Efficacy and safety of anti-vascular endothelial growth factor agents on corneal neovascularization: A meta-analysis

BACKGROUND Corneal neovascularization(CoNV)is the second major cause of blindness.Vascular endothelial growth factor(VEGF)inhibitors,e.g.,bevacizumab,have been used to prevent CoNV.AIM We conducted an updated systematic review and meta-analysis of clinical trials to examine the efficacy and safety of anti-VEGF in CoNV.METHODS A literature search was conducted using three electronic databases.Mean difference(MD),standard mean difference(SMD),and relative risk(RR)are used to estimate the effect size.RESULTS Nine randomized controlled and three non-randomized trials were obtained.The pooled results demonstrated a significant reduction of CoNV area/Length(SMD=-1.17,95%CI:-1.58 to-0.75),best corrected visual acuity(MD=-0.54,95%CI:-0.91 to-0.17),and graft rejection(RR=0.44,95%CI:0.24 to 0.8)and failure(RR=0.39,95%CI:0.19 to 0.78)rates in the anti-VEGF group than the placebo group.A non-significant reduction of the epithelial defect was also observed in the bevacizumab group compared with the placebo(RR=0.56,95%CI:0.30 to 1.06).Compared with a placebo,the unsynthesizable trials also support that bevacizumab improves visual acuity,CoNV,graft rejection,and failure rates.Trials reporting other comparisons revealed the superiority of combined remedy with bevacizumab compared to other treatments in reducing CoNV.CONCLUSION Anti-VEGF agents,mainly bevacizumab,are an effective and safe treatment for CoNV of all causes and prevent corneal graft rejection and failure in corneal transplantation.

Efficacy of internal limiting membrane peeling for diabetic macular edema after preoperative anti-vascular endothelial growth factor injection

AIM:To explore the efficacy of minimally invasive vitrectomy(MIV)with or without internal limiting membrane(ILM)peeling on the treatment of diabetic macular edema(DME)in proliferative diabetic retinopathy(PDR)combining with preoperative anti-vascular endothelial growth factor(anti-VEGF)injection.METHODS:Totally 132 eyes(132 patients)diagnosed PDR with DME were included between June 2015 and June 2018 in Tianjin Eye Hospital.The single MIV treatment group included 68 eyes and the MIV combined with ILM peeling group included 64 eyes.Anti-VEGF drugs were injected intravitreally 1wk before the operation and the period of follow-up was 1 to 3y.Best-corrected visual acuity(BCVA),central retinal thickness(CRT),total macular volume(TMV),macular edema(ME)severity,intraocular pressure(IOP),and complications were recorded.Prognostic factors of visual acuity following ILM peeling were analyzed.RESULTS:The BCVA was higher than preoperative values at 1,3,6,and 12mo after surgery in both groups(all P<0.05).At 6 and 12mo,the BCVA of the combined group was significantly higher than that of the MIV only group(0.52±0.23 v/s 0.64±0.29 IogMAR,P=0.011 in 6mo;0.41±0.25\/s 0.52±0.25 IogMAR,P=0.008 in 12mo).Mean CRT values postoperative were significantly lower than preoperative values in both groups from the 1^(st) month(lmo 397.65±106.18 vs 451.94±118.88 μm in MIV only group;388.88±108.68 v/s 464.36±111.53 μm in combined group;both P<0.05)and decreased gradually.The differences between the two groups were statistically significant at 3,6,and 12mo(P=0.004,0.003,0.00 respectively).The TMV was decreased from the 3^(rd) month in the single treatment group(3mo 11.14±1.66 vs 12.20±2.09 mm^(3),P<0.05).At 12mo,the proportion of eyes with edema that had CRT more than 350μm was significantly lower than before surgery(13.24%vs 77.94%in MIV only group;1.56%vs 81.25%in combined group;both P<0.05).There was no significant difference in the recurrence incidence of macular epiretinal membrane,ME,transient IOP increase,vitreous rebleeding,or traction retinal detachment between the two groups.BCVA after ILM excision was positively correlated with the CRT and ME degree before and after surgery(r=0.430,0.485,respectively;P<0.05).CONCLUSION:MIV combined with ILM peeling accelerates the absorption of ME,improves vision,reduces the postoperative CRT and TMV,and reduces the recurrence rate of postoperative ME.

Macular hole closure following anti-vascular endothelial growth factor injection in an eye with myopic choroidal neovascularization

Dear Editor,I am Cheolmin Yun,from the Department of Ophthalmology,Korea University College of Medicine.I write to present a case report of a female patient with a myopic patient suffering from atrophic choroidal neovascularization（CNV）and a full thickness macular hole（FTMH）,who was treated with an intravitreal anti-vascular endothelial growth factor （VEGF） injection without vitrectomy.

Real-world outcomes of anti-vascular endothelial growth factor therapy for retinal vascular vein occlusion in Tibet,China

AIM: To evaluate the outcomes of intravitreal antivascular endothelial growth factor(anti-VEGF) agents for patients with retinal vein occlusion(RVO) related-macular edema(ME) in Tibetan.METHODS: A retrospective, observational, single-center study. The demographic and clinical data of 90 RVO Tibetan patients(93 eyes) treated with either ranibizumab or conbercept in Tibet Autonomous Region People’s Hospital from Jan 2018 to December 2019 were collected.RESULTS: The mean patient age was 56.8±10.6y, 45(50%) of them were female. The mean living altitude was 3867.8±567.9 m. At the last visit, the best-corrected visual acuity(BCVA) significantly increased(52.2±21.8 letters) in comparison with the baseline(38.2±24.1 letters, P<0.001);while the central retinal thickness(CRT) significantly reduced(245.5±147.6 μm) in comparison with the baseline(504.1±165.2 μm, P<0.001). The 43.0% of the eyes gained≥15 letters, 60.2% of the eyes gained ≥10 letters, and 78.5% of the eyes gained ≥5 letters. No vision loss was noted in 92.5% of the eyes, 4 eyes lost more than 10 letters during follow-up period. The mean number of injections was 2.4±1.8. No severe ocular or systemic adverse events related to either the drug or injection were noted.CONCLUSION: Anti-VEGF therapy is effective and safe in Tibetan patients for the treatment of RVO related ME.

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。

多次玻璃体内注射抗VEGF药物对眼底血管性疾病患者角膜组织形态的影响

目的 探讨多次玻璃体内注射雷珠单抗和阿柏西普对湿性老年性黄斑变性(nAMD)、糖尿病黄斑水肿(DME)、视网膜静脉阻塞(RVO)患者角膜组织形态的影响。方法 前瞻性临床研究。选取2021年6月至2022年6月在我院眼内科注射中心治疗的患者共64例(64眼)作为研究对象;其中nAMD患者19例,DME患者20例,RVO患者25例。阿柏西普(40 g·L^(-1))治疗29例,雷珠单抗(10 g·L^(-1))治疗35例。所有入组病例均选取单眼注射,采取3+PRN的随访治疗方法。使用共聚焦显微镜行角膜神经检查,使用角膜内皮显微镜进行角膜厚度及角膜内皮细胞检查。比较nAMD、DME、RVO患者多次玻璃体内注射抗VEGF药物后角膜厚度、内皮细胞密度、变异系数、平均面积、六角形细胞比例、神经纤维长度、神经纤维密度,比较每次注射不同药物后1个月与基线时上述指标变化。结果 术前,DME组患者内皮细胞密度低于nAMD组和RVO组,DME组患者内皮细胞平均面积高于nAMD组和RVO组,差异均有统计学意义(均为P<0.05),三种不同疾病患者其余指标差异均无统计学意义(均为P>0.05)。注射抗VEGF药物3次后,DME组患者内皮细胞密度低于nAMD组和RVO组,内皮细胞平均面积高于nAMD组和RVO组,差异均有统计学意义(均为P<0.05);DME组患者神经纤维长度短于nAMD组和RVO组,差异均有统计学意义(均为P<0.05)。自从第2次注射阿柏西普后,nAMD组患者内皮细胞密度均较术前减少,差异均有统计学意义(均为P<0.05);每次注射后六角形细胞比例均较术前减少,差异均有统计学意义(均为P<0.05);其余指标注射后与术前相比,差异均无统计学意义(均为P>0.05)。自从第2次注射雷珠单抗后,RVO组患者内皮细胞密度均较术前减少,差异均有统计学意义(均为P<0.05)。结论 多次玻璃体内注射抗VEGF药物会一定程度降低角膜内皮六角形细胞比例及内皮细胞密度,注射药物后DME组的神经纤维长度显著低于nAMD组和RVO组。

Extended survival with metastatic pancreatic cancer under fruquintinib treatment after failed chemotherapy:Two case reports

BACKGROUND Pancreatic cancer is a highly malignant disease.After decades of treatment progress,the current five-year survival rate for patients is still less than 10%.For later-line treatment,the treatment options are even more limited.Anti-angiogenic drugs can improve progression-free survival in patients with advanced pancreatic cancer.Preclinical data show that fruquintinib might improve the prognosis of advanced pancreatic cancer by targeting angiogenesis and lymphopoiesis,improving the abnormal vascular structure,and modulating the tumour immune microenvironment.CASE SUMMARY We present two cases of third-line fruquintinib monotherapy that brought an extraprolonged progress-free survival(PFS)of 10 months.Patient 1 took adjuvant gemcitabine-based and first-line nab-paclitaxel-based chemotherapy and then used local radiotherapy combined with programmed cell death 1 receptor(PD-1).Each line lasted approximately 7 months.Moreover,the patient took third-line fruquintinib,which was followed by stable disease for 10 months,during which no additional adverse effect was observed.The patient later refused to take fruquintinib due to difficulty urinating and lower abdominal pain after the coronavirus disease 2019(COVID-19)infection.The patient died in February 2023.Patient 2 also took two prior lines of chemotherapy and then local radiotherapy combined with S-1.After confirmed disease progression,the patient experienced a continuous partial response after using fruquintinib monotherapy in the third line.After the patient had COVID-19 in December 2022,fruquintinib was discontinued.The patient died in January 2023 due to disease progression.CONCLUSION Both cases achieved a PFS benefit from later-line single-agent fruquintinib therapy.With its better safety profile,fruquintinib may be worth exploring and studying in more depth as a later-line treatment for pancreatic cancer patients.

Progress in the Treatment of DME

Diabetic macular edema (DME) is a common ocular complication of diabetes mellitus (DM) and an important cause of vision loss. The pathogenesis of DME is complex and can occur at any time of diabetic retinopathy (DR). Effective methods of treating DME are essential to prevent irreversible damage to visual function. To date, laser photocoagulation, vascular endothelial growth factor (VEGF) inhibitors, and corticosteroids have demonstrated their therapeutic efficacy in large randomized controlled trials and real-life observational studies. Clinicians need to consider various factors, such as efficacy, safety, accessibility, and cost, in the selection of various options. This review summarizes the current therapeutic approaches for DME to provide new references for the treatment of DM.

两种康柏西普治疗方案治疗息肉样脉络膜血管病变的效果分析

目的比较治疗-延长(TAE)方案与按需治疗(PRN)方案应用于玻璃体内注射康柏西普治疗息肉样脉络膜血管病变(PCV)的疗效和安全性。方法采用非随机对照研究方法,纳入2016年10月至2019年1月于北京大学人民医院眼科就诊的未经治疗的PCV患者91例91眼。所有患者确诊后均接受康柏西普0.5 mg玻璃体内注射;按照患者意愿决定其抗VEGF治疗方案,根据治疗方案将患者分为按需治疗组(3+PRN组)和治疗-延长组(3+TAE组)。随访时间为1年。所有患眼均接受ETDRS视力表、光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)及吲哚菁绿脉络膜血管造影(ICGA)检查,并记录最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CRT)、最大视网膜厚度(MRT)、色素上皮脱离(PED)高度、脉络膜息肉样病灶数量及面积、视网膜出血面积、分枝状血管网(BVN)面积。比较2个组在治疗后1年内的治疗间隔时间及治疗次数。结果治疗后1年,3+PRN组和3+TAE组的BCVA提升幅度分别为5.0(-2.0,15.0)和6.0(-1.0,14.0)个字母,组间比较差异无统计学意义(Z=-0.352,P=0.725);2个组患眼CRT、MRT、PED高度变化量比较差异均无统计学意义(Z=-0.145、-0.529、-0.985,均P>0.05);2个组患眼息肉数量、息肉面积、不同息肉消退程度眼数、BVN面积和视网膜出血面积比较差异均无统计学意义(Z=-0.502、-0.300、-0.047、-0.265、-1.243,均P>0.05)。随访1年时,3+PRN组患眼平均接受康柏西普玻璃体内注射(7.6±0.9)次,少于3+TAE组的(8.4±2.0)次,差异有统计学意义(t=2.432,P=0.019)。3+PRN组平均随访次数为(11.3±1.5)次,明显多于3+TAE组的(10.1±1.7)次,差异有统计学意义(t=3.403,P=0.001)。3+TAE组患眼负荷治疗期后有17.1%(6/35)的患者治疗间隔延长至12周,48.5%(17/35)的患者治疗间隔延长至8周及以上,平均最大延长间隔时间为(9.5±2.0)周。随访期间,3+PRN组和3+TAE组分别有10眼和8眼接受光动力治疗。结论3+PRN和3+TAE方案进行康柏西普玻璃体内注射联合光动力补救治疗在改善PCV患者的视力和解剖结果方面疗效接近。其中3+TAE方案治疗次数增加,患者随访次数减少。

雷珠单抗治疗缺血型和非缺血型视网膜分支静脉阻塞继发黄斑水肿患者视网膜体积变化的对比研究

目的 应用光学相干断层扫描血管成像(OCTA)对比雷珠单抗治疗缺血型和非缺血型视网膜分支静脉阻塞继发黄斑水肿(BRVO-ME)患者的临床疗效和视网膜体积变化的异同。方法 回顾性分析缺血型组34例(34眼)和非缺血型组21例(21眼)的BRVO-ME患者的临床资料,对两组患者均进行玻璃体内注射雷珠单抗治疗,并对治疗前及治疗后1 d、1周、1个月、3个月、6个月患者的最佳矫正视力和黄斑区视网膜体积进行分析。结果 治疗后1 d时最佳矫正视力(logMAR)缺血型组为0.63±0.37,非缺血型组为0.44±0.22,两组相比差异有统计学意义(P=0.017)。视网膜外层、视网膜全层以及视网膜全层Farafovea分区、Perifovea分区的视网膜体积,治疗前缺血型组分别为(6.42±1.90)mm^(3)、(8.75±1.82)mm^(3)、(3.20±0.87)mm^(3)、(5.10±0.89)mm^(3),非缺血型组分别为(5.52±1.57)mm^(3)、(7.83±1.56)mm^(3)、(2.80±0.71)mm^(3)、(4.66±0.77)mm^(3);治疗后1 d缺血型组分别为(4.97±1.18)mm^(3)、(7.46±1.47)mm^(3)、(2.62±0.60)mm^(3)、(4.53±0.80)mm^(3),非缺血型组分别为(4.25±0.48)mm^(3)、(6.58±0.56)mm^(3)、(2.26±0.26)mm^(3)、(4.06±0.40)mm^(3);治疗后1周缺血型组分别为(4.40±0.82)mm^(3)、(6.90±0.85)mm^(3)、(2.38±0.36)mm^(3)、(4.24±0.49)mm^(3),非缺血型组分别为(4.04±0.35)mm^(3)、(6.33±0.49)mm^(3)、(2.15±0.19)mm^(3)、(3.95±0.35)mm^(3),两组相比差异均有统计学意义(均为P<0.05)。视网膜外层和视网膜全层的视网膜体积与基线对比变化量,治疗后1个月时缺血型组分别为(-2.48±2.38)mm^(3)、(-2.54±2.38)mm^(3),非缺血型组分别为(-1.31±1.58)mm^(3)、(-1.38±1.58)mm^(3),两组相比差异均有统计学意义(均为P<0.05)。结论 雷珠单抗治疗缺血型和非缺血型BRVO-ME患者疗效均较好,治疗后短期视力预后非缺血型组较缺血型组患者好,缺血型组患者视网膜体积高于非缺血型组,长期治疗后两组患者视力预后和视网膜体积均无明显差异。

促内皮和抗炎的丹参酮ⅡA洗脱支架涂层研究

目的针对目前临床心血管支架存在的晚期血栓和支架内再狭窄等问题,通过超声雾化喷涂技术构建传统中药丹参酮ⅡA(TS)洗脱支架,探究其在动脉粥样硬化病变部位的治疗作用。方法采用超声雾化喷涂技术构建TS洗脱支架;利用水接触角(WCA)检测仪、傅里叶变换红外吸收光谱仪(FTIR)、球囊扩张实验及场发射扫描电镜(SEM)等对涂层表面的亲疏水性、化学成分及结构、涂层机械性能进行检测分析;采用紫外-可见光分光光度计(UV-Vis)对TS涂层药物释放行为进行检测;通过体外溶血率和血小板实验初步评价涂层的血液相容性;通过体外细胞相容性实验评估TS涂层对内皮细胞(ECs)和平滑肌细胞(SMCs)增殖的影响,以及对巨噬细胞炎症行为及表型的调节作用;通过半体内血液循环实验进一步探索涂层抗血栓形成效果。结果WCA、FTIR、SEM和UV-Vis等检测结果证实了TS洗脱支架的成功制备,涂层中TS在体外能够保持28 d持续释放;体外生物相容性结果表明,TS与聚乳酸-羟基乙酸共聚物(PLGA)质量比为30%的涂层具有显著抑制血小板的黏附和激活、促进ECs及抑制SMCs增殖的作用,同时能够有效调节巨噬细胞的炎症行为;半体内血液循环实验结果表明,涂层具有良好的抗血栓形成的效果。结论制备的TS洗脱支架具有选择性促进内皮增殖,抑制平滑肌增生、调控炎症的作用,以及优异的抗血栓形成能力,能够为病变血管修复提供一种潜在的解决方案。

Progress of anti-vascular endothelial growth factor therapy for ocular neovascular disease： benefits and challenges

publication. Study selection Clinical trials and case studies presented at medical conferences and published in peer-reviewed literature in the past decade were reviewed. Results Anti-VEGF agents have manifested great potential and promising outcomes in treating ocular neovascularization, though some of them are still used as off-label drugs. Intravitrea~ injection of anti-VEGF agents could be accompanied by devastating ocular or systemic complications, and intimate monitoring in both adult and pediatric population are warranted. Future directions should be focused on carrying out more well-designed large-scale controlled trials, promoting sustained duration of action, developing safer and more efficient generation of anti-VEGF agents. Conclusions Anti-VEGF treatment has proved to be beneficial in treating both anterior and posterior neovascular ocular diseases. However, more safer and affordable antiangiogenic agencies and regimens are warranted to be explored.

多次玻璃体腔注射抗血管内皮生长药物对黄斑水肿患者角膜生物力学的作用

目的观察多次玻璃体腔注射抗血管内皮生长因子(VEGF)药物对角膜生物力学的作用。方法前瞻性病例对照研究。选取玻璃体腔注射抗VEGF治疗的患者共64例(64只眼),其中,湿性老年性黄斑变性(nAMD)19例(19只眼),糖尿病黄斑水肿(DME)20例(20只眼),视网膜静脉阻塞(RVO)黄斑水肿25例(25只眼)。阿柏西普(2 mg/0.05 ml)治疗29例(29只眼),雷株单抗(0.5 mg/0.05 ml)治疗35例(35只眼)。经过3次连续注射治疗的患者共64例(64只眼),经过4次连续注射治疗的患者共10例(10只眼)。使用眼反应分析仪(ORA)对角膜生物力学指标进行测量。比较每次注药后1个月与注射前的角膜阻力因子(CRF)、角膜滞后量(CH)、角膜补偿眼压值(IOPcc)、可重复的模拟Goldmann眼压值(IOPg)的变化。比较使用阿柏西普和雷株单抗两种不同药物多次玻璃体腔注射后以上所有指标的变化,同时比较nAMD、DME、RVO三种不同疾病多次玻璃体腔注射抗VEGF药物后以上所有指标的变化。结果(1)雷株单抗/阿柏西普多次注射后角膜生物力学各指标在术后各时间点较术前相比,差异无统计学意义;(2)注射次数与角膜生物力学各项指标的改变无明显相关性;(3)术前基线时,角膜生物力学等各指标在3种不同疾病患者基线时差异无统计学意义;(4)注射3次后,DME组的CH值较RVO组和AMD组升高,且差异有统计学意义。结论多次玻璃体腔注射抗VEGF药物使DME组的CH值则显著高于RVO组和AMD组。糖尿病黄斑水肿患者多次玻璃体腔注射抗VEGF药物对角膜生物力学会产生一定影响。

黄连及其提取物防治肺部感染的研究进展

肺部感染已成为威胁人类健康的重大疾病,给数百万患者的身体健康造成严重威胁。黄连是典型清热药,主要活性成分包括黄连素(小檗碱)、黄连碱等,具有强效清热燥湿作用,可通过多种途径防治肺部感染。黄连及其提取物对肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌、肺炎链球菌、流感病毒、冠状病毒等多种肺部感染病原菌具有抗菌活性。黄连及其提取物还可增强抗生素的抗菌活性。黄连及其提取物可通过抑制多种炎症因子释放、阻止核因子κB(nuclear factor kappa-B,NF-κB)激活、抑制NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3, NLRP3)炎症小体活化、调节T细胞免疫反应、降低粘附分子的释放、抑制磷脂酶A2(Phospholipase A2,PLA2)的释放,降低病原菌引发的炎症反应。黄连及其提取物能降低肺部血管内皮损伤,抑制新血管形成,阻止肺纤维化,以降低肺部损伤。本研究通过文献整理,对黄连及其提取物防治肺部感染的作用机制进行了综述。

玻璃体腔与结膜下注射抗血管内皮生长因子联合小梁切除治疗新生血管性青光眼的效果比较

目的探究在新生血管性青光眼(NVG)患者治疗中应用玻璃体腔和结膜下注射抗血管内皮生长因子(VEGF)并小梁切除联合治疗的疗效对比差异。方法随机选取我院2021年1月至2022年6月期间,明确诊断为NVG的住院患者为研究主体,总计纳入患者26例,患眼30只。基于随机数字表法均衡原则分组,命名为A组(患者13例,患眼15只)和B组(患者13例,患眼15只)。A组患者行玻璃体腔注射抗VEGF药,然后行小梁切除术,B组患者行结膜下注射抗VEGF药后行小梁切除术,对比组间视力恢复效果、术后不同时点眼压水平、患眼新生血管面积和并发症发生情况。结果组间患者视力恢复效果对比无差异(P>0.05);在术后第7天,第21天、半年以及术后1年两组患者眼压水平均呈下降变化趋势(均P<0.05),但比较术前及术后各时间点,两组患者眼压水平对比差异无统计学意义(P>0.05);两组治疗前及术后1~6 d内每日比较,两组新生血管面积无差异(P>0.05),术后两组患者的新生血管面积呈逐渐减小趋势,且与术前相比更小(均P<0.05);和A组比较,B组患者术后并发症发生率更低(P<0.05)。结论玻璃体腔与结膜下注射抗VEGF均可有效治疗NVG,均可以达到降低眼压、促进视力恢复,缩小新生血管面积的作用,但是以结膜下注射方式的安全性更高。

Anti-vascular endothelial growth factor： the future treatment of choroidal neovascularization in pathologic myopia

-yopia is the most common refractive disorder. High .myopia affects 27%-33% of all myopic eyes inAsia.1,2 ;The pathologic myopia （PM） is the most severe vision-threatening phenotype of high myopia.3 It is also the second most common cause of choroidal neovascularization （CNV） in Asia. Unlike age-related macular degeneration （AMD） which mostly effecting elders, PM causes severe vision loss in young adults, resulting in a significant impairment of their working ability.4 PM has become the second leading cause of low vision and blindness particularly among those aged at 40-49 years in some Asia countries.

激光光凝术后视网膜新生血管形成对患者视功能的影响研究

目的 探究激光光凝术后视网膜新生血管形成(RNV)对患者视功能的影响因素。方法 选取2021年1月至2023年7月在本院接受激光光凝术治疗的120例RNV患者纳入研究。测定患者治疗前1 d和术后3个月的最佳矫正视力(BCVA)以评估视功能,并根据术后3个月BCVA将患者分为视功能不良组和视功能良好组。比较两组患者的临床资料,并对相关因素进行多因素分析。结果 患者术后3个月的BCVA显著高于治疗前1 d(P<0.05)。视功能不良组和视功能良好组的年龄、性别、体质量指数、患眼、吸烟史、饮酒史、高血压史、高脂血症史、冠心病史比较差异均无统计学意义(P>0.05),两组病程、治疗前BCVA、治疗前眼压、糖尿病史比较差异均有统计学意义(P<0.05)。病程短、治疗前眼压低均是影响激光光凝术后RNV患者视功能的保护因素,而治疗前BCVA低、有糖尿病史均是影响患者术后视功能的危险因素。结论 病程、治疗前眼压、治疗前BCVA、糖尿病史均会影响激光光凝术后RNV患者视功能。临床应给予重视,完善早期评估,对存在以上因素的患者进行及时干预,以改善其术后视功能。

抗血管内皮生长因子联合地塞米松植入物治疗糖尿病黄斑水肿患者的临床观察

目的研究抗血管内皮生长因子(VEGF)联合地塞米松植入物(DEX)治疗糖尿病黄斑水肿(DME)患者的临床效果。方法前瞻性选择2021年1月至2022年12月贵州医科大学附属医院收治的DME患者90例(90眼),依据随机数字表法将其分为试验组(n=45)、对照组(n=45)。对照组行抗VEGF治疗,试验组行抗VEGF联合DEX治疗。观察两组治疗前及治疗3个月后黄斑中心凹视网膜厚度(CMT)、患眼最佳矫正视力(BCVA)及眼压;房水中血小板源性生长因子(PDGF)、微小RNA-377-3p(miR-377-3p)及内皮抑制素(ES)等DME相关因子,并比较2组临床疗效、术后并发症及复发情况。结果治疗3个月后,两组CMT、BCVA均较治疗前降低,且试验组CMT、BCVA分别为(286.77±31.22)μm、(0.50±0.06)logMAR,均低于对照组[(322.95±34.61)μm、(0.43±0.04)logMAR],差异均有统计学意义(P<0.05),两组眼压比较差异无统计学意义(P>0.05)。治疗3个月后,两组房水PDGF及ES水平均较治疗前降低,房水miR-377-3p水平均较治疗前升高,且试验组房水PDGF及ES水平分别为(3.80±0.40)ng/mL、(89.95±9.27)ng/L,均低于对照组[(4.65±0.48)ng/mL、(102.26±11.34)ng/L],房水miR-377-3p水平为0.57±0.07,高于对照组(0.50±0.06),差异均有统计学意义(P<0.05)。试验组总有效率为93.18%,高于对照组(73.33%),差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(6.67%vs.4.44%)(P>0.05)。试验组复发率为2.22%,低于对照组(17.78%),差异有统计学意义(P<0.05)。结论抗VEGF联合DEX治疗DME可减小CMT,提高患眼最佳矫正视力,改善房水DME相关因子水平,疗效显著,术后并发症少,复发率低,且不显著增加眼压,值得推荐于临床。

抗血管内皮生长因子玻璃体腔注射在糖尿病性视网膜病变激光光凝治疗中的应用效果

目的 探讨抗血管内皮生长因子(VEGF)玻璃体腔注射在糖尿病性视网膜病变激光光凝治疗中的应用效果。方法 选取2021年6月至2022年6月收治的120例糖尿病性视网膜病变患者为研究对象,按照随机数字表法将其分为对照组与观察组,各60例。两组均给予激光光凝治疗,观察组于术前3~5 d给予康柏西普玻璃体腔注射治疗。比较两组的治疗效果。结果 治疗后,两组的最佳矫正视力(BCVA)均升高,且观察组高于对照组(P<0.05)。治疗后,两组的胎盘生长因子(PIGF)水平均降低,色素上皮衍生因子(PEDF)水平均升高,且观察组优于对照组(P<0.05)。观察组的并发症总发生率为8.33%,显著低于对照组的30.00%,差异具有统计学意义(P<0.05)。结论 抗VEGF玻璃体腔注射在糖尿病性视网膜病变激光光凝术中具有显著辅助治疗效果,可减轻视网膜前膜组织损伤,改善细胞因子水平,降低并发症发生率。

抗血管内皮生长因子联合全视网膜激光光凝术治疗新生血管性青光眼的临床效果

目的:分析抗血管内皮生长因子(VEGF)联合全视网膜激光光凝术(PRP)治疗新生血管性青光眼的临床效果。方法:选取2021年2月—2022年12月锦州医科大学附属第一医院眼科收治的85例新生血管性青光眼患者作为研究对象,根据随机数字表法分为对照组(n=42)及观察组(n=43)。对照组采用抗VEGF治疗,观察组在对照组基础上联合PRP。比较两组治疗效果。结果:治疗后6个月,两组视野缺损程度小于治疗前,且观察组小于对照组,两组视神经纤维层厚度大于治疗前,且观察组大于对照组,差异有统计学意义(P<0.05)。治疗后1周,两组眼压水平低于治疗前,差异有统计学意义(P<0.05);治疗后6个月,两组眼压水平低于治疗前,高于治疗后1周,观察组低于对照组,差异有统计学意义(P<0.05)。治疗后6个月,两组视力水平高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:抗VEGF联合PRP治疗新生血管性青光眼的临床效果显著,可减小视野缺损程度,提高视神经纤维层厚度,改善眼压及视力水平,且安全性较好。