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).     

Effectiveness of intravitreal ranibizumab for diabetic macular edema in vitrectomized versus non-vitrectomized eyes: a Meta-analysis

AIM: To evaluate the effectiveness and safety of intravitreal ranibizumab (IVR) for diabetic macular edema (DME) in vitrectomized versus non-vitrectomized eyes. METHODS: The PubMed, EMBASE, Web of Science, Cochrane, EBSCO were comprehensively searched for studies comparing vitrectomized and non-vitrectomized eyes with DME. Clinical outcomes of best-corrected visual acuity (BCVA), central macular thickness (CMT), the mean number of intravitreal injection and adverse events were extracted and analyzed. RESULTS: Six studies involving 641 eyes were included. Final visual gain significantly improved and CMT significantly reduced in vitrectomized eyes at 6mo and 12mo visits (P<0.05). Although the mean reduction in CMT among non-vitrectomized eyes was significantly greater than in vitrectomized eyes at the 6mo [mean difference (MD)=53.57, 95% confidence interval (CI): 28.03 to 78.72, P<0.0001] and 12mo (MD=49.65, 95%CI: 19.58 to 79.72, P=0.01), no significant difference was detected in improvement in BCVA at either 6mo (MD=0.05, 95%CI: -0.02 to 0.13, P=0.14) or 12mo (MD=0.03, 95%CI: -0.04 to 0.09, P=0.43). Injection number of ranibizumab in non-vitrectomized eyes was significantly less than that in vitrectomized eyes during 6-month period (MD=0.60, 95%CI: 0.16 to 1.04, P=0.008), while there was no statistically significant difference between the two groups during 12mo of follow-up. CONCLUSION: Evidence from current study suggests that IVR was useful for both vitrectomized group and non-vitrectomized group with DME. Although less reduction in macular thickness is found in vitrectomized group, visual improvement between two groups is similar.     

Clinical efficacy of intravitreal corticoid as an adjunctive therapy to anti-VEGF treatment of neovascular age-related macular degeneration: a Meta-analysis

AIM: To evaluate the efficacy and safety of intravitreal corticoid as an adjunctive therapy to anti-vascular endothelial growth factor (VEGF) treatment of neovascular age-related macular degeneration (nvAMD). METHODS: Four databases including PubMed, Embase, Cochrane Library, and the clinicaltrials.gov were comprehensively searched for studies comparing intravitreal corticoid plus anti-VEGF (IVC/IVA) vs anti-VEGF monotherapy (IVA) in patients with nvAMD. GRADE profiler was used to assess the quality of outcomes. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and adverse events including the occurrence of severe elevation of intraocular pressure (IOP) and the progress of cataract were extracted from the eligible studies. Review Manager (RevMan) 5.3 was used to analyze the data. RESULTS: There was no statistic difference of mean change in BCVA at 6 and 12mo between IVC/IVA and IVA group [95% confidence interval (CI): -2.28 to 4.24, P=0.55; 95%CI: -3.01 to 8.70, P=0.34]. No statistic difference was found in the change of CMT between two groups at 6mo time point (95%CI: -17.98 to 16.42, P=0.93) while the CMT reduction in IVC/IVA group was significantly more obvious than IVA group at 12mo time point [mean difference (MD)=-44.08, 95%CI: -80.52 to -7.63, P=0.02]. The risk of occurrence of severe elevation of IOP in the IVC/IVA group was higher than that in the IVA group (95%CI: 1.92 to 9.48; P=0.0004). Cataract progression risk was calculated no statistic difference between two groups (95%CI: 0.74 to 4.66; P=0.18). CONCLUSION: No visual or anatomical benefits are observed in IVC/IVA group at 6mo. At 12mo, the CMT of the IVC/IVA group is significantly lower than that of the IVA group. Risk of severe elevation of IOP is significantly higher when treated by IVC/IVA.     

康柏西普及光凝治疗弥漫型糖尿病性黄斑水肿的效果

目的:比较单纯康柏西普玻璃体内注射、单纯黄斑格栅激光光凝及二者联合治疗对弥漫型糖尿病性黄斑水肿(DME)的效果。方法:回顾性研究。将2016年8月至2019年10月长治医学院附属和平医院弥漫型DME 74例(82眼)分为单纯康柏西普玻璃体内注射组(A组,31眼)、单纯黄斑格栅激光光凝组(B组,24眼)和康柏西普联合激光光凝组(C组,27眼)。治疗后随访6个月,观察比较治疗前后视力、黄斑中心区厚度、FFA及注射次数。结果:治疗后A组和C组BCVA及黄斑中心区厚度(CMT)均较治疗前改善(P<0.05);B组治疗后BCVA无改善;B组CMT治疗后1个月无改善,治疗后3及6个月CMT下降(P<0.05)。治疗后BCVA及CMT的改善程度A组和C组差异无统计学意义,但均优于B组(P<0.05)。治疗后6个月FFA改善率3组间差异无统计学意义。治疗后6个月内康柏西普平均注射次数C组少于A组(P=0.001)。结论:康柏西普玻璃体内注射联合黄斑格栅激光光凝与单纯康柏西普注射治疗弥漫型DME效果相近,均优于单纯黄斑格栅激光光凝;黄斑格栅激光光凝可减少康柏西普注射次数。     

Efficacy and safety of vitrectomy with internal limiting membrane peeling for diabetic macular edema: a Meta-analysis

AIM: To evaluate the efficacy and safety of vitrectomy with internal limiting membrane (ILM) peeling for diabetic macular edema (DME). METHODS: The PubMed, Embase, Web of Science, Cochrane, SionMed, ClinicalTrials.gov, CNKI databases and Wanfang databases, published until Oct. 2017, were searched to identify studies comparing the clinical outcomes following vitrectomy with and without ILM peeling, for treating DME. Pooled results were expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CI) for vitrectomy with and without ILM peeling with regard to best corrected visual acuity (BCVA), central macular thickness (CMT), and complication incidents. RESULTS: A total of 14 studies involving 857 eyes were included of which three studies were Chinese and the rests were English literatures. Meta-analysis indicated that compared with vitrectomy alone, vitrectomy with ILM peeling could improve BCVA more obviously (OR=1.66, 95%CI: 1.12-2.46, P=0.01) and had higher rate of CMT reduction (OR=3.89, 95%CI: 1.37-11.11, P=0.01). There were significant statistical differences between the two surgical methods for both BCVA and CMT (P<0.05). For the incidence of intraoperative and postoperative complications, the incidence of epiretinal membrane (ERM) was slightly lower in the ILM peeling group than the group without ILM peeling (OR=0.38, 95%CI: 0.07-2.00, P=0.25), although insigni?cant statistically. Other incidences of overall complications, iatrogenic peripheral retinal break and increased intraocular pressure indicated no significant difference between two groups (OR=1.19, 95%CI: 0.82-1.73, P=0.36; OR=1.21, 95%CI: 0.66-2.21, P=0.53; OR=1.34, 95%CI: 0.75-2.40, P=0.32). CONCLUSION: Vitrectomy is effective for DME and the effect can be improved by additional ILM peeling, especially for anatomical efficacy, without increasing the incidence of intraoperative and postoperative complications. However, it is imperative to gain more evaluation in the future due to the paucity of prospective randomized study.     

玻璃体腔注射雷珠单抗联合Tenon囊注射曲安奈德治疗CRVO继发黄斑水肿

目的：评价玻璃体腔注射雷珠单抗( ranibizumab)联合筋膜囊下注射曲安奈德( triamcinolone acetonide)治疗视网膜中央静脉阻塞( central retinal venous occlusions,CRVO)继发黄斑水肿( macular edema,ME)的临床疗效。方法：经眼底荧光血管造影( fundus fluorescence angiography, FFA)及光学相干断层扫描( optical coherence tomography, OCT)检查确诊为缺血型CRVO合并黄斑水肿的患者46例46眼。全部患者行全视网膜光凝( panretinal photocoagulation,PRP),经4次激光治疗结束后1wk,随机选取A组23例23眼行玻璃体腔注射雷珠单抗( IVR)治疗;B组23例23眼行IVR治疗同时行筋膜囊下注射曲安奈德( PSTT)治疗,两组间黄斑水肿程度及最佳矫正视力无显著性差异。对比分析两组治疗前,治疗后1wk;1,3,6mo 患者最佳矫正视力( best corrected visual acuity, BCVA),黄斑中心厚度( central macular thickness,CMT)的变化。结果：治疗后1 wk与治疗前相比：A组BCVA平均值提高, CMT平均值降低,差异具有统计学意义( P<0.05);B 组BCVA平均值提高,CMT平均值亦降低,差异具有统计学意义( P<0.05),两组组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.05)。治疗后1,3mo与治疗前相比,A组与B组BCVA平均值均提高、CMT平均值均降低,差异具有统计学意义( P<0.05),两组间比较BCVA变化、CMT变化差异具有统计学意义( P<0.05)。治疗后6 mo与治疗前相比,A组与B组BCVA平均值提高、CMT平均值降低且差异具有统计学意义(P<0.05),组间比较BCVA变化差异具有统计学意义( P<0.05)、CMT变化差异无统计学意义(P>0.05)。结论：IVR联合PSTT及单纯IVR均可有效地减轻CRVO所致黄斑水肿、提升视力;但联合治疗可以更迅速地减轻黄斑水肿,对于保护视功能起到更为积极的作用。     

Impact of topical nonsteroidal anti-inflammatory drugs in prevention of macular edema following cataract surgery in diabetic patients

AIM: To evaluate the efficacy of prophylactic administration of topical non-steroidal anti-inflammatory drugs (NSAIDs) on macular edema following cataract surgery in diabetic patients, and to compare between types of NSAIDs (ketorolac tromethamine 0.4% and nepafenac 0.1%). METHODS: Group 1 (control) received artificial tears substitute as a placebo group, group 2 (nepafenac) received topical nepafenac 0.1%, and group 3 (ketorolac) received topical ketorolac tromethamine 0.4%. Patients were examined postoperatively after completing one week, one month, two months and three months'' intervals for evaluating cystoid macular edema (CME) development. The main study outcomes were achieving the best corrected visual acuity (BCVA) and change in the central macular thickness (CMT) measured with optical coherence topography (OCT). RESULTS: Eighty eyes of 76 patients were included in this study. BCVA showed a statistically significant difference at the third month postoperative follow up between the control group and the NSAIDs groups (P=0.04). There was an increase in the CMT in all cases starting from postoperative first week until third month. CMT showed a statistically significant difference between control group and NSAIDs groups from postoperative first month until third month (P=0.008, 0.027, 0.004). There was no statistically significant difference between nepafenac and ketorolac groups in BCVA and OCT CMT. CONCLUSION: Prophylactic preoperative and postoperative NSAIDs may have a role in reducing the frequency and severity of CME in diabetic eyes following cataract surgery.     

Sub-threshold micro-pulse diode laser treatment in diabetic macular edema: A Meta-analysis of randomized controlled trials

AIM: To examine possible differences in clinical outcomes between sub-threshold micro-pulse diode laser photocoagulation (SDM) and traditional modified Early Treatment Diabetic Retinopathy Study (mETDRS) treatment protocol in diabetic macular edema (DME). METHODS: A comprehensive literature search using the Cochrane Collaboration methodology to identify RCTs comparing SDM with mETDRS for DME. The participants were type I or type II diabetes mellitus with clinically significant macular edema treated by SDM from previously reported randomized controlled trials (RCTs). The primary outcome measures were the changes in the best corrected visual acuity (BCVA) and the central macular thickness (CMT) as measured by optical coherence tomography (OCT). The secondary outcomes were the contrast sensitivity and the damages of the retina. RESULTS: Seven studies were identified and analyzed for comparing SDM (215 eyes) with mETDRS (210 eyes) for DME. There were no statistical differences in the BCVA after treatment between the SDM and mETDRS based on the follow-up: 3mo (MD, -0.02; 95% CI, -0.12 to 0.09; P=0.77), 6mo (MD, -0.02; 95% CI, -0.12 to 0.09; P=0.75), 12mo (MD, -0.05; 95% CI, -0.17 to 0.07; P=0.40). Likewise, there were no statistical differences in the CMT after treatment between the SDM and mETDRS in 3mo (MD, -9.92; 95% CI, -28.69 to 8.85; P=0.30), 6mo (MD, -11.37; 95% CI, -29.65 to 6.91; P=0.22), 12mo (MD, 8.44; 95% CI, -29.89 to 46.77; P=0.67). Three RCTs suggested that SDM laser results in good preservation of contrast sensitivity as mETDRS, in two different follow-up evaluations: 3mo (MD, 0.05; 95% CI, 0 to 0.09; P=0.04) and 6mo (MD, 0.02; 95% CI, -0.10 to 0.14; P=0.78). Two RCTs showed that the SDM laser treatment did less retinal damage than that mETDRS did (OR, 0.05; 95% CI, 0.02 to 0.13; P<0.01). CONCLUSION: SDM laser photocoagulation shows an equally good effect on visual acuity, contrast sensitivity, and reduction of DME as compared to conventional mETDRS protocol with less retinal damage.     

Quantitative analysis of retinal intermediate and deep capillary plexus in patients with retinal deep vascular complex ischemia

AIM: To evaluate the efficacy and safety of intravitreal corticoid as an adjunctive therapy to anti-VEGF treatment of neovascular age-related macular Degeneration (nvAMD). METHODS: Four databases including PubMed, Embase, Cochrane Library, and the clinicaltrials.gov were comprehensively searched for studies comparing intravitreal corticoid plus anti-VEGF (IVC/IVA) vs anti-VEGF monotherapy (IVA) in patients with nvAMD. GRADE profiler was used to assess the quality of outcomes. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and adverse events including the occurrence of severe elevation of intraretinal pressure (IOP) and the progress of cataract were extracted from the eligible studies. Review Manager (RevMan) 5.3 was used to analyze the data. RESULTS: There was no statistic difference between mean change in BCVA at 6mo and 12mo (95% CI: -2.28 to 4.24, P=0.55). Mean change of CMT at 6mo and 12mo: no statistically significant difference were found in CMT at this time point (95% CI:-17.98 to 16.42, P=0.93). Occurrence of severe elevation of IOP: the risk in the IVC/IVA group was higher than that in the IVA group (95% CI: 1.92 to 9.48; P=0.0004). Cataract progression events: no statistic difference was found (95% CI: 0.74 to 4.66; P=0.18). CONCLUSION: No visual or anatomical benefits are observed in IVC/IVA group at 6mo. At 12mo, the CMT of the IVC/IVA group is significantly lower than that of the IVA group. Risk of severe elevation of IOP is significantly higher when treated by IVC/IVA.     

DR患者玻璃体切割术后黄斑水肿的治疗

目的:观察增生性糖尿病视网膜病变（proliferative diabetic retinopathy, PDR)玻璃体切割术后球周注射曲安奈德（triamcinolone acetonide, TA)联合黄斑区补充光凝治疗黄斑水肿的临床疗效。方法:PDR患者43例行玻璃体切割术及眼内全视网膜光凝术毕球周注射TA 40mg/mL,术后1wk选择有黄斑水肿患者32例,术后2wk行黄斑区补充532nm激光,术后1wk;1,3,6mo随访最佳矫正视力（best-corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度（central macular thickness, CMT)、并发症。结果:术后1mo视力提高28例（88%),视力不变4例（12%）,与术后1wk比较差异有显著性（P< 0.05）;术后3,6mo检查BCVA变化不大,与术后1mo比较均无显著性差异（P>0.05）;术后1wk CMT明显增厚,术后1mo黄斑水肿均不同程度减轻,与术后1wk比较差异有显著性（P<0.05）,术后3,6mo CMT变化不大,与术后1mo比较均无显著性差异（P> 0.05）。所有患者术后反应较轻,未出现严重并发症。结论:术后球周注射TA与黄斑区补充光凝结合起来治疗PDR患者术后糖尿病黄斑水肿取得了满意持久的临床效果。     

玻璃体注射雷珠单抗治疗老年性黄斑变性黄斑水肿与视网膜静脉阻塞性黄斑水肿的短期疗效观察

目的 观察玻璃体注射雷珠单抗治疗老年黄斑变性黄斑水肿（AMD-ME）与视网膜静脉阻塞性黄斑水肿（RVO-ME）的短期临床效果。设计 回顾性病例系列。研究对象 2015年10月至2016年7月确诊为AMD-ME 及RVO-ME 的患者共30例（30眼）,各15例（15眼）。方法 患眼接受玻璃体注射雷珠单抗（0.5 mg/0.05 ml）治疗,采用1+PRN的注射方法,比较治疗前和治疗后 1 天、1个月最佳矫正视力（BCVA）、眼压（IOP）、黄斑中心凹视网膜厚度（CMT）、注射后消除的水肿高度,评价每次随访时检查结果。主要指标 BCVA、CMT、消除的水肿高度、IOP。结果 AMD-ME组及RVO-ME 组注射雷珠单抗后1天、1个月的BCVA均较术前提高（P=0.000、0.000）。AMD-ME组 及RVO-ME 组每次治疗前和治疗后1个月CMT厚度均降低（P＝0.000、0.000）。治疗过程中患者眼压与治疗前比较并无明显变化 （P=0.096、0.066、0.213、0.088、0.240、0.337）。结论 玻璃体注射雷珠单抗治疗 AMD-ME 及 RVO-ME 在短期内均可减轻黄斑水肿和改善视力,两者治疗效果无明显差异。（眼科, 2017, 26： 120-124）     

葡萄膜炎继发黄斑囊样水肿的临床研究

目的 观察葡萄膜炎继发黄斑囊样水肿(eystoid macular edema,CME)的预后及其影响因素.方法 回顾性分析2011年8月至2015年12月于天津医科大学眼科医院确诊为葡萄膜炎继发CME的31例(41眼)患者临床资料.观察治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹视网膜厚度(central macular thickness,CMT)、黄斑其他并发症以及眼压变化.结果 27例(36眼)纳入数据分析.治疗后1个月,14眼(38.9％) CME完全缓解,BCVA(0.40±0.31) LogMAR较治疗前(0.66±0.36) LogMAR显著提高(P ＜0.001),CMT(368.7±85.9) μm较治疗前(469.0±99.1) μm显著降低(P＜0.001).治疗后3个月,19眼(52.8％)CME完全缓解,BCVA(0.37±0.32) LogMAR及CMT(323.9±60.0) μm与治疗后1个月差异均无统计学意义(均为P ＞0.05),与治疗前差异均有统计学意义(均为P＜0.001).治疗后6个月,25眼(69.4％) CME完全缓解,BCVA(0.32±0.28) LogMAR与治疗前、治疗后1个月及3个月差异均有统计学意义(均为P＜0.05).CMT(294.2±81.2) μm与治疗前及治疗后1个月差异均有统计学意义(均为P＜0.001),与治疗后3个月差异无统计学意义(P＞0.05).治疗后6个月,11眼(30.6％)仍然存在CME,均伴发黄斑前膜.CMT的降低幅度(185.0±114.2) μm与BCVA的提高幅度(0.29±0.21) LogMAR之间无明显相关性(r=0.322,P=0.052),BCVA的提高幅度(0.29±0.21) LogMAR与CME病程(8.4±9.8)个月之间呈负相关(r=-0.395,P=0.015).结论 目前现有全身和局部治疗可以有效治疗多数葡萄膜炎继发的CME,同时改善视力.视力改善程度与CME病程相关,黄斑前膜是影响黄斑水肿消退的重要因素.     

康柏西普与雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿的Meta分析

目的:系统比较康柏西普和雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿(RVO-ME)的疗效和安全性,为临床指导用药提供依据。方法:全网综合检索关于玻璃体腔内注射康柏西普和雷珠单抗治疗RVO-ME的临床随机对照试验文献,对纳入文献进行风险评估,并提取相关数据指标。采用RevMan 5.3软件进行数据分析,并采用Egger检验评价发表偏倚。结果:本研究纳入文献14篇,共计1 350眼。康柏西普组和雷珠单抗组患者最佳矫正视力(BCVA)在治疗后2wk,2、3、6mo无明显差异,但在治疗后1wk[WMD=-0.03,95%CI(-0.05,-0.02),P<0.0001]和1mo[WMD=-0.03,95%CI(-0.04,-0.01),P=0.001]康柏西普组患者BCVA相比雷珠单抗组较好。两组患者黄斑中心凹视网膜厚度(CMT)在治疗后1、2wk,1、2、3mo无明显差异,但在治疗后6mo[WMD=-28.77,95%CI(-54.23,-3.31),P=0.03]康柏西普组患者黄斑水肿减轻程度相比雷珠单抗组更明显。玻璃体腔内注射康柏西普和雷珠单抗产生的不良反应情况无差异[OR=0.95,95%CI(0.57,1.57),P=0.84],但康柏西普的平均注射次数较少。结论:康柏西普和雷珠单抗均可改善BCVA,降低CMT,二者在后期视力改善方面无差异,但康柏西普在改善CMT方面更具优势,且注射次数少,费用低。     

Avastin联合黄斑格栅样光凝治疗DME的视力预后的多因素分析

目的:探讨影响玻璃体腔注射Avastin联合黄斑格栅样光凝治疗糖尿病黄斑水肿(diabetic macular edema ,DME)后患者视力的相关因素。 方法:回顾性分析Avastin联合黄斑格栅样光凝治疗糖尿病黄斑水肿患者41例41眼。运用SPSS 14.0分析患者性别、年龄、病程、治疗前最佳矫正视力（BCVA）、治疗前黄斑中心凹视网膜厚度（CMT）、DME类型、治疗后CMT变化、黄斑中心凹下有无大片硬性渗出与治疗后BCVA之间的相关性。 结果:在治疗后1mo时,BCVA与病程、治疗前BCVA、黄斑水肿减轻程度及黄斑中心凹下是否有大片硬性渗出相关(P＜0.05)。 结论:选择术前视力较好、病程短、黄斑中心凹下无大片硬性渗出的患者经联合治疗后可获得较好的视力。     

中西医结合治疗糖尿病性黄斑水肿的疗效分析

目的:观察自拟中药益气引水消肿方联合康柏西普及激光治疗糖尿病性黄斑水肿(DME)的临床疗效。方法:选取2016-01/2018-10在我院眼科就诊的DME患者60例60眼,随机分为对照组给予玻璃体腔内注射康柏西普,中西医组在对照组的治疗基础上加用自拟益气引水消肿方,所有患者根据病情行光凝治疗。观察两组患者在治疗前和治疗后1、3、6mo最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT),以及治疗后6mo荧光素眼底血管造影(FFA)中黄斑荧光渗漏情况和黄斑水肿的复发率。结果:对照组治疗前BCVA(LogMAR)为0.92±0.26,治疗后1、3、6mo BCVA分别为0.58±0.18、0.60±0.27、0.62±0.28,中西医组治疗前BCVA(LogMAR)为0.94±0.31,治疗后1、3、6mo BCVA分别为0.56±0.20、0.50±0.25、0.51±0.21;对照组治疗前CMT为461.62±84.26μm,治疗后1、3、6mo CMT为299.92±43.18、290.60±39.36、311.10±42.78μm,中西医组治疗前CMT为455.74±83.89μm,治疗后1、3、6mo CMT分别为288.96±40.20、265.86±32.55、270.38±31.60μm,两组患者在治疗后与治疗前相比BCVA和CMT均有所改善(P<0.05)。在治疗后1mo中西医组与对照组比较BCVA和CMT无差异(t=0.539、0.739,P>0.05),在治疗后3、6mo中西医组BCVA和CMT有明显改善,与对照组相比有差异(t治疗后3mo=2.891、2.992,P治疗后3mo=0.004、0.021;t治疗后6mo=3.733、3.643,P治疗后6mo<0.01、0.005),在治疗后6mo中西医组黄斑水肿复发率更低(χ=4.344,P<0.05)。结论:益气引水消肿方联合康柏西普及激光治疗DME可以改善视力、减轻黄斑水肿、减少水肿复发率。     

玻璃体内注射康柏西普对弥漫性糖尿病性黄斑水肿的影响

目的　探讨玻璃体内注射康柏西普对弥漫性糖尿病性黄斑水肿（diabetic macular edema,DME）的影响。方法　选取2016年7月至2017年7月牡丹江医学院红旗医院眼科收治的弥漫性DME患者51例51眼,将患者分为3组,每组各17例17眼:单纯玻璃体内注射康柏西普0.5 mg组（A组）;玻璃体内注射康柏西普0.5 mg联合改良黄斑格栅样光凝组（B组）;单纯改良黄斑格栅样光凝组（C组）。分别于治疗前及治疗后1周、1 个月、3个月和6个月对患者进行光学相干断层扫描检测黄斑中心凹厚度（central macular thickness,CMT）、眼底荧光血管造影（fundus fluorescein angiography,FFA）、最佳矫正视力（best corrected visual acuity,BCVA）、裂隙灯、眼压等检查,比较三种治疗方式的疗效和安全性。结果　三种治疗方式均能改善弥漫性DME患者BCVA、CMT、视网膜新生血管渗漏,但A组、B组疗效均优于C组（均为P＜0.05）。A组、B组患者BCVA改善情况差异无统计学意义（P＞0.05）,但B组患者CMT（197.47±45.26）μm及视网膜新生血管渗漏（9.91±3.18）mm²改善情况优于A 组（205.59±47.33）μm、（13.24±4.87）mm²（P＜0.001）,且无光凝术及康柏西普相关的并发症发生。结论　改良黄斑格栅样光凝术联合玻璃体内注射康柏西普能迅速减轻弥漫性DME及新生血管形成,从而提高患者视力,其疗效优于单纯改良黄斑格栅样光凝术和单纯康柏西普玻璃体内注射。     

玻璃体内注射阿柏西普治疗顽固性糖尿病黄斑水肿的疗效

目的　研究玻璃体内注射阿柏西普治疗顽固性糖尿病黄斑水肿的短期效果。方法　收集2018年6月至2019年6月来我院眼科就诊的顽固性糖尿病黄斑水肿患者30例（30眼）,行玻璃体内注射阿柏西普治疗。治疗前所有患者均接受过至少3次的玻璃体内注射雷珠单抗治疗,随访期为1个月。在术前及术后1个月时,检查患者最佳矫正视力(best corrected vision acuity,BCVA)和眼压,并行黄斑区光学相干断层成像检查,记录黄斑中心区厚度（central macular thickness,CMT）。比较治疗前后各组数据差异。结果　BCVA从阿柏西普治疗前的（0.61±0.26）logMAR提升至治疗后1个月的（0.51±0.19）logMAR,差异有统计学意义(P=0.016)。治疗前CMT为（441.77±108.09）μm,治疗后1个月CMT为（354.47±83.93）μm,差异有统计学意义(P<0.001)。治疗前及治疗后 1个月眼压相比,差异无统计学意义(P>0.05)。在随访期间未发现任何眼部及全身相关并发症。结论　对于雷珠单抗不应答的顽固性糖尿病黄斑水肿患者,转为阿柏西普治疗能在短期内减轻黄斑区水肿程度,提高视力且无并发症的发生。     

玻璃体切割联合内界膜剥除治疗糖尿病性黄斑水肿

评估玻璃体切割联合内界膜剥除对糖尿病性黄斑水肿（DME）的疗效。方法：回顾性病例对照研究。2014年6月至2017年1月间因糖尿病视网膜病变合并玻璃体积血或增殖病变于温州医科大学附属眼视光医院杭州院区行玻璃体切割手术治疗，且术前或术中经光学相干断层扫描（OCT）检查确诊合并DME的患者31例（33眼）纳入研究。16例（18眼）术中联合内界膜剥除作为剥膜组，15例（15眼）仅接受玻璃体切割手术治疗者作为对照组。所有手术均由同一医师主刀完成。术后1、3个月随访时复查OCT，对比观察黄斑中心厚度（CMT）和视力的术后变化情况。随访中CMT和最佳矫正视力（BCVA）比较采用重复测量方差分析，组间CMT和BCVA比较采用独立样本t检验。结果：手术前，手术后1、3个月2组间比较LogMAR视力总体差异有统计学意义（F=15.93，P<0.001）。术后 1个月时剥膜组BCVA高于对照组（t=2.55，P=0.02），但术后3个月时2组间差异无统计学意义（t=0.82， P=0.42）。手术前，手术后1、3个月CMT总体差异无统计学意义（F=2.85，P=0.065）。术后1、3个月时，剥膜组的CMT均低于对照组，2组间差异均有统计学意义（t=2.24，P=0.03；t=3.79，P=0.001）。术后1个月时，剥膜组有效（与术前比CMT减少20%以上）、无效（变化不超过20%）及恶化（增厚超过 20%）的例数分别为8、6、4例，术后3个月时则分别为11、5、2例，与对照组相比，术后1个月时组间差异无统计学意义（Z=-1.687，P=0.092），术后3个月时剥膜组DME改善有效比例明显高于对照组，组间差异有统计学意义（Z=-2.177，P=0.029）。结论：对于非牵拉性DME，内界膜剥除有助于术后早期DME消退。     

玻璃体内注射康柏西普对糖尿病黄斑水肿患者和继发于视网膜静脉阻塞的黄斑水肿患者的疗效差异

目的 探讨玻璃体内注射康柏西普对糖尿病黄斑水肿(DME)患者和继发于视网膜静脉阻塞(RVO)的黄斑水肿患者的疗效差异。方法 回顾性研究。选取2019年8月至2021年12月在苏州市立医院北区眼科行玻璃体内注射康柏西普治疗的DME患者44例63眼记为DME组,另选取采用同样方法进行治疗的继发于RVO的黄斑水肿患者40例40眼记为RVO组。采用国际标准视力表(小数)检查并记录患者最佳矫正视力(BCVA),采用德国海德堡公司OCT仪进行OCT检查,自动测量患者黄斑中心凹1 mm视网膜厚度并以此作为黄斑中心视网膜厚度(CMT)。所有患者玻璃体内均一次性注射0.05 mL康柏西普(成都康弘生物科技有限公司)。对比分析DME组和RVO组患眼基线特征及康柏西普治疗后7 d疗效差异。结果 DME组患眼基线CMT为(484.94±152.89)μm, RVO组为(582.33±241.57)μm, RVO组基线CMT高于DME组,差异有统计学意义(P<0.05)。DME组患眼基线BCVA为0.31±0.20,RVO组为0.29±0.23,差异无统计学意义(P>0.05)。注射后7 d, DM...     

Different approaches for treating myopic choroidal neovascularization: a network Meta-analysis

AIM: To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients. METHODS: Two researchers independently searched PubMed, Cochrane Library, Web of Science, and other databases to screen studies comparing best-corrected vision acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. Post-treatment chorioretinal atrophy (CRA) is a secondary outcome indicator. The retrieval time limit is from the database construction to January 30, 2023. RESULTS: A total of 1072 eyes in 16 articles were included. In the RCTs, intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) were superior to PDT (MD=0.18, 95%CI: 0.02, 0.40, MD=0.18, 95%CI: 0.01, 0.42) in improving BCVA of mCNV patients (P<0.05). The relative effectiveness in improving BCVA, from high to low, appeared to be IVR, intravitreal aflibercept (IVA), IVB, LT, PDT, and sham first followed by IVA (Sham/IVA). While improving the FCT from high to low was IVA, IVR, IVB, PDT. In retrospective studies, the results of BCVA after long-term treatment showed that all the therapeutic effects from high to low was IVA, intravitreal conbercept (IVC), IVR, IVB, IVB/IVR, PDT with IVB/IVR, PDT. The effect of improving FCT was IVA, IVR, IVC, PDT, and IVB from high to low. And in the effects of improving CRA, the IVB appeared to be higher than IVR, while the PDT was the smallest, but none of the differences in the results were statistically significant. CONCLUSION: Anti-VEGF has the best effect on long-term vision improvement in mCNV patients, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT. There is no significant difference in the improvement of visual acuity, macular edema, and CRA in mCNV patients treated with any different anti-VEGF drugs.