Small laser spot versus standard laser spot photodynamic therapy for idiopathic choroidal neovascularization: a randomized controlled study

Background  Idiopathic choroidal neovascularization (ICNV) affects young patients and thus may have a significant impact on vision and life quality over a patient’s lifespan. This study was designed to compare the visual outcome and retinal pigment epithelium (RPE) damage after photodynamic therapy (PDT) with small laser spot and PDT with standard laser spot for idiopathic choroidal neovascularization (ICNV).

Methods  This was a randomized controlled study. Fifty-two patients with ICNV were enrolled and randomly divided into a study group (small laser spot PDT, n=27) and a control group (standard laser spot PDT, n=25). Best corrected visual acuity (BCVA), optic coherence tomography (OCT) and fluorescein angiography (FA) findings were the main measurements. The patients were followed up 1 week, 1, 3, 6, 9 months and 1 year after PDT.  

Results  BCVA improvement was statistically significantly higher in the study group than the control group at 6-month ((25.53±15.01) letters vs. (14.71±11.66) letters, P=0.025) and 9-month follow-ups ((27.53±17.78) letters vs. (15.59±12.21) letters, P=0.039). At 3- and 6-month follow-ups, the quadrants of RPE damage between the two groups varied significantly (P <0.001 and P=0.023, respectively). In each follow-up, the number of cases with decreased or unchanged leakage of choroidal neovascularization by FA and reduced subretinal fluid by OCT did not vary significantly between the two groups. Ten cases (37.0%) in the study group and eight cases (32.0%) in the control group suffered from recurrent CNV (P=0.703).

Conclusions  Better visual improvements, less RPE damage, a similar recurrent rate of CNV and change of subretinal fluid were observed in the small laser spot PDT group than in the standard laser spot PDT group for ICNV.

     

Retinoschisis and intravitreal ranibizumab treatment for myopic choroidal neovascularization

Background Intravitreal ranibizumab injection is effecitve on treating myopic CNVs,but it could be a risk factor for developing more severe retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.This study aimed to explore the incidence and features of retinoschisis after intravitreal ranibizumab injection for myopic choroidal neovascularization.Methods Eighty-three eyes of 81 patients with choroidal neovascularization secondary to pathologic myopia were treated with intravitreal ranibizumab injection.The best corrected visual acuity and optical coherence tomography （OCT） images were recorded at baseline and every month thereafter.Central retina thickness and maximal retina thickness were measured.The subjects were divided into three groups.Eleven eyes that had retinoschisis and epiretinal membrane were in group 1,six eyes that had simple epiretinal membrane were in group 2,and 66 eyes that had neither retinoschisis nor epiretinal membrane were in group 3.Six contralateral eyes in group 1 which had retinoschisis and epiretinal membrane but were not treated with intravitreal ranibizumab injection were set as the control group.Results Seven of the 11 eyes in group 1 developed more severe retinoschisis,the mean maximal retinal thickness increased from （380.28±90.13） to （467.00±70.20） μm （P 〈0.05）.The retinoschisis of all 6 eyes of the control group did not aggravate.Compared with the control group,the aggravation ratio of retinoschisis increased significantly （P 〈0.05）.No new onset of retinoschisis took place in group 2 and group 3.Conclusion Intravitreal ranibizumab injection may be a risk factor for aggravation of retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.     

Intravitreal ranibizumab for the treatment of pathological myopia associated with choroidal neovascularization in Chinese patients

Background Pathological myopia （PM） is the leading cause for choroidal neovascularization （CNV） in people below 50 years of age,the anti-vascular endothlial growth factor （VEGF） medicine is now available to treat CNV secondary to PM.This study aimed to observe the efficacy of intravitreal ranibizumab for PM associated with subfoveal or juxtafoveal CNV in Chinese patients.Methods Fifty-four eyes of 52 consecutive patients were included,they treated with intravitreal ranibizumab 0.5 mg for PM associated with CNV.The best corrected visual acuity （BCVA） of Snellen chart,letters of ETDRS chart,retinal thickness,leakage of CNV lesion,and complications with surgery were analyzed pre-and post-treatment.Eligibility criteria included diopter ≥-8.0 D or eye axis ≥28 mm with fundus changes of PM （lacquer crack,optic disc atrophy,chorioretinal atrophy,posterior scleral staphyloma）; CNV secondary to PM; subfoveal or juxtafoveal CNV.Results For 54 affected eyes of 52 consecutive patients,the average BCVA of Snellen chart and letters of ETDRS chart were 0.29 and 30.4,respectively; fundus fluorescein angiography （FFA）/indocyanine green angiography （ICGA） showed CNV leakage,and average retinal thickness on optical coherence tomography （OCT） was 267.2 μm before treatment.Injections of ranibizumab ranged from 1 to 4 （mean 2.2）.Follow-up time varied from 12 to 36 months （mean 31.9 months）.At the last visit,the BCVA of Snellen chart was increased by three lines （mean 0.65） （P 〈0.01）; the letters of ETDRS chart were increased to 17.0 letters （mean 47.4,P 〈0.01）; the visual acuity increased more than 15 letters in 30 eyes （55.5%）,decreased in 1 eye （1.9%）; the retinal thickness on OCT images was decreased by 17.0 μm （mean 250.2 μm） （P=0.082）; no active leakage from the CNV lesion occurred in 18 eyes （33.3%）,reduced leakage in 30 eyes （55.6%）,and no change in 6 eyes （11.1%） as shown by FFA/ICGA.Increased retinoschisis was observed in one eye after     

脉络膜新生血管单次光动力治疗后黄斑区视功能与形态变化

目的观察单次光动力治疗(PDT)脉络膜新生血管(CNV)后黄斑区视功能与形态变化及其相关性。方法选择17例(23眼)经典为主型CNV患者进行单次光动力治疗,于治疗前及治疗后3个月和8个月分别行视力、多焦视网膜电图(mfERG)、荧光素眼底血管造影(FFA)、相干光视网膜断层扫描(OCT)检查,观察黄斑中心的厚度以及功能改变;选择相匹配的正常30眼作为对照组。结果与对照相比,CNV患眼治疗前黄斑中心厚度增加,且mfERG的N1和P1波反应密度明显下降。PDT治疗后,视力有改善趋势,但差异无统计学意义。OCT显示治疗后黄斑区中心厚度显著减小,但治疗后8个月与治疗后3个月差异无统计学意义。mfERG显示治疗后1区P1波和2区N1波反应密度显著增加;治疗后8个月1区N1波反应密度显著增加;1区和2区的P1和N1潜伏期治疗前后差异无统计学意义。治疗后3个月视力变化与黄斑中心厚度变化有相关性(r=0.43,P=0.04),与mfERG各波的变化无相关性,1区的N1和P1波反应密度与黄斑中心厚度变化呈负相关(r=-0.43,P=0.04;r=-0.51,P=0.01)。结论对较小范围的CNV患眼单次PDT治疗可在3个月内减少黄斑区中心厚度并改善视功能,并在相对远期保持稳定。黄斑中心区和旁中心区的恢复有所不同;视功能变化与形态变化有一定相关性。     

Evaluation of visual functional and morphology change in young patients with idiopathic choroidal neovascularization

Background  Idiopathic choroidal neovascularization (ICNV) is an uncommon disorder affecting primarily individuals younger than the age of 50 years. In CNV patients, no apparent cause can be determined. This study aimed to evaluate the functional and morphological change of the retina with ICNV in young adults.

Methods  In this retrospective study, 32 eyes of 32 patients with subfoveal or juxta/extra foveal ICNV had been admitted into the Shanghai First People’s Hospital from January 2009 to July 2010. The functional changes were evaluated using the best corrected visual acuity (BCVA) and the microperimetry in the macular area. The morphology changes were evaluated using optical coherence tomography (OCT), the color fundus photography and the fluorescein angiography.

Results  Seventeen patients with juxta/extra foveal and 15 subfoveal CNV were investigated. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.39, the mean central retinal thickness (CRT) was 334 μm, and the mean sensitivity (MS) was 11.8 decibels (dB). In the subfoveal group, there was a strong correlation between CRT and BCVA (r=–0.675, F=2.167, P <0.01); as well as that between CRT and MS (r=–0.681, F=22.91, P <0.01). While in the juxta/extra foveal CNV group, the correlation of CRT and BCVA was not significant (r=–0.071, F=1.018, P >0.05); neither was the correlation of CRT and MS (r=–0.142, F=36.54, P >0.05). The microperimetry (MP-1) test revealed 17 (53%) patients with stable fixation, 9 (28%) with relatively unstable and 6 (19%) with unstable fixation. Fixation stability correlated positively with sensitivity in the central 2° diameter area (r=0.380, F=3.213, P <0.05) and the duration of symptoms (r=0.401, F=7.933, P <0.05).

Conclusions  ICNV was associated with reduced total MS, unstable fixation and eccentric fixation. These findings emphasized functional change in ICNV is beyond the BCVA and regular morphology change, which provided additional information of functional evaluation in clinical practice.

     

光动力疗法联合 Lucentis 玻璃体腔注射治疗 CNV 的疗效观察

目的：观察光动力疗法（PDT ）联合Lucentis玻璃体腔注射治疗脉络膜新生血管疾病（CNV ）的近期疗效和安全性。方法对30例（30只眼）经眼压、眼底检查、荧光素眼底血管造影（FFA）以及光学相干断层扫描（OCT ）等检查确诊为 CNV 患者行 PDT 联合 Lucentis 玻璃体腔注射治疗的患者资料进行回顾性分析。结果经4～6个月随访,30只眼中有22只眼视力提高（占73．3％）,8只眼视力稳定（占26．7％）,未见有视力下降者。20例 AMD 患者中14例（70．0％）通过一次联合治疗后 CNV 消退;3例（15．0％）3个月后需再次 Lucentis 玻璃体腔注射治疗。10例特发性脉络膜新生血管病例通过一次联合治疗而使 CNV 消退。治疗及随访期间无全身和眼部并发症发生。结论 PDT 联合 Lucentis 玻璃体腔注射治疗 CNV 的疗效显著,可以提高患者视力及减少重复治疗的次数。     

Comparison of the effect of reduced-fluence photodynamic therapy with intravitreal bevacizumab and standard-fluence alone for polypoidal choroidal vasculopathy

BackgroundPhotodynamic therapy (PDT) has previously been reported to be effective in treating polypoidal choroidal vasculopathy (PCV), with satisfactory polyp regression. However, the optimum treatment protocol remains controversial. This study compared the effect of reduced-fluence PDT combined with intravitreal bevacizumab (rPDT/IVB) and standard-fluence PDT (sPDT) alone for treating symptomatic PCV in Chinese patients.MethodsA retrospective review was carried out of the medical records of patients with PCV who were treated with rPDT/IVB (14 eyes of 13 patients) or sPDT (12 eyes of 12 patients) with at least 6 months of follow-up.ResultsThe mean best-corrected visual acuity of the rPDT/IVB group improved significantly at the 6-month follow-up (p = 0.041). Only one eye (7.1%) in the rPDT/IVB group showed a decrease in visual acuity, compared with four eyes (33.3%) in the sPDT group. A total of 40.0% of eyes in the sPDT group showed increased lipid exudate at follow-up 1 month after treatment, whereas no increase in lipid exudate was observed in the rPDT/IVB group (p = 0.015). The mean maximum area of post-treatment hemorrhage in the rPDT/IVB group was smaller than that in the sPDT group (2.57 ± 2.74 mm² vs. 12.69 ± 10.28 mm², p = 0.042).ConclusionCombination therapy with rPDT/IVB for patients with PCV showed encouraging results in vision improvement, a lower decrease in visual acuity, significantly less post-treatment lipid exudate and a smaller area of post-treatment hemorrhage at the 6-month follow-up than patients treated with sPDT.     

血卟啉衍生物光动力对两株人鼻咽癌细胞杀伤实验的对比研究

目的 探讨血卟啉衍生物(HpD)光动力学效应(PDT)对体外培养人鼻咽癌细胞株CNE2和C666-1的生物作用.方法 向体外培养的CNE2和C666-1分别加入不同浓度的HpD(0.5、1.0、1.5、2.0、2.5、3.0、3.5、4.0μg/m)孵育4 h,予波长为630nm的半导体激光进行照射,照射的功率密度为20mW/cm2,照射能量密度分别为2、5、10、20 J/cm2,继续孵育24h,用四唑盐比色法测定细胞存活率.结果 HpD-PDT能有效地杀伤体外培养的人鼻咽癌CNE2和C666-1细胞,其杀伤作用大小与HpD的浓度和激光剂量成正相关(P＜0.01).激光能量为20 J/cm2,HpD的浓度为2.5μg/ml或2.0μg/ml时,其杀伤CNE2、C666-1细胞的作用最明显;HpD-PDT对CNE2和C666-1的半数杀伤度分别为0.7μg/ml、1.2μg/ml,两者存在显著性差异(P＜0.05).相同HpD浓度、激光剂量条件下,C666-1细胞存活率显著高于CNE2(P＜0.05).结论 HpD-PDT对CNE2和C666-1细胞均有杀伤作用,但C666-1细胞对HpD-PDT的敏感性低于CNE2.     

血卟啉衍生物光动力对两株人结肠癌细胞杀伤实验的对比研究

目的 探讨血卟啉衍生物(HpD)光动力学效应(PDT)对体外培养人结肠癌细胞株LoVo和CoLo205的生物作用.方法 在体外培养的LoVo和CoLo205细胞中分别加入不同浓度的HpD(0.5、1.0、1.5、2.0、2.5、3.0、3.5、4.0 μg/ml)孵育6 h,予波长为630 nm的半导体激光进行照射,照射的功率密度为20mW/cm2,照射能量密度分别为2、5、10、20J/cm2,继续孵育24 h,用四唑盐(MTT)比色法测定细胞存活率.荧光分光光度计检测LoVo与CoLo205细胞内HpD荧光强度.结果 HpD-PDT对体外培养的人结肠癌LoVo和CoLo205细胞均有杀伤作用,两者无显著性差异(P＞0.05).其杀伤作用大小与HpD的浓度和激光剂量成正相关(P＜0.01).激光能量为20 J/cm2,HpD的浓度为2.5μg/ml时,其杀伤LoVo、CoLo205细胞的作用最明显;HpD-PDT对LoVo和CoLo205的半数杀伤度(IC50)分别为0.4 μg/ml、0.6 μg/ml,两者无显著性差异(P＞0.05).检测LoVo与CoLo205细胞内HpD荧光强度无显著性差异(P＞0.05).结论 HpD-PDT可有效杀伤体外培养的人结肠癌LoVo和CoLo205细胞,且对两种细胞的杀伤作用无明显差异.     

Intravitreal bevacizumab versus triamcinolone acetonide for macular edema due to branch retinal vein occlusion: a matched study

Background Branch retinal vein occlusion （BRVO） is a common retinal vascular disorder of the elderly and both intravitreal triamcinolone acetonide （TA） and intravitreal bevacizumab were reported to be effective. The purpose of this study was to compare intravitreal bevacizumab with intravitreal TA for the treatment of macular edema resulting from BRVO. Methods The retrospectively comparative interventional study included a bevacizumab group of 34 BRVO patients （1.25 mg bevacizumab） and a TA group of 34 BRVO patients （4.0 mg TA）, and the two groups were matched by baseline best corrected visual acuity （BCVA）. Examinations were designed to be carried out at 1 day, 3 days, 1 month, 2 months, 3 months, 6 months and 1 year after each injection. The mean follow-up was （148.43±130.56） days. Main outcome parameters were BCVA and morphometric measurements of the macula obtained by optical coherence tomography. Results In all follow-ups, the mean changes of BCVA （LogMAR） between two groups were not significantly different （P 〉0.10）. Similarly, the rates of patients who got BCVA improvement ≥2 lines or lost BCVA ≥2 lines were not significantly different, either （P 〉0.10）. In both groups, compared with baseline, the mean central macular thickness （CMT） got reduction from 4 weeks to 1 year after initial injection, however, which lost statistical significance at 6-month follow-up in TA group （P=0.25） and lost significance at 3-month and 6-month follow-up in bevacizumab group （P=0.07, 0.21）. The mean CMT between two groups differed at 3-month follow-up （P 〈0.01）, while almost kept parallel in other follow-ups （all P 〉0.40）. In TA group, retinal pigment epithelium tear occurred in 1 eye at 8 weeks after initial injection and 12 eyes （35.3%） got intraocular pressure 〉21 mmHg. In bevacizumab group, no severe complications were observed. Conclusion For BRVO, intravitreal bevacizumab versus intravitreal TA causes a similar increase in visual acuity and reduction of macular edema （except 3-month follow-up） with minor complications during 1 year.     

中医综合疗法对假性近视患者黄斑处脉络膜厚度及微血流密度的影响

[目的] 研究中医综合疗法对青少年假性近视患者黄斑处脉络膜厚度及微血流密度的影响,为中医疗法在青少年假性近视的治疗方面提供依据。[方法] 使用SPSS 21.0软件产生随机数字,将51例（102只眼）假性近视青少年患者随机分成对照组和治疗组。对照组患者27例（54只眼）,单纯使用复方托吡卡胺滴眼液点眼治疗;治疗组患者24例（48只眼）,在对照组治疗的基础上配合中药雾化、中药眼贴和耳穴埋籽等中医综合治疗。两组患者疗程均为8周,治疗前后检测两组患者裸眼远视力、电脑验光屈光度数、黄斑中心凹下脉络膜厚度及黄斑区浅层血流密度,并评价两组患者疗效。[结果] 1）治疗组1例因中药雾化过敏导致脱落,最终纳入23例（46只眼）。2）治疗8周后,治疗组总有效率为92.3%,对照组总有效率为75.0%,治疗组疗效优于对照组,差异有统计学意义（P＜0.05）。3）治疗后,治疗组患者平均视力较治疗前提高,差异具有统计学意义（P＜0.05）;对照组患者平均视力较治疗前无明显改善,差异无统计学意义（P＞0.05）。组间比较方面,治疗组治疗后平均视力较对照组有一定提高,差异有统计学意义（P＜0.05）。4）经治疗,治疗组患者平均假性近视度数较治疗前下降,差异有统计学意义（P＜0.05）;对照组患者平均假性近视度数较治疗前略有下降,差异无统计学意义（P＞0.05）。组间比较方面,治疗组治疗后平均假性近视度数较对照组有一定下降,差异有统计学意义（P＜0.05）。5）治疗组患者黄斑中心凹下脉络膜厚度较治疗前增厚,差异有统计学意义（P＜0.05）;对照组黄斑中心凹下脉络膜厚度较治疗前无明显改变,差异无统计学意义（P＞0.05）;组间比较方面,治疗组治疗后黄斑中心凹下脉络膜厚度较对照组增厚,两组比较差异有统计学意义（P＜0.05）。6）治疗后,治疗组黄斑区浅层血流密度较治疗前增加,差异有统计学意义（P＜0.05）;对照组黄斑区浅层血流密度较治疗前增加,但差异无统计学意义（P＞0.05）;组间比较方面,治疗组治疗后黄斑区浅层血流密度较对照组明显增加,两组比较差异有统计学意义（P＜0.05）。[结论] 采用中医综合疗法对青少年假性近视治疗效果较好,并且可以增加黄斑中心凹下脉络膜厚度及黄斑区浅层血流密度,短期观察无不良反应,值得临床推广运用。     

HB-PDT对经顺铂诱导耐药及非耐药肺癌细胞系杀伤效应的比较

目的:对比研究耐药及非耐药肺癌细胞株对竹红菌乙素-光动力疗法(HB-PDT)的反应性,以及耐药肿瘤对HB-PDT及化疗药物顺铂的反应性之间是否存在差别.方法:以不同浓度的竹红菌乙素(HB)分别孵育人肺腺癌细胞系A549及经顺铂(DDP)诱导耐药的多药耐药细胞系A549/DDP,然后分别在铜蒸汽激光混合光饱和光剂量条件下进行照光处理,照光后继续孵育24 h,MTT法分别测定不同HB浓度下2种细胞的存活率,分别绘制HB对2种细胞存活率曲线并拟合曲线方程,根据方程求出HB对2种细胞的半数杀伤浓度(IC50).结果:HB-PDT对经顺铂诱导耐药及非耐药细胞系均具有很强的杀伤效应,HB-PDT对A549及A549/DDP的IC50分别为33.82 ng/ml和34.19 ng/ml,两者之间差异不显著(P>0.05);顺铂对A549及A549/DDP的IC50分别为1.06 μg/ml和8.06 μg/ml,两者之间差异显著(P<0.01);HB-PDT和化疗药物顺铂对耐药肿瘤细胞杀伤效应间差异显著(P<0.01).结论: HB-PDT对于耐药及非耐药细胞的光毒效应无显著差别.HB-PDT对耐药肿瘤细胞具有明显的光毒效应,其杀伤经顺铂耐药肿瘤细胞的效果明显优于已产生耐药的化疗药物.HB-PDT有可能发展为对顺铂耐药肿瘤的有效治疗手段.     

新辅助内分泌联合治疗与单纯根治性手术对前列腺癌预后和疗效的Meta分析

目的 系统评价新辅助内分泌治疗局限性前列腺癌的有效性.方法 计算机检索Cochrane图书馆、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库和万方数据库.检索时间为1993-2010年.并追查已纳入文献的参考文献.收集有关新辅助内分泌治疗与单纯根治性手术治疗前列腺癌的随机对照...     

Combination therapy with pegylated interferon alpha-2b and adefovir dipivoxil in HBeAg-positive chronic hepatitis B versus interferon alone: a prospective,randomized study

Currently available monotherapies of oral nucleoside/nucleotide analogs or interferon are unable to achieve a sustained and effective response in most of patients with chronic hepatitis B（CHB）. The objective of the present study was to compare the efficacy and safety of pegylated interferon（Peg-IFN） alpha-2b plus adefovir dipivoxil combination therapy versus Peg-IFN alpha-2b alone. Sixty-one HBeAg-positive chronic hepatitis B patients were randomized to receive Peg-IFN alpha-2b alone（1.5 μg/kg once weekly） or Peg-IFN alpha-2b plus adefovir（10 mg daily） for up to 52 weeks. Efficacy and safety analyses were performed on all participants who received at least one dose of study medication. The rate of HBeAg seroconversion and undetectable HBV-DNA were evaluated after 52 weeks of therapy. At the end of treatment, 11 of 30（36.7%） patients receiving combination therapy achieved HBeAg seroconversion versus 8 of 31（25.8%） in the monotherapy group（P=0.36）. In contrast, the percentage of patients with undetectable serum HBV DNA was significantly higher in the combination group than in the monotherapy group（76.7% vs. 29.0%, P〈0.001）. Thyroid dysfunction was more frequent in the combination group than in the monotherapy group（P〈0.05）. In HBeAg-positive CHB, combination of Peg-IFN alpha-2b and adefovir for 52 weeks resulted, at the end of treatment, in a higher virological response but without significant impact on the rate of HBeAg seroconversion and possibly an adverse effect on thyroid function.