Transluminal Nd: YAG laser embolysis for branch retinal artery occlusion: Case report

Rationale:Central retinal artery occlusion and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision; to date there is no effective therapy for central retinal artery occlusion and BRAO. Transluminal Nd:YAG laser embolysis (TYE) could represent a therapeutic approach for retinal vascular occlusive diseases.Patient concerns:We report 2 cases with BRAO, 1 with inferor-temporal and 1 with superor hemiretinal BRAO. All the patients complained of a history of sudden blurry vision and impaired visual field and had a visible embolus within the intravascular, all of them treated with TYE, the laser applications being delivered directly to the embolus.Diagnosis:The diagnosis was based on the results from color retinography, optical coherence tomography and visual field testing. Fundus fluorescein angiography clearly indicated the location of retinal artery occlusion.Interventions:The patients’ symptoms could not be relieved after dilating the blood vessels in the eye, lowering intraocular pressure, massaging the eyeball, and inhaling oxygen. Informed consent was obtained from the patient for TYE and the patients were referred for this procedure.Outcomes:Upon the successful competition of the TYE procedure the embolus was removed completely, restoring the blood flow in the intraocular vessels and improving significantly the patients’ visual acuity.Lessons:World-wide experience with TYE is still limited, but the technique seems feasible for the treatment of RAO caused by visible emboli on the optic disc surface and the posterior pole of the fundus oculi.     

The laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion: A protocol for systematic review and meta-analysis

Background:At present, laser is regarded as an effective treatment for macular edema secondary to branch retinal vein occlusion. With the breakthrough of anti-vascular endothelial growth factor drugs in ophthalmology clinical research, the intravitreal injection of ranibizumab is widely applied, but both methods have their limitations, so some clinical studies have combined and applied them together. However, the clinical results are inconsistent and controversial, and there is no relevant system evaluation for the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion now.Objective:Meta analysis is used to analyze and evaluate the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion.Method:CNKI, VIP, WANFANG, China Biology Medicine disc, Web of Science, PubMed, Embase, Cochrane Library have used random controlled clinical trial of laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion from the establishment of the database to October 2020. Two researchers conducted independent screening, quality assessment and data extraction for the literatures, and used RevMan5.3 to conduct Meta analysis for the included literatures.Result:The research has evaluated the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion through the aspects of the best corrected visual acuity 6 months after operation, macular center thickness and the incidence of adverse reactions such as elevated intraocular pressure, endophthalmitis, vitreous hemorrhage and cataract.Conclusion:Laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion has good effect, and the research has provided reliable evidence for the use of clinical treatment of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion.     

Protein Z levels and central retinal vein or artery occlusion

OBJECTIVES: Central retinal vein occlusion (CRVO) and central retinal artery occlusion (CRAO) are common disorders associated with risk factors for atherosclerosis. Protein Z is a cofactor for the inactivation of activated factor X (Xa) by the protein Z dependent protease inhibitor. Protein Z deficiency was recently linked to increased risk of arterial thrombosis. We investigated whether CRVO and CRAO are associated with low protein Z levels. PATIENTS AND METHODS: Patients with CRVO, CRAO or recurrent branch retinal vein occlusion were recruited to the study. Protein Z level, lupus anticoagulant (LAC), anticardiolipin antibodies (ACA) and activated protein C resistance (APCR) were determined in plasma from patients (n = 36) and healthy controls (n = 42). RESULTS: Thirty patients in the study group had traditional risk factors for retinal vessel occlusion and six patients had none. There was no significant difference in protein Z levels between the whole study group patients and controls (1995 +/- 810 vs. 2010 +/- 603 ng/mL, P = 0.922). However, patients with no risk factors for retinal vessel occlusion had significantly lower protein Z levels than controls (1379 +/- 682 vs. 2010 +/- 603 ng/mL, P = 0.022). Positive LAC was found in six patients and one control subject (P = 0.04). There were three patients and one control subject with abnormal APCR (P = 0.3) and none with positive ACA. Low protein Z level (lower than fifth percentile of control) was not associated with the presence of LAC or APCR. CONCLUSION: Low protein Z level may be another risk factor for retinal vessel occlusion in patients without traditional risk factors for these disorders.     

27G玻璃体切除术治疗视网膜分支静脉阻塞继发玻璃体积血的临床疗效和安全性探讨

目的探讨27G玻璃体切除术治疗视网膜分支静脉阻塞继发玻璃体积血的临床疗效及安全性。方法回顾性分析27G玻璃体切除治疗视网膜分支静脉阻塞所致玻璃体积血患者33例(33眼)的临床资料,术后随访1个月。对比术前、术后1周和1个月的最佳矫正视力(best corrected visual acuity,BCVA)和眼压变化,记录玻璃体切除时间、切口缝合和渗漏情况,术中及术后并发症等情况。结果玻璃体切除平均时间为(16.30±4.10)min。术后1周和1个月术眼的BCVA均较术前提高,差异有统计学意义(P均<0.01),术后1个月较术后1周的BCVA有提高,差异有统计学意义(P<0.05)。术眼术前、术后1周和1个月的平均眼压分别为(16.39±3.46)mmHg(1 mmHg=0.133 kPa)、(15.37±2.32)mmHg和(16.69±2.45)mmHg,差异无统计学意义(P>0.05)。所有患眼术毕均无需缝合巩膜穿刺口。术中发生视网膜医源性裂孔1眼。随访期间发生高眼压2眼,低眼压1眼,经合理处理后眼压均恢复正常。其余患者在术中和术后随访均未见眼部或全身不良反应。结论采用27G玻璃体切除术治疗视网膜分支静脉阻塞继发的玻璃体积血是安全有效的,少有术中及术后并发症。     

Significant vision improvement and successful prevention of recurrence by electroacupuncture in hemiretinal vein occlusion combined with macular edema: A case report

Rationale:Retinal vein occlusion (RVO) is the second commonest retinal vascular pathology, with macular edema (ME) as one of its major complications, which could finally cause vision loss. Anti-vascular endothelial growth factor (anti-VEGF therapy), as the standard therapy, has an unsustainable effect and needs repeated injections, which associates with frequent adverse events and significant economic burden. We reported a patient who had developed RVO and ME, and finally recovered after electroacupuncture treatment.Patient concerns:A 56-year-old woman complained a decrease of visual acuity in the right eye for 1 year. She received injection of 0.5 mg Conbercept, one of the anti-VEGF therapies, in the vitreous cavity 6 times in 1 year, and finally turned to acupuncture for help out of short-term effectiveness after each injection and high expenditure (CNY 40,800). No other severe medical history was reported.Diagnosis:Under comprehensive consideration of clinical manifestations and the results of fluorescein fundus angiography and optical coherence tomography, the patient was diagnosed with hemi-RVO and ME.Interventions:The patient received electroacupuncture 3 sessions per week throughout 8 months (93 sessions in total).Outcomes:The visual acuity of the patient was improved from 0.6 to 0.9 after the 8-month electroacupuncture treatment and remained stable during the 24-month follow-up; the central retinal thickness remained stable between 350 and 414 throughout the treatment and follow-up periods. Patients regarded the vision-related quality of life as satisfactory. The total expenditure of electroacupuncture treatment was CNY 6045. The patient did not receive any Conbercept injection over the whole period of 32 months. No relevant adverse events occurred.Lessons:Electroacupuncture might be effective in alleviating the symptoms of hemi-RVO-associated ME, with a potential of long-lasting effect. The frequency of anti-VEGF therapy could be reduced to the most extent, and the possibility of recurrence could be reduced as well, resulting good economic benefits.     

Central retinal vein occlusion and cerebellar infarction complicating systemic lupus erythematosus: a case report

We treated a 17-year-old woman who had systemic lupus erythematosus (SLE) complicated by central retinal vein occlusion (CRVO) and bilateral cerebellar infarction in the absence of demonstrable antiphospholipid antibodies. General fatigue, diffuse polyarthralgia, malar rash, and fever had developed during the 2 weeks preceding admission. The patient was diagnosed with SLE based on the presence of pleuritis, oral ulceration, pancytopenia, and antinuclear antibodies. Despite intravenous pulse therapy with methylprednisolone, blindness developed in the left eye and bilateral cerebellar infarcts were evident on magnetic resonance images. Fluorescein angiography revealed extensive retinal venous thrombosis leading to widespread retinal vein leakage, and a diagnosis of CRVO. Received: May 15, 2000 / Accepted: January 15, 2001     

Impact of retinal vein occlusion on cardiovascular events in elderly Japanese patients

To assess the relationship between retinal vein occlusion (RVO) and the incidence of cardiovascular (CV) events.This was a single-institution, retrospective cohort study. We enrolled 57 patients diagnosed with RVO between January 2012 and December 2019, and 125 non-RVO patients who had undergone cataract surgery by a single surgeon between January and April 2012. We compared the relative risk and incidence rate ratio of CV events between the 2 groups. In addition, survival analysis was performed to calculate the hazard ratio (HR) using the Cox proportional hazards model. RVO, age, sex, blood pressure, body mass index, presence of diabetes, blood sample data, and smoking were considered confounders.The mean observation period (± standard deviation) for the RVO and non-RVO groups was 2.68 ± 2.04 and 2.81 ± 2.70 years, respectively. Seven CV events were observed in the RVO group and 2 in the non-RVO group. Relative risk and incidence rate ratio were 7.68 (95% confidence interval [CI]: 1.65–35.8) and 8.07 (95% CI: 1.54–79.6), respectively. Multivariate analysis revealed that the RVO group had a high HR for CV events (HR: 16.13 [95% CI: 2.29–113.74]) and older age (HR: 1.26 [95% CI: 1.06–1.49]).RVO can predict future CV events, especially in the elderly population. Fundus observations should be shared between ophthalmologists and internists to prevent future CV events.     

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。     

全视网膜光凝治疗不同阶段缺血型视网膜中央静脉阻塞的疗效分析

目的：评价全视网膜光凝（PRP）治疗对不同阶段缺血型视网膜中央静脉阻塞（CRVO）的疗效。方法2011年6月至2014年4月来上海交通大学医学院附属仁济医院眼科门诊通过视功能、裂隙灯、扩瞳眼底及眼底荧光血管造影（FFA）检查诊断为缺血型CRVO的患者,根据激光治疗时是否存在虹膜新生血管（INV）将患者分为无INV的A组（34眼）和已出现INV的B组（7眼）。所有患者均接受PRP治疗,并根据病情变化和FFA的结果在随访中予补充光凝。随访6个月～3年,平均（19.3±8.5）个月,观察PRP在减少和预防缺血型CRVO严重并发症及光凝等方面的差异。结果 A、B两组患者在发病年龄上差异无统计学意义（P＞0.05）。经PRP治疗后, B组患者最终的激光次数和总光凝点数均显著多于A组（P＜0.05）;B组患者新生血管性青光眼（NVG）的发生率较高（P＜0.05）,但两组间的玻璃体出血（VH）的发生率差异无统计学意义（P＞0.05）;两组患者在治疗前后的视力差异无统计学意义（P＞0.05）。结论本研究提示缺血型CRVO患者在没有出现INV之前进行PRP,最终严重并发症的发生率相对较低,所需光凝次数和点数均较少。     

Relapse of cryoglobulinemic vasculitis with new-onset severe renal involvement in two patients following mRNA COVID-19 vaccination: A case report

Rationale:Since mass-scale severe acute respiratory syndrome coronavirus 2 vaccination, there have been case reports of several immune-mediated reactions, including new-onset and flares of glomerular disorders following immunization with mRNA coronavirus disease 2019 vaccines. Here, we report two cases, the first to our knowledge, of relapsing cryoglobulinemic vasculitis with new-onset severe renal involvement following mRNA coronavirus disease 2019 vaccination.Patient concerns:The relapse of the cutaneous and the new onset of severe renal involvement of cryoglobulinemic vasculitis occurred three weeks after the second dose of the mRNA Moderna coronavirus disease 2019 vaccination and two days after the first dose of mRNA Pfizer coronavirus disease 2019 vaccination in the first and second patient, respectively.Diagnosis:Kidney biopsies were performed. The first pacient''s kidney biopsy showed a membranoproliferative pattern of glomerular injury with extensive mesangial and endocapillary hypercellularity, while severe endothelial swelling, loss of fenestrations and widening of subendothelial space were identified by electron-microscopy. The second patient''s kidney biopsy was consistent with cryoglobulin associated membrano-proliferative pattern of glomerular injury.Interventions:Our patients were managed with a combination of immunosuppressants consisting of corticosteroids, Cyclophosphamide and Rituximab with a favourable outcome at the end of the induction period.Outcomes:Clinical and immunological response was achieved in both patients after four months of follow-up.Lessons:The temporal association of the relapse of the cryoglobulinemic vasculitis to mRNA coronavirus disease 2019 vaccination suggest that the vaccine might have been a trigger for the reactivation of the disease in our cases. This possible association should be acknowledged by physicians in order to provide optimal monitoring and treatment in case of reactivation of the disease post-immunization.     

Hypertension as a risk factor for retinal vein occlusion in menopausal women: A nationwide Korean population-based study

Retinal vein occlusion (RVO) is an important cause of blindness. Hypertension is a well-known risk factor for RVO. Although the prevalence of hypertension increases in women after menopause, the relationship between blood pressure and RVO in women before and after menopause has not been studied in detail.We retrospectively analyzed 2,619,206 patients from the Korean National Health Insurance System database. A Cox proportional hazard regression model was used to evaluate the independent association between blood pressure and the risk of RVO development and identify differences between premenopausal and postmenopausal women.The incidence of RVO was higher among postmenopausal women than in premenopausal women. In the model adjusted for socioeconomic and clinical variables, there was an association between blood pressure and RVO development in premenopausal and postmenopausal women; however, this was stronger than premenopausal women.Both systolic and diastolic blood pressure are associated with an increased risk of RVO, and their effects are more potent in premenopausal women than postmenopausal women. Thus, comprehensive management of hypertension in premenopausal women is essential to reduce the risk of RVO.     

Reports of anaphylaxis after coronavirus disease 2019 vaccination,South Korea, 26 February to 30 April 2021

The South Korea mass vaccination programme administered 3.8 million doses of COVID-19 vaccinations between 26 February and 30 April 2021. After 173 suspected anaphylaxis reports to the nationwide monitoring system for adverse events following immunisation, 44 anaphylaxis cases were confirmed using Brighton Collaboration case definitions. The rates per million doses were 18.2 cases and 6.2 cases for Vaxzevria and Comirnaty, respectively. Median time of onset was 14 min after vaccination and most cases had recovered at the time of review.     

Antithrombotic treatment of retinal vein occlusion: a position statement from the Italian Society on Thrombosis and Haemostasis (SISET)

Retinal vein occlusion (RVO) represents a common cause of visual impairment and blindness. RVO may be associated with both local (e.g., hyperopia, glaucoma) and systemic (e.g., hypertension, diabetes, smoking, obesity, and dyslipidaemia) risk factors. The association with thrombophilia remains controversial. Data on the use of antithrombotic therapy for RVO are poor and inconsistent with most of the information being derived from observational studies. Here we provide a position statement from the Italian Society on Thrombosis and Haemostasis (SISET) to guide the clinical and therapeutic management of patients with RVO based on the available evidence and expert opinion.     

Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature

Rationale:Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations.Patient concerns:A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac–Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers.Diagnoses:Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies.Interventions:A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions.Outcomes:Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge.Lessons:This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.     

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。     

Acute pancreatitis soon after COVID-19 vaccination: A case report

Rationale:In response to the global coronavirus infectious disease 2019 (COVID-19) pandemic, several vaccines against severe acute respiratory syndrome coronavirus 2 have been developed. Although many infrequent side effects of COVID-19 mRNA vaccine have been reported, only a few cases of pancreatitis have been reported.Patient concerns:A 71-year-old woman was presented to the hospital with upper abdominal pain and vomiting. She had no history of alcohol consumption, pancreatitis, or allergic reactions to vaccines. She had received the first dose of the Pfizer/BioNTech COVID-19 mRNA vaccine 2 days prior to her current presentation. Laboratory tests revealed elevated serum pancreatic enzymes. An abdominal computed tomography scan showed diffuse enlargement of the pancreas with fat stranding extending to below the kidneys bilaterally.Diagnosis:The patient was diagnosed with acute pancreatitis.Interventions:The patient was treated with the administration of intravenous antimicrobials, proteolytic enzyme inhibitors, and proton pump inhibitors.Outcomes:The patient had an uneventful recovery with no complications.Lessons:Acute pancreatitis can develop shortly after COVID-19 mRNA vaccination. Therefore, of great importance to differentiate acute pancreatitis when abdominal pain occurs after COVID-19 mRNA vaccination.     

Low molecular weight heparin for the treatment of retinal vein occlusion: a systematic review and meta-analysis of randomized trials

Retinal vein occlusion is a frequent cause of visual loss for which few effective therapies are available. Anticoagulation with low molecular weight heparin might be of value in its treatment. We conducted a systematic review and meta analysis of randomized trials evaluating the effect of low molecular weight heparin in patients with retinal vein occlusion. Data sources included MEDLINE, EMBASE, HealthSTAR, the Cochrane Library, Lilacs, the Investigative Ophthalmology and Visual Science database and gray literature. Main outcome was the mean difference between the visual acuity measured at baseline and at six months expressed in the logMAR scale. Secondary outcome was a composite of any adverse ocular outcome including: worsening of visual acuity, visual fields or fluorescein angiography, or development of iris neovascularization, any neovascularization or neovascular glaucoma. Subgroup analyses for branch versus central retinal vein occlusion were conducted. We identified 1,084 references of which 3 studies comparing low molecular weight heparin with aspirin (229 evaluable patients) were included. Overall, the pooled mean visual acuity difference was −0.23 logMAR (95% CI −0.38, −0.09; P=0.002) in favor of low molecular weight heparin. Low molecular weight heparin was associated with a 78% risk reduction for developing any adverse ocular outcome (pooled RR 0.22; 95% CI 0.10, 0.46; P<0.001). In subgroup analyses benefits seemed lower in branch retinal vein occlusion. No increased vitreous hemorrhages were observed. In patients with retinal vein occlusion treatment with low molecular weight heparin seems to be associated with improvement in the visual acuity and less adverse ocular outcomes. These benefits might differ in patients with central as opposed to branch retinal vein occlusion. Further studies are required to confirm these findings and clarify its benefits in specific subgroups of patients before definitive recommendations can be made.