AIM: To evaluate retroprospectively the clinical consequences of posterior subtenon (PSTT) and intravitreal (IVT) triamcinolone acetonide injections in diabetic macular edema (DME) refractory to conventional grid laser photocoagulation. MATERIAL AND METHODS: Eyes with clinically significant DME refractory to grid laser photocoagulation were assessed for the inclusion in the study. Complete ophthalmic examination with fluorescein angiography (FA) and optic coherence tomography (OCT) were performed before and in the 1st, 3rd, and 6th months of the treatment. The IVT group received 4 mg/0.1 ml and the PSTT group received 20 mg/0.5 ml triamcinolone injection. PSTT but not IVT injection was repeated in case of recurrent edema. IVT was also applied to the eyes with resistant macular edema after PSTT injection (secondary IVT group). RESULTS: There were 85 eyes of 60 patients in the PSTT group and 41 eyes of 35 patients in IVT group. There were 24 eyes in the primary IVT group and 17 eyes in the secondary IVT group. Mean follow-up time was 4.1+/-1.9 and 4.6+/-2.2 months after PSTT and IVT injections, respectively. In the PSTT group, the mean visual acuity increased from 0.19+/-0.18 to 0.22+/-0.19 and the mean central foveal thickness decreased from 413.1+/-117.5 to 312.1+/-103.1 microm (P=.001 and P=.0001, respectively) during the first 3 months. In the IVT group, the mean visual acuity and central foveal thickness were found to be 0.15+/-0.14 and 494.5+/-141.3 microm before the treatment and 0.20+/-0.16 and 288.4+/-88.5 microm 3 months after the treatment, respectively (P=.008 and P=.001, respectively). The effect in central foveal thickness was significantly greater in the primary IVT group than in the PSTT group (P=.002). There was no significant difference with respect to the decrease in the central foveal thickness and increase in visual acuity between the primary and secondary IVT injections (Mann-Whitney U test, P>.05). The steroid effect started to diminish after the 3rd month. The recurrence of macular edema was seen in 7.1% in the PSTT group starting after 3 months. Twenty percent of the eyes in the PSTT group did not respond to the treatment at all and had secondary IVT injections. Significant intraocular pressure increase was found in 8.2% of the PSTT group and in 24.3% of IVT injection. There was one case of pseudomonas endophthalmitis in the IVT group. CONCLUSION: This study is the first study comparing the clinical outcomes of PSTT and IVT injections for the treatment of DME. Both PSTT and IVT injections caused a significant increase in visual acuity and a decrease in central foveal thickness, especially in the short term. The effect was more pronounced in the IVT group; however, PSTT injection also seemed to be a safe and effective technique for the treatment of DME. Further prospective studies are warranted to assess the efficacy and side effects of IVT and PSTT injections for the treatment of DME.     

Corticosteroid Use for Diabetic Macular Edema: Old Fad or New Trend?

Diabetic retinopathy is the leading cause of blindness in working age individuals in developed countries. Most cases of diabetes related vision loss result from breakdown of the blood-retinal barrier with resultant diabetic macular edema (DME). For over 30 years, laser photocoagulation has been the standard therapy for DME, but most eyes do not experience significant improvements in visual acuity. Intravitreal injections of drugs that inhibit the action of vascular endothelial growth factor (VEGF) lead to gains in vision, but can be expensive and need to be repeated frequently. In addition to VEGF-mediated breakdown of the blood-retinal barrier, recent evidence suggests that inflammation plays an important role in the development of DME. Recognizing this, physicians have injected steroids into the vitreous and developers have created sustained release implants. Intravitreal injections of triamcinolone acetonide lead to rapid resolution of macular edema and significant short-term improvements in visual acuity, but unfortunately, visual acuities diminish when treatment is continued through 2 years. However, intravitreal triamcinolone remains an attractive treatment option for eyes that are pseudophakic, scheduled to undergo cataract surgery, resistant to laser photocoagulation, or require urgent panretinal photocoagulation for proliferative retinopathy. In controlled trials, intraocular implants that slowly release dexamethasone and fluocinolone show promise in reducing macular edema and improving visual acuity. The high incidences of drug related cataracts and glaucoma, however, require that corticosteroids be used cautiously and that patients be selected carefully. The increasing number of patients with DME, the burgeoning cost of medical care and the continuing development of intravitreal steroids suggest that the use of these agents will likely increase in coming years.     

Intravitreal triamcinolone for the treatment of diabetic macular edema

Diabetic macular edema is one of the leading causes of visual loss in first world countries and the first cause in diabetic retinopathy. The Early Treatment Diabetic Retinopathy Study showed a significant benefit in using focal laser photocoagulation for the treatment of macular edema, more specifically defined as clinically significant macular edema. Nevertheless, progressive visual loss is found in the 26% of patients with diabetic macular edema treated with photocoagulation. The failure of laser treatment and the destructive nature of the therapy has forced researchers to pursue new alternatives including vitrectomy with or without internal limiting membrane peels, the use of proteinkinase C inhibitors, intravitreal injections of antibodies that inhibit the vascular endothelial growth factor, somatostatin analog, or the intravitreal injection with corticosteroids. Triamcinolone acetonide is glucocoticosteroid with antiangiogenic and antiedematous properties. Publications evaluating the safety and efficacy of intravitreal injection of triamcinolone in the treatment of diabetic macular edema show varying outcomes with respect to the increases of visual acuity and decreases in foveal thickness. Despite this, intravitreal triamcinolone is a treatment that has evolved quickly and is considered increasingly useful.     

Anatomic and functional outcome after surgical removal of idiopathic macular epiretinal membrane

The purpose of this study is to investigate the functional and structural outcomes of surgical treatment of eyes with idiopathic macular epiretinal membrane (ERM). Clinical records of 21 patients (22 eyes) who underwent macular ERM removal with at least 6 months of postoperative follow-up period were reviewed retrospectively. All patients were treated with pars plana vitrectomy and ERM peeling surgery. Fourteen patients also underwent cataract surgery at the same time. Pre- and postoperative visual acuity (VA), intraocular pressure (IOP), and macular thickness along with postoperative adverse events were all recorded. The mean follow-up was 8.5 ± 3.2 months. Three eyes were pseudophakic and 19 eyes were phakic preoperatively. Five phakic eyes undergoing simple ERM peeling surgery had worsened cataracts, and vision was recovered after subsequent cataract extraction surgery. Mean preoperative IOP was 13.1 ± 4.2mmHg, which did not differ significantly postoperatively (p=0.228). One patient had increased IOP postoperatively and needed topical antiglaucoma treatment. Thirteen eyes showed visual improvement, and six eyes became worse during the follow-up. Mean preoperative best-corrected VA was 0.36 decimal equivalent, which was then converted to logarithm of the minimum angle of resolution (logMAR 0.502 ± 0.259) for statistical analysis; this had improved to a mean of 0.536 decimal equivalent (logMAR 0.38 ± 0.35) at the final follow-up. Mean central macular thickness (CMT) also significantly declined (p<0.0001). From an analysis of dividing patients into two subgroups according to clinical severity [macular pucker (MP) and cellophane maculopathy (CM)], measured mean CMT of both groups demonstrated significant reduction at final follow-up (MP, p<0.0001; CM, p=0.005). Mean final best-corrected VA also reached significant improvement in MP group (p=0.008). However, in the CM group, no significant change in VA was observed (p=0.52). Besides, VA measurements in the MP group had improved significantly to that of CM (p=0.037). The measured CMTs of the MP group had also reduced significantly (p=0.046) compared with those of the CM group. In conclusion, membrane peeling surgery can lead to a significant reduction of macular edema in patients with idiopathic macular ERM. The advantages of combined peeling and cataract surgery will achieve maximum positive visual outcome.     

两种不同方式治疗视网膜分支静脉阻塞继发黄斑水肿的meta分析

目的系统评价激光联合玻璃体腔注射雷珠单抗与单独玻璃体腔注射雷珠单抗治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿的疗效及安全性。方法通过检索PubMed、CNKI、万方等数据库收集有关治疗BRVO继发黄斑水肿的随机对照试验研究(RCT)。检索时间为建库至2019年5月。采用RevMan 5.3软件对纳入文献进行meta分析。结果共纳入12篇文献,包括1081例患者。meta分析结果显示:与单纯注药组相比,联合治疗组黄斑中心凹厚度(CMT)在随访1、3、6个月时均降低,差异有统计学意义[95%CI(-135.44^-15.54),P<0.001];但对于最佳矫正视力(BCVA)的提高,2组间无统计学差异[95%CI(-1.75~0.80),P>0.05];2组不良反应的发生率无统计学差异[OR=1.50,95%CI(0.97~2.30),P=0.07]。结论激光联合玻璃体腔注射雷珠单抗能够显著降低BRVO继发黄斑水肿患者的CMT,早期疗效优于单纯注药组。但两种方式对于治疗后BCVA的影响及不良反应的发生尚需要大样本的随机对照双盲研究加以验证。     

Aggravated capillary non-perfusion after intravitreal bevacizumab for macular edema secondary to systemic lupus erythematosus and anti-phospholipid syndrome

A 22-year-old female with history of systemic lupus erythematosus (SLE) was referred for evaluation of decreased visual acuity in her right eye. Her best-corrected visual acuity (BCVA) at the time of presentation was 20/160. Widespread cotton wool spots and macular edema were seen on biomicroscopy. Fluorescein angiography (FA) revealed retinal arterial and venous obstruction with capillary nonperfusion at the superotemporal retina. Antiphospholipid syndrome (APS) was diagnosed based on positive lupus anti-coagulant and ocular manifestations. Scattered laser photocoagulation was applied at the nonperfusion area but the visual acuity continued to deteriorate due to macular edema. Intravitreal bevacizumab (IVB) was administered for macular edema. One day after IVB, the BCVA decreased to count fingers. FA revealed extended non-perfusion from the superotemporal area to the posterior pole. Use of intravitreal bevacizumab for macular edema secondary to SLE or APS should be considered carefully and patients monitored closely for vascular complications.     

Results of intravitreal dexamethasone implant (Ozurdex®) for retinal vascular diseases with macular edema: An observational study of real-life situations

To evaluate the efficacy of intravitreal dexamethasone implants (Ozurdex^®) for the treatment of macular edema (ME) associated with retinal vascular diseases in real-life situations.This retrospective study included patients with ME associated with retinal vascular occlusion (RVO) or diabetic macular edema (DME) treated with dexamethasone implants. Demographic data, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) at baseline and at 1, 3, and 6 months postoperatively were collected and analyzed, and the adverse events were recorded.Forty-four eyes, 42 patients were included in the study. The mean logMAR BCVA improved from 0.79 ± 0.38 at baseline to 0.60 ± 0.34 (P < 0.001), 0.72 ± 0.38 (P = .002), and 0.72 ± 0.37 (P = .002) at 1, 3, and 6 months, respectively. The CRT decreased from 526.70 ± 159.58 µm at baseline to 279 ± 66.23, 422.91 ± 206.99, and 350.23 ± 151.51 µm at 1, 3, and 6 months, respectively (P < 0.001, all visits). The average number of injections was 1.43 ± 0.5. Nineteen eyes (43.18%) received second injections at an interval of 4.20 ± 0.61 months. The mean logMAR BCVA was greater in RVO than in DME patients and in treatment-naïve eyes than in previously treated ones. The baseline CRT of the reinjection group was significantly higher than that of the single-injection group for both the RVO (P < 0.001) and DME groups (P = .002). Nine eyes (20.45%) with increasing intraocular pressure (IOP) were well controlled with medication, and cataract progression was observed in five eyes (21.73%) during follow-up.The dexamethasone implant was effective for the treatment of macular edema secondary to RVO and DME in terms of visual acuity and CRT improvement over 6 months. The visual acuity was greater in the RVO and treatment-naïve eyes. Reinjection may be associated with a high baseline CRT. The increase in the occurrence of IOP and cataract progression was similar to that reported in previous studies.     

糖尿病视网膜病变黄斑厚度定量分析

目的：研究糖尿病视网膜病变（DR）患者黄斑水肿情况及与荧光渗漏和视功能关系。方法：应用视网膜厚度分析仪（RTA）对18例（25眼）单纯型糖尿病视网膜病变的黄斑区视网膜进行扫描并对其厚度进行定量测量，并与荧光造影结果及视力进行对比分析，结果：RTA检查可清晰的观察到DR患者黄斑区的形态改变；矫正视力负对数之间呈现正相关关系。结论：DR患者黄斑区毛细血管渗漏与组织再吸收失衡是引起黄斑水肿的关键因素，黄斑水肿是导致视力下降的重要原因，RTA检查可为糖尿病黄斑水肿提供客观和精确的诊断依据。     

Difference in the efficacy of intravitreal dexamethasone implant before and after silicone oil removal: A case report

Rationale:An intravitreal dexamethasone (IV-DEX) implant is safe and effective for the treatment of macular edemas; however, the efficacy of IV-DEX implants in silicone oil (SO)-filled eyes remains controversial. There is no previous study comparing an IV-DEX implant in the same eye with and without intravitreal SO.Patient concerns:A 72-year-old man with proliferative diabetic retinopathy, macular edema, and rhegmatogenous retinal detachment, treated with pars plana vitrectomy with SO tamponade had refractory macular edema.Diagnosis:Refractory macular edema.Intervention:Subtenon triamcinolone injection, intravitreal anti-vascular endothelial growth factor injection, and IV-DEX implantation were performed; this was followed by intravitreal SO removal combined with IV-DEX implantation.Outcomes:The macular edema did not decrease significantly with posterior subtenon triamcinolone injection, intravitreal anti-vascular endothelial growth factor injection, and IV-DEX implantation; however, the edema was relieved after SO removal and a new IV-DEX implantation.Lessons:IV-DEX implant may be less efficacious in the treatment of macular edema in an SO-filled eye than that in a normal vitreous cavity.     

Quantitative measurement of retinal thickness in patients with diabetic macular edema is useful for evaluation of therapeutic agents

The effect of lisinopril (an angiotensin-converting enzyme inhibitor) on diabetic macular edema (DME) was investigated by quantitative measurement of macular thickness. In a nonrandomized clinical trial, 19 normotensive type 2 diabetic patients with DME prospectively received oral lisinopril therapy for 2 months. Another 10 normotensive type 2 diabetic patients with similar DME were prospectively followed for two months without treatment. Central macular thickness was measured with a retinal thickness analyzer (RTA). In the lisinopril group, visual acuity improved by two lines or more in two out of 19 eyes (11%), was unchanged in 15 eyes (78%), and deteriorated by two lines or more in two eyes (11%). The mean central macular thickness was significantly reduced after 2 months of treatment (381.3 +/- 121.1 microm) compared with that before administration (475.2 +/- 171.0 microm, P = 0.0093). In the control group, central macular thickness was not significantly decreased after 2 months (458.5 +/- 113.7 microm, P = 0.2178) compared with the baseline value (464.7 +/- 152.2). Fluorescein angiography showed that macular leakage was decreased in 10 patients from the lisinopril group (53%) and was unchanged in nine patients (47%). There was a significant difference of central macular thickness between the patients with and without improvement of macular leakage (P = 0.0040). Lisinopril therapy may reduce macular thickness in patients with DME, as shown by this quantitative study. In addition, quantitative measurement of retinal thickness is useful when evaluating therapeutic agents for DME.     

Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination: Case reports

Rationale:In this paper, we report on 2 patients who developed branch retinal vein occlusion (BRVO) exacerbation 1 day after administration of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine.Patient concerns:Case 1: A 71 year-old female developed vision loss in her left eye 1 day after receiving a second dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal inferior BRVO and secondary macular edema (ME) in her left eye. ME resolved after 3 doses of intravitreal aflibercept (IVA). After treatment, no recurrence of ME was observed.Case 2: A 72 year-old man developed vision loss in his right eye 1 day after receiving the first dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal superior BRVO in the right eye without ME. The patient was followed up and did not undergo any additional treatment.Diagnoses:Case1: Temporal superior BRVO and secondary ME were observed in the left eye. Her best-corrected visual acuity (BCVA) was 20/30.Case2: Temporal superior BRVO recurrence and secondary ME were observed in the right eye. BCVA was 20/25.Interventions:Case1: Additional dose of IVA was administered. Case2: Two times of Intravitreal ranibizumab was administered twice.Outcomes:Case1: Subsequently, ME resolved BCVA was 20/20. Case2: Subsequently, ME resolved BCVA was 20/25.Lessons:Both cases showed a possible association between SARS-CoV-2 vaccination and the exacerbation of BRVO.     

Bilateral Trichosporon asahii keratitis after ptosis correction: A case report

Rationale:Fungal keratitis (FK) is a severe vision-threatening disease that can lead to corneal perforation or endophthalmitis despite proper treatment. It is important to diagnose the disease promptly due to its indolent nature and disproportionate disease symptoms. Trichosporon asahii is reported rarely as the causative organism of FK. We report a case of highly unusual bilateral T asahii keratitis following ptosis surgery.Patient concerns:An 86-year-old female underwent bilateral levator resection surgery for ptosis. Postoperatively, the patient complained of gradually worsening bilateral ocular pain and a decrease in visual acuity associated with a chronic non-healing epithelial defect.Diagnoses:Both eyes of the patient were evaluated using best-corrected visual acuity, intraocular pressure, slit-lamp examination, fundus examination, and corneal culture. Multifocal deep stromal infiltrates were found in both corneas. Cultures from both corneal ulcers revealed growth of T asahii. Optical coherence tomographic examination showed bilateral macular edema.Interventions:The patient was treated with revisional ptosis surgery, an antifungal agent for the corneal ulcer, and intravitreal injection of steroid for macular edema.Outcomes:Both eyes recovered well. Her best-corrected visual acuity improved from 20/200 to 20/40 in the right eye and from 20/100 to 20/40 in the left eye.Lessons:FK can develop in the cornea when certain risk factors are present, including recent lid surgery, chronic keratitis, and steroid eye drop use. Identification and correction of risk factors can be beneficial in the treatment of FK.     

Elevation of intraocular pressure after intravitreal injection of triamcinolone acetonide in Taiwanese patients

The purpose of this study was to investigate the incidence and timing of elevation in intraocular pressure (IOP) after intravitreal injection of triamcinolone acetonide (IVTA). This was a retrospective observational case series that included 52 eyes from 52 patients. All patients received intravitreal injection with 4 mg of triamcinolone acetonide. Significant IOP elevation was defined as pressure greater than 21 mmHg. There were 26 males and 26 females included in this study. The mean age was 59.4 years. The mean IOP at baseline and postoperative mean highest IOP were 14.6 mmHg and 21.5 mmHg, respectively. There were 19 (36.5%) patients who experienced significant IOP elevation at a mean of 26.0 days after IVTA. IOP was well-controlled by topical antiglaucoma medication in 17 of these 19 patients. IOP elevation after intravitreal injection with 4 mg of triamcinolone acetonide is not a rare finding. This phenomenon usually starts approximately 1 month after IVTA. Patients considering this treatment should be fully informed of this known adverse effect.     

雷珠单抗治疗老年患者视网膜静脉阻塞继发黄斑水肿的临床观察

目的分析玻璃体腔注射雷珠单抗对老年视网膜静脉阻塞(RVO)继发黄斑水肿(ME)患者的疗效。方法回顾性研究2018年1月—2019年12月,复旦大学附属华东医院眼科收治的37例(37眼)老年RVO继发ME确诊患者。所有患者均接受3+PRN治疗方案,玻璃体腔注射雷珠单抗。分别于治疗前和治疗后1、3、6个月时,检测患者最佳矫正视力(BCVA);通过光学相干断层扫描分析患眼黄斑中心凹视网膜厚度(CMT)、黄斑区平均视网膜厚度(MMT)及黄斑中心体积(CMV)的变化情况。结果与治疗前比较,治疗后1、3和6个月患者的平均BCVA改善(χ²=37.70,P<0.05),CMT(F=22.06,P<0.01)及MMT变薄(F=30.75,P<0.01),CMV减小(F=27.57,P<0.01)。研究期间2例患者出现球结膜下出血,未见其他严重不良反应。结论玻璃体腔注射雷珠单抗治疗能一定程度上提高老年RVO继发ME患者的视力,减轻ME,有助于恢复患者的视网膜正常结构。     

Treatment of macular holes with indocyanine green-assisted retinal internal limiting membrane peeling

Removal of the internal limiting membrane (ILM) has been proposed as a useful surgical approach to enhance the closure of macular holes and the adjuvant indocyanine green (ICG) staining has been reported to facilitate ILM peeling. This study attempts to determine the efficacy and safety of ICG-assisted retinal ILM peeling in macular hole surgery. Seventeen eyes of 16 patients with stage 3 or 4 macular holes were included. All eyes underwent a pars plana vitrectomy, including the peeling of the posterior cortical hyaloid when necessary. ICG dye (0.5%) was instilled into the posterior vitreous cavity and left in place for 30 seconds. The retinal ILM was peeled after ICG removal. The procedure was completed with an intraocular tamponade (16% perfluoropropane), after which the patient remained in a face-down position for 1-2 weeks. ICG staining greatly facilitated the surgeon's ability to visualize and peel the ILM during surgery. Anatomic closure of the macular hole was achieved in 15 eyes (88.2%). However, the postoperative best-corrected visual acuity improved by two or more Snellen lines in only three eyes, remained the same in 13 eyes, and deteriorated in one eye. There was no statistically significant improvement in postoperative visual acuity. In conclusion, while ICG facilitates ILM peeling by providing a stark contrast between the stained ILM and the unstained retina, our results revealed that ICG might cause retinal damage and hinder visual acuity improvement.     

血管内皮生长因子在糖尿病眼部并发症中的作用探讨

目的分析评价血管内皮生长因子在糖尿病咽部并发症中的价值作用。方法将该院2017年2月—2018年2月收治的100例糖尿病眼部病变患者分成两组,每组50例;对照组患者采取曲安奈德注射液治疗,观察组患者采取血管内皮生长因子药物中的康柏西普玻璃体腔注药治疗,比较两组临床治疗效果。结果在眼部并发症总发生率方面,观察组比对照组明显更低。在最佳矫正视力下降率、最佳矫正视力不变率方面,观察组明显低于对照组。在最佳视力矫正提高率方面,观察组明显高于对照组。结论针对糖尿病眼部病变患者,采取血管内皮生长因子治疗具备显著的疗效,可预防眼部并发症的发生;值得采纳及应用。     

普罗布考治疗非增殖型糖尿病视网膜病变临床观察

目的 研究普罗布考对2型糖尿病非增殖型糖尿病视网膜病变患者血脂、抗氧化能力、视功能及眼底形态的影响,为普罗布考防治早期糖尿病视网膜病变提供临床依据.方法 纳入66例伴非增殖型糖尿病视网膜病变的2型糖尿病患者127眼,随机分为对照组和治疗组,对照组进行强化降血糖和降血压治疗,治疗组在强化治疗基础上口服普罗布考0.375 g,每天2次,总疗程为12个月.治疗前后两组患者均进行了血脂、血清总抗氧化能力、视力、眼底及眼底荧光血管造影检查.结果 共有62例120眼完成研究,普罗布考显著降低了患者总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平,显著提高患者总抗氧化能力和视力(P<0.01),明显改善患者眼底微血管瘤、出血及渗出,且显著降低患者眼底黄斑水肿(P<0.05),对于减少毛细血管无灌注区也有一定作用.结论 普罗布考对于非增殖型糖尿病视网膜病变患者除了降脂作用外,还可提高患者总抗氧化能力,改善患者视功能,降低患者视网膜微血管病变及降低患者黄斑水肿发生率,提示普罗布考对非增殖型糖尿病视网膜病变患者具有一定的治疗作用.     

Comparison of two different scleral fixation techniques of posterior chamber Carlevale lens

To investigate the surgical outcomes of 2 different scleral fixation techniques of the new single-piece foldable acrylic Carlevale lens (Soleko) and to compare our results with previous reports of the literature.A retrospective, non-randomized comparative study involving 2 series of patients who underwent 2 different scleral fixation techniques of Carlevale lens was performed. Minimum follow-up of 3 months was requested for inclusion in the study. All the patients underwent a standard ophthalmologic examination including best correct visual acuity, measurement of intraocular pressure, anterior segment, and fundus examination. In the first technique (group 1), plugs were externalized through a 23 gauge sclerotomy and placed within 2 scleral pockets. In the second technique (group 2), plugs were externalized through a 25-gauge sclerotomy and covered by 2 scleral flaps. For an estimation of the refractive prediction error, the postoperative spherical equivalent of objective refraction was calculated (IOL Master 750, Carl Zeiss Meditec AG, Jena, Germany). Spectral domain optical coherence tomography (Spectralis HRA+OCT2, Heidelberg Engineering, Heidelberg, Germany) of anterior segment was used to check plugs positioning postoperatively.Twenty-three eyes in group 1 and 9 eyes in group 2 were included. Preoperative diagnosis was aphakia, dislocated posterior chamber intra ocular lens, dislocated lens, anisometropia, Uveitis-Glaucoma-Hyphema syndrome, perforating trauma with dislocated intra ocular lens, and open globe injury with dislocated intra ocular lens. Respectively, in groups 1 and 2, refractive spherical equivalent prediction error was –0,31 ± 0,74 D and –0,27 ± 0,80 D, and postoperative best-corrected visual acuity was 0,42 ± 0,31 logMAR and 0,47 ± 0,45 logMAR. In group 1, 1 eye developed cystoid macular edema, 1 eye vitreous haemorrhage, and 3 eyes showed plugs located outside the scleral pockets under the conjunctiva. Rupture of 1 of the 2 tips of the plug was observed in 1 patient of group 1 during the externalization.Carlevale lens is a scleral fixated intra ocular lens specifically designed for posterior chamber implantation that could be successfully managed without any significant difference between the 2 surgical techniques, and appears approachable for anterior and posterior segment surgeons. A 25-gauge sclerotomy should be preferred with the aim of a sutureless surgery regardless the technique employed.     

Evaluation of Intravitreal Ranibizumab on the Surgical Outcome for Diabetic Retinopathy With Tractional Retinal Detachment

This study aims to investigate intravitreal injection of Ranibizumab on the surgical outcome for diabetic patients who had tractional retinal detachment but did not receive any preoperative retinal photocoagulation.Ninety-seven patients (97 eyes) who had diabetic retinopathy with tractional retinal detachment were enrolled to receive 23-G pars plana vitrectomy (PPV). They were assigned to an experimental group (Group I, n = 47 eyes) and a control group (Group II, n = 50 eyes). The patients in Group I were given 1 injection of intravitreal Ranibizumab (Lucentis 0.5 mg/0.05 mL) 1 week before surgery, whereas those in Group II went down to surgery directly. Follow-ups were performed for 6 months to 3 years (16 ± 6 months), and indicators observed included postoperative best-corrected visual acuity, complications, and retinal thickness in the macula measured by optical coherence tomography.In Group I, BCVA improved from logMAR 1.92 ± 0.49 to logMAR 0.81 ± 0.39 following surgery, whereas in Group II, BCVA improved from logMAR 1.91 ± 0.49 to logMAR 0.85 ± 0.41. There was significant postoperative gain in vision, but there was no significant difference between the 2 groups at postoperative follow-up visits. The mean duration of vitrectomy in Group I and Group II was (40 ± 7) minutes and (53 ± 9) minutes, respectively, with significant difference. Iatrogenic breaks were noted in 5 eyes (11%) in the experimental group and 17 eyes (34%) in the control group; the difference was significant. The retinal thickness in the macula measured by OCT was (256 ± 44) μm and (299 ± 84) μm in Group I and Group II respectively with significant difference. Besides, there were significantly more eyes in Group II that required silicone oil tamponade and postoperative retinal photocoagulation.23-G PPV combined with intravitreal tamponade and panretinal photocoagulation still remains an effective regimen for the treatment of diabetic retinopathy complicated with tractional retinal detachment. Preoperative intravitreal injection of Ranibizumab could shorten surgical duration, reduce intraoperative complications, and sometimes spare the need for silicone oil tamponade and postoperative retinal photocoagulation, alleviating patients’ suffering from surgery.