Efficacy comparison of multipoint and single point scanning panretinal laser photocoagulation in non-proliferative diabetic retinopathy treatment

BACKGROUND Non-proliferative diabetic retinopathy(NPDR)poses a significant challenge in diabetes management due to its microvascular changes in the retina.Laser photocoagulation,a conventional therapy,aims to mitigate the risk of progressing to proliferative diabetic retinopathy(PDR).AIM To compare the efficacy and safety of multi-spot vs single-spot scanning panretinal laser photocoagulation in NPDR patients.METHODS Forty-nine NPDR patients(86 eyes)treated between September 2020 and July 2022 were included.They were randomly allocated into single-spot(n=23,40 eyes)and multi-spot(n=26,46 eyes)groups.Treatment outcomes,including bestcorrected visual acuity(BCVA),central macular thickness(CMT),and mean threshold sensitivity,were assessed at predetermined intervals over 12 months.Adverse reactions were also recorded.RESULTS Energy levels did not significantly differ between groups(P>0.05),but the multi-spot group exhibited lower energy density(P<0.05).BCVA and CMT improvements were noted in the multi-spot group at one-month posttreatment(P<0.05).Adverse reaction incidence was similar between groups(P>0.05).CONCLUSION While energy intensity and safety were comparable between modalities,multi-spot scanning demonstrated lower energy density and showed superior short-term improvements in BCVA and CMT for NPDR patients,with reduced laser-induced damage.

Anti-vascular endothelial growth factor drugs combined with laser photocoagulation maintain retinal ganglion cell integrity in patients with diabetic macular edema: study protocol for a prospective, non-randomized, controlled clinical trial

The integrity of retinal ganglion cells is tightly associated with diabetic macular degeneration that leads to damage and death of retinal ganglion cells,affecting vision.The major clinical treatments for diabetic macular edema are anti-vascular endothelial growth factor drugs and laser photocoagulation.However,although the macular thickness can be normalized with each of these two therapies used alone,the vision does not improve in many patients.This might result from the incomplete recovery of retinal ganglion cell injury.Therefore,a prospective,non-randomized,controlled clinical trial was designed to investigate the effect of anti-vascular endothelial growth factor drugs combined with laser photocoagulation on the integrity of retinal ganglion cells in patients with diabetic macular edema and its relationship with vision recovery.In this trial,150 patients with diabetic macular edema will be equally divided into three groups according to therapeutic methods,followed by treatment with anti-vascular endothelial growth factor drugs,laser photocoagulation therapy,and their combination.All patients will be followed up for 12 months.The primary outcome measure is retinal ganglion cell-inner plexiform layer thickness at 12 months after treatment.The secondary outcome measures include retinal ganglion cell-inner plexiform layer thickness before and 1,3,6,and 9 months after treatment,retinal nerve fiber layer thickness,best-corrected visual acuity,macular area thickness,and choroidal thickness before and 1,3,6,9,and 12 months after treatment.Safety measure is the incidence of adverse events at 1,3,6,9,and 12 months after treatment.The study protocol hopes to validate the better efficacy and safety of the combined treatment in patients with diabetic macula compared with the other two monotherapies alone during the 12-month follow-up period.The trial is designed to focus on clarifying the time-effect relationship between imaging measures related to the integrity of retinal ganglion cells and best-corrected visual acuity.The trial protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Beihua University with approval No.(2023)(26)on April 25,2023,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR2300072478,June 14,2023,protocol version:2.0).

Long-term effects of pattern scan laser pan-retinal photocoagulation on diabetic retinopathy in Chinese patients: a retrospective study

●AIM:To evaluate the long-term effects of pattern scan laser(PASCAL)pan-retinal photocoagulation(PRP)on diabetic retinopathy(DR)in Chinese patients.●METHODS:In this retrospective study,we evaluated clinical data of 29 patients(53 eyes)with severe non-proliferative DR(SNPDR)or proliferative DR(PDR)who received PRP and follow-up at our hospital from 2008 to 2013.Sixteen patients(29 eyes)received PASCAL PRP and 13 patients(24 eyes)received 100-ms conventional laser PRP.●RESULTS:After long-term follow-up(mean,min-max days:719.8,290-1666 for PASCAL PRP vs 743.5,240-1348 for conventional PRP,P=0.569),patients receiving PASCAL PRP required fewer photocoagulation sessions than the conventional PRP group(2.6±1.0 vs 3.9±0.9,P<0.01).Best corrected visual acuity(BCVA)was reduced slightly in PASCAL PRP group while reduced significantly in conventional PRP group.At last visit,24 eyes in the PASCAL group(88.9%)and 21 eyes in the conventional group(91.7%)were improved or stable.Two eyes in PASCAL PRP group(7.4%)and 3 eyes in the conventional PRP group(12.5%)developed vitreous hemorrhage or vitreous fibrovascular proliferation.●CONCLUSION:PASCAL PRP is as effective and may be more conducive to maintaining visual acuity with less treatment sessions for DR treatment compared to conventional laser PRP.

Conbercept combined with laser photocoagulation in the treatment of diabetic macular edema and its influence on intraocular cytokines

BACKGROUND The prevalence of diabetes mellitus(DM)in China is high,and the base is broad.Diabetic retinopathy(DR)is a critical condition affecting the life and health of a nation and its economic development.DR is a common complication of DM.AIM To investigate the efficacy of laser photocoagulation combined with intravitreal injection of conbercept for treating macular edema.METHODS Overall,130 patients with diabetic macular edema(DME)hospitalized in The Third People’s Hospital of Changzhou from January 2019 to June 2022 were retrospectively included.According to the treatment plan,130 patients with DME were categorized into an observation and a control group,with 65 patients in each group.The control group received laser photocoagulation,and the observation group received laser photocoagulation with intravitreal injection of conbercept.Observe changes in vision,cytokines in the eye and so on.RESULTS The total efficacy rate in the observation group(93.85%)was higher than that in the control group(78.46%)(P<0.05).In both groups,the best corrected visual acuity correction effect improved after treatment,and the observation group was superior to the control group(P<0.05).Retinal thickness and central macular thickness improved after treatment,and the observation group was superior to the control group(P<0.05).The levels of vascular endothelial growth factor,interleukin-6,soluble intercellular adhesion molecule-1,and basic fibroblast growth factor in both groups improved after treatment,and the observation group was superior to the control group(P<0.05).CONCLUSION In patients with macular edema,combining laser photocoagulation and intravitreal injections of conbercept for DME is a more effective and safer strategy to improve vision,and lower intraocular cytokine levels.

Retinal laser photocoagulation and intravitreal injection of anti-VEGF for hemorrhagic retinal arterial microaneurysm

AIM:To evaluate the efficacy of retinal laser photocoagulation and intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF)for hemorrhagic retinal arterial macroaneurysm(RAM).METHODS:This was a retrospective clinical study.Patients with hemorrhagic RAM were divided into 4 groups defined by different treatments:a retinal laser photocoagulation therapy monotherapy group,an anti-VEGF intravitreal injection monotherapy group,a laser and anti-VEGF combination therapy group,and an observation group.Visual acuity(VA),central macular thickness(CMT),and retinal hemorrhage area(RHA)were collected.RESULTS:Forty-seven eyes of 47 patients were enrolled.VA improved and had a significant difference between baseline and final in each treatment group(logMAR;laser group:1.90±0.53 vs 1.05±0.63,P<0.001;anti-VEGF group:1.75±0.63 vs 1.12±0.54,P=0.009;combination group:1.76±0.38 vs 1.01±0.52,P<0.001);however,VA decreased and had no significant difference in observation group(1.63±0.51 vs 1.76±0.61,P=0.660).CMT decreased and had a significant difference between baseline and final in each group(laser group:815.16±310.83 vs 252.05±83.90μm,P<0.001;anti-VEGF group:725.00±290.79 vs 203.56±69.89μm,P=0.001;combination group:595.50±186.51 vs 253.13±55.06μm,P=0.001;observation group:758.88±195.65 vs 267.00±120.90μm,P=0.001).RHA were 28.99±28.15,25.94±11.58,19.64±8.97,and 27.45±13.76 mm^(2) in laser group,anti-VEGF group,combination group and observation group,respectively.RHA was statistically correlated with final VA(P=0.032)in the observation group.CONCLUSION:Both laser and anti-VEGF treatments are effective for hemorrhagic RAM.Combination therapy reduces the number of injections of anti-VEGF.RHA is a visual prognosis predictor in the natural history of hemorrhagic RAM.

Clinical correlation between blood glucose control-related factors and postoperative fundus hemorrhage after pan-retinal photocoagulation for diabetic retinopathy

Objective: To discuss the clinical correlation between blood glucose control-related factors and postoperative fundus hemorrhage after pan-retinal photocoagulation (PRP) for diabetic retinopathy (DR). Method: From February 2013 to January 2017, 98 patients at 7 d after PRP for DR were recruited. Depending on postoperative fundus status, the patients were divided into normal fundus group (n=42), fundus hemorrhage group (n=30) and proliferative DR group (n=27). The baseline data and monitoring data of blood glucose and blood lipid were recorded. Dynamic glucose monitor system was used to detect indicators of blood glucose fluctuation, MAGE and MBG. Result: The three groups were compared in terms of systolic pressure, diastolic pressure, course of disease, gender, age and body mass index (BMI), and no significant differences were found. As compared with the normal fundus group, the fundus hemorrhage group and proliferative DR group had a significant increase in FPG, HbA1c, 2hPG, LDL-C and TC, but a decrease in HDL-C. MAGE and MBG for the fundus hemorrhage group were (4.89±1.42) and (7.82±1.42), respectively, which were higher than those of the normal fundus group, but no significantly different from those of the proliferative DR group. Linear correlation analysis was performed in 98 patients, and significant linear correlations existed between MAGE, MBG, FPG, HbA1c and LDL-C with fundus hemorrhage. Conclusion: Blood glucose control-related factors MAGE, MBG, FPG, HbA1c and LDL-C were important influence factors of fundus hemorrhage following PRP for DR. Appropriate countermeasures are needed to reduce the fluctuation of blood glucose level.

Effects of laser photocoagulation on serum angiopoietin-1, angiopoietin-2, angiopoietin-1/angiopoietin-2 ratio, and soluble angiopoietin receptor Tie-2 levels in type 2 diabetic patients with proliferative diabetic retinopathy

·AIM: To determine the effects of laser photocoagulation on serum levels of angiopoietin-1(Ang-1),angiopoietin-2(Ang-2), soluble angiopoietin receptor Tie-2(Tie-2), Ang-1/Ang-2 ratio and vascular endothelial growth factor(VEGF) in patients with type 2diabetes mellitus(T2DM) and proliferative diabetic retinopathy(PDR). We also explored the role of the Ang/Tie system in PDR.·METHODS:Totally 160patientswithT2 DM, including50 patients with non-diabetic retinopathy(NDR), 58 patients with non-proliferative diabetic retinopathy(NPDR), and52 patients with PDR were enrolled in this study. Serum Ang-1, Ang-2, Tie-2 receptor and VEGF levels were measured using enzyme-linked immunosorbent assays for all patients and were repeated in 26 patients who underwent laser photocoagulation two months after the procedure.·RESULTS:ThemedianlevelsofAng-2andVEGFinserum were significantly higher in the NPDR group(4.23 ng/mL and 303.2 pg/mL, respectively) compared to the NDR group(2.67 ng/mL and 159.8 pg/mL, respectively, P 【0.01), with the highest level in the PDR group(6.26 ng/mL and531.2 pg/mL, respectively, P 【0.01). The median level of Ang-1 was significantly higher in the NPDR group(10.77ng/mL) compared to the NDR group(9.31 ng/mL) and the PDR groups(9.54 ng/mL)(P 【0.05), while no difference was observed between the PDR and NDR groups. Ang-1/Ang-2 ratio of PDR group was lowest in three groups(1.49 vs 2.69 and 2.90, both P 【0.01). The median level of Tie-2was not significantly different among three groups(P 】0.05).Ang-2 was positively correlated with VEGF and Tie-2 in the PDR and NPDR groups(both P 【0.05). Among the 26 patients who underwent laser photocoagulation, serum Ang-2 and VEGF levels significantly decreased(both P 【0.05), whereas serum Ang-1 level and Ang-1/Ang-2ratio were weakly increased(P 】0.05). The median levels of Ang-2 and VEGF in serum were highest in PDR group,however, Ang-1/Ang-2 ratio of PDR group was lowest in three groups.·CONCLUSION: Laser photocoagulation can reduce serum Ang-2 and VEGF levels. The Ang/Tie system and VEGF play an important role in the development and progression of T2 DM patients with PDR.

Is laser photocoagulation still effective in diabetic macular edema? Assessment with optical coherence tomography in Nepal

AIM: To find out the outcome of laser photocoagulation in clinically significant macular edema (CSME) by optical coherence tomography (OCT). · METHODS: It was a prospective, non-controlled, case series study enrolling 81 eyes of 64 patients with CSME between August 2008 and January 2010. All patients received modified grid photocoagulation with frequency doubled Nd: YAG laser. Each patient was evaluated in terms of best-corrected visual acuity (BCVA) and regression or progression of maculopathy after laser therapy at 1, 3 and 6 months. Spearman’s correlation test was used to show the correlation between BCVA and total macular volume (TMV). Analysis of variance (ANOVA) was used to compare among groups and independent t-test was used to compare in each group. · RESULTS: There is high correlation between BCVA and TMV (P ≤0.001). BCVA improved in 50.6%, remained static in 39.5 % and deteriorated in 9.9% patients after 6 month of treatment. The Baseline TMV (mean and SD) were 9.26±1.83, 10.4±2.38, 11.5±3.05, 8.89±0.75 and 9.47±1.98 mm3 for different OCT patterns, ST (sponge like thickening), CMO (cystoid macular edema), SFD (subfoveal detachment), VMIA (Vitreo macular interface abnormality) and average TMV respectively (P =0.04). After 6 months of laser treatment, the mean TMV decreased from 9.47±1.98mm3 to 8.77±1.31mm3(P =0.01). In ST there was significant decrease in TMV, P =0.01, Further within these groups at 6 months, they were significantly different, P =0.01. · CONCLUSION: OCT showed the different morphological variant of CSME while the response of treatment is different. TMV decreased the most and hence showed the improvement in vision after 6 months of laser treatment. In the era of Anti vascular endothelial growth factors (VEGFs), efficacy of laser seems to be in shadow but it is still first line of treatment in developing nation like Nepal where antiVEGFs may not be easily available and affordable.

Effects of diode laser photocoagulation treatment on ocular biometric parameters in premature infants with retinopathy of prematurity

AIM:To investigate the effects of diode laser treatment on ocular biometric parameters in premature infants with retinopathy of prematurity(ROP).METHODS:Premature infants who received diode laser treatment for ROP(n=68)and premature infants with spontaneous regressed ROP without treatment(n=50)were performed longitudinal ocular biometric measurements including anterior chamber depth,lens thickness and axial length as follows:1 d prior to laser treatment,and 3,6,9,and 12 mo after the laser treatment.RESULTS:The mean birth weight,gestational age and initial examination time values were 936.53±302.07 g,26.66±2.42 wk,36.26±2.73 wk in the treatment group and 959.78±260.08 g,27.28±2.10 wk,36.56±2.54 wk in the control group.There was no statistically significant difference in these demographic characteristics of the groups.Anterior chamber depth,lens thickness and axial length demonstrated statistically significant linear increases during the study period in the two groups(P<0.001 for each).There were no statistically significant differences between the two groups in terms of anterior chamber depth after laser treatment.Measurements of the lens thickness at 9 th and 12 th months(9 th month 3.70±0.22 vs 3.60±0.21 mm,P=0.017;12 th month 3.81±0.21 vs 3.69±0.22 mm,P=0.002)and the axial length at 12 th month(19.35±0.79 vs 19.13±0.54 mm,P=0.031)after laser treatment were statistically higher in the treatment group.CONCLUSION:Diode laser retinal photocoagulation treatment in premature infants seems to increase the lens thickness and axial length.

Effect of two different doses of intravitreal bevacizumab with temporal retina-sparing laser photocoagulation for retinopathy of prematurity

This study aims to compare the efficacy and safety between two different doses of intravitreal bevacizumab（IVB） injection with temporal retina-sparing laser（TRSL） photocoagulation for retinopathy of prematurity（ROP）. We retrospectively evaluated 22 eyes of ROP infants who underwent IVB combined with partial TRSL for stage 3＋ zone I or posterior zone II ROP. Laser photocoagulation was applied on the avascular retina, sparing two-discdiameter width temporal avascular area anterior to ridge. A half dose（0.625 mg） or minimal dose（0.25 mg） of IVB was conducted. Four eyes in minimal dose group were retreated with IVB and laser photocoagulation on the spared retina. Of those 4 retreated eyes, three developed preretinal hemorrhage around the ridge after the first treatment, resulting in fibrotic macular dragging. A half dose of IVB may be more effective than a minimal dose with partial TRSL for ROP. Preretinal hemorrhage may be a harbinger of poor prognosis.

Short-term effects of intravitreal Conbercept injection combined with laser photocoagulation on macular edema secondary to ischemic retinal vein occlusion

AIM:To observe changes in the best-corrected visual acuity(BCVA),central macular thickness(CMT),and central choroidal thickness(CCT)of patients with macular edema(ME)secondary to ischemic retinal vein occlusion(i RVO)following intravitreal Conbercept injection.METHODS:This retrospective study included 33 eyes from 33 patients who received intravitreal injections of Conbercept for ME secondary to i RVO.Treatments were performed on a 3+pro re nata(3+PRN)basis.All of the patients were examined by fundus fluorescein angiography and spectral domain optical coherence tomography at the first visit.Laser photocoagulation was performed in the nonperfusion area of the retina of all eyes after the first injection.BCVA,CMT,and CCT were observed before and after 6 mo of treatment.The number of injections necessary to achieve improved vision was also noted.RESULTS:Following Conbercept treatment,the mean BCVA significantly improved from 0.81±0.39 at baseline to 0.41±0.25 and 0.43±0.29 log MAR in the third and sixth months,respectively(both P=0.000).The CMT of the patients at baseline was 556.75±98.57μm;304.78±68.53 and 306.85±76.77μm 3 and 6 mo after treatment,respectively(both P=0.000 vs baseline).The CCTs of the patients at baseline,3 and 6 mo after treatment were 304.63±57.83,271.31±45.53,and 272.29±39.93μm,respectively(P=0.026 and 0.035 vs baseline).No severe adverse event relevant to the therapy was noted,and the average number of injections delivered was 3.35.CONCLUSION:Intravitreal Conbercept injection combined with laser photocoagulation appears to be a safe and effective treatment for ME secondary to i RVO in the short-term.

Long-term outcomes of focal laser photocoagulation for the treatment of polypoidal choroidal vasculopathy

AIM:To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy(PCV).METHODS:Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2 y after focal laser photocoagulation treatment.The patients were diagnosed with PCV using indocyanine green angiography,and eyes with other comorbid ocular diseases were excluded.The measurement outcomes of the study were the post-treatment regression and recurrence of polyps,complications,and changes in visual acuities.Paired t-test was performed to compare visual outcome before and after the treatment.RESULTS:The mean age of the 13 patients was 70.2±5.5 y,and the follow-up period was 72.3±31.0(range,25-118)mo.Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps.Of the 13 eyes,9 eyes(69.2%)had regression of polyps 1.7±1.2(range,0.9-4)mo after focal laser photocoagulation.Five eyes(55.6%)showed recurrence of polyps during the follow-up periods,and the recurrence period was 12.8±18.9(range,1.9-48)mo.Mild subretinal hemorrhage occurred in two eyes(15.4%)27 and 72 d after laser treatment,respectively.There were no statistically significant differences in visual acuities at baseline;1,2,3 y post-treatment(all P>0.05);and last follow-up(0.63±0.5,0.73±0.70,0.67±0.57,0.75±0.7,and 0.95±0.8 log MAR,respectively).CONCLUSION:Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up.Furthermore,it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.

Prophylactic juxtapapillary laser photocoagulation in pediatric morning glory syndrome

AIM:To determine the anatomic and visual outcomes of prophylactic juxtapapillary laser photocoagulation treatment alone in the prevention of retinal detachment(RD)in a cohort of pediatric patients diagnosed with morning glory syndrome(MGS).METHODS:A total of 24 eyes of 22 consecutive patients aged 0-15 y diagnosed with MGS treated with prophylactic juxtapapillary laser photocoagulation alone were reviewed.Data including demographics,ocular examination,anatomic and visual outcomes,following treatment and complications were collected.RESULTS:Two patients had bilateral laser treatment and 20 had monocular laser treatment.The age at treatment of 13(59.1%)patients was less than 12 mo.The presenting symptoms included strabismus(6/22,27.3%),decreased vision(2/22,9.1%),and routine fundus screening(14/22,63.6%).Fifteen(68.2%)patients underwent cranial magnetic resonance imaging(MRI)examinations,and 3 of those 15(20.0%)had abnormal findings in the nervous system.Based on preoperative wide-field fundus photography and B-scan echography,all(100.0%)eyes had no obvious RD.On postoperative 1 mo and 6 mo and the following follow-ups,the anatomic outcomes of all eyes remained stable.The mean follow-up duration was 27.7±17.5 mo.No severe complications were found.Preoperative visual acuity acquired from 2(9.1%)patients ranged from light perception to 20/200.Postoperative acuity acquired from 11(50.0%)patients ranged from light perception to 20/125.CONCLUSION:The preliminary anatomic and visual outcomes of prophylactic juxtapapillary laser treatment alone in pediatric MGS patients are relatively stable in a short-term follow-up.Further long-term clinical observation will be needed to confirm its efficacy and safety.

Conjunctival cystectomy assisted by pattern scan laser photocoagulation

Background: To introduce a new technique of laser-assisted conjunctival cystectomy using pattern scan laser(PASCAL) photocoagulation.Case presentation: A 50-years-old Asian woman presented with a conjunctival cyst in the left eye. Slit-lamp examination revealed a 5 mm×2 mm sized freely movable conjunctival cyst. After a 1 mm×1 mm sized conjunctival opening was made using PASCAL photocoagulation, the cyst was extracted using a non-toothed forceps without rupture. Two weeks later, complete re-epithelialization of the conjunctiva was observed without any complications. No evidence of recurrence was noted over the 6-month follow-up period.Conclusion: Conjunctival cystectomy with the adjunctive use of PASCAL photocoagulation can be an effective and safe treatment method.

A COMPARATIVE STUDY ON CELLULAR ELECTROPHYSIOLOGIC CHANGES BETWEEN LASER PHOTOCOAGULATION AND RADIOFREQUENCY ABLATION

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Pattern Scan Laser Photocoagulator on Retinopathy: an annual clinical application summary

Purpose:To evaluate the clinical efficacy of Pattern Scan Laser Photocoagulator (PASCAL) by observing the efficacy of PASCAL on retinopathy.Methods:A total of 92 patients with retinopathy (121 eyes) who underwent PASCAL between December 2008 and February 2009 in our center were retrospectively analyzed to evaluate the visual acuity changes and recovery conditions of the patients from baseline to posterior to the treatment.The retinopathy included:diabetic retinopathy,ischemic retinal vein occlusion.(IRVO),central serous chorioretinopathy (CSC),retinal periphlebitis (Eales disease) and retinal degeneration /holes.Results:The patients were subject to a 12-month follow up after PASCAL.The visual acuity findings were stated as below:for diabetic retinopathy.(73 eyes),10 eyes had improved visual acuity;55 eyes were stabilized and 8 eyes progressed;for IRVO (13 eyes),4 eyes showed improvement,6 eyes were stabilized and 3 eyes progressed;for CSC (9 eyes),6 eyes were alleviated and 3 eyes progressed;for retinal periphlebitis (5 eyes),2 eyes had enhanced visual acuity and 3 eyes showed stable visual acuity;for retinal degeneration /holes (21 eyes),5 eyes presented improved visu-al acuity,16 eyes were stabilized and no eye progressed.Indirect ophthalmoscopic reexamination confirmed secured blockage by laser spots and favorable absorption of the retinal edema and newborn capillaries.No obvious leakage was observed during fundus fluorescein angiography and no laser-related ocular adverse effect was reported.Conclusion:PASCAL is accurate,effective and well-tolerated.The duration of short laser pulse falls within the safety range,ensuring the stabilization and improvement in the pa-tient's visual acuity.The parameters,long-term efficacy and complications of PASCAL should be further demonstrated by performing long-term clinical trials with larger sample size.

Intravitreal Bevacizumab with Grid Photocoagulation for Recurrent Macular Edema Secondary to Retinal Vein Occlusion

Purpose: To assess the efficacy of intravitreal bevacizumab (IVB) combined with grid photocoagulation in the management of recurrent macular edema secondary to retinal vein occlusion (RVO). Methods: This is a prospective, non-randomized, interventional study. Thirty five eyes with branch retinal vein occlusion (BRVO) and 15 eyes with central retinal vein occlusion (CRVO) were treated with grid photocoagulation combined with IVB for recurrent macular edema. The visual acuity, central macular thickness and intraocular pressure were outcome measures. The mean duration of follow-up was 18.1 ± 3.6 months. Results: One month after treatment, 45 of the 50 eyes showed complete resolution of the cystoid space. Compared with initial values, final central macular thickness was reduced significantly in both BRVO and CRVO groups (P < 0.001), but improvement in VA was significant only for eyes with BRVO (P = 0.012). The total number of IVB was 1.8 ± 0.3 for eyes with either BRVO or CRVO. Conclusion: IVB combined with grid photocoagulation is an effective treatment for reducing recurrent macular edema associated with RVO.

Outcomes of vitrectomy,complete pan-retinal photocoagulation,and endoscopic cyclophotocoagulation surgery after anti-VEGF treatment in neovascular glaucoma

Purpose:To establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor(VEGF)injection,pars plana vitrectomy(PPV),endoscopic pan-retinal photocoagulation(PRP),and endoscopic cyclophotocoagulation(ECP)surgery for neovascular glaucoma(NVG)patients.Methods:This retrospective study included 30 patients(30 eyes)who were suffering from NVG and treated with PPV&PRP&ECP(ECP group,16 eyes),or Ahmed glaucoma valve implantation(Ahmed group,14 eyes).The intraocular pressure(IOP),number of postoperative anti-glaucoma medications,best-corrected visual acuity(BCVA),successful rate of surgery,and postoperative complications were recorded and statistically analyzed at the time points of preoperative,1-day,1-month,3-months,6-months,and 12-months after operation.Results:An obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation(P<0.05),and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months(P=0.014)and 12-months(P=0.047)postoperative time points,while there was no significant difference of medication number between the two groups except for 1-day after surgery.The BCVA showed no marked difference between the two groups preoperatively and postoperatively(P>0.05),while it was significantly improved in ECP group at 3-months(P=0.001),6-months(P=0.004),and 12-months(P=0.010)time points comparing with preoperative BCVA.The surgical success rates in ECP group were also slightly higher than Ahmed group.And the complications after operation showed no marked differences.Conclusions:The comprehensive treatment of PPV,endoscopic PRP,and ECP surgery for NVG patients after antiVEGF injection can control IOP effectively and be friendly to patients’BCVA without obvious serious complications throughout a 12-months follow-up period.

雷珠单抗联合激光光凝治疗视网膜静脉阻塞继发黄斑水肿患者的效果

目的探讨视网膜静脉阻塞(RVO)继发黄斑水肿(ME)患者采用雷珠单抗联合激光光凝治疗对视力的影响。方法选取2020年1月至2022年12月南昌市第一医院收治的84例(84只眼)RVO继发ME患者作为研究对象,按照随机数字表法分为对照组(42例)与观察组(42例),对照组采用激光光凝治疗,观察组采用雷珠单抗与激光光凝联合治疗。比较两组患者的最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、眼压、血管内皮生长因子(VEGF)、眼底视网膜出血治疗效果及并发症。结果观察组治疗后的BCVA、CMT及VEGF低于对照组,眼底视网膜出血治疗总有效率(92.86%)高于对照组(76.19%),差异有统计学意义(P<0.05);两组患者治疗后的眼压比较,差异无统计学意义(P>0.05)。所有患者均未出现视网膜脱离、玻璃体积血及眼内感染等并发症,仅观察组出现1例一过性眼压升高。结论RVO继发ME患者采用雷珠单抗与激光光凝联合治疗有利于降低CMT、VEGF水平,改善患者的视力及眼底视网膜出血,且对患者眼压影响小,并发症并未增加,临床应用安全性高。

增生型糖尿病视网膜病变患者术后玻璃体再积血风险的列线图模型构建

目的 探讨增生型糖尿病视网膜病变(PDR)患者术后玻璃体再积血风险的影响因素,构建其风险预测的列线图模型。方法 回顾性收集2020年1月至2023年6月因增殖性糖尿病视网膜病变行玻璃体切割术(PPV)或抗血管内皮生长因子(VEGF)联合全视网膜激光光凝治疗术后,随访再发玻璃体积血患者182例182眼的临床资料,将再积血患者纳入研究组,未发生患者纳入对照组,比较2组资料并分析再积血发生可能的影响因素,将分析得到的风险因素纳入构建列线图模型。结果 182例PDR患者术后并发玻璃体再积血共31例,发生率为17.03%;未并发玻璃体再积血151例,占82.97%。单因素分析发现,研究组合并慢性肾脏病(CKD)、视盘新生血管(NVD)比例高于对照组,术前糖化血红蛋白(HbA1c)水平高于对照组,差异有统计学意义(P<0.05);2组间其他基线资料比较,差异无统计学意义(P>0.05)。多因素Logistic分析显示,合并CKD、NVD、术前HbA1c高均可能是PDR患者术后玻璃体再积血的危险因素(OR>1,P<0.05)。基于多因素Logistic回归分析结果,构建相关风险预测列线图模型,采用Bootstrap自抽样法和C-index对上述模型进行内部验证(C-index=0.958),列线图的精确度和区分度良好,校准曲线与理想曲线贴合良好。结论 PDR患者PPV或抗VEGF联合全视网膜激光光凝治疗术后玻璃体再积血的危险因素可能为合并CKD、NVD、术前HbA1c高,据此建立的列线图模型对PDR患者术后玻璃体再积血发生风险的预测效能良好。