玻璃体腔注射康柏西普治疗高度近视黄斑脉络膜新生血管的疗效

目的：探究玻璃体腔注射康柏西普治疗高度近视黄斑脉络膜新生血管(CNV)的疗效。

方法：回顾性选取2017-06/2019-12我院眼科收治的因高度近视导致CNV的患者56例56眼作为研究对象,根据治疗方式分为对照组和观察组,对照组28例28眼行玻璃体腔注射雷珠单抗治疗,观察组28例28眼行玻璃体腔注射康柏西普治疗。末次治疗后随访3mo,记录患者眼压、最佳矫正视力(BCVA)及并发症发生情况,采用光学相干断层扫描(OCT)测定黄斑中心凹视网膜厚度(CMT),采用OCT仪水平线性扫描测量CNV面积。

结果：治疗后两组患者BCVA均较治疗前改善,且观察组BCVA优于对照组(均P<0.05)。治疗后3mo两组患者眼压、CNV面积及CMT均较治疗前降低,且观察组改善情况优于对照组(均P<0.05)。随访期间,观察组并发症发生率(4%)低于对照组(18%)。

结论：玻璃体腔注射康柏西普治疗高度近视CNV疗效优于雷珠单抗,可有效改善BCVA,降低CMT,减少术后并发症,提高临床疗效。     

补肾利水方联合玻璃体腔注射雷珠单抗治疗湿性年龄相关性黄斑变性临床研究

目的:观察补肾利水方联合玻璃体腔注射雷珠单抗治疗湿性年龄相关性黄斑变性(AMD)的临床疗效。方法:选取60例湿性AMD患者,按照随机数字表法分为治疗组和对照组,每组30例(眼数30只)。治疗组给予补肾利水方联合玻璃体腔注射雷珠单抗治疗,对照组单纯给予玻璃体腔注射雷珠单抗治疗。观察2组治疗前后最佳矫正视力、黄斑中心凹视网膜厚度和中医证候积分的变化。结果:治疗后,2组最佳矫正视力均较治疗前提高(P<0.05)。治疗组治疗3个月后最佳矫正视力优于对照组(P<0.05)。治疗后,2组黄斑中心凹视网膜厚度均较治疗前缩小(P<0.05);治疗组治疗3个月后黄斑中心凹视网膜厚度小于对照组(P<0.05)。治疗3个月后,2组各项中医证候积分均较治疗前降低(P<0.05),治疗组视物昏朦、视物变形、腰膝无力积分均比对照组降低更明显(P<0.05)。结论:补肾利水方联合玻璃体腔注射雷珠单抗治疗湿性AMD,可以提高患者的视力,缩小黄斑中心凹视网膜厚度,改善中医证候,疗效优于单纯玻璃体腔注射雷珠单抗治疗。     

Intravitreal ranibizumab (Lucentis) for choroidal neovascularization associated with Stargardt’s disease

Purpose To describe a young patient with choroidal neovascularization, associated with Stargardt’s disease, who underwent treatment with intravitreal ranibizumab. Methods A 26-year-old man with a diagnosis of Stargard’s disease presented at our department for sudden decreased vison in his right eye (20/800). Upon a complete oplthamologic examination, including fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT), the patient was diagnosed with subfoveal CNV of the right eye. Owing to the subfoveal localization of the CNV, intravitreal ranibizumab injection was performed on this young patient. Results Three months after the last intravitreal injection of ranibizumab, fundus biomicroscopy, FA, ICGA and OCT revealed the CNV closure and total resolution of the associated cistoid macular edema and serous retinal detachment, with no recurrence and no complication from the intravitreal injection of ranibizumab. Visual acuity improved only to 20/400. Conclusion Intravitreal ranibizumab injection seems to induce total regression of CNV complicating Stargardt’s disease. Further investigations are required to confirm our results. The authors have no proprietary interest in the materials used in this study.     

Ranibizumab as an adjunct to laser for macular edema secondary to branch retinal vein occlusion

Purpose:

To compare the safety, efficacy, and dosing regimen of intravitreal ranibizumab as an adjunct to laser therapy for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO).

Materials and Methods:

Thirty eyes of 30 patients of BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received grid laser treatment alone, Group 2 received a single dose of intravitreal injection of ranibizumab (0.5 mg / 0.05 ml) followed by grid laser treatment on 7^th day following injection, while Group 3 received three loading doses of intravitreal ranibizumab at monthly interval (i.e. 0, 1, & 2 months) + standard laser treatment 7 days after the 1^st injection. Outcome measure noted at 6 months follow-up were the improvement in best-corrected visual acuity (BCVA) and central macular thickness (CMT).

Results:

At 6 months follow-up, there was an average gain of 12 letters (P=0.05), 17.5 letters (P=0.05) and 19 letters (P=0.05) in groups 1, 2, and 3, respectively, with the decrease in CMT being 208.7 μm (P=0.05), 312.9 μm (P= 0.05) and 326.8 μm (P=0.05), respectively, in these groups. Gain in BCVA of more than 3 lines was noted in 1/10 patients in Group 1(10%) as compared to 3/10 (30%) and 4/10 (40%) patients in groups 2 and 3, respectively.

Conclusion:

The gain in BCVA and reduction in CMT were better with combination therapy (single- and triple- dose regimen) compared to grid laser alone. Single dose of intravitreal ranibizumab with grid laser seems to be an effective therapy.     

A systematic review of the efficacy and safety outcomes of anti-VEGF agents used for treating neovascular age-related macular degeneration: comparison of ranibizumab and bevacizumab

Abstract

Objective:

To systematically review ocular and systemic events in treatment of wet age-related macular degeneration (AMD) with anti-vascular endothelial growth factor antibodies, ranibizumab and bevacizumab, and to provide a detailed perspective of their differences on clinical use, efficacy and safety.     

Clinical safety of ranibizumab in age-related macular degeneration

Importance of the field: Clinical safety of pharmaceutical products in the elderly is vital because of their increased risk of cardiac and other adverse events.

Areas covered in this review: Search of the Medline database, including articles and abstracts from 1984 to 2009.

What the reader will gain: Knowledge of ocular and systemic risks: The rate of endophthalmitis was 0.05% per injection (MARINA) and <0.1% per injection (ANCHOR), rates confirmed in a retrospective analysis of 14,320 injections. Moderate increases in intraocular pressure were transient, and incidences of intraocular inflammation were rarely serious. Systemic arterial thromboembolic events occurred in 4.6 and 0% of ranibizumab-treated patients and in 3.8 and 0% of sham-treated patients in MARINA (2 years) and PIER (1 year), respectively. In SAILOR, there was a numerically higher rate of cerebrovascular stroke with 0.5 mg ranibizumab compared with 0.3 mg ranibizumab (1.2 vs 0.7%), which was a non-statistically significant trend in patients with a history of stroke.

Take home message: Although further studies to investigate the risk of stroke with ranibizumab therapy are required, repeated intravitreal ranibizumab was well tolerated and not associated with clinically significant safety risks during up to 2 years of treatment.     

雷珠单抗玻璃体注射联合激光治疗视网膜大动脉瘤

目的：研究雷珠单抗玻璃体腔内注射联合激光治疗视网膜大动脉瘤的临床疗效。 方法：回顾性分析2011-01/2013-07就诊于我院眼科确诊的视网膜大动脉瘤伴发黄斑水肿9例9眼患者行雷珠单抗玻璃体腔内注射联合视网膜光凝治疗。观察治疗前和治疗后1,3 mo患者的最佳矫正视力、眼底动脉瘤的变化情况及黄斑水肿的消退情况,进行统计学分析。 结果：治疗后大于3 mo的随诊观察,所有患者的最佳矫正视力均有明显提高,与治疗前相比,差异有统计学意义（ P〈0.05）;OCT检测的黄斑中心凹厚度,治疗后较治疗前变薄,差异有统计学意义（P〈0.05）。治疗后3mo眼底荧光血管造影检查显示：动脉瘤均有不同程度的萎缩和变小。 结论：雷珠单抗玻璃体腔内注射联合视网膜光凝治疗伴发黄斑水肿的视网膜大动脉瘤安全、有效。     

玻璃体腔注射Lucentis辅助治疗新生血管性青光眼

目的：观察玻璃体腔注射Lucentis在治疗新生血管性青光眼（NVG）中的作用。方法：回顾性系列病例分析。25例25眼NVG患者接受玻璃体腔Lucentis 注射（ranibizumab 0.5mg/0.05mL）,待虹膜新生血管消退后,根据病情采用不同治疗方式。术后观察虹膜及房角新生血管情况、眼压及视力变化,随访3mo。结果：玻璃体腔注射Lucentis 3～7d后,20例20眼虹膜和房角新生血管完全消退,5例5眼7d后新生血管未完全消退。继续治疗情况如下：复合式小梁切除术14例14眼,玻璃体切割术4例4眼。患者治疗前平均眼压为43.42±10.99mmHg,出院时平均眼压明显下降（14.26±7.64mmHg, P〈0.05）,并且在随访3mo时保持稳定（18.76±5.96mmHg,P〈0.05）。随访3mo时,视力较前提高和不变者20眼,视力下降者5眼。手术完全成功21眼,部分成功3眼,失败为1眼。 结论：璃体腔注射Lucentis,可作为治疗NVG的辅助方法,根据不同病情联合其他治疗方法,可有效治疗NVG。     

玻璃体腔注射雷珠单抗联合577 nm眼底激光治疗视网膜静脉阻塞继发黄斑水肿的临床疗效

目的观察玻璃体腔注射雷珠单抗联合577 nm眼底激光治疗视网膜静脉阻塞继发黄斑水肿的临床疗效。方法选取视网膜静脉阻塞继发黄斑水肿患者82例(82眼),采用随机数字表法分为观察组(玻璃体腔注射雷珠单抗联合577 nm眼底激光治疗41例41眼)、对照组(577 nm眼底激光治疗41例41眼)。比较两组临床疗效,治疗前、治疗后3个月、治疗后6个月最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT),治疗前、治疗后6个月固视情况,统计两组患者6个月内复发情况、全身及眼部并发症发生情况。结果观察组治疗总有效率高于对照组(P＜0.05);两组治疗后3个月、治疗后6个月BCVA较治疗前均有所改善(P＜0.05),两组治疗后3个月、治疗后6个月BCVA组间差异有统计学意义(P＜0.05);治疗后3个月、治疗后6个月CRT较治疗前均显著降低(P＜0.05),观察组治疗后3个月、治疗后6个月CRT均显著低于对照组(P＜0.05);观察组治疗后6个月固视情况较对照组改善(P＜0.05)。结论玻璃体腔注射雷珠单抗联合577 nm眼底激光治疗视网膜静脉阻塞继发黄斑水肿可有效缓解症状,提高视力,改善视功能,同时不良反应轻微,安全性高。     

Narrative review of artificial intelligence in diabetic macular edema: Diagnosis and predicting treatment response using optical coherence tomography

Diabetic macular edema (DME), being a frequent manifestation of DR, disrupts the retinal symmetry. This event is particularly triggered by vascular endothelial growth factors (VEGF). Intravitreal injections of anti-VEGFs have been the most practiced treatment but an expensive option. A major challenge associated with this treatment is determining an optimal treatment regimen and differentiating patients who do not respond to anti-VEGF. As it has a significant burden for both the patient and the health care providers if the patient is not responding, any clinically acceptable method to predict the treatment outcomes holds huge value in the efficient management of DME. In such situations, artificial intelligence (AI) or machine learning (ML)-based algorithms come useful as they can analyze past clinical details of the patients and help clinicians to predict the patient''s response to an anti-VEGF agent. The work presented here attempts to review the literature that is available from the peer research community to discuss solutions provided by AI/ML methodologies to tackle challenges in DME management. Lastly, a possibility for using two different types of data has been proposed, which is believed to be the key differentiators as compared to the similar and recent contributions from the peer research community.