Visual acuity and multifocal electroretinographic changes after arteriovenous crossing sheathotomy for macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the influence of arteriovenous (AV) sheathotomy on retinal function with central multifocal electroretinography (mfERG) in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Fifteen patients (15 eyes) who underwent AV sheathotomy for macular edema secondary to BRVO were included in the study. Best-corrected visual acuity and mfERG responses from the most central seven hexagons were analyzed before and 6 months after the operation. RESULTS: The mean preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score +/- SD was 34.1 +/- 12.7 letters (Snellen equivalent, 20/50) and significantly improved up to 40.5 +/- 10.9 letters (Snellen equivalent, 20/40) at 6 months after AV sheathotomy (P = 0.027, Wilcoxon signed rank test). The mean preoperative P1 amplitude +/- SD of the most central 7 hexagons was 39.30 +/- 10.86 nV/deg(2) for the affected eye versus 47.72 +/- 6.67 nV/deg(2) for the normal fellow (control) eye (P = 0.013, Mann-Whitney U test) and significantly increased up to 50.71 +/- 15.58 nV/deg at 6 months after the operation (P = 0.014, Wilcoxon signed rank test). Significant correlations between preoperative and postoperative ETDRS score and preoperative P1 amplitude were present (r = 0.929, P < 0.001; r = 0.768, P = 0.001; respectively [Spearman correlation]). CONCLUSIONS: AV sheathotomy improved macular function and anatomical outcome as measured by ETDRS score and mfERG responses in patients with macular edema due to BRVO.     

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.     

Long-term outcomes of vitrectomy with or without arteriovenous sheathotomy in branch retinal vein occlusion

PURPOSE: To evaluate the long-term effect of vitrectomy with or without arteriovenous sheathotomy for macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: The study was a prospective, randomized, comparative, interventional case series of 36 patients (36 eyes) who underwent pars plana vitrectomy with or without arteriovenous sheathotomy for macular edema due to BRVO of 相似文献   

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.     

Effect of arteriovenous sheathotomy on retinal blood flow and macular edema in patients with branch retinal vein occlusion

PURPOSE: To determine the effect of arteriovenous sheathotomy on retinal blood flow (RBF) in eyes with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: Seven eyes of 7 patients with BRVO underwent sheathotomy and were followed for more than 6 months. RESULTS: At 1 week postoperatively, the RBF in the affected vessels was significantly improved from 14.1 +/- 5.7 to 27.3 +/- 11.3 pixel(2)/sec (P < 0.01), and the foveal thickness (FT) was significantly reduced from 536 +/- 84 to 366 +/- 134 microm (P = 0.03). However, the RBF was reduced again to 11.7 +/- 7.7 pixel(2)/sec at 1 month postoperatively, and the FT was increased to 424 +/- 184 microm. CONCLUSIONS: Arteriovenous sheathotomy led to a transient improvement of the RBF and was effective in reducing macular edema. It is not clear whether the transient effect of sheathotomy affects the long-term visual acuity and macular edema.     

Evaluation of arteriovenous crossing sheathotomy for decompression of branch retinal vein occlusion

PURPOSE: To report the effects of arteriovenous adventitial sheathotomy on anatomical and functional improvements in patients with macular oedema due to branch retinal vein occlusion (BRVO). METHODS: Pars plana vitrectomy and arteriovenous sheathotomy was performed on 11 patients with BRVO who had vision loss due to macular oedema. Ten patients with macular oedema due to BRVO and who have been treated with grid laser photocoagulation were included in the control group. The measurement of visual acuity with ETDRS chart was taken preoperatively and at 1, 3, 6, and 9 months follow-up in the study group and at 1, 3, 6, and 9 months after grid laser in the control group. RESULTS: The mean preoperative logMAR visual acuity was 0.84+/-0.3 in the surgical group and 1.06+/-0.4 in the control group. The postoperative mean logMAR visual acuity was 0.41+/-0.2, 0.40+/-0.2, 0.40+/-0.3, and 0.36+/-0.3 at 1, 3, 6, and 9 months follow-up, respectively. In the control group the postlaser mean logMAR visual acuity was 0.92+/-0.3, 0.87+/-0.4, 0.85+/-0.3, and 0.82+/-0.3 at 1, 3, 6, and 9 months follow-up, respectively. The improvements of visual acuity in both groups were statistically significant when compared to pretreatment (P=0.003 and P=0.007 at 9 months in the study and control group, respectively). CONCLUSION: Arteriovenous sheathotomy for decompression of BRVO in patients who have vision loss due to macular oedema was safe and effective for anatomical and functional improvement and resulted in significantly better visual outcomes than a matched control group of laser-treated eyes.     

Arteriovenous sheathotomy for persistent macular edema in branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. METHODS: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. RESULTS: The mean preoperative BCVA (log MAR) were 0.79 +/- 0.29 and postoperative BCVA (log MAR) at 3 months was 0.57 +/- 0.33. And improvement of visual acuity > or = 2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22 +/- 76.83 microm (510-737 microm) and postoperative fovea thickness was 217.60 +/- 47.33 microm (164-285 microm). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.     

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.     

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。     

Efficiency of surgical treatment for chronic macular edema due to branch retinal vein occlusion

INTRODUCTION: Internal limiting membrane peeling has recently given interesting results in the management of macular edema in diabetic patients, even in the absence of vitreomacular tractions. This study was conducted to evaluate the results of a surgical treatment for macular edema resulting from branch retinal vein occlusion. MATERIAL AND METHODS: A nonrandomized prospective study was conducted between March 2001 and April 2002 on 12 eyes of 12 consecutive patients with a visual acuity of 20/40 or less resulting from branch retinal vein occlusion with macular edema. Internal limiting membrane peeling associated with arteriovenous crossing sheathotomy was performed on six eyes and internal limiting membrane peeling alone was performed on six eyes. Patients were tested with ETDRS visual acuity, fluorescein angiography, automated perimetry, and OCT pre- and postoperatively (at 3 and 6 months). RESULTS: At 6 months, postoperative visual acuity was improved in all patients (mean VA=20/40; range, 20/125-20/20), with an average gain of three lines of vision (or 14 ETDRS points) (p=0.002). Fundus examination and fluorescein angiography results were improved in all patients. At 6 months, on automated field testing, the mean corrected defect improved from 3.4+/-0.9dB to 2.3+/-0.9dB (p=0.008). On OCT, mean foveal thickness decreased from 419+/-57 micro m to 233+/-10 micro m (p=0.02). No difference was noted between simple vitrectomy with internal limiting membrane peeling and arteriovenous crossing sheathotomy in terms of visual acuity (p=0.5), visual field (p=0.2), or foveal thickness (p=0.6) improvement. CONCLUSION: Our findings suggest that internal limiting membrane removal for macular edema may improve the functional prognosis in patients with branch retinal vein occlusion. Adventitial sheathotomy did not yield further functional benefits in these cases.     

Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology

ABSTRACT: BACKGROUND: The influence of serous retinal detachment (SRD) on visual acuity, macular sensitivity, and macular thickness is unclear after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO). Methods: Twenty-one eyes of 21 BRVO patients with macular edema received IVTA. Patients were divided into two groups by optical coherence tomography findings: 11 patients who had cystoid macular edema (CME) with SRD (SRD (+) group) and 10 patients who had CME without SRD (SRD (-) group). Microperimetry was performed with a Micro Perimeter 1 before and at 3 and 6 months after IVTA. Macular thickness was measured by optical coherence tomography. We exchanged the superior and inferior regions to separate the regions into those with and without occlusion. As a result, the superior region was always the occluded region and the inferior region was non-occluded. Results: In both the SRD (-) group and the SRD (+) group, the mean macular thickness within the central 4degrees field and the 10degrees and 20degrees fields of the occluded region decreased significantly from baseline to 3 and 6 months after IVTA (all P<0.01). Visual acuity also improved significantly in both groups from baseline to 3 and 6 months after IVTA (both P<0.05). In both groups, the mean macular sensitivity (measured with by microperimetry) within the central 4degrees field and the 10degrees and 20degrees fields of the occluded region showed a significant increase from baseline to 3 and 6 months after IVTA (all P<0.05). The trend profiles of macular thickness within the 10degrees and 20degrees fields of the occluded region showed significant differences, but there were no significant differences with respect to the trend profiles of visual acuity and macular sensitivity within the central 4degrees field and the 10degrees and 20degrees fields of the occluded region. Conclusions: These results suggest that IVTA may achieve more marked improvement of macular morphology in BRVO patients with SRD than in those without SRD, while this therapy may have a similar effect on macular function in BRVO patients with or without SRD.     

Comparison of two doses of intravitreal bevacizumab (Avastin) for treatment of macular edema secondary to branch retinal vein occlusion: results from the Pan-American Collaborative Retina Study Group at 6 months of follow-up

PURPOSE: To report the 6-month anatomical and visual outcomes after injecting two different doses of intravitreal bevacizumab in patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: An interventional, retrospective multicenter study of 45 eyes that were treated with at least one intravitreal injection (24 eyes, 1.25 mg; 21 eyes, 2.5 mg) of bevacizumab is reported. The main outcome measures were the central 1-mm macular thickness (CMT) and the change in ETDRS lines of best-corrected visual acuity (BCVA) at 6 months. RESULTS: Forty-five eyes were injected on average 26.1 months (range, 3-86 months) after the diagnosis. The average follow-up was 35.2 weeks (range, 24-52 weeks). All patients completed at least 6 months of follow-up. In the 1.25-mg dose group, at 1 month, there was an average gain of 4.5 lines of BCVA; at 3 months, 5.1 lines of BCVA; and at 6 months, 5.1 lines of BCVA (P < 0.005). In the 2.5-mg dose group, at 1 month, there was an average gain of 2.3 lines of BCVA; at 3 months, 3.8 lines of BCVA; and at 6 months, 4.8 lines of BCVA (P = 0.05). In the 1.25-mg dose group, the mean CMT +/- SD decreased from 461 +/- 211 microm at baseline to 321 +/- 152 microm at 1 month, 273 +/- 99 microm at 3 months, and 277 +/- 114 microm at 6 months (P = 0.0002). In the 2.5-mg group, the mean CMT +/- SD decreased from 385 +/- 168 microm at baseline to 279 +/- 111 microm at 1 month, 249 +/- 97 microm at 3 months, and 240 +/- 93 microm at 6 months (P = 0.011). CONCLUSION: There were no statistically significant differences between the two dose groups with regard to the number of injections and anatomical and functional outcomes. Intravitreal injection of bevacizumab at doses up to 2.5 mg appears to be effective in improving BCVA and reducing CMT in BRVO in the short term. Multiple injections are needed in a large number of eyes for continued control of macular edema and preservation of visual acuity in the short term. Longer studies are needed to determine what role if any intravitreal injection of bevacizumab may play in the long-term treatment of this condition.     

Prognostic factors for visual outcome after intravitreal bevacizumab for macular edema due to branch retinal vein occlusion

PURPOSE: To evaluate the prognostic factors for visual outcome after intravitreal bevacizumab injection to treat macular edema due to branch retinal vein occlusion (BRVO). METHODS: Fifty eyes of 50 consecutive patients treated with intravitreal bevacizumab for macular edema due to BRVO with minimum follow-up of 3 months were retrospectively reviewed. Patients were categorized into two groups according to the final visual acuity. Group 1 consisted of eyes with 5 or more ETDRS letters gain, and group 2 consisted of eyes with less than 5 letters improvement or which had worsened at last follow-up visit. Comparative clinical and fluorescein angiographic characteristics were analyzed between the two groups. RESULTS: Of 50 eyes, 28 (56%) had improved vision after intravitreal bevacizumab injections and were categorized as group 1; 22 eyes (44%) were categorized as group 2. The number of early VA gainers, who showed visual improvement at 1 month after bevacizumab injection, was significantly higher in group 1 (P < 0.001, chi-square test). The early gainers tend to maintain significantly better visual outcome until last follow-up. The number of eyes with angiographically documented macular ischemia was significantly higher in group 2 (P < 0.001). In group 2, the decrease in central macular thickness was not accompanied by visual acuity improvement. CONCLUSION: Preoperative presence of macular ischemia can be useful in predicting the outcome of visual acuity after intravitreal bevacizumab for macular edema due to BRVO. The early gainers who favorably responded to the initial intravitreal bevacizumab injection are most likely to benefit from the bevacizumab treatment.     

Effects of macular ischemia on the outcome of intravitreal bevacizumab therapy for diabetic macular edema

PURPOSE: To evaluate the effects of macular ischemia on visual outcomes in patients with diabetic macular edema (DME), after intravitreal bevacizumab injections. METHODS: Data on 59 eyes of 53 consecutive patients treated with intravitreal bevacizumab for DME were retrospectively reviewed. Data from preoperative fluorescein angiography (FA) tests were examined. Patients with an enlarged foveal avascular zone (FAZ), >or=1000 microm, or a broken perifoveal capillary ring at the border of the FAZ, with a distinct area of capillary nonperfusion within one disk diameter of the foveal center in the transit phase of fluorescein angiography, were defined as having macular ischemia. The patients were thus divided into two groups: with or without macular ischemia. Early Treatment Diabetic Retinopathy Study (ETDRS) scores, and foveal thicknesses measured using third generation ocular coherence tomography (OCT), were evaluated at baseline and at 1 month and 3 months after treatment. RESULTS: At 3 months after treatment, the mean visual acuity (VA) score decreased from a baseline VA of 0.52 +/- 0.27 (approximate Snellen equivalent, 20/63) to 0.57 +/- 0.21 (20/80) in the ischemic group. In the nonischemic group, by contrast, the VA improved from 0.66 +/- 0.34 (20/100) at baseline to 0.59 +/- 0.33 (20/80) at 3 months post-treatment. Nine of 18 eyes (50%) in the ischemic group, but only 9 of 41 eyes (21%) in the nonischemic group, experienced visual losses of >or=1 line on the ETDRS chart (P = 0.031, Pearson chi-square test). Four eyes (22%) in the ischemic group, but only 2 eyes (5%) in the nonischemic group, lost >or=3 lines (P = 0.042, Pearson chi-square test). CONCLUSION: Macular ischemia may have a negative effect on short term visual outcomes after intravitreal bevacizumab injections in patients with DME.     

Intravitreal tissue plasminogen activator to treat macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of intravitreal tissue plasminogen activator (tPA) injection for branch retinal vein occlusion (BRVO). DESIGN: Retrospective, interventional case series. METHODS: Seventeen eyes presenting with macular edema caused by BRVO were treated with an intravitreal tPA (Monteplase, 40 k IU) injection. We assessed the visual acuity (VA) and foveal thickness measured with optical coherence tomography. RESULTS: The mean duration of symptoms before surgery was 3.6 +/- 3.8 weeks. The mean logMAR VA significantly improved from 0.603 +/- 0.327 at baseline to 0.388 +/- 0.248 (P < .01) at one month and 0.359 +/- 0.319 (P < .05) at six months. The mean foveal thickness significantly decreased from 738 +/- 156 microm at baseline to 454 +/- 213 microm (P < .001) at one month and 253 +/- 164 microm (P < .001) six months. CONCLUSION: Intravitreal tPA injection may be an effective treatment for resolving macular edema and improving the VA in BRVO.     

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.     

曲安奈德玻璃体内注射联合激光光凝治疗黄斑水肿的临床研究

目的观察激光光凝联合曲安奈德玻璃体内注射治疗黄斑水肿的疗效。方法将40例(40眼)黄斑水肿患者分为单纯光凝组和联合注药组,每组20眼,分别行黄斑格栅样光凝和黄斑格栅样光凝联合玻璃体内注射40g·L-1曲安奈德0.1mL治疗,观察治疗前及治疗后1个月、3个月、6个月2组患者视力和黄斑中心凹厚度的变化,并观察术后并发症情况。结果单纯光凝组和联合注药组术前平均视力分别为0.11±0.09和0.12±0.10,黄斑中心厚度分别为(535±147)μm和(527±145)μm,2组间差异均无统计学意义(均为P>0.05)。治疗后1个月、3个月、6个月,单纯光凝组和联合注药组平均视力分别为0·19±0.09和0.42±0.09、0.24±0.09和0.38±0.10、0.24±0.09和0.42±0.09;黄斑厚度分别为(405±150)μm和(248±164)μm、(354±124)μm和(279±133)μm、(325±124)μm和(285±118)μm,2组间比较差异均有统计学意义(均为P<0·05)。光凝组术后1例患者眼压升高,联合注药组6例眼压升高,经药物治疗后均恢复正常;联合注药组治疗后2例患者黄斑水肿复发,经再次注药后1例治愈;随访期内均未见严重并发症发生。结论曲安奈德玻璃体内注射联合激光光凝治疗黄斑水肿可较快提高视力、减轻黄斑水肿、减少水肿复发。     

Macular function by multifocal electroretinogram in diabetic macular edema after intravitreal triamcinolone acetonide injection

PURPOSE: The purpose of this study was to assess macular function by multifocal electroretinography (mfERG) in eyes with diabetic macular edema (DME) after intravitreal triamcinolone acetonide (IVTA) injection. METHODS: Fifteen eyes of 15 patients with DME scheduled for 4 mg IVTA injection were prospectively recruited. The response to treatment was monitored functionally by visual acuity (VA) measurement and mfERG and anatomically by foveal thickness measured by optical coherence tomography (OCT). The first-order kernel P1 mfERG responses from 0 to 7 degrees (central) and 7 to 25 degrees (peripheral) were grouped and analyzed. Changes in functional parameters (VAs and the P1 mfERG response amplitudes and peak latencies) and morphometric parameters (OCT foveal thickness) in eyes with DME 1 and 3 months after IVTA injection were compared with baseline values by Student t test. RESULTS: The mean baseline logMAR value for VAs of the patients before treatment was 0.49+/-0.26. After treatment, it was 0.27+/-0.23 at 1 month and 0.26+/-0.18 at 3 months, and differences from pretreatment values were significant (for each, p<0.001). There were statistically significant decreases in the mean foveal thickness at 1 and 3 months after treatment compared with pretreatment values (for each, p<0.001). There were also statistically significant increases in the mean P1 response amplitude for both central and peripheral groups at all examinations compared with pretreatment (for each, p<0.001). The mean P1 peak latencies for both the central and peripheral groups were shortened, but not significantly. CONCLUSIONS: As well as the reduction in DME and improvement in VA, IVTA injection improves macular function as assessed by mfERG in diabetic patients.     

The effect of intravitreal triamcinolone on foveal edema in exudative macular degeneration

PURPOSE: To evaluate the effect of a single intravitreal injection of triamcinolone (IVTA) on central macular thickness and visual acuity in eyes with minimally classic exudative age-related macular degeneration (AMD). DESIGN: Retrospective, nonrandomized clinical interventional study. METHODS: Optical coherence tomography (OCT) and best-corrected logarithm of the minimum angle of resolution visual acuity were performed at baseline and one month after treatment. RESULTS: We identified 11 eyes with foveal edema and minimally classic subfoveal neovascularization treated with an IVTA. Foveal edema decreased significantly from 401 +/- 98 microm at baseline to 295 +/- 141 microm (mean +/- standard deviation; P = .004) at one month. There was, however, no significant change in visual acuity at one or three months after the intervention. CONCLUSIONS: This biological effect of IVTA does not support its clinical use, yet it does warrant further research to determine whether locally delivered corticosteroids may be synergistic with other treatments. Reduction in foveal edema is not necessarily associated with improved visual function in exudative AMD.     

Long-term visual outcomes after vitrectomy for macular edema with foveal hemorrhage in branch retinal vein occlusion

PURPOSE: To determine the long-term visual outcomes after vitreous surgery for macular edema with foveal hemorrhage associated with branch retinal vein occlusion (BRVO). METHODS: One hundred twenty eyes of 120 patients underwent pars plana vitrectomy with or without internal limiting membrane (ILM) peeling for macular edema with foveal hemorrhage due to BRVO with a minimum 12 months of follow-up. Simultaneous cataract extraction with intraocular lens implantation was performed on 117 phakic eyes. RESULTS: Follow-up after surgery ranged from 12 months to 129 months (average, 48 months). Visual acuity improved in 71% of cases at the 1-year visit. Mean visual acuity significantly increased from 0.24 (median, 0.3) before surgery to 0.57 (median, 0.7) 1 year after surgery (P < 0.0001) and 0.66 (median, 0.9) at the final visit (P < 0.0001). There was a significant difference between visual acuity at 1 year after surgery and visual acuity at the final visit (P < 0.0001). Of 120 patients, 95 (79%) had final visual acuity of > or =0.5, and 55 (46%) had final visual acuity of > or =1.0. ILM removal did not seem to have significant beneficial effects on visual outcomes in this series. No serious complications occurred during the follow-up period. CONCLUSION: After vitreous surgery for macular edema with foveal hemorrhage associated with BRVO, visual acuity continued to improve beyond 1 year after surgery. A randomized, multicenter clinical trial is warranted to determine the efficacy of this procedure.