中西医结合治疗外伤性视神经病变疗效评价的Meta分析

目的:系统评价中西医结合治疗外伤性视神经病变(TON)的临床疗效及安全性。方法:通过计算机检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库自建库至2020-05的关于中西医结合与单纯西医治疗TON的随机对照研究,使用Cochrane评价手册对纳入文献进行质量评价,使用RevMan5.3统计软件进行资料提取与Meta分析。结果:共筛选出12篇符合纳入、排除标准的文献;Meta分析结果显示,与单纯西药治疗TON比较,中西医结合治疗有效率更高[RR=1.33,95%CI(1.23~1.45),P<0.001];在改善视力[MD=0.18,95%CI(0.14~0.23),P<0.001]、视野平均缺损[MD=-3.08,95%CI(-5.20~0.96),P=0.004]、视觉诱发电位P100波峰潜时[MD=-9.47,95%CI(-16.37~2.57),P=0.007]以及视觉诱发电位P100波峰振幅[MD=1.44,95%CI(0.22~2.66),P=0.02]上作用更显著。纳入文献有2篇提及不良反应的发生和处理,余10篇均未描述。结论:与单纯西医治疗相比,中西医结合治疗TON的疗效更佳。     

Meta analysis on the relationship between gene polymorphisms of vascular endothelial growth factor and retinal prognosis risk of prematurity

AIM: To explore the relationship between gene polymorphisms of vascular endothelial growth factor (VEGF) and retinopathy of prematurity (ROP). METHODS: Literature materials related to gene polymorphisms of VEGF and ROP in PubMed, EMBASE, Cochrane and CBM database were retrieved. These materials were screened according to inclusion and exclusion standards. Patients diagnosed with ROP in clinic were regarded as control group and ROP patients who were in treatment were regarded as observation group. The indexes in two groups were matched except birth weight (BW), gender and gestational weeks. Meta5.1 was used to analyze the relationship between gene polymorphisms of VEGF and ROP. RESULTS: Four random control tests (RCT) were included in this research, including 2611 patients. Meta analysis results showed that VEGF affected ROP, having statistical significance. The combined ratio was 0.44 (95%CI, 0.07, 0.80), 0.42 (95%CI, 0.09, 0.74) and 0.75 (95%CI, 0.02, 1.49), respectively. Carrying +405 allele might increase the premature infants’ risk of having ROP. CONCLUSION: ROP may be related to its carrying of +405 allele. Large-scale, multi-factor RCT researches are still needed in order to identify the relation between VEGF and ROP.     

Meta analysis on the relationship between gene polymorphisms of vascular endothelial growth factor and retinal prognosis risk of prematurity

AIM: To explore the relationship between gene polymorphisms of vascular endothelial growth factor (VEGF) and retinopathy of prematurity (ROP). METHODS: Literature materials related to gene polymorphisms of VEGF and ROP in PubMed, EMBASE, Cochrane and CBM database were retrieved. These materials were screened according to inclusion and exclusion standards. Patients diagnosed with ROP in clinic were regarded as control group and ROP patients who were in treatment were regarded as observation group. The indexes in two groups were matched except birth weight (BW), gender and gestational weeks. Meta5.1 was used to analyze the relationship between gene polymorphisms of VEGF and ROP. RESULTS: Four random control tests (RCT) were included in this research, including 2611 patients. Meta analysis results showed that VEGF affected ROP, having statistical significance. The combined ratio was 0.44 (95%CI, 0.07, 0.80), 0.42 (95%CI, 0.09, 0.74) and 0.75 (95%CI, 0.02, 1.49), respectively. Carrying +405 allele might increase the premature infants’ risk of having ROP. CONCLUSION: ROP may be related to its carrying of +405 allele. Large-scale, multi-factor RCT researches are still needed in order to identify the relation between VEGF and ROP.     

玻璃酸钠联合rhEGF滴眼液治疗白内障术后干眼疗效的Meta分析

目的:运用Meta分析方法系统评价近5a玻璃酸钠联合重组人表皮生长因子(rhEGF)滴眼液治疗白内障术后干眼的疗效。方法:计算机检索2015-01/2020-05中国知网数据库、万方数据库、重庆维普中文科技期刊全文数据库、中国生物医学文献数据库(CBM)、Cochrane Library、PudMed、MEDLINE等数据库关于采用玻璃酸钠联合rhEGF滴眼液治疗白内障术后干眼的的临床对照研究相关文献,使用Rev-man 5.3统计软件进行Meta分析和统计处理。结果:共纳入14项随机对照研究,患眼1529例。其中14项研究在治疗结束后进行了角膜荧光素染色(FL)评分,结果显示差异有统计学意义[MD=-0.86,95%CI(-1.07~-0.66),P<0.00001];14项研究在治疗结束后进行了泪膜破裂时间(BUT)测定,结果显示差异有统计学意义[MD=2.33,95%CI(1.64~3.03),P<0.00001];12项研究在治疗结束后进行了泪液分泌试验(SⅠt)测定,结果显示差异无统计学意义[MD=0.49,95%CI(-0.52~1.50),P=0.34];12项研究在治疗结束后进行了总体有效率计算,结果显示差异有统计学意义[OR=4.88,95%CI(3.34~7.14),P<0.00001];4项研究在治疗结束后进行了干眼症状评分测定,结果显示差异有统计学意义[MD=-1.09,95%CI(-1.58~-0.61),P<0.00001]。结论:玻璃酸钠联合rhEGF滴眼液治疗白内障术后干眼能显著提高角膜修复能力和BUT,在治疗白内障术后干眼总体疗效上更具优势。     

抗VEGF药物联合皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿的Meta分析

目的:评价抗VEGF药物联合糖皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿的临床效果。方法:计算机全面检索PubMed、Embase、The Cochrane Library、中国知网、万方、维普数据库6个数据库,检索时间从建库至2020-01,收集抗VEGF药物联合皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿的随机对照试验(RCT)。由2名研究人员根据纳入和排除标准,独立检索文献、提取数据及进行方法学质量评估,采用Review Manager 5.3进行Meta分析。结果:最终纳入5篇RCT文献,共212例患者。Meta分析结果显示,在第1、3、6mo,抗VEGF药物联合皮质类固醇药物与单用抗VEGF药物对提高患者最佳矫正视力(BCVA)无差异;在缓解黄斑水肿方面,在第1mo和第3mo联合用药的治疗效果要高于单用抗VEGF药物,差异具有统计学意义(1mo:MD=-20.89,95%CI:-34.65~-7.13,P=0.003;3mo:MD=-22.83,95%CI:-33.68~-11.97,P<0.0001),在第6mo两组无差异(P=0.06);联合用药的不良反应及并发症发生率高于单用抗VEGF药物(P=0.02);联合用药注射次数要低于单用抗VEGF药物(P<0.001)。结论:相比较单一使用抗VEGF药物,抗VEGF药物联合皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿具有起效快、注射次数少、更加经济的特点,但不良反应及并发症的发生率高于单一用药,主要为眼压升高及白内障,治疗过程要严密随访患者眼压及晶状体情况。     

玻璃体腔注射雷珠单抗与康柏西普治疗早产儿视网膜病变疗效比较

目的：比较早产儿视网膜病变(ROP)患儿采用玻璃体腔注射雷珠单抗(IVR)与康柏西普(IVC)两种药物的治疗效果。

方法：回顾性研究。纳入我院2015-01/2023-06玻璃体腔注射抗VEGF药物治疗的ROP患眼1 100眼。根据治疗药物的不同,将患儿分为IVR组和IVC组。根据ROP的病变程度分为急进型ROP(A-ROP)、Ⅰ区1型ROP和Ⅱ区1型ROP。通过倾向性匹配分析(PSM)匹配后对两组复活与再次治疗情况进行比较。随访时间至少至术后3 mo。

结果：在Ⅱ区1型ROP中,IVR组和IVC组的病变复活率及再次治疗率均有差异(P<0.05); A-ROP和Ⅰ区1型ROP中两组病变复活率及再次治疗率均无差异(P>0.05)。Ⅰ区1型ROP复活风险及再次治疗风险高于Ⅱ区1型ROP,药物的选择和首次治疗矫正胎龄是术后病变复活及再次治疗的影响因素。

结论：玻璃体腔注射IVR或IVC对Ⅱ区1型ROP的首次治愈效果有明显差异,且IVC组的复活率和再次治疗率远低于IVR组。     

翼状胬肉切除联合结膜自体移植术中纤维蛋白胶应用的Meta分析

目的 探讨纤维蛋白胶(FG)在翼状胬肉切除联合结膜自体移植术中的临床疗效.方法 应用循证医学的研究方法检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国知网、万方数据库、中国期刊全文数据库及维普中文科技期刊数据库并辅以手工检索,遵循Cochrane Handbook 5.0质量评价原则评价纳入研究的质量,采用RevMan5.0软件进行统计学处理.结果 纳入7项随机对照实验,共366只眼.Meta分析结果显示:与缝线组相比,FG组在术后复发方面,差异有统计学意义[RR=0.28,95%CI(0.10,0.76),P=0.01];在术后并发症方面,两组比较差异无统计学意义[RR=2.53,95%CI(0.47,13.51),P=0.28].结论在翼状胬肉切除联合结膜自体移植术中,应用FG封闭伤口可降低术后复发.(中华眼科杂志,2011,47:550-554)

Abstract：

Objective To evaluate the clinical efficacy of FG for attaching conjunctival autografts in pterygium surgery. Methods Search was conducted in Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, CBM and VIP,and hand-search was also performed, the methodological quality were carried out according to evidence-based medicine (EBM). The qualities of the randomized controlled trials(RCT) were evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. The Cochrane Collaboration's software RevMan 5.0 was used for Meta-analysis. Results Only 7 trials, involving 366 eyes, were included. Meta-analysis showed that significant differences were found between the FG and suture in recurrence [RR=0.34, 95%CI(0.15,0.80), P=0.01], but there is no difference in reducing the complications [RR=2.53,95%CI(0.47,13.51),P=0.28]. ConclusionFibrin glue-assisted conjunctival autograft in pterygium surgery reduces postoperative recurrence.     

玻璃体切除术前注射抗VEGF类药物治疗PDF的疗效及安全性的Meta分析

目的:探究增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者行玻璃体切除术治疗前玻璃体腔内注射抗VEGF类药物的有效性与安全性.方法:全面检索EMbase、The Cochrane Library、Pubmed、中国生物医学文摘数据库(CBM)、万方数据库(WanFang Database)、中国期刊全文数据库(CNKI)等数据库,检索时限均从建库至2017-01,语种不限,检索文献类型为随机对照试验;采用Jadad量表及Cochrane协作网提供的风险偏倚评估工具评价所纳入研究的质量,采用GRADEpro软件对各评价指标的参数进行循证医学质量评价;采用漏斗图检测所纳入文献的发表偏倚;最后采用Review Manager 5.3软件行Meta分析.结果:最终纳入发表时间介于2008/2016的16篇随机对照试验文献.共包含923例患眼,其中493例患眼进入PPV联合术前玻璃体腔内注射anti-VEGF组(试验组),430例患眼进入单纯行PPV组(对照组).Meta分析结果显示:(1)试验组术中出血的发生概率明显低于对照组[OR=0.06,95%CI(0.02~0.15),P<0.01],两组之间的差异具有统计学意义.(2)试验组手术持续时间明显短于对照组[WMD=-29.13,95%CI(-36.95~-21.30),P<0.01],两组之间的差异具有统计学意义.(3)试验组术后早期[OR=0.29,95%CI(0.19~0.44),P<0.01]及晚期[OR=0.34,95%CI(0.20~0.58),P<0.01]玻璃体出血的概率均低于对照组,两组之间的差异均具有统计学意义.(4)试验组术后最佳矫正视力水平不优于对照组[WMD=-0.51(LogMAR),95%CI(-1.10~0.08),P=0.09],两组之间的差异无统计学意义.(5)试验组术中医源性视网膜破裂发生概率低于对照组[OR=0.24,95%CI(0.14,0.40),P<0.01],两组之间的差异具有统计学意义.(6)在纳入的16篇文献共493例试验组患眼中,无1例报道出现与注射anti-VEGF类药物相关的明显眼内及全身不良反应.结论:PDR患者行玻璃体切除术治疗前玻璃体腔内注射抗VEGF类药物是安全、有效的治疗措施,能够显著减少术中及术后并发症的发生概率,改善患者的整体治疗效果.其具体的实施方案,如注射药物的剂量、玻璃体腔内注射与手术的间隔时间等,还有待进一步的探索与完善.     

早产儿视网膜病变抗VEGF治疗进展

早产儿视网膜病变(retinopathy of prematurity, ROP)是发生于早产儿的一种未成熟视网膜血管增生性眼病,是发展中及发达国家儿童致盲的主要因素。ROP的传统治疗方法是视网膜激光光凝或冷冻治疗,但凝固治疗可导致视网膜永久性破坏,存在发生视野缺损、高度近视等并发症风险。玻璃体腔注射抗血管内皮细胞生长因子(VEGF)药物治疗ROP后视网膜功能的发育比凝固治疗更趋向正常,再加上操作简便、耗时短等优点,玻璃体腔注射抗VEGF药物逐渐成为ROP的重要治疗方式; 在Ⅰ区ROP、Ⅱ区后部ROP和急进型ROP治疗中为首选治疗方式。但是抗VEGF药物治疗ROP所致的严重系统并发症、最低有效剂量及后期复发情况等问题尚待进一步研究。本文将对ROP抗VEGF治疗现状进行综述。     

联合方案治疗BRVO-ME远期疗效的Meta分析

目的:评价视网膜激光光凝联合玻璃体腔注射雷珠单抗与单纯雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿(BRVO-ME)的远期疗效及安全性。方法:系统检索Embase、The Cochrane Library、PubMed、中国期刊全文数据库(CNKI)、万方数据库(Wanfang Database)、维普中文科技期刊数据库(VIP)关于激光和雷珠单抗治疗BRVO-ME的随机对照临床研究文献,对纳入研究进行风险评估、提取数据指标。采用RevMan 5.3软件进行数据分析,采用漏斗图评价发表偏倚。结果:共纳入7项研究,641眼。激光联合雷珠单抗组和单纯雷珠单抗组患者的最佳矫正视力(BCVA)在治疗后12mo[WMD=0.00,95%CI(-0.13,0.14),P=0.95]和24mo[WMD=0.05,95%CI(-0.12,0.22),P=0.57]变化均无明显差异。两组在治疗12mo[WMD=-7.67,95%CI(-54.58,39.24),P=0.75]和24mo[WMD=12.21,95%CI(-81.68,106.09),P=0.80]黄斑中心凹厚度的变化无明显差异。两组在12、24mo的雷珠单抗注药次数及最终不良事件发生情况方面亦无统计学差异。结论:激光联合雷珠单抗相较单纯雷珠单抗治疗BRVO-ME,在视力和黄斑中心凹厚度方面的远期结果无明显差异,在雷珠单抗的注药次数和安全性方面也无较大差距。     

Analysis of the rates of emulsification in intraocular silicone oil tamponades of differing viscosities

AIM:To investigate the rates of emulsification in silicone oil(SO)tamponades of differing viscosities used during pars plana vitrectomy(PPV)in the treatment of complicated vitreoretinal diseases.METHODS:This study was a prospective randomized clinical trial.Totally 290 cases with greater likelihoods of secondary detachment were included and randomly grouped into either Siluron 2000(n=143)or Siluron 5000(n=147)SO tamponades with 23-gauge PPV.Patient followups and data analyses were conducted 1,3,6,and 12 mo post-surgery.RESULTS:The time of the SO emulsification ranged from 1 to 17 mo,with a mean of 7.3±4.2 mo.The Siluron 5000 group showed a slower emulsification rate in comparison to the Siluron 2000 group.The Siluron 2000 group took a shorter time to show signs of emulsification,necessitating earlier SO removal.However,there were no significant differences in the occurrence of complications,including secondary retinal detachment,cataract,corneal abnormality,high intraocular pressure and hypotony.CONCLUSION:The Siluron 2000 SO tamponade shows a faster rate of emulsification than the Siluron 5000 SO,necessitating earlier removal.Both groups show similar results in terms of anatomical success and visual acuity outcome,and there is no significant difference between the SOs regarding the occurrence of complications.     

Laser therapy versus intravitreal injection of anti-VEGF agents in monotherapy of ROP:a Meta-analysis

AIM:To compare the efficacy and safety between laser therapy and anti-vascular endothelial growth factor(VEGF)agents intravitreal injection monotherapy in type-1 retinopathy of prematurity(ROP)and aggressive posterior retinopathy of prematurity(APROP).METHODS:A systematic literature search was performed in PubMed,Cochrane Library,and Embase for original comparable studies.We included studies that compare laser therapy and intravitreal injections of anti-VEGF agents monotherapy in ROP regardless of languages and publication types.RESULTS:Complication incidence was significantly higher in laser therapy group(OR:0.38;95%CI:0.19-0.75;P=0.005).Spherical equivalent(SE)was higher in laser therapy[weighted mean difference(WMD):2.40,95%CI:0.88-3.93;P=0.002].The time between treatment and retreatment was longer in laser therapy group(WMD:8.45,95%CI:5.35-11.55;P<0.00001).Recurrence incidence(OR:0.97;95%CI:0.45-2.09;P=0.93)and retreatment incidence(OR:1.24;95%CI:0.56-2.73;P=0.59)were similar in two approaches.Subgroup analysis between type-1 ROP and APROP was not significant except SE reported in the included studies(P<0.0001).CONCLUSION:This Meta-analysis outcome indicates anti-VEGF agents are as effective as laser treatment,and safer than laser in type-1 ROP and APROP.The degree of myopia in APROP is higher than type-1 ROP.More randomized controlled trials in large sample size should be conducted in the future.     

玻璃体内注射雷珠单抗治疗早产儿视网膜病变疗效观察

目的 观察玻璃体内注射雷珠单抗治疗早产儿视网膜病变(retinopathy of prematurity,ROP)的疗效及安全性.方法 将2014年6月至2015年8月在我院确诊并首次进行抗VEGF治疗的连续性Ⅰ、Ⅱ区ROP患儿49例95眼纳入研究.将患儿依据病变分区分为Ⅰ区组和Ⅱ区组,主要比较2组患儿出生体质量、孕周、治疗时矫正胎龄、治疗好转、复发及再治疗时间之间的差异.用30G 1 mL注射器抽取10 mg·mL-1的雷珠单抗0.025 mL(含雷珠单抗0.25 mg)于患儿角膜缘后1.5 mm穿刺注射.注射结束时妥布霉素地塞米松眼膏包眼.注药后3d运用手持裂隙灯及眼压计观察患眼有无眼压增高、眼内新鲜出血及眼内炎情况,治疗后1周间接检眼镜观察视网膜血管迂曲扩张及病变嵴消退情况.同时观察有无与治疗相关的其他全身不良反应.结果 本研究病例首次治疗后血管迂曲、扩张消失或程度减轻,新生血管及嵴消退93眼,占95.9％.其中,Ⅰ区组58眼,Ⅱ区组35眼.两组ROP好转率比较,差异无统计学意义(P＞0.05).随访期间复发22眼.其中,Ⅰ区组17眼,占Ⅰ区ROP消退患眼的29.3％;Ⅱ区组5眼,占Ⅱ区ROP消退患眼的14.3％.两组复发率比较,差异有统计学意义(P＜0.05).复发后再次行雷珠单抗或激光光凝治疗.复发至再次治疗时间为(6.50±2.54)周.Ⅰ区组和Ⅱ区组复发至再次治疗时间分别为(6.44±2.74)周、(6.67±2.31)周,两组差异无统计学意义(P＞0.05).末次随访时,可观察到继续血管化.随访期间和末次随访时,未见与治疗方式和药物相关的其他眼部并发症和全身不良反应发生.结论 雷珠单抗治疗Ⅰ、Ⅱ区ROP疗效较好,但ROP复发率较高.未见明确与药物有关的局部和全身并发症.     

抗血管内皮生长因子玻璃体内注射治疗不同区域早产儿视网膜病变的疗效观察

目的 观察抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗不同区域早产儿视网膜病变的临床效果.方法 回顾性分析2013年4月至2014年4月在郑州儿童医院行玻璃体内注射抗VEGF药物的早产儿视网膜病变患儿24例(46眼),分为Ⅰ区病变组15例(28眼),Ⅱ区病变组9例(18眼).所有患者均在全身麻醉下行玻璃体内注射抗VEGF药物雷珠单抗,对患儿术后眼底进展情况进行观察,分析两组首次注射治愈和进展情况以及并发症发生情况.结果 两组间的出生孕周、出生体质量相比,差异均无统计学意义(均为P ＞0.05);手术矫正孕周相比,差异有统计学意义(P=0.001).24例(46眼)中,首次注射治愈21眼,病情继续发展25眼,治愈率为45.65％,治疗到治愈的时间间隔为2～12个月.Ⅰ区病变组首次注射治愈9眼,治愈率为32.14％,进展率为67.86％;Ⅱ区病变18眼中12眼首次注射治愈,6眼病情继续进展,治愈率为66.67％,进展率为33.34％.两组首次注射治愈率相比,差异有统计学意义(x2=5.263,P=0.022),Ⅰ区病变的首次注射治愈率明显低于Ⅱ区病变.两组进展率相比,差异有统计学意义(x2=-2.269,P=0.023),Ⅰ区病变的进展率明显高于Ⅱ区病变.随访中未发现与玻璃体内注射有关的白内障、眼内炎、视网膜裂孔等出现,仅有2例出现角膜水肿,4例出现结膜下出血,均未做特殊处理自愈.结论 玻璃体内注射抗VEGF药物对于Ⅰ区、Ⅱ区病变均有效,Ⅰ区病变手术成功率低,再次手术的几率大,但可为再次手术创造时间和条件.     

倍频Nd:YAG激光治疗早产儿视网膜病变疗效分析

目的 评价倍频Nd:YAG间接检眼镜激光治疗早产儿视网膜病变(retinopathy of rematurity,ROP)的治疗效果,探讨其合理的治疗时机和模式.结果 对39例76只眼ROP患儿经倍频Nd:YAG间接检眼镜激光治疗后,71只眼病变完全退化,总治愈率93.42%.Ⅰ区病变的出生体重(1232±325)g出生胎龄(28.79±1.93)周与Ⅱ区病变(1333±264)g,(29.47±2.11)周的差异无统计学意义(P>0.05),而Ⅰ区病变的治疗时矫正胎龄(34.29±1.44)周明显小于Ⅱ区病变(36.00±2.03)周(P<0.05);Ⅰ区病变的激光斑数(1618±607)明显多于Ⅱ区病变(813±470)(P<0.05).结论 倍频Nd:YAG间接检眼镜激光治疗ROP早期病变是安全有效的.Ⅰ区腐变患儿阈值病变出现早,进展快,预后差.     

Comparison of conbercept and ranibizumab for the treatment efficacy of diabetic macular edema: a Meta-analysis and systematic review

AIM: To evaluate the efficacy of intravitreal injection of conbercept (IVC) and ranibizumab (IVR) in patients with diabetic macular edema. METHODS: Reviewers have searched 12 databases, including PubMed, Medline, EMBASE, Web of Science, Springer, ScienceDirect, OVID, Cochrane Library, ClinicalTrials.gov, cqVIP, WanFangdata and China National Knowledge Infrastructure (CNKI), up to December 28, 2018. RevMan 5.3 (Cochrane Library Software, Oxford, UK) was employed for statistical analysis. Fixed and random effects models were applied to assess heterogeneity. Odds ratio (OR) was applied for dichotomous variables; weighted mean difference (WMD) was applied for continuous variables. The confidence interval (CI) was set at 95%. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were employed to analyze the improvement of DME patients. Inclusion criteria for picking out studies were retrospective studies and randomized controlled trials (RCTs) that compared IVC and IVR for the treatment of diabetic macular edema. RESULTS: Four retrospective studies and five RCTs were included with a total of 609 patients. No statistically significant difference was observed in mean CMT and mean BCVA in the baseline parameters [BCVA (WMD: -0.48; 95%CI: -1.06 to 0.10; P=0.1), CMT (WMD: -0.83; 95%CI: -15.15 to 13.49; P=0.91). No significant difference was found in the improvement of BCVA and adverse event (AE) in IVC group, compared with IVR group after treatment of loading dosage [the 1st month BCVA (WMD: 0.01; 95%CI: -0.26 to 0.27; P=0.96), the 3rd month BCVA (WMD: -0.04; 95%CI: -0.14 to 0.06; P=0.46); the 6th month BCVA (WMD: -0.24; 95%CI: -1.62 to 1.14; P=0.73)], AE (OR: 0.84; 95%CI: 0.38 to 1.84; P=0.66)]. A slight difference was found in the effectiveness rate (OR: 1.70; 95%CI: 0.97 to 2.96; P=0.06), There were statistically significant differences between IVC and IVR treatment in terms of CMT [1st month CMT (WMD: -19.88; 95%CI: -27.94 to -11.82; P<0.001), 3rd month CMT (WMD: -23.31; 95%CI: -43.30 to -3.33; P=0.02), 6th month CMT (WMD: -74.74; 95%CI: -106.22 to -43.26; P<0.001)]. CONCLUSION: Pooled evidence suggests that both IVC and IVR are effective in the therapy of diabetic macular edema and affirms that IVC presents superiority over IVR therapy in regard of CMT in patients with diabetic macular edema, but no statistically significant difference with regard to visual improvement. Relevant RCTs with longer-term follow-up are necessary to back up our conclusion.     

Frequency of presenting visual acuity and visual impairment in Chinese college students

AIM: To understand retinopathy of prematurity (ROP) screening and treatment preferences among Chinese ophthalmologists. METHODS: A Chinese language survey was administered anonymously using WebQ (Catalyst, Seattle, WA, USA) among Chinese ROP screeners from 12/2016 to 01/2017. RESULTS: Among 70 ophthalmologists contacted, 65 responded (93%; 78% female, mean age 40y, 57% pediatric ophthalmologists and 25% retina specialists). Most used screening criteria of birth weight £2 kg (62%) with variation in cut-off gestational age (£37wk, 34%; £34wk, 22%; £32wk, 31%). RetCam (Natus Medical Incorporated, Pleasanton, CA, USA) wide-field fundus photography assisted most screeners (72%) and was exclusively used by many (29%). Among 55 ophthalmologists treating ROP, anti-vascular endothelial growth factor (VEGF) was preferred over laser for both zone I (76% vs 24%) and zone II ROP (58% vs 42%). Retina specialists (P=0.004) and ophthalmologists with >3mo of training (P=0.03) were more likely to use anti-VEGF over laser for zone I ROP. Lack of laser training (8/20, 40%), access (6/20, 30%) and anesthesia (4/20, 20%) were common barriers to laser treatment. CONCLUSION: Chinese ROP screeners favor anti-VEGF injection and RetCam imaging for ROP management. A better understanding of ROP screening and treatment informs future research and education efforts in China.     

Transscleral vs transpupillary diode laser photocoagulation for the treatment of zone II type 1 retinopathy of prematurity: Anatomical and refractive outcomes

Purpose:To compare the anatomical and refractive outcomes of transscleral diode versus transpupillary laser photocoagulation for the treatment of zone II type 1 retinopathy of prematurity (ROP).Methods:In this prospective comparative interventional case series, infants with type 1 ROP in zone II were assigned to either transpupillary or transscleral laser based on the surgeons’ expertise area. The rate of regression, need for retreatment, and structural and biometric outcomes at month 6 were evaluated and compared between the two treatment groups.Results:In total, 209 eyes were enrolled; 145 eyes of 77 infants and 64 eyes of 33 infants and were in transscleral and transpupillary groups, respectively. There was no significant difference in baseline characteristics between the groups. There was no significant difference in retreatment rates (1.6% vs. 3.4%; P = 0.669) and progression to stage 4 (1.6% vs. 2.8%; P = 0.999) between the transpupillary and transscleral groups, respectively. At month 6, the mean spherical equivalent was 0.31 ± 3.57 and 0.44 ± 2.85 diopters, and the axial length was 18.28 ± 6.22 and 18.36 ± 6.87 mm in the transpupillary and transscleral groups, respectively, without a significant difference between groups. There was no significant difference in the rate of myopia (43.8% vs. 33.8%; P = 0.169) and high myopia (4.7% vs. 4.8%; P = 0.965) in transpupillary and transscleral groups at month 6.Conclusion:The transpupillary and transscleral laser photocoagulation routes are both effective in the treatment of zone II type 1 ROP and show no significant differences in anatomical or refractive outcomes in relation to the route chosen.     

Efficiency and safety of laser photocoagulation with or without intravitreal ranibizumab for treatment of diabetic macular edema: a systematic review and Meta-analysis

AIM: To compare the therapeutic effect and safety of laser photocoagulation along with intravitreal ranibizumab (IVR) versus laser therapy in treatment of diabetic macular edema (DME). METHODS: Pertinent publications were identified through comprehensive searches of PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to identify randomized clinical trials (RCTs) comparing IVR+laser to laser monotherapy in patients with DME. Therapeutic effect estimates were determined by weighted mean differences (WMD) of change from baseline in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6, 12, or 24mo after initial treatment, and the risk ratios (RR) for the proportions of patients with at least 10 letters of improvement or reduction at 12mo. Data regarding major ocular and nonocular adverse events (AEs) were collected and analyzed. The Review Manager 5.3.5 was used. RESULTS: Six RCTs involving 2069 patients with DME were selected for this Meta-analysis. The results showed that IVR+laser significantly improved BCVA compared with laser at 6mo (WMD: 6.57; 95% CI: 4.37-8.77; P<0.00001), 12mo (WMD: 5.46; 95% CI: 4.35-6.58; P<0.00001), and 24mo (WMD: 3.42; 95% CI: 0.84-5.99; P=0.009) in patients with DME. IVR+laser was superior to laser in reducing CRT at 12mo from baseline with statistical significance (WMD: -63.46; 95% CI: -101.19 to -25.73; P=0.001). The pooled RR results showed that the proportions of patients with at least 10 letters of improvement or reduction were in favor of IVR+laser arms compared with laser (RR: 2.13; 95% CI: 1.77-2.57; P<0.00001 and RR: 0.37; 95% CI: 0.22-0.62; P=0.0002, respectively). As for AEs, the pooled results showed that a significantly higher proportion of patients suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye) in IVR+laser group compared to laser group (RR: 3.29; 95% CI: 1.53-7.09; P=0.002 and RR: 3.02; 95% CI: 1.24-7.32; P=0.01, respectively). The incidence of other ocular and nonocular AEs considered in this Meta-analysis had no statistical difference between IVR+laser and laser alone. CONCLUSION: The results of our analysis show that IVR+laser has better availability in functional (improving BCVA) and anatomic (reducing CRT) outcomes than laser monotherapy for the treatment of DME. However, the patients who received the treatment of IVR+laser may get a higher risk of suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye).