Optimal timing of preoperative intravitreal anti-VEGF injection for proliferative diabetic retinopathy patients

AIM: To analyze concentrations of vascular endothelial growth factor(VEGF) and fibrosis-related factors in vitreous fluid of proliferative diabetic retinopathy(PDR) patients pretreated with intravitreal anti-VEGF injections(IVI) at different time periods prior to pars plana vitrectomy(PPV), and their correlation with the degree of vitreoretinal fibrosis and explore the optimal timing of preoperative IVI.METHODS: The prospective case-control study from January 2019 to July 2020 included 31 eyes with PDRrelated complications(PDR group) and 21 eyes with nondiabetic ocular disease(control group) requiring PPV. PDR eyes were divided into four groups based on timing of PPV: 3 d after IVI(3-day group);5 d after IVI(5-day group);7 or more days after IVI(≥7-day group);and no IVI. Vitreous fluid samples(0.5-1.0 m L) were collected prior to switching on the infusion before routine 23-G PPV. Concentrations of VEGF, basic fibroblast growth factor(b FGF), periostin(PN), interleukin(IL)-6, IL-8, and tumor necrosis factor(TNF)-α were measured by immunoassay, and concentration differences for each cytokine were compared among the groups. The degree of vitreoretinal fibrosis was graded intraoperatively, and the correlation between the changes in cytokine levels and the severity of vitreoretinal fibrosis was analyzed by univariate ordinal logistic regression analysis.RESULTS: PDR eyes without IVI had significantly higher VEGF, b FGF, PN, and IL-6 concentrations than nondiabetic eyes(all P<0.05), and had a significantly higher concentration of VEGF(P<0.05) and a significantly lower concentration of IL-8(P<0.05) than PDR eyes with IVI. Statistically significant differences were also observed for concentrations of VEGF, b FGF, PN, IL-6, and IL-8 among 3-day, 5-day, and ≥7-day groups(all P<0.05);meanwhile there was no significant difference in TNF-α among groups(P=0.226). The 5-day group had the lowest concentration of VEGF and the ≥7-day group had the highest concentration of b FGF and PN. The degree of vitreoretinal fibrosis was significantly higher in the ≥7-day group compared to the 3-day(P=0.015) and 5-day group(P=0.039), and vitreoretinal fibrosis correlated significantly with concentrations of b FGF, PN, IL-6, and IL-8(all P<0.05). Univariate ordinal logistic regression analysis showed that b FGF was an independent risk factor for the severity of vitreoretinal fibrosis in PDR patients pre-treated with IVI.CONCLUSION: The vitreous concentrations of VEGF, b FGF, PN, IL-6, and IL-8 change after pretreatment with IVI before PPV in PDR patients. The degree of vitreoretinal fibrosis is higher in patients with a longer time between IVI treatment and PPV, which may be related to the angiofibrosis switch. The results suggest that PPV should be performed 5 d after IVI administration in PDR patients.

Retinal Functional Changes Measured by Microperimetry after Intravitreal Ranibizumab Injection and Sulfotanshinone Sodium Injection for Macular Edema Secondary to Retinal Vein Occlusion

Objectives: To study the visual field changes after intravitreal ranibizumab (IVR) injection and sulfotanshinone sodium (SS) injection for macular edema (ME) secondary to retinal vein occlusion (RVO), and discuss the value of microperimetry as a routine diagnostic test in the follow-up of RVO patients. Methods: This was a retrospective, interventional, case-series study. Twelve eyes of 12 RVO patients, including 6 eyes with central RVO (CRVO) and 6 eyes with branch RVO (BRVO) were included. The eyes were treated with IVR (0.5 mg) injections and SS injections (20 mg per day, one week consecutively in one month). The outcomes measured included best corrected visual acuity (BCVA), central retinal thickness (CRT), mean defect (MD), pattern standard deviation (PSD), macular light sensitivity of the central 16 points in CRVO group and the central 8 points in BRVO group before and after the treatment. Statistical analyses were then performed on the main outcome measures. Results: An improvement of BCVA was found in all patients after treatment with significant difference (t = 7.74, p p p p > 0.05). All RVO patients had their macular light sensitivity of the involved part improved significantly (t = 5.03, p p p < 0.01). The Pearson’s correlation was calculated among BCVA, MD, macular light sensitivity and CRT. No obvious significance was found between CRT and BCVA outcomes, whereas MD and mean macular light sensitivity outcomes were closely related to BCVA results in the BRVO group and the latter showed a more intimate correlation. No similar correlation was found in RVO and CRVO group. Conclusion: IVR injection and SS injection together could effectively improve the therapeutic effect in RVO patients with ME. Microperimetry could be used as a routine diagnostic test and a possible valuable tool in the follow-up of patients with RVO, especially in BRVO.

Efficacy of intravitreal injection of ranibizumab in the treatment of macular edema secondary to non-ischemic branch retinal vein occlusion

Objective: To observe the efficacy of intravitreal injection of ranibizumab in the treatment of macular edema(ME) secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods: The clinical data of 27 patients (27 eyes) with macular edema secondary to non-ischemic BRVO were diagnosed by ophthalmology in Chongqing University Center Hospital from May 2018 to April 2019, selected as the experimental group, and 20 cases (20 eyes) of normal people as the control group. For the experimental group, before and after treatment, 1wk, 1mo, 2mo, 3mo and 6mo were used to observe the uncorrected visual acuity(UCVA),best corrected visual acuity (BCVA), intraocular pressure (IOP), central retinal thickness (CRT) macular center volume (MCV) and EN FACE images. Subjects in the normal control group were examined by optical coherence tomography (OCT) for CRT and CMV at 1wk, 1mo, 2mo, 3mo and 6mo on the day of and after enrollment. Results: The mean age of patients in the experimental group was (67.37±8.63) years old and the times of Intravitreal injection was (3.26 ±0.59) times. The successful rate of treatment was 85.19%. There was no significant difference in IOP between pre-treatment and 1wk, 1mo, 2mo, 3mo and 6mo (P > 0.05). 1wk, 1mo, 2mo, 3mo and 6mo BCVA were significantly higher than those before treatment (P < 0.0001). The levels of CRT and CMV at 1wk, 1mo, 2mo, 3mo and 6mo after treatment were significantly lower than those before treatment (P <0.01). Compared with the normal control group, the CRT and CMV of the experimental group before and after treatment showed statistically significant differences in 1wk, 1mo, 2mo and 3mo (P <0.05). There was no statistically significant difference in 6mo CRT and CMV after treatment (P>0.05). EN FACE showed that 1wk, 1mo, 2mo, 3mo and 6mo macular thickness decreased gradually, retinal edema subsided, cystoid changes disappeared, and the interlamellar structure of the ellipsoid zone gradually recovered after intravitreal injection of ranibizumab. Conclusion: Intravitreal injection of ranibizumab in the treatment of non-ischemic BRVO secondary ME has significant efficacy, EN FACE is an effective means to assess the severity, treatment and prognosis of patients.

Intravitreal Ranibizumab Combined with Sulfotanshinone Sodium Injection in Treating Type II Optic Disc Vasculitis

Objectives: To present the effect of intravitreal ranibizumab (IVR) therapy combined with sulfotanshinone sodium (SS) injection in a patient suffering from type II optic disc vasculitis (ODV). Methods: A 26-year-old female patient was diagnosed with type II ODV with macular edema (ME). The information was obtained by complete medical and ophthalmic history taking and a detailed ophthalmic examination at the initial and follow-up visits. Functional and morphological outcomes at baseline, 1 week and 1 month following IVR+SS injections, are presented. Results: Best-corrected visual acuity (BCVA) improved from 78 letters (ETDRS) at baseline to 90 letters at 1-week follow-up and maintained stable through 1-month follow-up. Central retinal thickness (CRT) measured by optical coherence tomography (OCT) decreased from 465 μm at baseline to 240 μm at 1-week follow-up and to 226 μm at 1-month follow-up. Mean deviation (MD) measured by perimetry increased from ?5.17 dB to ?4.59 dB and to ?4.29 dB, respectively. Fluorescein angiography (FFA) showed that the initial macular edema at baseline disappeared while the arm-retina circulation time (ART) was also greatly shortened when compared to the baseline. Electroretinogram (ERG) measured at 1-month follow-up demonstrated an overall improvement of the retinal function after the injection. No ocular or systemic side effects were detected. Conclusions: IVR+SS injection may lead to resolution of the associated ME and improve the retina morphologically as well as functionally. To our knowledge, this is the first case of a type II ODV benefiting from treatment with IVR+SS injection. The observed results warrant further investigation.

Effects of three consecutive monthly intravitreal injection of ranibizumab for polypoidal choroidal vasculopathy in Korea

AIM: To evaluate the efficacy and safety of three consecutive monthly injections of intravitreal ranibizumab for the treatment of polypoidal choroidal vasculopathy(PCV) in Korea.METHODS: A retrospective chart review of 25 patients(27 eyes) with PCV was conducted. Patients received three initial monthly intravitreal injections(0.5 mg) of ranibizumab and were monitored monthly for 12 mo from January 2010 to October 2011. Reinjection of ranibizumab after three initial monthly loading was administered on an as-needed basis, guided by the optical coherence tomography(OCT), fluorescein angiography(FA) and indocyanine green angiography(ICGA). The main outcomes were the changes of the mean best corrected Snellen visual acuity(VA), central macular thickness(CMT) by OCT, the changes of polyps and branching vascular network by FA and ICGA, and total number of injections received by patients during the 12 mo.RESULTS: The mean best corrected Snellen visual acuities at baseline, 1, 3, 6 and 12 mo after primary injection were 0.77 ±0.59, 0.76 ±0.53, 0.70 ±0.47, 0.63 ±0.43,0.61 ±0.43, 0.62 ±0.42 log MAR, respectively, and showed significant improvement at 3, 6, 12mo(P =0.003, P =0.002,P =0.018, Wilcoxon signed-rank test). The mean CMT at baseline, 1, 2, 3, 6, and 12 mo was 312.41 ±66.38 μm,244.59 ±71.47 μm, 232.32 ±69.41 μm, 226.69 ±69.03 μm,228.62 ±37.07 μm, 227.59 ±51.01 μm respectively, and showed significant reduction(all P 【0.001, Wilcoxon signed-rank test). Polypoidal lesions resolved on ICGA in 3 eyes(11.1%) and a branching vascular network remained in all 24 eyes(88.9%). A total of 106 injections were given in the 12-month period, which equaled to a mean of 3.92(range, 3-6) times. Sixteen of the 27 treatedeyes had additional 1.56 ±0.91 injections. The others(11eyes) had just 3 consecutive injections.CONCLUSION: An initial loading dose of three monthly ranibizumab injections is a safe and effective method in treating PCV, with visual and anatomical improvement over one year follow-up.

Impact of switching from ranibizumab to aflibercept on the number of intravitreous injection and follow up visit in wet AMD:results of real life ELU study

●AIM:To study if one of the two molecules could lead to a lower number of follow up visits and intra-vitreous injection(IVI)with the same efficacy.●METHODS:ELU(or"elected"in French)study is a retrospective study conducted in real life in patients presenting suboptimal response after ranibizumab IVI(phase 1)and secondary switched to aflibercept(phase 2).The number of follow up visits and IVI were compared in both phases.Visual acuity(VA)evolution and"switching"reasons were secondary analyzed.●RESULTS:We retrospectively included data of 33 patients(38 eyes)with age-related macular degeneration(AMD;mean age:77±7.7 y).The number of monthly follow up visits[median(Q1;Q3)]:was significantly lower with aflibercept(phase 2),respectively 1.0(0.81;1.49)visits in phase 1,versus 0.79(0.67;0.86)visits in phase 2.The median number of monthly IVI also significantly decreased in phase 2,respectively 0.67(0.55;0.90)IVI in phase 1,versus 0.55(0.45;0.67)IVI in phase 2.The mean VA evolution(VA final-VA initial)was similar in both phases,(P>0.05).Whatever the reason for"switching"(loss of efficacy,tachyphylaxis,tolerance problems),there was no incidence on VA evolution over the time.●CONCLUSION:Our results show that switching from ranibizumab to aflibercept in"suboptimal"patients significantly reduce the number of follow up visits and IVI,with a comparable efficacy.This decrease in visit number could improve patients’quality of life and reduce surgical risk by reducing the number of injections.

Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

AIM:To evaluate efficacy of intravitreal ranibizumab(IVR)therapy for aggressive posterior retinopathy of prematurity(ROP),threshold ROP disease and type 1 pre-threshold ROP.METHODS:A retrospective analysis was performed on 40 patients(76 eyes)who had IVR as the primary treatment for ROP from April 2017 to January 2018.According to disease pathogenic features,the 76 eyes were divided into three groups:aggressive posterior ROP(AP-ROP)group(16 eyes),threshold ROP group(28 eyes)and type 1 pre-threshold ROP group(32 eyes).The characteristics of patients and lesions situation before the first intravitreal injection,and posttreatment fundus outcomes determined by wide-angle Ret Cam fundus imaging were recorded.RESULTS:The birth weight and postmenstrual age of first IVR treatment in AP-ROP,threshold ROP,and type 1 pre-threshold ROP groups were significant difference(1087.50±246.78,1103.75±168.30,1257.03±210.82 g,P=0.005;34.50±1.46,36.89±2.97,36.50±2.36 wk,P=0.008),while the gestational age was not difference(28.00±2.00,28.54±1.90,28.59±1.43 wk,P=0.510).The retina hemorrhage ratio(with/without:14/2,8/20,5/27),iris neovascularization or vascular engorgement ratio(with/without:12/4,11/17,6/26),and the zone I(inside/outside:16/0,2/26,5/27)in AP-ROP,threshold ROP,and type 1 pre-threshold ROP group were difference significantly(all P<0.05).The regression rates were 37.5%,92.86%,and 100%,and the recurrence rates were 62.5%,7.14%,and 0 in AP-ROP,threshold ROP,and type 1 pre-threshold ROP group,respectively(both P<0.05).The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation.CONCLUSION:IVR is an effective treatment for all types of ROP.The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease.Birth weight,retinal hemorrhage,iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment,which should be noted in follow-up.

The Effect of Intraocular Pressure Lowering Medications on the Pressure Spike Associated with Intravitreal Injection

Aim: This study investigates whether the post intravitreal injection intraocular pressure (IOP) spike is modifiable with the use of prophylactic apraclonidine and dorzolomide. Methods: The study design was a prospective, randomised controlled trial. 80 eyes undergoing intravitreal injection of anti-VEGF agent were studied. A control group (n = 42) received no IOP lowering drops, and a study group (n = 38) received guttae apraclonidine and dorzolamide 30 to 40 minutes before the intravitreal injection. IOP measurements were taken in both groups using the Perkins tonometer at baseline, immediately before and after the injection, 5 minutes post-injection, and 15 minutes post-injection. Results: Mean IOP immediately post injection in the study group was 26.71 mmHg, and in the control group was 32.73. The main outcome measure was the area under the curve (AUC)—reflecting the trend of IOP post injection. The AUC was lower in the study group compared to the control group (Mann-Whitney U test, p = 0.046). Conclusions: The use of prophylactic apraclonidine and dorzolamide is effective in modifying the post-injection IOP spike. IOP lowering prophylaxis may be considered in patients with a high baseline IOP.

Intravitreal ranibizumab therapy versus photodynamic therapy for idiopathic choroidal neovascularization： a comparative study on visual acuity, retinal and choroidal thickness

Background Photodynamic therapy （PDT） has been recommended as a main treatment for idiopathic choroidal neovascularization （I-CNV）.But the visual results of PDT were inconsistent and variable,and PDT may bring severe damage to the retinal pigment epithelium and choriocapillaries.In recent years,intravitreal ranibizumab therapy,showing favorable visual outcomes,has developed as an advanced treatment for choroidal neovascularization （CNV）.Although both methods have been reported to be effective in treating I-CNV,there is no detailed comparative report between the two methods.This study aimed to compare visual outcomes,retinal and choroidal thickness between intravitreal ranibizumab therapy and PDT in the treatment of I-CNV,and investigate the correlation of visual outcomes with retinal and choroidal thickness in each of the two groups.Methods Thirty-seven eyes of 37 patients with I-CNV were involved in this study; 19 eyes were treated with intravitreal ranibizumab therapy and 18 eyes were treated with PDT.The best corrected visual acuity （BCVA） was recorded before and at each follow-up visit after treatments （IogMAR）.Enhanced-depth imaging optical coherence tomography （EDI-OCT） was used to evaluate the retinal structural changes,and to measure central retinal thickness （CRT） and central choroidal thickness （CCT）.Results Mean BCVA was 0.64±0.27 in PDT group and 0.69±0.22 in ranibizumab group at baseline （P=0.55）.When compared with the baseline,mean BCVA in PDT group was improved significantly at 3-month after PDT （0.41±0.16,P=0.002）,then changed little （0.42±0.25 at 12-month,P=0.88）.Whereas mean BCVA in Ranibizumab group was improved significantly at each follow-up visit.It improved much more obviously in the first month and then remained stable.The mean BCVA in the ranibizumab group was significantly better at each follow-up visit than that in PDT （P ＜0.05）.When compared with the baseline,mean CRT in PDT group decreased significantly since 3-month visit,whereas mean CRT in ranibizumab group decreased significantly from 1-month visit.Mean CRT at 1-month and 3-month decreased much more in ranibizumab group than that in PDT group,almost in the same period as BCVA improving.When compared with the baseline,mean CCT did not change significantly at each follow-up visit in each group （P ＞0.05）.The CCT difference was not statistically significant between the two groups at each same time visit （P ＞0.05）.Mean BCVA was correlated with CRT,but was not correlated with CCT.Conclusions Both intravitreal ranibizumab therapy and PDT are effective for the treatment of I-CNV.It is obvious that ranibizumab therapy is significantly superior to PDT in improving BCVA and decreasing CRT.CRT decreases much more rapidly in ranibizumab group than in PDT group,simultaneously with visual improvement.CRT reduction has significant correlation with the visual outcomes in the recovery of I-CNV,whereas BCVA prognosis may have no correlation with CCT.CCT is not changed significantly after each of the treatments.Both PDT and ranibizumab therapy may have no significant effect on choroid.

Anatomical and functional changes after dexamethasone implant and ranibizumab in diabetic macular edema: a retrospective cohort study

AIM: To investigate the efficacy and safety of ranibizumab(RZB group) and dexamethasone implant(DEX group) intravitreal treatments in patients with treatment-na?ve center involved diabetic macular edema(DME) by means of functional and morphological assessments.METHODS: This retrospective cohort study included 50 eyes of 50 patients with DME treated either with RBZ or DEX. Best-corrected visual acuity(BCVA) and microperimetry were evaluated at baseline and during a 6-month follow-up. In addition, central macular thickness(CMT) by means of structural optical coherence tomography(OCT) and retinal capillary plexus density and choriocapillary density by means of OCT angiography were assessed in all cases.RESULTS: Functional and morphological parameters significantly improved during the study period in both groups. BCVA improved significantly in both groups witha greater increase in the DEX group compared to the RBZ group(P=0.030). Microperimetry significantly differed during follow-up between the two treatments(P=0.031). In both groups CMT significantly decreased(P<0.001) without statistically significant differences between the two groups. A statistically significant increase of deep capillary plexus density was detected in both groups at 30 d after therapy. The retreatment rate was 0.70±0.10 and 0.65±0.10 in the RBZ group and 0.65±0.10 and 0.50±0.11 in DEX group at 120 and 180 d respectively. Two out of 25 patients in DEX group showed intraocular pressure increase requiring hypotonic eye drops.CONCLUSION: Both treatments are very effective for DME treatment during 6 mo of follow-up with a lower retreatment rate in DEX group.

Retinoschisis and intravitreal ranibizumab treatment for myopic choroidal neovascularization

Background Intravitreal ranibizumab injection is effecitve on treating myopic CNVs,but it could be a risk factor for developing more severe retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.This study aimed to explore the incidence and features of retinoschisis after intravitreal ranibizumab injection for myopic choroidal neovascularization.Methods Eighty-three eyes of 81 patients with choroidal neovascularization secondary to pathologic myopia were treated with intravitreal ranibizumab injection.The best corrected visual acuity and optical coherence tomography （OCT） images were recorded at baseline and every month thereafter.Central retina thickness and maximal retina thickness were measured.The subjects were divided into three groups.Eleven eyes that had retinoschisis and epiretinal membrane were in group 1,six eyes that had simple epiretinal membrane were in group 2,and 66 eyes that had neither retinoschisis nor epiretinal membrane were in group 3.Six contralateral eyes in group 1 which had retinoschisis and epiretinal membrane but were not treated with intravitreal ranibizumab injection were set as the control group.Results Seven of the 11 eyes in group 1 developed more severe retinoschisis,the mean maximal retinal thickness increased from （380.28±90.13） to （467.00±70.20） μm （P 〈0.05）.The retinoschisis of all 6 eyes of the control group did not aggravate.Compared with the control group,the aggravation ratio of retinoschisis increased significantly （P 〈0.05）.No new onset of retinoschisis took place in group 2 and group 3.Conclusion Intravitreal ranibizumab injection may be a risk factor for aggravation of retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.

Ranibizumab in diabetic macular edema

By 2050 the prevalence of diabetes will more than triple globally,dramatically increasing the societal and financial burden of this disease worldwide.As a consequence of this growth,it is anticipated that there will be a concurrent rise in the numbers of patients with diabetic macular edema(DME),already among the most common causes of severe vision loss worldwide.Recent available therapies for DME target the secreted cytokine,vascular endothelial growth factor(VEGF).This review focuses on the treatment of DME using the first humanized monoclonal antibody targeting VEGF that has been Food and Drug Administrationapproved for the use in the eye,ranibizumab(Lucentis).

Effect of Lingqi Huangban granule plus intravitreal ranibizumab on macular edema induced by retinal vein occlusion: a randomized controlled clinical trial

OBJECTIVE: To investigate the effect of Lingqi Huangban granule(LQHB) plus intravitreal ranibizumab in the treatment of macular edema(ME) induced by retinal vein occlusion(RVO).METHODS: A prospective, randomized controlled study was conducted. A total of 60 subjects with RVO induced ME were randomized into control group(CG)(30 eyes) and LQHB group(LQHBG)(30 eyes). CG patients underwent intravitreal ranibizumab(IVR) injections. LQHBG patients were treated with oral LQHB combined with IVR injections. In order to reduce the financial burden of the injections, we used one injection and pro re nata(PRN)regimen for both groups. The best-corrected visual acuity(BCVA), central macular thickness(CMT), and mean number of injections were evaluated at the beginning of treatment and 3, 6, 9 and 12 months afterward. All the subjects were followed up for 1 year.RESULTS: At the beginning of treatment, there were no statistically significant differences between the two groups in terms of the general condition of patients(P > 0.05). At 3, 6, 9 and 12 months after treatment, however, the BCVA scores improved and the CMT measurements decreased in all patients(P < 0.05), with the improvement of LQHBG significantly greater than that of CG(P <0.05). The mean numbers of ranibizumab injections were 1.8 ± 0.3 in LQHBG and 2.3 ± 0.6 in CG, respectively(P < 0.05). No adverse events were reported in both groups.CONCLUSION: LQHB plus intravitreal ranibizumab could be a much more effective and economic treatment for stabilizing and improving vision with fewer intravitreal injections in the treatment of RVO induced ME. This integrative therapy appears to be a promising option for this type of patient.

Assessment of the long-term visual and anatomical outcomes of ranibizumab to treat neovascular age-related macular degeneration

AIM： To investigate the long-term visual and anatomical outcomes of patients who underwent intravitreal ranibizumab monotherapy to treat neovascular age-related macular degeneration（AMD） and followed-up for at least 2 y.METHODS： A total of 74 eyes of 74 patients who underwent ranibizumab monotherapy for neovascular AMD were included in this retrospective study.RESULTS： The average patient age was 72.1±6.5（range, 57-85）y, the average follow-up time 46.2±13.1（range, 24-75）mo, and the average number of visits 24.1±9.5（range, 8-48）. The mean number of injections in year 1 was 4.5, 1.6 in year 2, 0.9 in year 3, 0.4 on year 4, and 0.1 in the following years. Within the entire follow-up period, the mean number of injections was 7.6±4.4（range, 2-21）. The mean visual acuity was 48.1±15（range, 15-76） letters at baseline and 45.7±19（range, 7-75） at year 5. The mean central macular thickness was 303±78（range, 178-552） μm at baseline and 251±51（range, 138-359） μm at year 5. Scars developed in 47（63.5%） eyes at the end of the follow-up period, and atrophy was evident in 6（8.1%） eyes.CONCLUSION： Ranibizumab monotherapy can stabilize visual acuity for a mean period of 4 y in patients with neovascular AMD.

Combined photodynamic therapy and ranibizumab for polypoidal choroidal vasculopathy：a 2-year result and systematic review

AIM：To report a cohort of patients with polypoidal choroidal vasculopathy（PCV）treated with photodynamic therapy（PDT）followed by intravitreal ranibizumab injection 24-48 h later,and to compare the results between eyes with PCV treated by PDT followed by intravitreal anti-vascular endothelial growth factor（VEGF）injection and intravitreal anti-VEGF injection followed by PDT by Meta-analysis.METHODS：Retrospective study and systematic literature review. Medical records of patients with PCV who were initially treated using PDT followed by intravitreal ranibizumab injection 24-48 h after PDT and had completed at least 2y follow-up were reviewed and analyzed. Clinical data,including age,sex,best-corrected visual acuity（BCVA）,fundus photograph,fluorescein angiography,indocyanine green angiography and optical coherence tomography were investigated. A systematic literature review was also conducted,and a visual outcome of studies over 1y was compared using Meta-analysis. RESULTS：A total of 52 patients were included in the study. Mean BCVA at baseline and follow-up at 1 or 2y were 0.71± 0.61,0.51±0.36 and 0.68±0.51 log MAR,respectively. The cumulative hazard rate for recurrence at 1 and 2y followup was 15.4% and 30.3% respectively. The percentage of eyes with polyps regression at 3,12 and 24 mo follow-up was 88.5%,84.6% and 67.3% respectively. A Meta-analysis based on 22 independent studies showed the overall vision improvements at 1,2 and 3y follow-up were 0.13±0.04（P〈0.001）,0.12±0.03（P〈0.001）,0.16±0.06（P〈0.001）,respectively. The proportion of polyps regression at 1y follow-up was 64.6%（95%CI：51.5%,77.7%,P〈0.001）in 434 eyes treated by intravitreal anti-VEGF agents beforePDT and 76.0%（95%CI：64.8%,87.3%,P=0.001）in 199 eyes treated by intravitreal anti-VEGF agents after PDT. CONCLUSION：Intravitreal ranibizumab injection 24-48 h following PDT effectively stabilizes visual acuity in the eye with PCV. PDT followed by intravitreal anti-VEGF agents may contribute to a relatively higher proportion of polyps＇ regression as compared to that of intravitreal anti-VEGF before PDT.

Approved pharmacotherapy for macular edema secondary to branch retinal vein occlusion:A review of randomized controlled trials in dexamethasone implants,ranibizumab,and aflibercept

There are three approved pharmacotherapies for treating macular edema secondary to branch retinal vein occlusion(BRVO), including corticosteroids(dexamethasone implants) and anti-vascular endothelial growth factor(VEGF)(ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular grid laser treatment. There is no severe ocular or systemic adverse reaction reported in studies associated with anti-VEGF for macular edema after BRVO. Intraocular pressure elevation and cataract aggravation should be addressed after intravitreal dexamethasone implants. Single intravitreal dexamethasone implant had effective duration as long as four to six months. Intravitreal anti-VEGF requires six monthly injections as loading doses, and then PRN regimen needed according to functional and anatomical changes. Ozurdex and ranibizumab reduce not only macular edema, but also the probability of retinal ischemia and neovascularization in patient s with BRVO. Prompt treatment with these agents can lead to a better outcome.

Ranibizumab治疗湿性年龄相关性黄斑变性的安全性分析

湿性年龄相关性黄斑变性（AMD）的主要病理改变为脉络膜新生血管（CNV）的形成，血管内皮生长因子（VEGF）水平的升高是其重要的发病机制之一。Ranibizumab是一种重组人源化抗VEGF单克隆抗体片段，能够抑制新生血管形成，玻璃体腔内注射ranibizumab治疗湿性AMD的疗效已得到多项临床研究的证实。此外，玻璃体腔内注射ranibizumab的耐受性良好，眼内与全身不良反应的风险未显著增加。其主要眼内不良事件为眼部炎症和一过性眼压升高，但发生率较低。主要的严重眼内不良事件的发生率〈4％。Ranibizumab应用后心脑血管意外的发生风险无显著增加，采取在每月随访监测的基础上降低注射频率的方法可能得到最佳的风险获益比。就近年来湿性AMD患者应用ranibizumab治疗的临床试验为基础，从循证医学角度讨论其玻璃体腔内注射的安全性。

Ranibizumab玻璃体内注射治疗病理性近视脉络膜新生血管研究进展

病理性近视是仅次于年龄相关性黄斑变性(age-related macular degeneration,AMD)可致脉络膜新生血管(choroidal neovascularization,CNV)形成的主要原因,且是50岁以下患者发生CNV的最常见原因。近年来抗血管内皮生长因子药物不仅被广泛用于AMD的治疗,在病理性近视CNV患者中也显示出较好疗效。本文主要就近年来ranibizumab玻璃体内注射治疗病理性近视CNV的研究进展进行综述。

Analysis of the Efficacy of Triamcinolone Acetonide Combined with Ranibizumab in the Treatment of Fundus Diseases

Objective:To analyze the effect of triamcinolone acetonide combined with ranibizumab in patients with fundus diseases.Methods:100 patients with fundus diseases admitted from January 2018 to January 2023 were selected.The patients were separated into two groups according to the random number table method,with 50 cases in the control group(treated with ranibizumab),and 50 cases in the observation group(treated with triamcinolone acetonide combined with ranibizumab).The clinical effects of both treatment regimens were compared.Results:The time taken for symptom disappearance of the observation group was shorter than that of the control group(P<0.05).The observation group had higher naked-eye visual acuity(4.18±0.89)compared to the control group.Besides,the observation group also had lower intraocular pressure(14.19±1.33 mmHg)and retinal thickness(283.14±3.29μm),with(P<0.05)compared to the control group.Moreover,the observation group had a lower adverse reaction rate and a higher quality of life(P<0.05).Conclusion:The application of triamcinolone acetonide combined with ranibizumab treatment can quickly relieve the clinical symptoms of patients with fundus disease,improve visual acuity,intraocular pressure,and retinal thickness,with low adverse reaction rate and better prognosis and quality of life.

Ranibizumab治疗湿性年龄相关性黄斑变性的系统综述

年龄相关性黄斑变性（AMD）可导致严重的视力丧失，脉络膜新生血管（CNV）是其主要的致盲原因，血管内皮生长因子（VEGF）在CNV的形成过程中起着至关重要的作用。Ranibizumab是一种重组的人源化抗VEGF单克隆抗体片段，能够抑制新生血管形成，减少血管渗漏。国内外多项研究证实玻璃体腔内注射ranibizumab治疗湿性AMD具有一定的疗效，为ranibizumab的临床应用提供了高等级的临床试验证据。Ranibizumab治疗湿性AMD的最佳时机为治疗的起始阶段，其最佳治疗方案为每月注射1次，连续3个月，之后每月注射1次进行维持治疗。维持期的治疗应每月监测病情的动态变化，光学相干断层扫描（OCT）、荧光素眼底血管造影（FFA）、视力等是主要的检测指标，对调整治疗方案起指导作用。维持阶段也可采取个体化治疗或与光动力疗法（PDT）的联合疗法，以适当减少注射次数和频率。系统检索和总结ranibizumab治疗湿性AMD的文献资料．可从循证医学的角度为ranibizumab的临床应用提供证据支持。