Comparison of central macular thickness between two spectral-domain optical coherence tomography in elderly non-mydriatic eyes

AIM: To compare central macular thickness (CMT) measurements obtained by two spectral-domain optical coherence tomography (SD-OCT) exams, and to evaluate measurement reproducibility and agreement between these two exams, and to investigate the relationship between CMT and possible influencing factors such as age, sex, eye (OD/OS), and operators in elderly non-mydriatic eyes. METHODS: Seventy-two normal subjects were included. Every subject underwent CMT measurement twice using one of two SD-OCT (OSE-2000, Moptim, Shenzhen, China & 3-D OCT-1000, Topcon, Tokyo, Japan) instruments respectively where we randomly chose one eye in each patient for the test; these exams were performed by two operators over an hour period with a brief rest between sessions. Comparison of the OSE-2000 and 3-D OCT-1000 CMT measurements was based on paired- t test The mean difference between the CMT measurements was calculated. General linear model analyzed the relationships among eye (OD/OS), operator, sex, and CMT values using age as co-variant. All tests were considered statistically significant at P <0.05. The main outcome measures included CMT. RESULTS: When evaluated with general linear model analysis, CMT measurements were found to have high reproducibility across the two instruments between the two operators for the OSE-2000 single line scan and 3-D OCT-1000 macular scans (P=0.731; P=0.443). There was statistically significant difference in CMT values between the two instruments (P<0.001) and the mean difference was -46.83 mu m at 95% confidence limits (-49.15,-44.51). Age was positively correlated with CMT (beta coefficient =0.516, P=0.001; beta coefficient=0.453, P =0.009) and sex was correlated with CMT from the OSE-2000 (P=0.021) but not with the 3-D OCT-1000 (P=0.056). According to the actual thickness measurements, the CMT of the male was thicker than the female's but there was no statistical difference. There was interaction between sex and eye in OSE-2000 and not in 3-D OCT-1000 (P=0.02; P =0.374). No significant correlation was found between CMT and the influencing factor of eye in both of the instruments (P=0.884; P=0.492). CONCLUSION: Reproducibility of CMT measurement using the two SD-OCTs is excellent in normal eyes according to the operator factor analysis. OSE-2000 has a different posterior retinal boundary of CMT measurement, which results in the CMT value differences, compared with the 3-D OCT-1000. Age is positively correlated with CMT measurement while sex is correlated with CMT in the OSE-2000 but not in the 3-D OCT-1000 and eye (OD/OS) had no correlation with CMT values. Mydriatic drops may not be necessary for CMT measurement using high scan rate SD-OCT in normal eyes in dark room.

Foveal thickness reduction after anti-vascular endothelial growth factor treatment in chronic diabetic macular edema

AIM：To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor（anti-VEGF） therapy for center-involving diabetic macular edema（DME）.METHODS：Foveal thickness was assessed with optical coherence tomography to determine the central subfield foveal thickness（CSFT） and macular volume in 42 eyes with DME（CSFT〉275 μm）. Evaluations also included measurement of best-corrected visual acuity（BCVA）, and were performed at baseline, and upon foveal depression recovery achieved after 12 monthly intravitreal injections of either 1.5 mg/0.06 mL bevacizumab（n=21） or 0.5 mg/0.05 mL ranibizumab（n=21）. Data was compared to 42 eyes of normally sighted, non-diabetic, healthy individuals with similar age, gender and race distributions.RESULTS：Mean baseline BCVA was 0.59±0.04 and 0.32± 0.03 log MAR（P〈0.001） after treatment and resolution of DME, with all, but 3 eyes, showing BCVA improvement. Mean CSFT before treatment was 422.0±20.0 μm, and after treatment, decreased to 241.6±4.6 μm（P〈0.001）, which is significantly thinner than CSFT found in control subjects（272.0±3.4 μm; P〈0.001）. Moreover, in 33/42 DM eyes（79%）, CSTF was thinner than the matched control eye. Macular volume showed comparable results, but with lower differences between groups（control：8.5±0.4 mm^3; DME：8.2±1.0 mm^3; P=0.0267）.CONCLUSION：DME eyes show significantly lower foveal thickness than matched controls after DME resolution achieved with one-year anti-VEGF therapy. Further investigation into the reasonsfor this presumable retinal atrophy using fluorescein angiography and functional parameters as well as establishing possible predictors is warranted. This finding should be considered during the treatment of DME.

Non-linear relationship between age and subfoveal choroidal thickness in Chinese patients with proliferative diabetic retinopathy

BACKGROUND No study has investigated the change regularity between age and subfoveal choroidal thickness(SFCT)in proliferative diabetic retinopathy(PDR).AIM To investigate the relationship between the SFCT and age in Chinese patients with PDR.METHODS This was a cross-sectional retrospective study.The participants were hospitalized individuals with type 2 diabetes who underwent vitrectomy for PDR.Contralateral eyes that met the criteria were included in the study.All necessary laboratory tests were performed at the time of admission.Central macular thickness(CMT)and SFCT were two quantitative assessments made using enhanced depth imaging optical coherence tomography.CMT was measured automatically and SFCT was measured manually with digital calipers provided by the Heidelberg Eye Explorer software.RESULTS The final analysis included a total of 234 individuals with PDR.The average age was 55.60 years old±10.03 years old,and 57.69%of the population was male.Univariate analysis revealed a significant negative connection between age and SFCT in patients with PDR[β=-2.44,95%confidence interval(95%CI):-3.46 to-1.42;P<0.0001].In the fully adjusted model,the correlation between SFCT and age remained steady(β=-1.68,95%CI:-2.97 to-0.39;P=0.0117).Spline smoothing showed that the relationship between SFCT and age in patients with PDR was non-linear,with an inflection point at 54 years of age.CONCLUSION Our findings suggest that age is a key determinant of choroidal thickness.The non-linear link between SFCT and age in PDR patients should be taken into account.

Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema

BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.

雷珠单抗联合激光治疗糖尿病性黄斑水肿的疗效及对BCVA、CMT的影响

目的分析雷珠单抗联合激光治疗糖尿病性黄斑水肿的疗效及对最佳矫正视力(best corrected vision acuity,BCVA)和黄斑中心凹厚度(central macular thickness,CMT)的影响。方法非随机选取莒县中医医院于2022年3月—2023年3月收治的82例糖尿病性黄斑水肿患者为研究对象,根据治疗方法不同分为研究组和对照组,各41例。对照组提供激光治疗,研究组增加雷珠单抗治疗。对比两组临床疗效、视力恢复结果、临床指标及并发症发生情况。结果研究组治疗总有效率为97.56%(40/41),高于对照组的82.93%(34/41),差异有统计学意义(χ^(2)=4.987,P<0.05);治疗后,两组BCVA均明显升高,研究组的BCVA高于对照组,差异有统计学意义(P均<0.05);治疗后研究组CMT、黄斑区视网膜厚度、眼压低于对照组,差异有统计学意义(P均<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论糖尿病性黄斑水肿采取雷珠单抗联合激光治疗,可改善BCVA和CMT,提高临床疗效,且安全性较好。

通络驻景丸联合康柏西普治疗年龄相关性黄斑变性的疗效及对CMT和视力的影响

目的探究通络驻景丸联合康柏西普治疗年龄相关性黄斑变性(AMD)的疗效及对黄斑中心凹视网膜厚度(CMT)和视力的影响。方法选取2020年1月至2022年1月宝鸡市中医医院收治的94例AMD患者作为研究对象,按区组随机化法分为观察组和对照组,每组47例(47眼)。对照组患者采用康柏西普治疗,观察组患者在对照组治疗基础上联合通络驻景丸治疗,两组患者均持续治疗3个月。比较两组患者的治疗效果,以及治疗前后的视力情况[最佳矫正视力(BCVA)、视觉功能评估表(VF)]、CMT、眼血流动力学[收缩期血液最大流速(PSV)、舒张期血液最大流速(EDV)、阻力指数(RI)]的变化,同时比较两组患者治疗期间的不良反应发生情况。结果治疗3个月后,观察组患者的治疗总有效率为95.74%,明显高于对照组的82.98%,差异有统计学意义(P<0.05);治疗3个月后,观察组患者的BCVA、视觉反应评分、视野情况评分、个体感受评分、立体视觉评分、PSV、EDV水平明显高于对照组,CMT、RI明显低于对照组,差异均有统计学意义(P<0.05);观察组患者的不良反应总发生率为12.77%,明显低于对照组的29.79%,差异有统计学意义(P<0.05)。结论通络驻景丸联合康柏西普治疗AMD能有效改善患者的视觉功能,控制黄斑病变进展,临床疗效显著,且不良反应少。

清热利湿法治疗糖尿病视网膜病变患者激光术后黄斑水肿的疗效及对视功能、糖代谢、CMT的影响

目的 探讨清热利湿法治疗糖尿病视网膜病变(DR)患者激光术后黄斑水肿的疗效及对视功能、糖代谢、黄斑中心凹视网膜厚度(CMT)的影响。方法 选取激光术后黄斑水肿的70例DR患者,将其随机分为激光组(n=35)和中药组(n=35)。激光组行激光治疗,中药组在上述基础上联合清热利湿冲剂口服治疗。治疗1个月后评估两组疗效及中医证候积分变化,并比较治疗后1个月、3个月、6个月两组视功能、糖代谢以及CMT变化。结果治疗1个月后,中药组治疗总有效率为97.14%,高于激光组的82.86%(χ^(2)=3.97,P<0.05),中药组各中医证候积分均低于激光组(t分别=3.51、5.32、2.85、2.25,P均<0.05);治疗后1个月、3个月、6个月中药组最佳矫正视力高于激光组(t分别=5.50、6.12、4.67,P均<0.05),CMT、空腹血糖、餐后2 h血糖均低于激光组(t分别=4.35、5.87、9.59;2.01、2.09、2.04;2.99、2.17、2.93,P均<0.05)。结论 清热利湿法治疗DR患者激光术后黄斑水肿较单激光光凝治疗的效果更佳,能有效提升患者视功能水平,减少CMT,改善患者典型症状,同时能更好地控制血糖水平。

Comparison of conbercept and ranibizumab for the treatment efficacy of diabetic macular edema: a Metaanalysis and systematic review

AIM: To evaluate the efficacy of intravitreal injection of conbercept(IVC) and ranibizumab(IVR) in patients with diabetic macular edema.METHODS: Reviewers have searched 12 databases, including PubMed, Medline, EMBASE, Web of Science, Springer, ScienceDirect, OVID, Cochrane Library, Clinical Trials.gov, cqVIP, WanFangdata and China National Knowledge Infrastructure(CNKI), up to December 28, 2018. Rev Man 5.3(Cochrane Library Software, Oxford, UK) was employed for statistical analysis. Fixed and random effects models were applied to assess heterogeneity. Odds ratio(OR) was applied for dichotomous variables;weighted mean difference(WMD) was applied for continuous variables. The confidence interval(CI) was set at 95%. Central macular thickness(CMT) and best-corrected visual acuity(BCVA) were employed to analyze the improvement of DME patients. Inclusion criteria for picking out studies were retrospective studies and randomized controlled trials(RCTs) that compared IVC and IVR for the treatment of diabetic macular edema.RESULTS: Four retrospective studies and five RCTs were included with a total of 609 patients. No statistically significant difference was observed in mean CMT and mean BCVA in the baseline parameters [BCVA(WMD:-0.48;95%CI:-1.06 to 0.10;P=0.1), CMT(WMD:-0.83;95%CI:-15.15 to 13.49;P=0.91). No significant difference was found in the improvement of BCVA and adverse event(AE) in IVC group, compared with IVR group after treatment of loading dosage [the 1 st month BCVA(WMD: 0.01;95%CI:-0.26 to 0.27;P=0.96), the 3 rd month BCVA(WMD:-0.04;95%CI:-0.14 to 0.06;P=0.46);the 6 th month BCVA(WMD:-0.24;95%CI:-1.62 to 1.14;P=0.73)], AE(OR: 0.84;95%CI: 0.38 to 1.84;P=0.66)]. A slight difference was found in the effectiveness rate(OR: 1.70;95%CI: 0.97 to 2.96;P=0.06), There were statistically significant differences between IVC and IVR treatment in terms of CMT (1 st month CMT(WMD:-19.88;95%CI:-27.94 to-11.82;P<0.001), 3 rd month CMT(WMD:-23.31;95%CI:-43.30 to-3.33;P=0.02), 6 th month CMT(WMD:-74.74;95%CI:-106.22 to-43.26;P<0.001))CONCLUSION: Pooled evidence suggests that both IVC and IVR are effective in the therapy of diabetic macular edema and affirms that IVC presents superiority over IVR therapy in regard of CMT in patients with diabetic macular edema, but no statistically significant difference with regard to visual improvement. Relevant RCTs with longerterm follow-up are necessary to back up our conclusion.

Predicting anatomical results of surgical treatment of idiopathic macular hole

AIM： To determine the parameters most informative in predicting the anatomical results of surgical treatment of idiopathic full-thickness macular hole （IMH）. METHODS： One hundred and sixty-two consecutive patients （170 eyes） after primary operation for IMH were enrolled. Outcomes were classified as anatomical success when both IMH closure and restoration of the outer retinal structure were achieved. ＂Prospective＂ group included 108 patients （115 eyes） followed with optical coherence tomography （OCT） and microperimetry for ly after surgery. Potential prognostic criteria, except microperimetry data, were tested in ＂retrospective＂ group （54 patients, 55 eyes）. Prognostic value of each parameter was determined using receiver operating characteristic （ROC） analysis. Combined predictive power of the best prognostic parameters was tested with the use of linear discriminant analysis. RESULTS： IMH closure was achieved in 106 eyes （92%） in the prospective group and 49 eyes （89%） in the retrospective group. Despite anatomical closure, the outer retinal structure was not restored in two eyes in the first group and in one eye in the second group. Preoperative central subfield retinal thickness demonstrated the best discriminatory capability between eyes with anatomical success and failure： area under the ROC-curve （AUC） 0.938 （95% Ch 0.881-0.995）, sensitivity 64% at fixed specificity 95% （cut-off value 300um） in the prospective group; sensitivity 57% and specificity 90% in the retrospective group. Other continuous parameters except tractional hole index （AUC： 0.796, 95% Ch 0.591- 1.000） had significantly lower AUCs （P〈0.05）. The best combination of the parameters, established by discriminant analysis in the prospective group, could not confirm its predictive value in the retrospective group. CONCLUSION： Preoperative central subfield retinal thickness is a strong and probably the best predictor of anatomical results of IMH surgical treatment.

Six-year outcomes in neovascular age-related macular degeneration with ranibizumab

AIM： To evaluate the outcomes of （6y ranibizumab therapy in neovascular age-related macular degeneration （AMD）.METHODS： HELIX was a retrospective, observational effectiveness study using medical records of patients treated in three clinics in Belgium. Patients had neovascular AMD and were initially treated with intravitreal ranibizumab （0.5 mg） between November 1, 2007 and October 31, 2008, had （6y of data available, and were treated on an ongoing, as-needed basis. Outcomes included best-corrected visual acuity （BCVA） and central retinal thickness （CRT）.RESULTS： The sample consisted of 88 eyes from 69 patients. Mean age was 76.4±6.5y, most patients were female （62.3%）. Most eyes （62.5%） were treatment-naive, 33 previously treated eyes had received predominantly other anti-vascular endothelial growth factor agents and verteporfin. Mean baseline BCVA was 57.4±12.7 ETDRS letters and CRT was 291.5±86.1 （m. On average, patients received 20.6±11.9 ranibizumab injections over the （6y. Intervals between injections were on average 12.7±16.1wk. Mean change in BCVA from baseline to last observation for the sample was less than one letter （-0.9±17.3 letters）, with an average loss of -3.2±15.6 letters in previously treated eyes versus a gain of 0.6±18.4 letters in treatment-na？ve eyes. When considering a loss of 〈15 letters over 6y as stabilization of disease, 75.9% of all eyes showed a positive （improvement or stabilization） outcome. Mean change in CRT from baseline to last observation for the sample was -26.9±148.4 （m with the greatest reduction observed in treatment-naive eyes.CONCLUSION： This retrospective study of 69 neovascular AMD patients treated for （6y with ranibizumab demonstrates long-term visual stabilization. In light of the natural evolution of the disease, these data confirm that ranibizumab is effective long-term under real-world conditions of heterogeneity of patients, clinicians, and centers.

Comparison of intravitreal aflibercept and dexamethasone implant in the treatment of macular edema associated with diabetic retinopathy or retinal vein occlusion:a Meta-analysis and systematic review

·AIM:To compare the efficacy and safety of intravitreal aflibercept with dexamethasone implant in the treatment of macular edema(ME)associated with diabetic retinopathy(DR)or retinal vein occlusion(RVO).·METHODS:A comprehensive search of studies comparing dexamethasone and aflibercept in patients with ME was conducted at PubMed,Embase,and Cochrane Central Register of Controlled Trials from the beginning of library to April 16,2021.Extracting the data including bestcorrected visual acuity(BCVA),central retinal thickness(CRT),number of injections and serious adverse events(SAEs)from the final qualified articles.RevMan 5.3 software was used for Meta-analysis of the included studies.·RESULTS:Totally 7 studies with 369 eyes were included.The causes of ME in the final screening study included RVO and DR.Compared with the aflibercept treatment group,the BCVA of the dexamethasone implant treatment group showed no significant difference in the follow-up for 3 mo[mean difference(MD):-0.05,95%confidence interval(CI):-0.11,0.02;P=0.17]and 12 mo(MD:-0.01,95%CI:-0.38,0.37;P=0.98),but it was slightly worse than the aflibercept group at 6 mo(MD:0.12.95%CI:0.03,0.21;P=0.008).In terms of CRT reduction,there was no significant difference between the two groups at 3 mo(MD:-28.14,95%CI:-79.95,23.67;P=0.29),6 mo(MD:27.67,95%CI:-84.89,140.24;P=0.63),and 12 mo(MD:-59.00,95%CI:-127.37,9.37;P=0.09).However,dexamethasone implant had fewer injections,but more adverse events such as elevated intraocular pressure(IOP)and cataract.·CONCLUSION:Intravitreal injection of aflibercept and dexamethasone implant can both effectively increase BCVA and reduce CRT.Compared with aflibercept,dexamethasone implant is not inferior in improving vision and reducing CRT in the initial treatment period(3 mo)and long-term treatment period(12 mo).Besides,it has fewer injections and more likely to cause elevated IOP and cataract.

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.

Intravitreal dexamethasone implant in naive and previously treated patients with diabetic macular edema:a retrospective study

AIM:To assess the effect of the intravitreal dexamethasone implant(DEX)Ozurdex on the best corrected visual acuity(BCVA)and central retinal thickness(CRT)in patients with diabetic macular edema(DME).METHODS:Totally 43 eyes(24 naive and 19 previously treated)were included in the study.Retrospective and single-center study involved patients with a clinical diagnosed of DME,who received treatment with DEX implant and had a follow-up of at least 12 mo.Primary endpoints included changes in BCVA and CRT.RESULTS:At month 12,mean improvement in BCVA from baseline was 20.4±20.8 letters and 6.8±6.9 letters in naive and previously treated patients,respectively(P=0.0132).The naive patients achieved the BCVA improvement significantly faster(2.4±1.5 mo)than the previously treated ones(3.5±2.4 mo,P=0.0298;MannWhitney test).The proportion of eyes gaining≥15 letters was 54.2%and 21.1%in the non-previously treated and previously treated groups,respectively(P=0.0293).CRT was significantly reduced from 484.0±119.8 and 487.5±159.9μm to 272.0±39.2 and 233.5±65.7μm in the naive and previously treated patients,respectively;P<0.0001 each,respectively.The presence of subretinal fluid was significantly associated with the proportion of patients achieving a BCVA improvement≥5 letters[HR(95%CI),1.23(1.04 to 1.45),P=0.0145];≥10 letters[HR(95%CI),1.75(1.10 to 2.77),P=0.0182];and≥15 letters[HR(95%CI),2.04(1.03 to 4.02),P=0.0407].Naive patients received less DEX implants throughout the study than the previously treated ones(1.8±0.6 vs 2.3±0.6,P=0.0172,respectively).Totally 9 patients(20.9%)have developed ocular hypertension,which was successfully controlled with topical hypotensive drugs.Of the 23 phakic eyes at baseline,5 eyes(21.7%)either had new onset lens opacity or progression of an existing opacity during the study follow-up.Four of them(2 in the naive group and 2 in the previously treated one)required cataract surgery at months 4,6,6,and 6,respectively.CONCLUSION:The results obtained in this study may support the early use of DEX Ozurdex as first line therapy in naive patients.

视网膜静脉阻塞继发黄斑水肿患者基线房水细胞因子水平与抗VEGF疗效的相关性

目的利用基线房水细胞因子预测视网膜静脉阻塞继发黄斑水肿(RVO-ME)患者抗血管内皮生长因子(VEGF)治疗3个月后黄斑中心凹厚度(CMT)和最佳矫正视力(BCVA)的改善情况。方法选择2021年10月至2023年1月在南京医科大学附属眼科医院首诊为RVO-ME的患者30例(30眼),在抗VEGF药物注射前行前房穿刺收集房水。采用Luminex液相芯片技术测定患者房水中VEGF、细胞间黏附分子-1(ICAM-1)、白细胞介素(IL)和干扰素-γ(IFN-γ)等11种细胞因子的水平。分析RVO-ME患者基线房水细胞因子水平与CMT、BCVA(logMAR)以及其变化值(基线与抗VEGF治疗3个月后差值)的相关性;在基线时与抗VEGF治疗3个月后分别分析CMT和BCVA(logMAR)间的相关性。CMT、BCVA应答者定义为从基线到抗VEGF治疗3个月后CMT、BCVA(logMAR)减少50%及以上的患者,使用Logistic回归模型分析基线房水细胞因子与RVO-ME患者抗VEGF治疗3个月后成为CMT或BCVA应答者的关系。结果与基线时相比,抗VEGF治疗3个月后RVO-ME患者CMT明显下降,BCVA明显改善(均为P<0.001)。RVO-ME患者基线时、抗VEGF治疗3个月后CMT与BCVA(logMAR)之间均呈正相关(P=0.026、0.002)。基线时,RVO-ME患者VEGF、IL-8水平与CMT均呈正相关(P=0.032、0.035);IL-6、IL-8水平与BCVA(logMAR)均呈正相关(P=0.018、0.002)。RVO-ME患者基线IL-8水平与CMT变化值呈负相关(P=0.024)。Logistic回归分析结果表明,基线ICAM-1水平升高增加RVO-ME患者抗VEGF治疗3个月后BCVA无应答的风险(P=0.023)。结论基线IL-8与ICAM-1可能是RVO-ME抗VEGF治疗后CMT及BCVA改善的预测因子。

无灌注区、黄斑区双激光方案在视网膜静脉分枝阻塞继发黄斑水肿患者中的应用分析

目的 探讨无灌注区、黄斑区双激光方案在视网膜静脉分枝阻塞(BRVO)继发黄斑水肿(ME)患者中的应用分析。方法 根据随机数字表法将浙江省丽水市人民医院2021年5月至2022年5月收治的150例BRVO继发ME患者分为对照组(雷珠单抗玻璃体腔内注射治疗)和双激光组(雷珠单抗联合无灌注区、黄斑区双激光治疗),各75例。治疗后3个月,比较两组临床效果、恢复情况[最佳矫正视力(BCVA)、眼内压(IOP)、黄斑中心视网膜厚度(CMT)]、黄斑区血流情况及荧光素眼底血管造影检查结果。结果 双激光组疗效优于对照组(P<0.05)。治疗后3个月,两组BCVA高于治疗前,IOP、CMT低于治疗前,且双激光组BCVA高于对照组,IOR、CMT低于对照组(P<0.05)。治疗后3个月,两组浅、深层毛细血管血流密度均高于治疗前,且双激光组高于对照组(P<0.05)。双激光组囊样渗漏、弥漫渗漏、局部渗漏发生率均低于对照组(P<0.05)。结论 玻璃体腔内注射雷珠单抗联合无灌注区、黄斑区双激光治疗BRVO继发ME可提高雷珠单抗的效果,促进患者视力恢复,还可改善黄斑区血流状况,减少血管渗漏发生。

DME患者黄斑微循环和细胞因子与抗VEGF疗效的关系

目的探讨糖尿病黄斑水肿(diabetic macular edema,DME)患者抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗后黄斑区微循环和房水细胞因子表达的变化,并分析其与抗VEGF疗效的关系。方法选取2021年10月至2023年8月于南昌市第一医院就诊的DME患者62例(91眼),均行玻璃体腔注射康柏西普治疗。根据黄斑中心厚度(central macular thickness,CMT)的降幅将其分为疗效显著组(CMT降幅≥100μm,59眼)和非疗效显著组(CMT降幅<100μm或增加,32眼)。分析抗VEGF治疗后CMT、黄斑浅层毛细血管丛(superficial capillary plexus,SCP)血管密度(vessel density,VD)、中心凹无血管区(fovea avascular area,FAZ)、VEGF、白细胞介素(interleuki,IL)-6、IL-8、IL-10的变化。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评估各指标的疗效预测价值。结果治疗前,疗效显著组患眼房水的VEGF、IL-10均显著高于非疗效显著组,IL-8水平显著低于非疗效显著组(P<0.05);治疗后,两组患眼房水的VEGF、IL-6、IL-8、IL-10均显著低于本组治疗前(P<0.05),疗效显著组患眼房水的VEGF、IL-6、IL-8均显著低于非疗效显著组,IL-10水平显著高于非疗效显著组(P<0.05);抗VEGF治疗前后,两组患眼的FAZ面积和SCP-VD均无显著变化(P>0.05)。相关性分析显示,基线房水VEGF(r=0.571,P<0.001)、IL-10(r=0.382,P=0.008)与CMT降幅呈正相关;IL-8与CMT降幅呈负相关性(r=–0.689,P<0.001);IL-6、FAZ面积、SCP-VD与CMT降幅无相关性(P>0.05);细胞因子水平与FAZ面积和SCP-VD无相关性(P>0.05)。ROC曲线结果显示,基线房水IL-8、VEGF和IL-10预测抗VEGF疗效的曲线下面积分别为0.825、0.813和0.676。结论DME患者的基线房水VEGF、IL-8、IL-10水平与抗VEGF疗效相关,且能够预测抗VEGF疗效。

玻璃体切割术在增殖性糖尿病视网膜病变治疗中的应用效果

目的:探讨玻璃体切割术在增殖性糖尿病视网膜病变(PDR)治疗中的应用效果。方法:选取2019年1月—2023年12月北海市人民医院收治的60例PDR患者,所有患者在入院后均开展视力、眼压、眼底照相、眼底荧光素血管造影以及光学相干断层扫描检查等,并开展25 G微创玻璃体切割术进行治疗,观察患者术中各方面情况以及术后恢复情况。结果:60例患者中55例双眼均表现为PDR,仅5例患者表现为单眼PDR。所有患者在手术过程中未观察到新鲜玻璃体出血以及视网膜出血症状,均顺利开展玻璃体切割术治疗。术后恢复过程中患者眼部黄斑中心区厚度、视力优于术前,差异有统计学意义(P<0.05)。手术后患者泪膜破裂时间、泪液分泌距离长于术前,眼表疾病指数量表低于术前,差异有统计学意义(P<0.05)。在术后恢复中3例出现并发症,1例眼压增加、1例视网膜水肿、1例眼部干涩。结论:及时诊断并进行玻璃体切割术治疗可有效改善患者的视力和眼部症状,降低眼部黄斑中心区厚度,改善泪膜功能,有助于患者康复。

糖尿病性黄斑水肿治疗中康柏西普玻璃体内注射的应用效果

目的探究糖尿病性黄斑水肿(diabetic macular edema,DME)患者应用康柏西普玻璃体内注射的临床疗效。方法选取2022年1月—2024年6月上海市第一人民医院蚌埠医院收治的60例DME患者为研究对象,根据不同治疗方式分为常规组(n=30,雷珠单抗玻璃体内注射)、观察组(n=30,康柏西普玻璃体内注射)。比较两组临床疗效、不良反应发生情况及临床指标。结果观察组治疗总有效率高于常规组,不良反应发生率低于常规组,差异有统计学意义(P均<0.05)。治疗3个月后,观察组黄斑中心凹视网膜厚度、最佳矫正视力水平优于常规组,差异有统计学意义(P均<0.05)。治疗3个月后,两组眼压水平比较,差异无统计学意义(P>0.05)。结论康柏西普应用于DME患者治疗可提高临床疗效,降低不良反应发生风险,并改善黄斑中心凹视网膜厚度、提高最佳矫正视力水平。

“补虚化浊法”中药联合抗VEGF治疗wAMD的Meta分析

目的系统评价“补虚化浊法”中药联合抗血管内皮生长因子(VEGF)治疗湿性年龄相关性黄斑变性(wAMD)的临床疗效。方法检索PubMed、Web of Science、Embase、中国知网、万方、维普、中国生物医学文献数据库中应用“补虚化浊法”中药治疗wAMD的随机对照试验文献,检索时间为建库至2023年5月31日,对文献按照纳入标准与排除标准进行筛选和数据录取,采用Cochrane软件评价文献质量,采用RevMan 5.4软件进行统计分析。结果共纳入13项研究,包括患者1,002例(1,041只眼),其中采用“补虚化浊法”联合抗VEGF治疗的治疗组501例(523只眼),单纯抗VEGF治疗的对照组501例(518只眼)。治疗组在提高国际标准视力[MD=0.100,95%CI(0.050,0.140),Z=4.310,P=0.000]、LogMAR视力[MD=-0.080,95%CI(-0.110,-0.050),Z=5.560,P=0.000]、视力总有效率[OR=2.070,95%CI(1.280,3.340),Z=2.970,P=0.000]、降低黄斑中心凹厚度[MD=-19.130,95%CI(-24.940,-13.310),Z=6.450,P=0.000]、提高荧光渗漏吸收率[OR=4.910,95%CI(2.870,8.400),Z=5.800,P=0.000]、提高临床总有效率[OR=3.810,95%CI(1.990,7.310),Z=4.030,P=0.000]方面优于对照组,差异均有统计学意义。结论“补虚化浊法”中药联合抗VEGF治疗wAMD疗效优于单纯抗VEGF治疗。

常规药物联合视网膜激光光凝术治疗眼底病的临床效果研究

目的:探讨在眼底病治疗中应用常规药物联合视网膜激光光凝术的临床效果。方法:选取滨州沪滨爱尔眼科医院2023年5月—2024年5月收治的眼底病患者作为研究对象,共800例,随机分为参比组(常规药物治疗)和研究组(在参比组基础上实施视网膜激光光凝术治疗),每组400例。比较两组治疗效果、黄斑区视网膜厚度、中心凹容积、视功能。结果:研究组总有效率高于参比组(P=0.0001);治疗后,两组黄斑区视网膜厚度、中心凹容积升高,研究组高于参比组(P<0.05);治疗后,两组上方、下方、鼻侧、颞侧视神经纤维层厚度升高,研究组高于参比组(P<0.05);治疗后,两组视力、视野灰度水平降低,研究组低于参比组(P<0.05)。结论:常规药物联合视网膜激光光凝术在眼底病患者中的应用效果显著,能够改善患者的黄斑区视网膜厚度、中心凹容积及视神经纤维层厚度,提高视功能。