Arteriovenous crossing sheathotomy versus intravitreal triamcinolone acetonide injection for treatment of macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the functional and anatomical outcomes of arteriovenous (AV) sheathotomy and intravitreal triamcinolone acetonide (IVTA) injection in the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Forty eyes of 40 patients with macular edema secondary to BRVO were randomized into two treatment groups. A total of 20 patients received AV sheathotomy (sheathotomy group), and the second group of 20 patients was treated with IVTA (IVTA group). Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) score, total macular volume measured, and foveal thickness by 3rd generation optical coherence tomography (OCT3) were evaluated as main outcome measurements. RESULTS: The average changes in ETDRS scores, total macular volumes, and foveal thicknesses compared to baseline values, were significant 3 months and 6 months after treatment in both groups (P < 0.05, paired t-test), but only the IVTA group showed significant improvements 1 month after treatment. The between-group differences in average ETDRS score, total macular volume, and foveal thickness changes were significantly better at 1 month after treatment in the ITVA group (P = 0.026, P < 0.001, P = 0.001, respectively, Student's t-test), at which time IVTA patients had better vision and anatomical outcomes than did those in the sheathotomy group. CONCLUSIONS: After either AV sheathotomy or IVTA treatment, patients with macular edema secondary to BRVO showed similar functional and anatomical outcomes 6 months later. When the cost and the risks of vitreoretinal surgery are considered, IVTA treatment may be a better treatment option, as the drug yields better short-term outcomes.     

Natural history of macular status in recent-onset branch retinal vein occlusion: an optical coherence tomography study

Purpose: To evaluate serially the course of structural changes in the macula in recent onset branch retinal vein occlusion (BRVO), using optical coherence tomography (OCT). Methods: Twenty eyes of patients at an institutional practice with recent onset BRVO were examined by OCT at presentation and at 3 and 6 months of onset of the occlusion. The macular thickness (MT) and the visual acuity were correlated with the macular perfusion status and analyzed statistically. Results: The mean MT at presentation, 3 and 6 months was 398.9 +/- 98.6 mm, 346.8 +/- 84.8 mm and 341.3 +/- 95.3 mm, respectively. Three distinct anatomical patterns of structural changes were appreciated on OCT-serous retinal detachment (SRD) only in 15%, cystoid macular edema (CME) only in 40%, and a combined form with both SRD and CME in 45%. At 6 months while the non-ischemic group showed an average percentage decline of 26.8% in thickness, the ischemic group showed an increase of 19.2% (P < 0.01). CME resolved in 10 of 13 perfused (non-ischemic) maculae, but persisted in all seven ischemic cases. Conclusion: OCT delineates macular changes at a stage when fundus biomicroscopy and fluorescein angiography are not very informative. The anatomical cause for the increase in MT i.e., SRD and/or CME is also well delineated. Non-ischemic maculae show an early and more rapid decline in MT compared with ischemic occlusions. An increase in MT at 3 months on OCT in BRVO patients could be an indication of a possible ischemic course.     

视网膜分支静脉阻塞致黄斑水肿的视网膜地形图

目的 使用光学相干断层成像仪（OCT）的视网膜地形图观察视网膜分支静脉阻塞（BranchRetinalVeinOcclusion,BRVO）所致黄斑水肿的图像特征,监测黄斑水肿的变化,探讨BRVO所致黄斑水肿患者黄斑中心凹1mm直径范围（黄斑中心凹区）视网膜厚度与最佳矫正视力之间的关系.方法 使用OCT对17人17眼发病后3个月以内、继发于BRVO的黄斑水肿患者行视网膜地形图检查,对图像进行分类并随访观察,将初诊时黄斑中心凹区视网膜厚度与最佳矫正视力进行相关分析.结果 根据黄斑水肿范围及程度的不同将黄斑水肿的视网膜地形图分为3种类型,视网膜地形图对黄斑水肿的轻微变化非常敏感,黄斑中心凹区视网膜厚度与最佳矫正视力呈负相关.结论 OCT的视网膜地形图可有效地观察BRVO所致黄斑水肿的范围及程度,并可用于监测黄斑水肿的发展以及治疗后水肿的变化,早期BRVO（发病后3个月以内）所致黄斑水肿患者黄斑中心凹区视网膜厚度与最佳矫正视力呈负相关.     

Early treatment of cystoid macular edema secondary to branch retinal vein occlusion with intravitreal triamcinolone acetonide.

BACKGROUND AND OBJECTIVE: To determine the efficacy of intravitreal triamcinolone acetonide (IVTA) in the early treatment of severe cystoid macular edema (CME) related to acute branch retinal vein occlusion. PATIENTS AND METHODS: Retrospective, non-comparative case series. Twelve eyes with severe CME (foveal thickness > 450 microm) secondary to acute branch retinal vein occlusion received IVTA. RESULTS: Average follow-up was 15.3 months. Mean visual acuity was 0.88 LogMar units (20/160) initially, 0.55 LogMar units (20/70) at 1 week, 0.46 LogMar units (20/60) at 1 month, and 0.49 LogMar units (20/60) at last follow-up. Visual acuity improved by 3 lines or greater in 42% of patients at 1 week, 50% at 1 month, and 42% at last follow-up. Average foveal thickness was 589 microm (range, 460 to 840 microm) at baseline, 237 microm at 1 week, 196 microm at 1 month, and 235 microm at last follow-up. All eyes showed reduction of foveal thickness as measured by optical coherence tomography. Eight eyes developed recurrent CME at an average of 5.5 months after initial IVTA injection. Ten eyes required additional intervention during the follow-up period. CONCLUSIONS: Early treatment of severe CME secondary to branch retinal vein occlusion with IVTA is effective in reducing foveal thickness as measured by optical coherence tomography and improving visual acuity. However, monotherapy with IVTA can be associated with a significant rate of recurrent CME.     

Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) for ischemic macular edema associated with branch retinal vein occlusion (BRVO) and foveal ischemia. DESIGN: Prospective interventional case series. METHODS: setting: Clinical practice. study population: Eighteen eyes of 18 patients with macular edema associated with BRVO and foveal ischemia. intervention: Four mg IVTA. main outcome measures: Visual acuity (VA), optical coherence tomography, macular thickness measurements, and treatment-related complications. RESULTS: The mean duration of BRVO before treatment was 14 months. All patients were followed for a minimum of nine months, and 12 patients completed 12 months follow-up. The mean logarithm of the minimum angle of resolution (logMAR) VA improved significantly from 0.81 +/- 0.36 at baseline to 0.65 +/- 0.30 at one month (P = .03) but did not vary significantly from baseline at three, six, nine, and 12 months. Macular thickness improved significantly in all eyes from a mean of 400 +/- 134 mum preinjection, to 228 +/- 58 mum at one month (P < .01) and 256 +/- 121 mum at three months (P < .01) but did not vary significantly from baseline at six, nine, and 12 months. Eight eyes developed posterior subcapsular cataract, intraocular pressure (IOP) exceeded 21 mm Hg in four eyes, and two eyes developed vitreomacular traction during follow-up. CONCLUSIONS: IVTA is effective in reducing ischemic macular edema associated with BRVO and foveal capillary nonperfusion. This reduction is often associated with a temporary improvement in VA. Raised IOP and development of posterior subcapsular cataract are disadvantages of this treatment.     

Early versus late intravitreal triamcinolone acetonide for macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of or 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.     

Prospective comparisons of intravitreal injections of triamcinolone acetonide and bevacizumab for macular oedema due to branch retinal vein occlusion

Purpose: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO). Design: Prospective, comparative, randomized, interventional clinical trial. Methods: Forty‐three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4‐mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25‐mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best‐corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months. Results: Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow‐up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure–lowering medications. Conclusion: Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO.     

Influence of retinal ischemia on macular function after pars plana vitrectomy for macular edema with branch retinal vein occlusion

The influence of retinal ischemia on changes of visual acuity, macular sensitivity, macular thickness, and macular volume is unclear after pars plana vitrectomy (PPV) for macular edema with branch retinal vein occlusion (BRVO). Twenty-three patients (23 eyes) with BRVO and macular edema underwent PPV. Retinal ischemia was evaluated from capillary non-perfusion on fluorescein angiography, and patients were classified as ischemic or nonischemic. Microperimetry was performed with a Micro Perimeter 1. Macular thickness and volume were measured by optical coherence tomography. Mean macular thickness within the central 4°, 10°, and 20° fields decreased significantly from before to 3 and 6 months after PPV (all P < 0.001). Likewise, total macular volume within the central 4°, 10°, and 20° fields decreased significantly from before to 3 and 6 months after PPV (all P < 0.001). Best-corrected visual acuity (BCVA) improved significantly from before to 3 and 6 months after PPV (P < 0.001). Furthermore, mean macular sensitivity within the central 4°, 10°, and 20° fields increased significantly from before to 3 and 6 months after PPV (P = 0.002, P = 0.001, and P = 0.001, respectively). There were no significant differences in the trend profiles of macular thickness, macular volume, and BCVA between the ischemic and nonischemic groups. However, there was a significant difference in the trend profile of macular sensitivity within the central 4°, 10°, and 20° fields between the ischemic and nonischemic groups (P = 0.017, P = 0.010 and P = 0.025, respectively). These findings suggest PPV may be more effective for improving macular sensitivity in ischemic than nonischemic BRVO.     

Visual function after pars plana vitrectomy in macular edema with branch retinal vein occlusion

The objective of this study is to evaluate functional and morphological changes of the macula after pars plana vitrectomy (PPV) for macular edema with branch retinal vein occlusion (BRVO). Eighteen patients with BRVO (mean age: 71.3 ± 5.9 years; six women and 12 men) received PPV. Macular function was documented by microperimetry and best-corrected visual acuity (BCVA) was determined. Retinal thickness and retinal volume were measured by optical coherence tomography (OCT), and mean retinal sensitivity was calculated for each of nine macular subfields. Ischemia and serous retinal detachment (SRD) were evaluated by fluorescein angiography and OCT, respectively. Mean BCVA was significantly improved at 3 and 6 months after PPV. Mean retinal sensitivity, retinal thickness, and retinal volume were significantly improved after 3 and 6 months in five, eight, and eight subfields, respectively. Improvement of visual acuity and the percent change in retinal thickness or retinal volume were not correlated in any of the nine subfields, while improvement of retinal sensitivity was correlated with the percent change in both retinal thickness and retinal volume in the temporal outer subfield. There were significant differences with respect to the percent changes in retinal thickness and volume in the temporal outer field between the non-ischemic and ischemic groups, as well as between the patients with and without SRD. There was also a significant difference between the non-ischemic and ischemic groups with respect to the improvement of retinal sensitivity in three out of nine fields. These findings suggest that PPV can improve both functional and morphological changes due to macular edema in BRVO patients, and that morphological improvement in the temporal outer subfield after PPV might influence the functional prognosis of these patients.     

曲安奈德和激光治疗静脉阻塞性黄斑水肿

目的：观察并对比玻璃体腔注射曲安奈德（TA）和激光光凝治疗视网膜静脉阻塞性黄斑水肿的效果,探讨两者联合治疗的必要性及联合治疗的时机。方法：对非缺血型分支静脉阻塞累及中心凹且有灌注的黄斑水肿（中央视网膜厚度≥300μm）患者,随机分为TA组和激光组,采用双盲法进行前瞻性治疗。TA组（46眼）玻璃体腔注射曲安奈德4mg,激光组（44眼）行血管弓内格栅样光凝及无灌注区播散光凝。采用最佳矫正视力（BCVA）和相干光断层扫描（OCT）作为评价两种方法治疗前后不同时期疗效的主要指标,应用独立样本t检验对数据进行统计学处理。结果：中央视网膜厚度介于300～500μm,1wk～1mo时TA组改善视力和减轻黄斑水肿的程度较激光组非常显著;1～3mo时TA组治疗效果随时间延长呈缓慢下降趋势,而激光组呈缓慢稳定上升趋势;6mo时TA组和激光组治疗效果无显著差异;6moTA组个别患者黄斑水肿复发需再次注射。结论：对于视网膜分支静脉阻塞性黄斑水肿中央视网膜厚度介于300～500μm,玻璃体腔注射TA及激光光凝均可以选择;对中央视网膜厚度≥500μm患者可采用联合治疗,TA联合光凝治疗的时机应在玻璃体腔注射TA后1wk～1mo内积极进行;玻璃体腔注射TA后黄斑水肿复发,再次注射需间隔6mo以上。     

Resolution of serous macular detachment after intravitreal triamcinolone acetonide treatment of patients with branch retinal vein occlusion

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on serous macular detachment in patients with branch retinal vein occlusion (BRVO). METHODS: Eight eyes of 8 patients with BRVO (6 men and 2 women; age range, 52-76 years) made up the study population. The eligibility criteria for this study included clinically and angiographically detectable cystoid macular edema (CME) in which the presence of serous macular detachment was documented by optical coherence tomography (OCT). After intravitreal injection of 0.1 mL (4 mg) of triamcinolone acetonide, the visual and anatomical responses were observed. RESULTS: In all eyes, after injection of triamcinolone acetonide, CME and serous macular detachment regressed. At 3 and 6 months, CME and serous macular detachment had recurred in 1 eye (12.5%) and 2 eyes (25%), respectively. Patients with recurrence were retreated. No eyes lost vision at 1 month, and all eyes showed improvement. At 3 months, no eyes had lost vision from baseline, and 7 eyes (87.5%) showed improvement. At 6 months, again no eyes had lost vision from baseline, and 7 eyes (87.5%) maintained improved visual acuity. CONCLUSIONS: The preliminary results of our study showed prompt resolution of serous macular detachment with corresponding improved visual acuity in patients with CME secondary to BRVO. Further study with longer follow-up and a larger series is warranted to assess the long-term efficacy and safety.     

Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion

PURPOSE: compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively. RESULTS: The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P = .008 and P = .001, respectively). Foveal thickness decreased significantly 1 month after surgery in both groups (P = .002 and P = .007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. CONCLUSIONS: Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.     

Efficacy of intravitreal conbercept injection on short- and long-term macular edema in branch retinal vein occlusion

AIM: To observe the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) repeatedly after the intravitreal injection of conbercept (IVC) for treating cystoid macular edema (CME) in branch retinal vein occlusion (BRVO) and explore the relationship between the duration of CME and visual outcome. METHODS: Subgroup analysis was performed to compare short-term (within 90d of CME onset) and long-term (over 90d of CME onset) macular edema in BRVO. After an initial IVC, a pro re nata (PRN) strategy was performed according to the recurrence of CFT or decrease of BCVA. Analysis of variance using repeated measurements, statistical analysis following indicators including BCVA and CFT collected at baseline and 1, 3, and 6mo after IVC. RESULTS: Among the 60 cases included in this retrospective study, 36 were short-term CME, and 24 were long-term CME. There were statistical significances between and within groups of the BCVAs at different time points (P<0.001). The interaction was found between group and time (P=0.006), indicating the difference in the speed of BCVA improvement between groups. In particular, the improvement speed of BCVA in the short-term CME group was faster than that in the long-term CME group. There were significant differences between and with groups of the CFT at different time points (P<0.001). However, the interaction between group and time in relation to CFT had no significant differences (P=0.59). CONCLUSION: IVC treatment for CME following BRVO is effective and safe. The duration of CME before treatment is a significant predictor of the visual outcomes of patients with BRVO. The improvement of vision might be faster with early IVC treatment than with delayed treatment.     

曲安奈德治疗视网膜分支静脉阻塞继发黄斑水肿的疗效评估

目的 应用光学相干断层扫描(optical coherence to mo graphy,OCT)和多焦视网膜电流图(multifocal electmretinogram.mfERG),随访观察曲安奈德玻璃体腔注射治疗视网膜分支静脉阻塞继发黄斑水肿患者的疗效.方法 对28例视网膜分支静脉阻塞继发黄斑水肿患者,于曲安奈德玻璃体腔注射前后进行视力及OCT、nfERG检查,对比分析视力与视网膜神经上皮层厚度及黄斑区视功能变化.结果 :与治疗前相比,视力均有不同幅度的提高;视网膜神经上皮层厚度平均厚度明显降低;中心凹处(1环)P1波振幅密度增加,均与治疗前比较差异具有统计学意义(P<0.05).结论 应用OCT、mfERG随访检查,司以对病情的发展进行有效的跟踪观察,为曲安奈德玻璃体腔注射治疗的疗效提供可靠的依据.     

Serous macular detachment combined with branch retinal vein occlusion

PURPOSE: To report frequency, clinical characteristics, treatment, and the complications of branch retinal vein occlusion (BRVO) with serous macular detachment. PATIENTS AND METHODS: We retrospectively studied 22 eyes of 22 patients in 111 eyes with acute BRVO, whose eyes had serous macular detachment that was detected by optical coherence tomography (OCT). Fluorescein angiography was conducted in 19 of the 22 eyes. Fourteen of the 22 eyes underwent scatter laser photocoagulation of the BRVO area. We observed serial OCT findings before and after treatment. RESULTS: Approximately 20% of the BRVO eyes had serous macular detachment. The superotemporal vein was occluded in 15 eyes and the inferotemporal vein was involved in 7 eyes. Four eyes were ischemic and 15 eyes were not ischemic. Extensive dye leakage was observed in the BRVO area in all examined eyes (19 eyes). The occlusion area of perifoveal capillary network ranged from 5 to 60%, with an average of 40%. OCT demonstrated pure serous macular detachment in 13 eyes and the remaining 9 eyes had both serous macular detachment and cystoid macular edema(CME). The occlusion area of perifoveal capillaries in these 9 eyes was more than 20%. Serous macular detachment was resolved in 11 of 14 eyes (80%) 6 months after laser treatment. The average period for resolution of macular detachment was 3.4 months after treatment. Visual acuity was improved more than 2 lines in 8 of the treated 11 eyes (73%). Hard exudates appeared in the posterior fundus in 13 of 14 treated eyes (93%) and in 16 of the total of 22 eyes (73%) in the follow-up period. Massive macular hard exudates and ensuing macular atrophy resulted in poor visual outcome. CONCLUSIONS: Serous macular detachment is one of the patterns of macular edema in BRVO. OCT is an essential tool to detect it. Leakage from the entire BRVO area seems to travel via subretinal space by gravity or other factors and may form serous detachment in the macular area. Laser photocoagulation is indicated for early resolution of serous macular detachment. The major complication of serous detachment is the deposit of macular hard exudates, which may result in poor visual outcome.     

Efficacy of intravitreal triamcinolone for the treatment of macular edema secondary to branch retinal vein occlusion in eyes with or without grid laser photocoagulation

PURPOSE: To evaluate the efficacy of primary and secondary (following grid laser photocoagulation) intravitreal triamcinolone acetonide (IVTA) injection for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Eyes with macular edema secondary to BRVO and best-corrected visual acuity (BCVA) worse than 20/40 were included. Eyes eligible for Branch Retinal Vein Occlusion Study (BVOS) guidelines received grid laser treatment first. Those that were not improved at least two lines following grid laser or that did not meet those guidelines received 4 mg IVTA injection. The efficacy of IVTA treatment was assessed by analyzing the change in BCVA and reduction in central macular thickness (CMT) measured by optical coherence tomography. Intraocular pressure (IOP) spikes and other complications were recorded. RESULTS: The data from 37 eyes were included; in 12 of them IVTA injection was given after grid laser while 25 of them received IVTA as a primary treatment. Mean follow-up was 9.6 +/- 4.5 months. BCVA was 0.06 +/- 0.30 and 0.17 +/- 0.50 in the primary and secondary IVTA injection groups, respectively. In the primary injection group, there was a statistically significant gain in BCVA throughout the follow-up (P < 0.05), while a small increase in BCVA was noted only at the third month visit in the secondary IVTA injection group (P = 0.04). Average CMT were 434.8 +/- 122.1microm and 389.0 +/- 171.9 microm before IVTA injection in the two groups, respectively. In the primary IVTA injection group, CMT decreased at 1 month following IVTA injection and remained statistically significant until the sixth month visit (P < 0.05). In the secondary IVTA injection group, a slight reduction in CMT was noted only in the first month visit (P = 0.02). Pre-IVTA BCVA was found to be the single statistically significant predictor of BCVA gain following IVTA injection. In 8 patients (21.6%), the IOP increased above 25 mmHg postoperatively, and was successfully managed by medical treatment. Endophthalmitis did not develop in any of the patients. CONCLUSION: IVTA injection produced a significant reduction of macular edema in eyes with BRVO either with or without prior grid laser treatment. Reduction of CMT increased the BCVA in most of the eyes receiving IVTA primarily, while only a slight improvement of BCVA was found in eyes with prior grid laser. The IVTA effect was transient. Larger studies are necessary to find the best approach (either grid laser or IVTA) to patients with macular edema associated with BRVO.     

Time course of changes in retinal thickness and visual acuity after intravitreal triamcinolone acetonide for diffuse diabetic macular edema with and without previous macular laser treatment

PURPOSE: To describe the changes in retinal thickness (RT) and visual acuity over time in patients with clinically significant diffuse diabetic macular edema (DME) after intravitreal injection of triamcinolone acetonide (IVTA) and to compare patients with and without previous laser treatment. METHODS: A total of 23 eyes with clinically significant DME received a 4-mg IVTA injection. Twelve eyes were refractory to macular laser treatment (group 1), and 11 eyes received IVTA as primary therapy (group 2). Visual acuity and changes in macular thickening shown by optical coherence tomography were evaluated 48 hours after injection, every 7 days for 1 month, and at 3 months and 6 months of follow-up. RESULTS: RT decreased in all eyes in both groups. The reduction of edema was maximal in the first 7 days after IVTA and tended to remain stable for 3 months. The decrease in RT over time was significant in both groups (P < 0.001). At 6 months, RT had increased in almost all eyes. Visual acuity improved quickly, to a maximum at 2 weeks in both groups, after which it remained stable for 3 months and then decreased. Improvement in visual acuity over time was significant in both groups (P < 0.001). The temporal characteristics of the changes in RT and visual acuity were similar in the two groups (P < 0.05). CONCLUSIONS: IVTA was effective in reducing clinically significant DME and improving visual acuity in eyes with and without previous laser treatment. Its action was maximal in the first week and lasted approximately 3 months in this study.     

伴浆液性视网膜脱离的糖尿病囊样黄斑水肿的危险因素及康柏西普治疗效果研究

目的　探讨伴浆液性视网膜脱离（serous retinal detachment，SRD）的糖尿病囊样黄斑水肿（cystoid macular edema，CME）和不伴SRD的糖尿病CME形成的影响因素及康柏西普治疗疗效的差异。方法　选取就诊于空军特色医学中心并行康柏西普治疗的50例（70眼）糖尿病CME患者纳入研究，其中28例42眼为不伴SRD的CME水肿类型，为单纯CME组；22例28眼为伴SRD的CME水肿类型，为伴SRD组。比较可能影响两种CME形成的全身指标（血压、血糖、血脂等）和眼部情况，包括糖尿病视网膜病变分期，基线黄斑中心凹厚度（central macular thickness，CMT）等；并比较两组DME患者接受单纯康柏西普治疗后的疗效差异。结果　单因素分析显示，单纯CME组水肿类型的发生与高脂蛋白a水平、增生型糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）、既往全视网膜光凝史和既往黄斑光凝史均相关（均为P＜0.05）。伴SRD组水肿类型的发生与高尿酸水平、高胆固醇水平和高基线CMT均相关（均为P＜0.05）；多因素Logistic回归分析显示，较高基线CMT为伴SRD组水肿类型发生的独立危险因素［OR（95% CI）=1.006（1.002~1.010）］。两种类型的CME患者接受康柏西普治疗后明显有效（均为P＜0.000 1），伴SRD的CME水肿消退较不伴SRD的CME效果更好（P＜0.05），但术后视力比较，差异无统计学意义（P＞0.05）。结论　较高尿酸和总胆固醇水平与SRD的发生有关，基线CMT较高是伴SRD的CME发生的独立危险因素；高脂蛋白a水平、PDR、既往全视网膜光凝史和既往黄斑光凝史与不伴SRD的CME发生有关。伴SRD的CME接受康柏西普治疗的效果较不伴SRD的CME效果更好，SRD可能是DME抗血管内皮生长因子治疗预后良好的指标。     

Transient increase in macular edema following vitrectomy for retinal branch vein occlusion

Purpose We confirmed a transient increase in macular edema in some patients after simple vitrectomy for macular edema associated with branch retinal vein occlusion (BRVO). Methods We studied 54 consecutive patients (54 eyes) with macular edema secondary to BRVO and preoperative visual acuity of 0.5 or below, who underwent vitrectomy and were followed for at least 1 year. Visual acuity and foveal retinal thickness measured by optical coherence tomography were determined before and after vitrectomy. Results The patients were divided into two groups according to whether there was a postoperative increase in foveal retinal thickness. In group A (11 eyes; 20.3%), a significant increase in foveal retinal thickness was observed at 1 month after surgery, but there was no significant change in visual acuity. In group B (43 eyes; 79.6%), there was no transient increase in retinal thickness, and visual acuity improved while foveal retinal thickness decreased gradually by 1 year after surgery. In group A, macular edema had improved significantly at 3 months after surgery without local injection of triamcinolone acetonide (TA), and visual acuity and foveal retinal thickness at 1 year after surgery did not differ significantly from those in group B. Multiple regression analysis was conducted to identify the preoperative factors associated with transient increase in macular edema, and no significant factor was detected. Conclusions When simple vitrectomy is conducted for macular edema associated with BRVO, a transient postoperative increase in macular edema occurs in some cases, but resolves spontaneously without TA injection. Further study is required to determine whether this transient increase in macular edema is a phenomenon that occurs after vitrectomy for diseases accompanied by macular edema.     

Serous macular detachment in branch retinal vein occlusion

PURPOSE: To evaluate the relationship between the extent of branch retinal vein occlusion (BRVO) and the incidence of serous retinal detachment (SRD) in the macular area. METHODS: One hundred nine eyes of 109 consecutive patients with BRVO comprised the study population. These eyes were characterized as having either macular BRVO or major BRVO. We compared the tomographic macular findings between the two groups. RESULTS: Thirty-nine eyes had macular BRVO, and 70 eyes had major BRVO. The incidence of SRD was higher in the group with major BRVO (63%) than in the group with macular BRVO (21%) (P < 0.001). The incidence of cystoid macular edema was similar in both groups (macular BRVO, 97%; and major BRVO, 90%). Foveal thickness of major BRVO (610 +/- 190 micro m) was significantly greater than that of macular BRVO (500 +/- 140 micro m) (P < 0.01). There was no significant difference in thickness of the neurosensory retina between the group with macular BRVO (450 +/- 120 micro m) and the group with major BRVO (480 +/- 140 micro m). CONCLUSIONS: Serous macular detachment occurs more frequently in major BRVO than in macular BRVO. Vascular leakage from congested retinal veins outside the macular area appears to be a major source of subretinal fluid at the fovea.