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).

Identification of retinal thickness and blood flow in agerelated macular degeneration with reticular pseudodrusen

AIM:To investigate thickness characteristics and vascular plexuses in retinas with reticular pseudodrusen(RPD)as an early detection strategy for age-related macular degeneration(AMD).METHODS:This retrospective study included 24 subjects(33 eyes)with RPD and 25 heathy control subjects(34 eyes).The superficial capillary plexus(SCP)and the deep capillary plexus(DCP)of the retinal posterior poles were investigated with optical coherence tomography angiography(OCTA).Retinal thicknesses and vessel densities were analyzed statistically.RESULTS:The general retinal thicknesses of RPD eyes were significantly decreased(95%CI-14.080,-0.655;P=0.032).The vessel densities of DCP in RPD eyes were significantly increased in the global(95%CI 1.067,7.312;P=0.027),parafoveal(95%CI 0.417,5.241;P=0.022),and perifoveal(95%CI 0.181,6.842;P=0.039)quadrants.However,the vessel densities of the SCP were rarely increased in the eyes with RPD.CONCLUSION:The thinning of retinas in the RPD group suggests a reduction in the number of cells.Additionally,the increased vessel density of the DCP in retinas with RPD indicates a greater demand for blood supply,possibly due to the hypoxia induced RPD compensation caused by RPD in the outer retina.This study highlights the pathological risks associated with RPD and emphasizes the importance of early intervention to retard the progression of AMD.

Comment on “The diurnal variation pattern of choroidal thickness in macular region of young healthy female individuals using spectral domain optical coherence tomography”

Dear Editor,We have read and reviewed the article entitled＂The diurnal variation pattern of choroidal thickness in macular region of young healthy female individuals using spectral domain optical coherence tomography＂by Zhao et al^（[1]）with great interest.

Morphological and functional changes in the macular area in diabetic macular edema after a single intravitreal injection of aflibercept

AIM:To evaluate the changes in macular morphology and function after a single intravitreal injection of aflibercept in diabetic macular edema(DME)using optical coherence tomography angiography(OCTA)and MP-3 microperimetry.METHODS:Twenty-eight patients(42 eyes)diagnosed with DME were treated with intravitreal injection of aflibercept.The changes in best corrected visual acuity(BCVA),central retinal thickness(CRT),foveal avascular zone(FAZ)area,vessel density of superficial retinal capillary plexus(SVD),vessel density of deep retinal capillary plexus(DVD),mean light sensitivity(MLS),2°fixation rate(P1),4°fixation rate(P2),and other indicators 1mo after treatment were compared;of these,BCVA was conver ted into logarithm of the minimum angle of resolution(logMAR),and the correlation among the factors was analyzed.RESULTS:After treatment,logMAR BCVA was 0.47±0.24,which was significantly better than that before treatment(0.63±0.28,P<0.001).The CRT was 359.21±107.87μm after treatment,which was significantly lower than before treatment(474.10±138.20μm,P<0.001).The FAZ area,SVD,and DVD were not significantly changed after treatment compared with the baseline.MLS was 22.16±4.20 dB after treatment,which was significantly higher than before treatment(19.63±4.23 dB,P<0.001).P2 significantly increased after treatment than before treatment(P=0.007).P1 had no significant change after treatment than before treatment(P=0.086).CONCLUSION:A single intravitreal injection of aflibercept effectively reduces macular edema and improves retinal sensitivity,fixation stability,and visual acuity,possibly without causing significant changes in the retinal vascular condition in a short time.

Retinal thickness and vascular parameters using optical coherence tomography in Alzheimer's disease:a meta-analysis

Examining the retinal tissue has the potential to provide a unique method and technique to quantify Alzheimer’s disease-related changes in participants at various stages of the disease.In this metaanalysis,we aimed to investigate the association of various optical coherence tomography parameters with Alzheimer’s disease and whether retinal measurements can be used to diffe rentiate between Alzheimer’s disease and control subjects.Scientific databases including Google Schola r,Web of Science,and PubMed were systematically searched for published articles that evaluated retinal nerve fiber layer thickness and retinal microvascular network in Alzheimer’s disease and control subjects.Seventy-three studies(5850 participants,including 2249 Alzheimer’s disease patients and 3601controls) were included in this meta-analysis.Relative to controls,Alzheimer’s disease patients had a significantly lower global retinal nerve fiber layer thickness(standardized mean difference [SMD]=-0.79,95% confidence intervals [CI]:-1.03 to-0.54,P <0.00001) as well as each quadrant being thinner in Alzheimer’s disease versus controls.Regarding macular paramete rs,values measured by optical coherence tomography were significantly lower in Alzheimer’s disease than controls for macular thickness(pooled SMD:-0.44,95% CI:-0.67 to-0.20,P=0.0003),foveal thickness(pooled SMD=-0.39,95% CI:-0.58 to-0.19,P <0.0001),ganglion cell inner plexiform layer(SMD=-1.26,95% CI:-2.24 to-0.27,P=0.01) and macular volume(pooled SMD=-0.41,95% CI-0.76 to-0.07,P=0.02).Analysis using optical coherence tomography angiography parameters revealed mixed results between Alzheimer’s disease and controls.Superficial vessel density(pooled SMD=-0.42,95% CI:-0.68 to-0.17,P=0.0001) and deep vessel density(pooled SMD=-0.46,95% CI:-0.75 to-0.18,P=0.001) were found to be thinner in Alzheimer’s disease patients whereas the foveal avascular zone(SMD=0.84,95% CI:0.17-1.51,P=0.01) was larger in controls.Vascular density and thickness of various retinal laye rs were decreased in Alzheimer’s disease patients compared to controls.Our results provide evidence for optical coherence tomography technology having the potential to detect retinal and microvascular changes in patients diagnosed with Alzheimer’s disease and aid in monito ring and early diagnosis methods.

Macular and peripapillary retinal nerve fiber layer thickness in children with hyperopic anisometropic amblyopia

AIM:To compare the retinal nerve fiber layer (RNFL) thickness and macular thickness in the amblyopic eye with that in the sound eye of children with hyperopic anisometropic amblyopia using optical coherence tomography (OCT). METHODS:A prospective, nonrandom, intraindividual comparative cohort study includes 72 children with hyperopic anisometropic amblyopia in a single center. Macular thickness, macular foveola thickness, and peripapillary RNFL thickness were compared between the amblyopia eyes and the contralateral sound eyes. ·RESULTS:There were 38 male and 34 female patients, with a mean age as 9.7 ±1.9 years (range, 5-16 years). Hyperopic was +3.62±1.16D (range +2.00D to +6.50D) in the amblyopic eyes, which was significantly higher in the control eyes with +0.76±0.90D (range 0D to +2.00D) (P 【 0.01). The mean peripapillary RNFL thickness was 113.9± 7.2μm and 109.2 ±6.9μm in the amblyopic eye and the normal eye, respectively, reaching statistical significance (P = 0.02). The mean macular foveola thickness was significantly thicker in the amblyopic eyes than the contralateral sound eyes (181.4±14.2μm vs 175.2±13.3μm, P 【0.01), but the 1mm, 3mm or 6mm macular thickness central macular thickness was not significantly different. Degree of anisometropia in the contralateral eyes was not significantly correlated with differences of peripapillary RNFL, macular foveola thickness or central macular thickness. CONCLUSION:Eyes with hyperopic anisometropic amblyopia are found thicker macular foveola and peripapillary RNFL than the contralateral eyes in children.

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.

Comparison of retinal nerve fiber layer and macular thickness measurements with Stratus OCT and OPKO/OTI OCT devices in healthy subjects

AIM: To compare retinal nerve fiber layer(RNFL) and macular thickness measurements obtained with the Stratus optical coherence tomography(OCT) and OPKO/OTI OCT devices.METHODS: Included in the study were 59 eyes of 30 participants. All measurements for each eye were done on the same day with both devices. Student’s paired t-tests were used to compare the central macular thickness and RNFL measurements of the Stratus OCT and OPKO/OTI OCT. Pearson correlation was used to assess the relationship between the devices. Coefficient of variation(COV) was calculated to assess intersession repeatability.RESULTS: Using both the Stratus OCT and OPKO/OTI OCT, respectively, the measured mean average RNFL thicknesses were 98.9±11.1 μm and 115.1±9.6 μm(P =0.001),and the measured mean central retinal thicknesses(CRT)were 196.2 ±18.8 μm and 204.5 ±21.1 μm(P 【0.001).Measured by the two devices, the RNFL thickness values were correlated in all quadrants, as were the retinal thickness values except the inferior outer sector. COV for average RNFL and CRT thickness were 2.9% and 4.6%for Stratus OCT, and 2.1% and 4.2% for OPKO/OTI OCT,respectively.CONCLUSION: We found good reproducibility of RNFL and retina thickness measurements for both Stratus OCT and OPKO/OTI OCT devices. However, even though the two OCT systems provided statistically correlated results,the values for both RNFL and macular thickness were statistically different. RNFL and macular thickness measurements with the OPKO/OTI OCT were higher than that of the Stratus OCT; therefore, the two OCT systems cannot be used interchangeably for the measurements of RNFL and macular thickness.

Effect of nepafenac 0.1% on retinal thickness after cataract surgery in patients without risk factors for cystoid macular edema

AIM:To evaluate the effect of topical preoperative nepafenac 0.1%treatment on postoperative macular edema using optical coherence tomography(OCT)after uncomplicated cataract surgery.METHODS:Ninety eyes of 90 patients without any risk factors were included in the study.The patients were assigned to three groups:group 1,treated with topical prednisolone acetate 1%;group 2,treated with topical nepafenac 0.1%in addition to prednisolone acetate(1%);and group 3,those who started receiving nepafenac 0.1%treatment 3 d prior to surgery and continued the treatment postoperatively in addition to prednisolone acetate(1%).Central retinal thickness(CRT)and macular volume values were recorded using OCT at weeks 3 and 6.RESULTS:The increases in macular volume in the central 1 mm area after 3 and 6 wk were significantly lower in patients who used prophylactic topical nepafenac preoperatively(group 3)compared with those in group 1(P=0.028 and 0.008,respectively).No significant differences in the increase in macular volume and CRT were noted between groups 2 and 3(P>0.05).In group 1,the increases in macular volume in the central 3 mm area at weeks 3 and 6 were significantly higher than that in group 2 and 3(3rd week,P=0.004;6th week,P=0.005).CONCLUSION:Nepafenac 0.1%treatment in addition to topical steroids after uncomplicated cataract surgery reduce the increase in macular volume in the early postoperative period.

Choroidal thickness measurements with optical coherence tomography in branch retinal vein occlusion

AIM： To evaluate central macular thickness（CMT） and mean choroidal thickness（MCT） in eyes with branch retinal vein occlusion（BRVO）, before and after ranibizumab treatment using spectral domain-optical coherence tomography（SD-OCT）.·METHODS： Forty-two patients with unilateral BRVO and macular edema were included in this study. There were 25 men and 17 women. Using SD-OCT, choroidal thickness was measured at 500 μm intervals up to 1500μm temporal and nasal to the fovea. MCT was calculated based on the average of the 7 locations. All the eyes with BRVO were treated with intravitreal ranibizumab（0.5 mg/0.05 m L）. Comparisons between the BRVO and fellow eyes were analyzed using Mann-Whitney U test. Preinjection and post-injection measurements were analyzed using Wilcoxon test and repeated measure analysis.· RESULTS： At baseline, there was a significant difference between the BRVO and fellow eyes in MCT[BRVO eyes 245（165-330） μm, fellow eyes 229（157-327） μm]and CMT [BRVO eyes 463（266-899） μm, fellow eyes 235（148-378） μm（P =0.041, 0.0001, respectively）]. Following treatment, CMT [295（141-558） μm] and MCT [229（157-329） μm] decreased significantly compared to the baseline measurements（P =0.001, 0.006, respectively）.Also BCVA（log MAR） improved significantly（P=0.0001） in the BRVO eyes following treatment. After treatment CMT[BRVO eyes 295（141-558） μm, fellow eyes 234（157-351） μm]and MCT [BRVO eyes 229（157-329） μm, fellow eyes 233（162-286） μm] values did not reveal any significant difference in BRVO eyes and fellow eyes（P=0.051, 0.824,respectively）.· CONCLUSION： In eyes with BRVO, CMT and MCT values are greater than the fellow eyes, and decrease significantly following ranibizumab injection.

Intraocular retinal thickness asymmetry in early stage of primary open angle glaucoma and normal tension glaucoma

AIM： To investigate the intraocular retinal thickness asymmetry of peripapillary retinal nerve fiber layer（pR NFL） and macular layers measured by spectral-domain optical coherence tomography（SD-OCT） in patients with early stage of primary open angle glaucoma（POAG） and normal tension glaucoma（NTG）.METHODS： A total of 117 patients with early stage of glaucoma（54 patients with POAG and 63 patients with NTG） and 32 normal subjects were recruited for the study. The pR NFL thickness, total macular layer（TML） thickness, and isolated inner macular layer（IML） thickness were measured by SD-OCT. Hemisphere TML thickness asymmetry measured by the posterior pole asymmetry scan was evaluated. Thickness differences of pR NFL and IML between superior and inferior quadrants were calculated. Asymmetry indices（AIs） of the p RNFL, TML and isolated IML were also computed. Areas under the receiver-operating characteristic curves（AROCs） were generated to determine the diagnostic capabilities of different parameters. RESULTS： Intraocular p RNFL thickness differences and AIs between the superior and inferior quadrants were significantly different between normal and NTG groups（P=0.009 and P〈0.001, respectively）. Intraocular p RNFL thickness differences and AIs between the temporal-superior and temporal-inferior sectors were also significantly different between normal and NTG groups（P=0.035 and P〈0.001, respectively）. The thickness differences and AIs of TML between superior and inferior hemispheres were significantly different between normal and NTG groups（P=0.001 and P=0.001, respectively） and between normal and POAG groups（P=0.032 and P=0.020, respectively）. The thickness differences and AIs of macular ganglion cell layer（mG CL） between superior and inferior quadrants were significantly different between normal and NTG groups（P=0.013 and P=0.004, respectively）, and between NTG and POAG groups（P=0.015 and P=0.012, respectively）. The thickness difference of TML between superior and inferior hemispheres showed the highest diagnostic capability for early NTG eyes（AROC=0.832）.CONCLUSION： Intraocular retinal thickness asymmetry in pR NFL, TML and mG CL are found in early stage of NTG. Hemisphere TML thickness asymmetry is also found in POAG eyes. Asymmetry analysis of retinal thickness can be an adjunctive modality for early detection of glaucoma.

Macular thickness as a predictor of loss of visual sensitivity in ethambutol-induced optic neuropathy

Ethambutol is a common cause of drug-related optic neuropathy.Prediction of the onset of ethambutol-induced optic neuropathy and consequent drug withdrawal may be an effective method to stop visual loss.Previous studies have shown that structural injury to the optic nerve occurred earlier than the damage to visual function.Therefore,we decided to detect structural biomarkers marking visual field loss in early stage ethambutol-induced optic neuropathy.The thickness of peripapillary retinal nerve fiber layer,macular thickness and visual sensitivity loss would be observed in 11 ethambutol-induced optic neuropathy patients（22 eyes） using optical coherence tomography.Twenty-four healthy age-and sex-matched participants（48 eyes） were used as controls.Results demonstrated that the temporal peripapillary retinal nerve fiber layer thickness and average macular thickness were thinner in patients with ethambutol-induced optic neuropathy compared with healthy controls.The average macular thickness was strongly positively correlated with central visual sensitivity loss（r2=0.878,P=0.000）.These findings suggest that optical coherence tomography can be used to efficiently screen patients.Macular thickness loss could be a potential factor for predicting the onset of ethambutol-induced optic neuropathy.

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.

Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema

AIM： To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema（DME） determined with optical coherence tomography（OCT）. METHODS： In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness（DRT）, cystoid macular edema（CME） and serous retinal detachment（SRD） and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS： Of the 57 patients with DME, 21（36.8%） had DRT, 24（42.1%） had CME and 12（21.0%） had SRD. Microor macro-albuminuria was significantly higher in the DRT pattern（61.9%） compared with the SRD（50.0%） and CME patterns（25.0%; P=0.040）. Hemoglobin A1 c（Hb A1 c） level was significantly higher and patients were younger in the DRT pattern group（P=0.034, P=0.032）. Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION： Micro-or macro-albuminuria may be more frequent and Hb A1 c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.

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.

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.

Analysis of retinal vasculature changes in indirect traumatic optic neuropathy using optic coherence tomography angiography

AIM:To assess the retinal vasculature alterations in indirect traumatic optic neuropathy(ITON)patients following craniofacial trauma by optic coherence tomography angiography(OCTA).METHODS:Patients diagnosed of monocular ITON were recruited from August 2016 to May 2020.OCTA was performed using the Angio Vue OCT-A system for two cube scans centered at the optic nerve head and fovea.OCTA data included thicknesses of peripapillary retinal nerve fiber layer(RNFL)and macular ganglion cell complex(GCC),as well as proportion of capillary perfusion and data were analyzed for correlation with post-injury timepoints:within 7,8-30,31-90,and 91-365d.RESULTS:A total of 73 ITON patients were studied.Significant thinning of RNFL and GCC layers and attenuation of microvascular perfusion were observed in ITON eyes as compared to contralateral unaffected eyes(for most of the analyzed sectors and quadrants,P<0.05).Without respect to surgical intervention and vision recovery,the decrease in retinal layer thicknesses and microvascular perfusion was time-dependent,and most significant within three months(P<0.001).CONCLUSION:ITON presents with time-dependent thinning of retinal layers and attenuation of microvasculature,indicating possible degeneration of retinal ganglion cells due to reduced retinal blood supply.

A study of retinal parameters measured by optical coherence tomography in patients with multiple sclerosis

AIM: To investigate the difference of retinal nerve fiber layer (RNFL) thickness and macular fovea thickness/volume between multiple sclerosis (MS) patients and healthy normal individuals using optical coherence tomography (OCT) and assess its association with visual field parameters. METHODS: Thirty consecutive MS patients and 28 healthy controls were recruited in this prospective study. Comprehensive standardized ophthalmic examinations included visual acuity, cycloplegic refraction, intraocular pressure, gonioscopy, visual field, and RNFL thickness and macular fovea thickness/volume detection using Humphrey OCT. Mean values for the thickness of the peripapillary RNFL and macular volume were calculated. Associations between visual field parameters and RNFL thickness/macular volume were analyzed by Pearson correlation analysis. RESULTS: The RNFL thicknesses in each quadrant, the average macular thickness, and the average macular volume in MS patients were all less than those in healthy controls, with statistically significant differences. The RNFL thickness and macular fovea thickness/volume were greater in eyes without optic neuritis than in eyes with optic neuritis. The average visual field parameters had positive correlations with the RNFL thickness and negative correlations with macular parameters in MS patients. CONCLUSION: OCT measurements can effectively identify the nerve changes of MS patients, which provide more data for the diagnosis of MS.

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。

Angio-OCT引导IQ577TMIRIDEX微脉冲激光联合抗新生血管药物治疗糖尿病性黄斑水肿的临床效果

目的探究Angio-OCT引导IQ577TMIRIDEX微脉冲激光联合抗新生血管药物治疗糖尿病性黄斑水肿的临床效果。方法回顾性分析2019年1月至2021年1月乐平市人民医院眼科收治的60例糖尿病黄斑水肿患者的临床资料,按照不同治疗方案将其分为联合治疗组(30例)与单纯抗血管内皮生长因子(VEGF)组(30例),联合治疗组患者采用Angio-OCT引导IQ577TMIRIDEX微脉冲激光联合抗VEGF药物进行治疗,单纯抗VEGF组采用抗VEGF药物进行玻璃体腔注射治疗,比较两组患者的最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、黄斑中心凹无血管区面积(FAZ)、浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)的平均血流密度(VD)的变化,并评估治疗安全性。结果两组患者治疗1、2、3个月时的BCVA均高于本组治疗前,治疗2、3个月时的BCVA均高于治疗1个月时,治疗3个月时的BCVA高于治疗2个月时,差异有统计学意义(P<0.05)。治疗2、3个月时,单纯抗VEGF组的BCVA均低于同时刻联合治疗组,差异有统计学意义(P<0.05)。两组患者治疗1、2、3个月时的CMT均低于本组治疗前,治疗2、3个月时的CMT均低于治疗1个月时,治疗3个月时的CMT低于治疗2个月时,差异有统计学意义(P<0.05)。治疗1、2、3个月时,单纯抗VEGF组的CMT均高于同时刻联合治疗组,差异有统计学意义(P<0.05)。两组患者治疗前后的FAZ、SCP VD、DCP VD比较,差异无统计学意义(P>0.05);两组患者均未出现明显眼部或全身性不良反应。结论在糖尿病黄斑水肿患者的治疗中,采用Angio-OCT引导IQ577TMIRIDEX微脉冲激光联合抗VEGF药物能够有效地改善患者的视力水平,降低黄斑中心凹厚度,提升患者的治疗效果,方法操作简便,安全性较高,值得临床应用与推广。