Diabetic macular edema:New promising therapies

The treatment of diabetic macular edema is rapidly evolving.The era of laser therapy is being quickly replaced by an era of pharmacotherapy.Several pharmacotherapies have been recently developed for the treatment of retinal vascular diseases such as diabetic macular edema.Several intravitreal injections or sustained delivery devices have undergone phase 3 testing while others are currently being evaluated.The results of clinical trials have shown the superiority of some of these agents to laser therapy.However,with the availability of several of these newer agents,it may be difficult to individualize treatment options especially those patients respond differently to various therapies.As such,more effort is still needed in order to determine the best treatment regimen for a given patient.In this article,we briefly summarize the major new therapeutic additions for the treatment of diabetic macular edema and allude to some future promising therapies.

An eighteen-month follow-up study on the effects of Intravitreal Dexamethasone Implant in diabetic macular edema refractory to anti-VEGF therapy

AIM： To evaluate the long-term efficacy and safety of dexamethasone implants in subjects affected by diabetic macular edema（DME） resistant to anti-vascular endothelial growth factor（VEGF） therapy.METHODS： Thirty-two DME patients were enrolled.A700 microgram slow release Intravitreal Dexamethasone Implant（Ozurdex~） was placed in the vitreous cavity.All patients were followed for 18 mo.Best-corrected visual acuity（BCVA） measured with Early Treatment Diabetic Retinopathy Study（ETDRS） and central macular thickness（CMT） exams were carried out at baseline（T0）and after 1（T1）,3（T3）,4（T4）,6（T6）,9（T9）,12（T12）,15（T15）,and 18mo（T18） post injection. RESULTS： Repeated measures ANOVA showed an effect of treatment on ETDRS（P〈0.0001）.Post hoc analyses revealed that ETDRS values were significantly increased at T1,T3,T4,T9,and T15（P 〈0.001） as compared to baseline value（T0）.At T6,T12,and T18,ETDRS values were still statistically higher than baseline（P〈0.001 vs T0）.However,at these time points,we observed a trend to return to baseline conditions.ANOVA also showed an effect of treatment（P 〈0.0001）.CMT decreased significantly at T1,T3,T4,T9,and T15（P〈0.001）.At T6（P〈0.01）,T12 and T18（P〈0.001） CMT was also significantly lower than T0 although a trend to return to the baseline conditions was also observed.CONCLUSION： Our findings demonstrate that Intravitreal Dexamethasone Implant is a good option to improveBCVA and CMT in DME patients resistant to anti-VEGF therapy.Our data also show that the use of drugs administered directly into the vitreous allows achieving appropriate and long-lasting concentration at the site of disease without systemic side effects.

Intravitreal therapy for the management of diabetic retinopathy:A concise review

Diabetic retinopathy(DR)is a serious microvascular complication of diabetes mellitus and may result in irreversible visual loss.Laser treatment has been the gold standard treatment for diabetic macular edema and proliferative diabetic retinopathy for many years.Of late,intravitreal therapy has emerged as a cornerstone in the management of DR.Among the diverse pharmacotherapeutic options,anti-vascular endothelial growth factor agents have demonstrated remarkable efficacy by attenuating neovascularization and reducing macular edema,thus preserving visual acuity in DR patients.

Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion

AIM： To compare three initial monthly intravitreal ranibizumab（IVR） injections followed by pro re nata（PRN） dosing with one initial monthly IVR injections followed by PRN dosing for macular edema（ME） secondary to branch retinal vein occlusion（BRVO）.METHODS： Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection（1＋PRN group） and 24 eyes received 3 monthly IVR injections（3＋PRN）. At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography（SD-OCT） was performed. Central macular thickness（CMT）, the integrity of the external limiting membrane（ELM）, the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment（IS/OS） defect were determined.RESULTS： At baseline the mean CMT was 521.3±153.2 μm in the 3＋PRN group while it was 438.1±162.4 μm in 1＋PRN group. At the final visit, mean CMT was 278.3±87.8 μm in the 3＋PRN group and 285.2±74.2 μm in the 1＋PRN group（P=0.079）. The changes in CMT over the entire study period were also comparable in both groups（243±160 μm in the 3＋PRN group, and 152.9±175.3 μm in the 1＋PRN group; P=0.090）. At baseline, best-corrected visual acuity（BCVA） was 0.92±0.60 logarithm of the minimal angle of resolution（logMAR） in the 3＋PRN group, while it was 0.72±0.46 logMAR in the 1＋PRN group. Final BCVA was 0.42±0.55 logMAR in the 3＋PRN group and 0.38±0.50 logMAR in the 1＋PRN group（P=0.979）. Additionally, the BCVA changes from baseline to final visit were not significantly different（-0.50±0.45 logMAR in the 3＋PRN group, and-0.33±0.39 logMAR in the 1＋PRN group; P=0.255）.CONCLUSION： No significant differences in the anatomical or functional results are found between 3＋PRN and 1＋PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain.

Current status in diabetic macular edema treatments

Diabetes is a serious chronic condition,which increase the risk of cardiovascular diseases,kidney failure and nerve damage leading to amputation.Furthermore the ocular complications include diabetic macular edema,is the leading cause of blindness among adults in the industrialized countries.Today,blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy.The treatment should include an optimized control of glycemia,arterial tension,lipids and renal status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME),can be valid as gold standard in many countries.The intravitreal anti vascular endothelial growth factor drugs(ranibizumab and bevacizumab),are indicated in the treatment of all types of DME,but the correct protocol for administration should be defined for the different Retina Scientific Societies.The corticosteroids for diffuse DME,has a place in pseudophakic patients,but its complications restricted the use of these drugs for some patients.Finally the intravitreal interface plays an important role and its exploration is mandatory in all DME patients.

Diabetic macular edema:Current management 2013

Diabetic retinopathy(DR)is the leading cause of vision loss of working-age adults,and diabetic macular edema(DME)is the most frequent cause of vision loss related to diabetes.The Wisconsin Epidemiologic Study of Diabetic Retinopathy found the 14-year incidence of DME in type 1 diabetics to be 26%.Similarly the Diabetes Control and Complications Trial reported that 27% of type 1 diabetic patients develop DME within9 years of onset.The most common type of diabetes,type 2,is strongly associated with obesity and a sedentary lifestyle.An even higher incidence of macular edema has been reported in older patients with type 2diabetes.Within the last 5 years,the use of intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor(VEGF)agents have come into clinical practice for the management of DME and several recent randomized clinical trials have shown improved effectiveness of ranibizumab compared to focal/grid laser.In this theme issue,we discuss the classification of DR and the treatment options currently available for the treatment of DME including corticosteroids,anti-VEGF agents,combined therapy,enzymatic vitrectomy(vitreolysis),and new therapies.

Navigated laser in diabetic macular edema: the impact of reduced injection burden on patients and physicians-who wins and who loses?

We inquired the impact of reduced therapy discontinuation in diabetic macular edema(DME) on physician's revenue considering anti-vascular endothelial growth factor(VEGF) monotherapy and its combination with Navilas treatment. Data were collected on injection frequency, treatment discontinuation and reimbursement fees for DME treatment with anti-VEGF compared to anti-VEGF in combination with navigated laser. Based on these data an economic model was built to compare physicians revenue over a 5y period using either therapy for 4 European countries and the USA. Due to patients' higher therapy adherence, physicians using navigated laser therapy with anti-VEGF generate similar or higher revenues compared to VEGF monotherapy in all analyzed countries. The use of Navilas decreases the patient's injection burden at the same clinical outcome, while the physician's revenue remained stable or increased. Therewith, therapy discontinuation in DME can be reduced using the combination therapy with Navilas.

Progress of clinical therapies for dry age-related macular degeneration

Dry age-related macular degeneration(AMD)is a progressive blinding disease that currently affects millions of people worldwide with no successful treatment available.Significant research efforts are currently underway to develop therapies aimed at slowing the progression of this disease or,more notably,reversing it.Here the therapies which have reached clinical trial for treatment of dry AMD were reviewed.A thorough search of Pub Med,Embase,and Clinicaltrials.gov has led to a comprehensive collection of the most recent strategies being evaluated.This review also endeavors to assess the status and future directions of therapeutics for this debilitating condition.

Diabetic macular edema in proliferative stage treated with anti-vascular endothelial growth factor agent and triamcinolone acetonide by laser-based strategies

AIM： To appraise the effect of treatment for diabetic macular edema（DME） in proliferative stage with sufficient panrentinal photocoagulation（PRP） therapy and intravitreal injections（IV） Conbercept and posterior subtenon＇s triamcinolone acetonide（STTA） sequential therapy.METHODS： This prospective clinical randomized controlled trial of cross-over design was conducted in three phases. The participants included cases of DME in proliferative stage. They were divided into two groups and treated with PRP before enrollment. Group A were treated with IVConbercept 0.5 mg for one month in the 1^st phase. Group B were treated with STTA 40 mg（twice per two weeks）. The interventions were exchanged in the second phase（2mo） between the two groups. In the third phase（3-6mo） no other treatment was given. Best corrected visual acuity（BCVA）, central macular thickness（CMT） measured by OCT and complications were compared.RESULTS： After phase I： in Group A, BCVA improved from 0.201±0.17 to 0.37±0.24（F=5.88, P=0.004）. CMT changed from 449±155.10 to 304.1±84.70 μm（F=14.9, P〈0.01）. In Group B, BCVA changed from 0.195±0.19 to 0.26±0.20（F=0.76, P=0.41） while CMT changed from 463.82±152.92 to 366.00±115.40 μm（F=3.70, P〈0.03）. The improvement of BCVA was better in Group A（P〈0.05）. After phase II： in Group A, BCVA raised to 0.47±0.27（F=0.26, P〈0.01）, CMT reduced to 260.67±62.97 μm（F=-188.3, P〈0.01）; in Group B, BCVA raised to 0.51±0.26（F=0.31, P〈0.01）, CMT reduced to 261.93±50.15 μm（F=-201.9, P〈0.01）. But there were no difference between two groups（P〉0.05）. After phase III： in Group A, BCVA maintained 0.42±0.25（F=0.22, P=0.001）, CMT maintained 267.8±58.34 μm,（F=-0.27, P〈0.01）; in Group B, BCVA was 0.47±0.25（F=-0.27, P〈0.01）, CMT was 272.71±49.16 μm（F=-191.1, P〈0.01）. No serious complications happened in all phases.CONCLUSION： PRP＋Conbercept is better than PRP＋STTA in DME with proliferative stage but PRP＋Conbercept＋STTA sequential therapy may be a wiser choice for persistent effectiveness on anatomical as well as functional status.

Dexamethasone intravitreal implant(Ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes

AIM: To investigate the safety and efficacy of intravitreal dexamethasone implants(Ozurdex?/DEX) in patients with diabetic macular edema(DME) either na?ve or nonna?ve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors(anti-VEGFs).METHODS: This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients na?ve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity(BCVA), central macular thickness(CMT), and intraocular pressure(IOP) was collected over 6 mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients(57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment na?ve before receiving DEX implant, was collected.RESULTS: Improvement in mean BCVA was observed from 1-4 mo after injection with a decreased effect at month 6 as expected, with better outcomes in na?ve compared to non-na?ve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2 mo after DEX therapy. The mean number of injections of the overall population during the 6 mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported.CONCLUSION: This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in na?ve patients.

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 Pub Med, EMBASE, Web of Science, Cochrane Library, and Clinical Trials.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 24 mo after initial treatment, and the risk ratios（RR） for the proportions of patients with at least 10 letters of improvement or reduction at 12 mo. 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 12 mo 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 ofpatients 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）.

New treatments for diabetic macular edema

This work comprehensively reviews the latest treatment options for diabetic macular edema(DME) used in its management and presents further work on the topic.Diabetic retinopathy is an important and increasingly prevalent cause of preventable blindness worldwide. To meet this increasing burden there has recently been a proliferation of pharmacological therapies being used in clinical practice. A variety of medical treatment options now exist for DME. These include non-steroidal antiinflammatory drugs such as nepafenac, as well as intravitreal steroids like triamcinolone(kenalog). Longterm results up to 7 years after commencing treatment are presented for triamcinolone. Studies are reviewed on the use of dexamethasone(ozurdex) and fluocinolone(Retisert and Iluvien implants) including the FAME studies. A variety of anti-vascular endothelial growth factor(anti-VEGF) agents used in DME are considered in detail including ranibizumab(lucentis) and the RESTORE, RIDE, RISE and Diabetic Retinopathy Clinical Research Network(DRCR.net) studies. Bevacizumab(avastin) and pegaptinib(macugen) are also considered. The use of aflibercept(eylea) is reviewed including the significance of the DA VINCI, VISTA-DME, VIVIDDME and the DRCR.net studies which have recently suggested potentially greater efficacy when treating DME for aflibercept in patients with more severely reduced visual acuity at baseline. Evidence for the antiVEGF agent bevasiranib is also considered. Studies of anti-tumour necrosis factor agents like infliximab are reviewed. So are studies of other agents targeting inflammation including minocycline, rapamycin(sirolimus) and protein kinase C inhibitors such as midostaurin and ruboxistaurin. The protein kinase C β inhibitor Diabetic Macular Edema Study is considered. Other agents which have been suggested for DME are discussed including cyclo-oxygenase-2 inhibitors like celecoxib, phospholipase A2 inhibitors, recombinant erythropoietin, and monoclonal anti-interleukin antibodies such as canakinumab. The management of DME in a variety of clinical scenarios is also discussed- in newly diagnosed DME, refractory DME including after macular laser, and postoperatively after intraocular surgery. Results of long-term intravitreal triamcinolone for DME administered up to seven years after commencing treatment are considered in the context of the niche roles available for such agents in modern management of DME. This is alongside more widely used treatments available to the practitioner such as anti-VEGF agents like aflibercept(Eylea) and ranibizumab(Lucentis) which at present are the mainstay of pharmacological treatment of DME.

Updates in uveitic macular edema

Macular edema is one of the most common visionthreatening complications of uveitis noted in one third of patients with uveitis. The release of a number of inflammatory mediators induces retinal vascular hyperpermeability leading to uveitic macular edema(UME)which most commonly is of cystoid shape. Fluorescein angiography and non-invasive spectral-domain optical coherence tomography are standard procedures for diagnosis and follow-up of UME with some innovations such as scanning laser ophthalmoscope retro-mode imaging. Effective management of UME requires thorough understanding of the individual case. Proper control of intraocular inflammation is mandatory before targeting macular edema itself. Mainstay of treatment is immunosuppressive therapy with various drug delivery routes including topical, local subconjunctival, peribulbar and sub-Tenon's, intravitreal and systemic. Clinical trials with biologics are under way to study the efficacy of these agents in suppressing intraocular inflammation and resolution of UME. Visual prognosis in UME depends on numerous factors. Younger age and better visual acuity at baseline are associated with more favorable visual outcome in most

Narrative review-drug delivery in age-related macular degeneration

This narrative review highlights routes of ocular drug delivery for age-related macular degeneration(AMD).AMD is the leading cause of irreversible blindness in industrialized countries and accounts for 8.7%of blindness worldwide.Advanced AMD can be classified into two subtypes:late-stage dry AMD[known as geographic atrophy(GA)]and neovascular AMD(nAMD).GA is often bilateral and results from progressive and irreversible loss of photoreceptors and areas of the retinal pigment epithelium.Wet AMD is characterized by angiogenesis from the choroid to the normally avascular regions underneath the retinal pigment epithelium(RPE)or retina,a process known as choroidal neovascularization(CNV).Various targeted therapeutic options are currently available to reduce the progression rate and maintain vision in patients with nAMD.Intravitreal delivery of anti-VEGF protein treatments to halt CNV is currently the gold-standard of care for nAMD.Subretinal and suprachoroidal delivery approaches are also being explored for gene and molecular therapies.Advancements in nanotechnology and biomaterials have also led to the development of microscopic drug delivery systems,including hydrogels,microparticles,nanoparticles,implants,and liposomes.Gene therapy and stem cell therapy has recently emerged as a potential candidate treatment modality for AMD and other retinal degenerations.New drug targets and modalities have stimulated exciting developments in ocular drug delivery with the promise of greater efficacy and durability of AMD treatment.

缺血性视网膜静脉阻塞继发黄斑水肿患者基线血清己糖激酶1抗体滴度与抗VEGF治疗后视力改善的相关性分析

目的分析缺血性视网膜静脉阻塞继发黄斑水肿(RVO-ME)患者基线血清己糖激酶1抗体滴度与抗血管内皮生长因子(VEGF)治疗后视力改善的相关性。方法招募2017年6月至2020年2月在首都医科大学宣武医院确诊为缺血性RVO-ME并接受初始抗VEGF治疗的53例患者,其中缺血性视网膜中央静脉阻塞(CRVO)23例(CRVO组),缺血性视网膜分支静脉阻塞(BRVO)30例(BRVO组)。另选取该院同期30例行超声乳化的白内障患者作为对照组。研究对象行基线血清己糖激酶1抗体滴度检测、眼科常规检查和光学相干断层成像(OCT)检查。所有RVO-ME患者按照“3+按需治疗方案(pro re nata,PRN)”向玻璃体内注射抗VEGF药物治疗。随访12个月,采用多元线性回归分析缺血性RVO-ME患者抗VEGF治疗后视力改善的影响因素。结果CRVO组基线logMAR BCVA高于对照组和BRVO组,CRVO组和BRVO组基线CRT、基线血清己糖激酶1抗体滴度高于对照组,且CRVO组基线CRT、基线血清己糖激酶1抗体滴度高于BRVO组,差异有统计学意义(P<0.05)。RVO-ME患者基线血清己糖激酶1抗体滴度与随访6个月(r=0.377,P=0.005)、9个月(r=0.362,P=0.008)和12个月(r=0.465,P<0.001)时BCVA改善呈正相关,与随访12个月时中断EZ横向长度减少值(r=0.401,P=0.001)呈正相关。多元线性回归分析结果显示,基线logMAR BCVA、基线血清己糖激酶1抗体滴度是缺血性RVO-ME患者抗VEGF治疗随访12个月时BCVA改善的影响因素(P<0.05)。结论己糖激酶1抗体作为一种新的血清生物标志物,与缺血性RVO-ME患者抗VEGF治疗后的视力改善相关。

自拟中药组方联合康柏西普治疗糖尿病性黄斑水肿临床观察

目的观察自拟中药组方联合康柏西普治疗糖尿病性黄斑水肿(DME)的临床疗效。方法选取2023年6月-2023年9月在辽源市中医院眼科门诊就诊的DME患者(78例96眼),随机分为2组,对照组(39例,46眼)采用眼内注射康柏西普,观察组(39例,50眼)在对照组的基础上口服自拟中药组方,治疗周期为2个月,随访4个月。比较2组的治疗效果、并发症的发生率、治疗前后的最佳矫正视力及黄斑中心视网膜厚度以及治疗后4个月内因DME再次治疗的次数。结果观察组的治疗效果优于对照组(P<0.05)。2组并发症总发生率比较,差异无统计学意义(P>0.05)。治疗后2组的最佳矫正视力均有明显提高,且观察组优于对照组(P<0.001);2组的黄斑中心视网膜厚度均有明显降低,且观察组优于对照组(P<0.001)。治疗后4个月内,观察组因DME再次治疗的次数少与对照组(P<0.05)。结论自拟中药组方联合康柏西普治疗DME的疗效更为显著,可有效提高患者视力,降低黄斑水肿程度,减少眼内注药次数,降低复发率,具有临床应用价值。

雷珠单抗不同重复注药标准治疗视网膜分支静脉阻塞继发黄斑水肿的效果比较

目的:探讨雷珠单抗不同重复注药标准治疗视网膜分支静脉阻塞继发黄斑水肿的效果。方法:选择2020年7月—2022年7月在广西壮族自治区南溪山医院眼科确诊为视网膜分支静脉阻塞继发黄斑水肿的60例(60眼)的患者为研究对象,患者均采用玻璃体腔注射雷珠单抗治疗。采用前瞻性随机对照研究方法,将患者按随机数表法分入试验组(n=30)和对照组(n=30)。试验组重复注药标准为黄斑中心凹厚度(central macular thickness,CMT)>250μm或存在中心凹或中心凹旁水肿(严格的注药标准)。对照组重复注药标准为CMT>300μm,较末次随访明显增厚,且视力下降大于1行(宽松的注药标准)。两组均随访半年,每月随访1次。观察两组患者随访期间的平均注射次数、治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、CMT及并发症发生情况。结果:试验组患者的平均注射次数显著多于对照组,差异有统计学意义(P<0.05)。两组患者治疗前最佳矫正视力比较,差异无统计学意义(P>0.05);与治疗前相比,试验组患者治疗不同时间的BCVA均显著升高,对照组患者治疗4个月、5个月、6个月的BCVA显著升高,差异有统计学意义(P<0.05);试验组患者治疗2个月、3个月、4个月、5个月、6个月的BCVA均显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者CMT比较,差异无统计学意义(P>0.05);与治疗前相比,两组患者治疗不同治疗时间的CMT均显著降低,且试验组患者CMT显著低于对照组,差异有统计学意义(P<0.05)。研究期间两组均未发生雷珠单抗注射相关的眼部或非眼部并发症。结论:宽松的雷珠单抗重复注药标准可使随访期间的重复注药次数显著减少,严格的重复注药标准更有助于BCVA及CMT的改善,在临床中,应根据患者的具体情况进行选择。

围术期应用非甾体类抗炎滴眼液防治白内障术后并发症研究进展

白内障是眼科首位致盲疾病,临床常以手术治疗为主,但术后常伴有多种眼部并发症,严重影响患者预后情况。非甾体类抗炎滴眼液具有抗炎作用,是近年来眼科用于防治与白内障手术相关的炎症和囊样黄斑水肿等术后并发症的常用眼用制剂。本文对非甾体类抗炎滴眼液在白内障术后的疗效和安全性进行综述,以期为临床合理用药提供依据。

玻璃体腔注射抗VEGF与激光治疗对老年DME患者的影响

目的:探讨玻璃体腔注射抗血管内皮生长因子(VEGF)与激光治疗对老年糖尿病性黄斑水肿(DME)患者焦虑状况及生活质量的影响。方法:选取2021年6月1日~2022年6月1日接受治疗的91例DME患者,根据不同治疗方案分为对照组45例(45眼)和研究组46例(46眼),两组实施相同的护理方式,对照组实施视网膜格栅样光凝治疗,研究组实施玻璃体腔注射抗VEGF治疗;比较两组治疗前后最佳矫正视力(BCVA)、黄斑中心凹厚度(CFT)、焦虑状况[采用状态-特质焦虑量表(STAI)]及生活质量[采用中文版低视力者生活质量量表(CLVQOL)]。结果:治疗6个月后,两组BCVA、CFT、STAI评分均低于治疗前(P<0.05,P<0.01),且研究组低于对照组(P<0.01);治疗6个月后,两组CLVQOL评分高于治疗前(P<0.05,P<0.01),且研究组高于对照组(P<0.05,P<0.01)。结论:与单纯激光治疗相比,玻璃体腔注射抗VEGF治疗对老年DME患者具有良好疗效,可有效消退黄斑水肿、提高患者视力,有助于缓解患者焦虑情绪,从而提高患者生活质量。

温通针法联合康柏西普治疗阴虚夹瘀型糖尿病性黄斑水肿临床观察

目的:观察温通针法联合康柏西普治疗阴虚夹瘀型糖尿病性黄斑水肿的临床疗效。方法:选取阴虚夹瘀型糖尿病性黄斑水肿患者58例(58眼),随机分为两组各29例。对照组予玻璃体腔内注射康柏西普治疗;治疗组在对照组基础上联合温通针法进行联合治疗。比较两组患者最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)及中医证候评分,评价临床疗效。结果:治疗后,两组患者视力、CMT及中医证候评分均较治疗前明显改善(P﹤0.01);治疗组CMT、中医证候评分明显优于对照组(P﹤0.01)。结论:温通针法联合康柏西普治疗阴虚夹瘀型糖尿病性黄斑水肿能够有效降低CMT及中医证候评分,临床疗效较好。