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.

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.

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.

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）.

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.

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

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.

Update on treatments of diabetic macular edema

Objective To review the update research progress about the treatment of diabetic macular edema and to give helpful guidelines in the treatment of diabetic macular edema based on available evidence to date. Data sources A literature search of all English articles was performed on the online electronic PubMed database dated 1984 to 2009. The keywords searched included： macular edema, therapy, laser coagulation, intravitreal triamcinolone acetonide, vascular endothelial growth factor inhibitor, protein kinase C inhibitor and Pars plana vitrectomy. After finding relevant articles within these search limits, a manual search was conducted through the references from these articles. Study selection Original articles and critical reviews were reviewed and selected to address the stated purpose. Results To date, demonstrated means to reduce the risk of vision loss from diabetic macular edema include focal/grid laser photocoagulation and improved metabolic control. Emerging pharmacologic therapies （intravitreal triamcinolone acetonide, vascular endothelial growth factor inhibitors and protein kinase C beta-isoform inhibitors） and Pars plana vitrectomy have shown early promise in the treatment of diabetic macular edema. Conclusions As there has been extensive development in multiple treatments of diabetic macular edema, choice of the most suitable treatment for specific patients becomes important. Combination therapy of laser, pharmacological and surqical treatment modalities mav offer an alternative to treatment of diabetic macular edema.

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。

Characteristics of retinal vein occlusion with final vision better than 78 letters after sequential therapy with ranibizumab and triamcinolone acetate

AIM： To analyze the reasons that may lead to the different vision result by combining the ranibizumab and triamcinolone acetate（TA） in sequence to treat macular edema in retinal vein occlusion（RVO）.METHODS： Ranibizumab and TA were combined in sequence to treat 43 patients with macular edema secondary to RVO.Six months after the treatment,patients with central fovea thickness（CFT） less than 300 μm in optical coherence tomography（OCT） were collected into Groups I and II,based on vision acuity（VA） better than 78 letters or less than 60 letters.The age,baseline VA,duration from onset to treatment,CFT at the baseline,sub-retinal fluid（SRF）,sub-foveal exudates and injection times of TA and ranibizumab were taken into comparison.RESULTS： The mean age of the subjects was 46.4y in Group I but 57.5y in Group II.The difference of age was significant between groups（P〈0.01）.The mean baseline VA was 51.4 letters in Group I and 43.9 letters in Group II（P〈0.05）.The baseline CFT were 670.9 μm in Group I with SRF in 54.3% patients and 678.1 μm in Group II with SRF in 52.9%（P〉0.05）.The mean number of injections of TA was 0.9 and the mean number of injections of ranibizumab was 2.3 in Group I but 1.7 and 2.9 respectively in Group II.The treatment times of ranibizumab had no difference between the 2 groups（P〉0.05） but the difference of TA injection times was significant（P〈0.05）.Subfoveal exudates at final stage happened in no subjects in Group I but in 45.83% subjects in Group II.CONCLUSION： This combined treatment is safer than TA injection and cheaper than ranibizumab injection alone.Younger patients and earlier treatment will help to get better vision outcome.Subfoveal exudates at the final stage have significant relationship with vision outcome.No relationship existed between the baseline CFT,SRF and the vision outcome.

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.

康柏西普联合视网膜激光治疗视网膜静脉阻塞继发黄斑水肿的疗效及对其睡眠的影响

目的:探究分析玻璃体腔注射康柏西普联合视网膜激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿的疗效及对其睡眠的影响。方法:选取2022年5月至2023年5月福建南安市医院眼科收治的视网膜分支静脉阻塞继发黄斑水肿患者86例作为研究对象,按照抛币法随机分为观察组和对照组,每组43例。对照组实施视网膜激光光凝治疗,观察组实施玻璃体腔注射康柏西普联合视网膜激光光凝治疗,比较2组患者的临床疗效、治疗前后最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)和睡眠质量。结果:1)观察组临床治疗总有效率高于对照组(P<0.05);2)观察组患者治疗后的BCVA高于对照组,CMT低于对照组(P<0.05);3)观察组治疗后的睡眠质量(PSQI)评分低于对照组(P<0.05)。结论:玻璃体腔注射康柏西普联合视网膜激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿可以获得较为理想的疗效,促进视力改善,还有助于提高睡眠质量,是一种切实有效的治疗方式,值得推广应用。

红花黄色素注射液联合抗VEGF药物治疗非缺血性视网膜中央静脉阻塞

目的:分析红花黄色素注射液联合抗血管内皮生长因子(VEGF)药物治疗非缺血性视网膜中央静脉阻塞(CRVO)的疗效和安全性。方法:选取2017-04/2021-12于南昌大学附属眼科医院接受治疗的非缺血性CRVO合并黄斑水肿患者91例91眼,随机分为观察组(47例47眼,采用红花黄色素注射液联合玻璃体腔注射雷珠单抗治疗)和对照组(44例44眼,采用玻璃体腔注射雷珠单抗治疗)。随访11mo,观察两组患者最佳矫正视力(BCVA)和中心凹视网膜厚度(CRT)改善情况,并记录视网膜出血完全吸收、抗VEGF药物注射次数、缺血性CRVO发生情况及全身和眼部并发症发生情况。结果:治疗后1、2、3、5、7、9、11mo,两组患者BCVA和CRT均较治疗前显著改善,且治疗后3、5、7、9、11mo,观察组患者BCVA和CRT均优于对照组(均P<0.05)。治疗后5、7、9、11mo时,观察组患者视网膜出血完全吸收率均高于对照组(P<0.05)。随访期间,观察组患者抗VEGF药物注射次数明显少于对照组(4.83±1.05次vs 5.75±1.01次,P<0.05),缺血性CRVO发生率明显低于对照组(21%vs 86%,P<0.05),且两组患者均未出现与治疗相关的全身和眼部并发症。结论:红花黄色素注射液联合抗VEGF药物是治疗非缺血性CRVO安全有效的方法,可显著改善视力,降低CRT,该治疗方案与抗VEGF药物单药治疗相比可增加视网膜出血完全吸收率、减少抗VEGF药物注射次数、减少缺血性CRVO发生率。

眼底激光联合IVR治疗RVO-ME患者的疗效观察

目的探讨眼底激光联合玻璃体腔注射雷珠单抗(IVR)治疗视网膜静脉阻塞继发性黄斑水肿(RVO-ME)患者的临床疗效。方法选取2019年3月至2022年5月于济南市第二人民医院治疗的60例RVO-ME患者作为研究对象,根据随机数字表法分为观察组与对照组,各30例。观察组男16例,女14例,年龄(54.66±2.31)岁;对照组男15例,女15例,年龄(54.70±2.29)岁。两组患者均予以眼底激光治疗,观察组在此基础上联合使用IVR治疗,比较观察两组患者的黄斑中心凹厚度(CMT)、玻璃体腔相关因子水平变化、最佳矫正视力(BCVA)、中央脉络膜厚度(CCT)以及疾病相关并发症情况。统计学方法采用t检验、χ^(2)检验。结果治疗后观察组与对照组患者CMT值较治疗前均有所降低(F=501.71、303.62,均P<0.05),治疗后两组各时间点(治疗后1周、1个月、3个月)CMT值比较,差异均有统计学意义(t=11.37、t=6.71、t=5.29,均P<0.05)。治疗后两组患者玻璃体腔内血管内皮生长因子(VEGF)、白介素-6(IL-6)、白介素-8(IL-8)水平较治疗前均有所下降,观察组VEGF、IL-6、IL-8水平均低于对照组[(256.49±62.13)ng/L比(294.18±60.39)ng/L、(42.58±6.15)ng/L比(51.30±6.44)ng/L、(41.08±6.13)ng/L比(49.87±6.34)ng/L],差异均有统计学意义(t=2.38、5.36、5.46,均P<0.05)。观察组与对照组治疗后患者BCVA值较治疗前均有所升高(F=27.64、21.29,均P<0.05)。结论采用眼底激光联合IVR治疗RVO-ME患者能够有效降低CMT值及玻璃体腔内相关因子水平,提高BCVA值。

雷珠单抗联合微脉冲激光对视网膜分支静脉阻塞继发黄斑水肿的疗效评估

目的:探讨黄斑区微脉冲激光联合雷珠单抗治疗视网膜分支静脉发生阻塞(BRVO)继发黄斑水肿(ME)的疗效评估。方法:本研究采用回顾性数据分析,选取自2020年2月-2022年12月连云港市第一人民医院90例BRVO继发ME患者(全部是单眼患病),按照其治疗手段的不同分成2组,对照组(45例)实施玻璃体腔注射雷珠单抗治疗,研究组(45例)实施玻璃体腔注射雷珠单抗联合黄斑区微脉冲激光治疗。比较2组患者治疗后1、3、6个月的临床疗效等差异。结果:两组治疗后1、3、6个月BCVA、CMT均低于治疗前,其中对照组治疗后3、6个月均低于治疗后1个月,而研究组治疗后1、3、6个月各个时间点间比较,差异均有统计学意义(均P<0.05);此外,治疗后6个月研究组BCVA(0.29±0.05)、CMT(205.37±13.84)均低于对照组(0.40±0.06,236.58±15.07),差异有统计学意义(P<0.05)。研究组治疗6个月内雷珠单抗注射次数(3.51±0.88)少于对照组(4.25±1.02),差异具有统计学意义(P<0.05),而两组复发率对比,差异无统计学意义(P>0.05)。治疗后两组的并发症发生率比较,差异无统计学意义(P>0.05)。结论:临床上对于BRVO继发ME的患者实施黄斑区微脉冲激光联合雷珠单抗治疗效果较好,值得临床推广应用。

基因治疗在眼底血管性疾病中的应用和展望

眼底血管性疾病,如新生血管性年龄相关性黄斑变性(nAMD)和糖尿病视网膜病变(DR)是全球范围内患者视力损害的主要病因。随着全球人口老龄化进程和糖尿病发病率的不断提高,这两种眼底疾病的患病率也将持续攀升。当前对眼底血管性疾病的治疗以眼内注射抗血管内皮生长因子(anti-VEGF)药物为主,但存在频繁注射、费用高昂、患者依从性差等问题,因此需要探寻更加持久且有效的治疗策略。基因治疗在遗传性视网膜疾病(IRDs)中的成功应用为眼底血管性疾病的治疗提供了新思路。随着多项临床试验的开展,眼底血管性疾病的基因治疗有望实现临床转化,但仍存在一些问题,包括最佳治疗靶点选择、给药途径和潜在的安全性等。本文重点阐述基因补充和基因编辑技术介导的anti-VEGF治疗在nAMD和DR中的应用和展望。

温阳利水方联合抗VEGF药物治疗糖尿病视网膜病变黄斑水肿临床观察

目的:观察温阳利水方治疗糖尿病视网膜病变黄斑水肿的临床疗效。方法:选取符合纳入标准的糖尿病视网膜病变黄斑水肿患者42例,随机分为两组各21例。对照组患者眼内注射雷珠单抗,治疗组在对照组基础上口服温阳利水方,治疗的有效起始记录点选择观察到黄斑厚度﹤300μm为标准,记录再次发生黄斑水肿的时间点、黄斑中心视网膜厚度变化、以及各时段的视力改变。结果:在黄斑水肿复发及治疗3w时,比较两组患者的最佳矫正视力,差异均有统计学意义(P﹤0.05),且治疗组疗效优于对照组(P﹤0.05);并且将两组黄斑水肿复发时间进行对比,差异有统计学意义(P﹤0.05),且治疗组黄斑水肿复发时间更迟;两组患者复发时的黄斑中心厚度比较,差异有统计学意义(P﹤0.05),且治疗组复发时黄斑中心厚度低于对照组(P﹤0.05)。结论:温阳利水方联合眼内注射抗VEGF药物对治疗糖尿病性黄斑水肿疗效较好,可延缓其复发及降低黄斑水肿的程度,提高患者视力,减轻黄斑水肿。

抗VEGF治疗对不同类型DME患者黄斑中心凹无血管区的影响

目的基于糖尿病性黄斑水肿(DME)的不同影像类型,采用OCTA探讨DME患者抗血管内皮生长因子(VEGF)治疗前后黄斑中心凹无血管区(FAZ)结构的变化。方法回顾性分析2019年10月至2021年10月来我院就诊的经3+PRN抗VEGF治疗的51例62眼DME患者资料。根据黄斑水肿类型分为弥漫增厚型DME(DRT-DME)组30例(36眼)和黄斑囊样水肿型DME(CME-DME)组21例(26眼)。分别收集两组患者抗VEGF治疗前、治疗后3个月及治疗后6个月的临床资料和OCTA指标,包括最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)、FAZ面积、黄斑中心凹旁300μm范围内的视网膜血流密度(FD)和FAZ非圆度指数(AI),并对其进行比较分析。对CME-DME组患者抗VEGF治疗前后OCTA指标差值(治疗前与治疗后6个月差值)之间的相关性采用Spearman相关性分析。结果与治疗前相比,DRT-DME组患者治疗后3个月和治疗后6个月各方位的CRT均下降、BCVA均改善(均为P<0.05),但FAZ面积、FD和AI的差异均无统计学意义(均为P>0.05)。与治疗前相比,CME-DME组患者治疗后3个月和治疗后6个月各方位的CRT均下降、BCVA均改善、FAZ面积均减小、FD均增加和AI均减小(均为P<0.05)。而DRT-DME组和CME-DME组患者治疗后3个月、6个月之间相比,上述各指标间的差异均无统计学意义(均为P>0.05)。对CME-DME组患者抗VEGF治疗前后OCTA指标差值(△=治疗前-治疗后6个月)的Spearman相关性分析结果显示:△FAZ面积与△AI呈正相关(P<0.05);△FD与△FAZ面积、△AI均呈负相关(均为P<0.05);△CRT与△FAZ面积、△AI均呈正相关,与△FD呈负相关(均为P<0.05)。结论抗VEGF治疗对不同影像类型DME患者FAZ结构的影响不同,有助于改善CME-DME患者黄斑区血供,促进FAZ结构的修复,而对DRT-DME患者无明显影响,但随访期内未加重中心凹旁视网膜缺血。