BACKGROUND No study has investigated the change regularity between age and subfoveal choroidal thickness(SFCT)in proliferative diabetic retinopathy(PDR).AIM To investigate the relationship between the SFCT and age in ...BACKGROUND No study has investigated the change regularity between age and subfoveal choroidal thickness(SFCT)in proliferative diabetic retinopathy(PDR).AIM To investigate the relationship between the SFCT and age in Chinese patients with PDR.METHODS This was a cross-sectional retrospective study.The participants were hospitalized individuals with type 2 diabetes who underwent vitrectomy for PDR.Contralateral eyes that met the criteria were included in the study.All necessary laboratory tests were performed at the time of admission.Central macular thickness(CMT)and SFCT were two quantitative assessments made using enhanced depth imaging optical coherence tomography.CMT was measured automatically and SFCT was measured manually with digital calipers provided by the Heidelberg Eye Explorer software.RESULTS The final analysis included a total of 234 individuals with PDR.The average age was 55.60 years old±10.03 years old,and 57.69%of the population was male.Univariate analysis revealed a significant negative connection between age and SFCT in patients with PDR[β=-2.44,95%confidence interval(95%CI):-3.46 to-1.42;P<0.0001].In the fully adjusted model,the correlation between SFCT and age remained steady(β=-1.68,95%CI:-2.97 to-0.39;P=0.0117).Spline smoothing showed that the relationship between SFCT and age in patients with PDR was non-linear,with an inflection point at 54 years of age.CONCLUSION Our findings suggest that age is a key determinant of choroidal thickness.The non-linear link between SFCT and age in PDR patients should be taken into account.展开更多
BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and redu...BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.展开更多
AIM: To compare central macular thickness (CMT) measurements obtained by two spectral-domain optical coherence tomography (SD-OCT) exams, and to evaluate measurement reproducibility and agreement between these two exa...AIM: To compare central macular thickness (CMT) measurements obtained by two spectral-domain optical coherence tomography (SD-OCT) exams, and to evaluate measurement reproducibility and agreement between these two exams, and to investigate the relationship between CMT and possible influencing factors such as age, sex, eye (OD/OS), and operators in elderly non-mydriatic eyes. METHODS: Seventy-two normal subjects were included. Every subject underwent CMT measurement twice using one of two SD-OCT (OSE-2000, Moptim, Shenzhen, China & 3-D OCT-1000, Topcon, Tokyo, Japan) instruments respectively where we randomly chose one eye in each patient for the test; these exams were performed by two operators over an hour period with a brief rest between sessions. Comparison of the OSE-2000 and 3-D OCT-1000 CMT measurements was based on paired- t test The mean difference between the CMT measurements was calculated. General linear model analyzed the relationships among eye (OD/OS), operator, sex, and CMT values using age as co-variant. All tests were considered statistically significant at P <0.05. The main outcome measures included CMT. RESULTS: When evaluated with general linear model analysis, CMT measurements were found to have high reproducibility across the two instruments between the two operators for the OSE-2000 single line scan and 3-D OCT-1000 macular scans (P=0.731; P=0.443). There was statistically significant difference in CMT values between the two instruments (P<0.001) and the mean difference was -46.83 mu m at 95% confidence limits (-49.15,-44.51). Age was positively correlated with CMT (beta coefficient =0.516, P=0.001; beta coefficient=0.453, P =0.009) and sex was correlated with CMT from the OSE-2000 (P=0.021) but not with the 3-D OCT-1000 (P=0.056). According to the actual thickness measurements, the CMT of the male was thicker than the female's but there was no statistical difference. There was interaction between sex and eye in OSE-2000 and not in 3-D OCT-1000 (P=0.02; P =0.374). No significant correlation was found between CMT and the influencing factor of eye in both of the instruments (P=0.884; P=0.492). CONCLUSION: Reproducibility of CMT measurement using the two SD-OCTs is excellent in normal eyes according to the operator factor analysis. OSE-2000 has a different posterior retinal boundary of CMT measurement, which results in the CMT value differences, compared with the 3-D OCT-1000. Age is positively correlated with CMT measurement while sex is correlated with CMT in the OSE-2000 but not in the 3-D OCT-1000 and eye (OD/OS) had no correlation with CMT values. Mydriatic drops may not be necessary for CMT measurement using high scan rate SD-OCT in normal eyes in dark room.展开更多
AIM：To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor（anti-VEGF） therapy for center-involvin...AIM：To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor（anti-VEGF） therapy for center-involving diabetic macular edema（DME）.METHODS：Foveal thickness was assessed with optical coherence tomography to determine the central subfield foveal thickness（CSFT） and macular volume in 42 eyes with DME（CSFT〉275 μm）. Evaluations also included measurement of best-corrected visual acuity（BCVA）, and were performed at baseline, and upon foveal depression recovery achieved after 12 monthly intravitreal injections of either 1.5 mg/0.06 mL bevacizumab（n=21） or 0.5 mg/0.05 mL ranibizumab（n=21）. Data was compared to 42 eyes of normally sighted, non-diabetic, healthy individuals with similar age, gender and race distributions.RESULTS：Mean baseline BCVA was 0.59±0.04 and 0.32± 0.03 log MAR（P〈0.001） after treatment and resolution of DME, with all, but 3 eyes, showing BCVA improvement. Mean CSFT before treatment was 422.0±20.0 μm, and after treatment, decreased to 241.6±4.6 μm（P〈0.001）, which is significantly thinner than CSFT found in control subjects（272.0±3.4 μm; P〈0.001）. Moreover, in 33/42 DM eyes（79%）, CSTF was thinner than the matched control eye. Macular volume showed comparable results, but with lower differences between groups（control：8.5±0.4 mm^3; DME：8.2±1.0 mm^3; P=0.0267）.CONCLUSION：DME eyes show significantly lower foveal thickness than matched controls after DME resolution achieved with one-year anti-VEGF therapy. Further investigation into the reasonsfor this presumable retinal atrophy using fluorescein angiography and functional parameters as well as establishing possible predictors is warranted. This finding should be considered during the treatment of DME.展开更多
目的系统评价“补虚化浊法”中药联合抗血管内皮生长因子(VEGF)治疗湿性年龄相关性黄斑变性(wAMD)的临床疗效。方法检索PubMed、Web of Science、Embase、中国知网、万方、维普、中国生物医学文献数据库中应用“补虚化浊法”中药治疗wAM...目的系统评价“补虚化浊法”中药联合抗血管内皮生长因子(VEGF)治疗湿性年龄相关性黄斑变性(wAMD)的临床疗效。方法检索PubMed、Web of Science、Embase、中国知网、万方、维普、中国生物医学文献数据库中应用“补虚化浊法”中药治疗wAMD的随机对照试验文献,检索时间为建库至2023年5月31日,对文献按照纳入标准与排除标准进行筛选和数据录取,采用Cochrane软件评价文献质量,采用RevMan 5.4软件进行统计分析。结果共纳入13项研究,包括患者1,002例(1,041只眼),其中采用“补虚化浊法”联合抗VEGF治疗的治疗组501例(523只眼),单纯抗VEGF治疗的对照组501例(518只眼)。治疗组在提高国际标准视力[MD=0.100,95%CI(0.050,0.140),Z=4.310,P=0.000]、LogMAR视力[MD=-0.080,95%CI(-0.110,-0.050),Z=5.560,P=0.000]、视力总有效率[OR=2.070,95%CI(1.280,3.340),Z=2.970,P=0.000]、降低黄斑中心凹厚度[MD=-19.130,95%CI(-24.940,-13.310),Z=6.450,P=0.000]、提高荧光渗漏吸收率[OR=4.910,95%CI(2.870,8.400),Z=5.800,P=0.000]、提高临床总有效率[OR=3.810,95%CI(1.990,7.310),Z=4.030,P=0.000]方面优于对照组,差异均有统计学意义。结论“补虚化浊法”中药联合抗VEGF治疗wAMD疗效优于单纯抗VEGF治疗。展开更多
AIM: To evaluate the efficacy of intravitreal injection of conbercept(IVC) and ranibizumab(IVR) in patients with diabetic macular edema.METHODS: Reviewers have searched 12 databases, including PubMed, Medline, EMBASE,...AIM: To evaluate the efficacy of intravitreal injection of conbercept(IVC) and ranibizumab(IVR) in patients with diabetic macular edema.METHODS: Reviewers have searched 12 databases, including PubMed, Medline, EMBASE, Web of Science, Springer, ScienceDirect, OVID, Cochrane Library, Clinical Trials.gov, cqVIP, WanFangdata and China National Knowledge Infrastructure(CNKI), up to December 28, 2018. Rev Man 5.3(Cochrane Library Software, Oxford, UK) was employed for statistical analysis. Fixed and random effects models were applied to assess heterogeneity. Odds ratio(OR) was applied for dichotomous variables;weighted mean difference(WMD) was applied for continuous variables. The confidence interval(CI) was set at 95%. Central macular thickness(CMT) and best-corrected visual acuity(BCVA) were employed to analyze the improvement of DME patients. Inclusion criteria for picking out studies were retrospective studies and randomized controlled trials(RCTs) that compared IVC and IVR for the treatment of diabetic macular edema.RESULTS: Four retrospective studies and five RCTs were included with a total of 609 patients. No statistically significant difference was observed in mean CMT and mean BCVA in the baseline parameters [BCVA(WMD:-0.48;95%CI:-1.06 to 0.10;P=0.1), CMT(WMD:-0.83;95%CI:-15.15 to 13.49;P=0.91). No significant difference was found in the improvement of BCVA and adverse event(AE) in IVC group, compared with IVR group after treatment of loading dosage [the 1 st month BCVA(WMD: 0.01;95%CI:-0.26 to 0.27;P=0.96), the 3 rd month BCVA(WMD:-0.04;95%CI:-0.14 to 0.06;P=0.46);the 6 th month BCVA(WMD:-0.24;95%CI:-1.62 to 1.14;P=0.73)], AE(OR: 0.84;95%CI: 0.38 to 1.84;P=0.66)]. A slight difference was found in the effectiveness rate(OR: 1.70;95%CI: 0.97 to 2.96;P=0.06), There were statistically significant differences between IVC and IVR treatment in terms of CMT (1 st month CMT(WMD:-19.88;95%CI:-27.94 to-11.82;P<0.001), 3 rd month CMT(WMD:-23.31;95%CI:-43.30 to-3.33;P=0.02), 6 th month CMT(WMD:-74.74;95%CI:-106.22 to-43.26;P<0.001))CONCLUSION: Pooled evidence suggests that both IVC and IVR are effective in the therapy of diabetic macular edema and affirms that IVC presents superiority over IVR therapy in regard of CMT in patients with diabetic macular edema, but no statistically significant difference with regard to visual improvement. Relevant RCTs with longerterm follow-up are necessary to back up our conclusion.展开更多
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 patien...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.展开更多
基金Supported by the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC21025.
文摘BACKGROUND No study has investigated the change regularity between age and subfoveal choroidal thickness(SFCT)in proliferative diabetic retinopathy(PDR).AIM To investigate the relationship between the SFCT and age in Chinese patients with PDR.METHODS This was a cross-sectional retrospective study.The participants were hospitalized individuals with type 2 diabetes who underwent vitrectomy for PDR.Contralateral eyes that met the criteria were included in the study.All necessary laboratory tests were performed at the time of admission.Central macular thickness(CMT)and SFCT were two quantitative assessments made using enhanced depth imaging optical coherence tomography.CMT was measured automatically and SFCT was measured manually with digital calipers provided by the Heidelberg Eye Explorer software.RESULTS The final analysis included a total of 234 individuals with PDR.The average age was 55.60 years old±10.03 years old,and 57.69%of the population was male.Univariate analysis revealed a significant negative connection between age and SFCT in patients with PDR[β=-2.44,95%confidence interval(95%CI):-3.46 to-1.42;P<0.0001].In the fully adjusted model,the correlation between SFCT and age remained steady(β=-1.68,95%CI:-2.97 to-0.39;P=0.0117).Spline smoothing showed that the relationship between SFCT and age in patients with PDR was non-linear,with an inflection point at 54 years of age.CONCLUSION Our findings suggest that age is a key determinant of choroidal thickness.The non-linear link between SFCT and age in PDR patients should be taken into account.
基金Youth Project of Liangxiang Hospital Fangshan District Beijing,No.2022-11.
文摘BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.
文摘AIM: To compare central macular thickness (CMT) measurements obtained by two spectral-domain optical coherence tomography (SD-OCT) exams, and to evaluate measurement reproducibility and agreement between these two exams, and to investigate the relationship between CMT and possible influencing factors such as age, sex, eye (OD/OS), and operators in elderly non-mydriatic eyes. METHODS: Seventy-two normal subjects were included. Every subject underwent CMT measurement twice using one of two SD-OCT (OSE-2000, Moptim, Shenzhen, China & 3-D OCT-1000, Topcon, Tokyo, Japan) instruments respectively where we randomly chose one eye in each patient for the test; these exams were performed by two operators over an hour period with a brief rest between sessions. Comparison of the OSE-2000 and 3-D OCT-1000 CMT measurements was based on paired- t test The mean difference between the CMT measurements was calculated. General linear model analyzed the relationships among eye (OD/OS), operator, sex, and CMT values using age as co-variant. All tests were considered statistically significant at P <0.05. The main outcome measures included CMT. RESULTS: When evaluated with general linear model analysis, CMT measurements were found to have high reproducibility across the two instruments between the two operators for the OSE-2000 single line scan and 3-D OCT-1000 macular scans (P=0.731; P=0.443). There was statistically significant difference in CMT values between the two instruments (P<0.001) and the mean difference was -46.83 mu m at 95% confidence limits (-49.15,-44.51). Age was positively correlated with CMT (beta coefficient =0.516, P=0.001; beta coefficient=0.453, P =0.009) and sex was correlated with CMT from the OSE-2000 (P=0.021) but not with the 3-D OCT-1000 (P=0.056). According to the actual thickness measurements, the CMT of the male was thicker than the female's but there was no statistical difference. There was interaction between sex and eye in OSE-2000 and not in 3-D OCT-1000 (P=0.02; P =0.374). No significant correlation was found between CMT and the influencing factor of eye in both of the instruments (P=0.884; P=0.492). CONCLUSION: Reproducibility of CMT measurement using the two SD-OCTs is excellent in normal eyes according to the operator factor analysis. OSE-2000 has a different posterior retinal boundary of CMT measurement, which results in the CMT value differences, compared with the 3-D OCT-1000. Age is positively correlated with CMT measurement while sex is correlated with CMT in the OSE-2000 but not in the 3-D OCT-1000 and eye (OD/OS) had no correlation with CMT values. Mydriatic drops may not be necessary for CMT measurement using high scan rate SD-OCT in normal eyes in dark room.
基金Supported by Fundacao de Amparoà Pesquisa do Estado de Sao Paulo(FAPESP)and FAEPA(Fundacao Apoioao Ensino Pesquisa e Assistência,HCFMRP-USP),(No.2010/013368)the initial trial was registered at clinical trials.gov(No.NCT01487629)
文摘AIM：To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor（anti-VEGF） therapy for center-involving diabetic macular edema（DME）.METHODS：Foveal thickness was assessed with optical coherence tomography to determine the central subfield foveal thickness（CSFT） and macular volume in 42 eyes with DME（CSFT〉275 μm）. Evaluations also included measurement of best-corrected visual acuity（BCVA）, and were performed at baseline, and upon foveal depression recovery achieved after 12 monthly intravitreal injections of either 1.5 mg/0.06 mL bevacizumab（n=21） or 0.5 mg/0.05 mL ranibizumab（n=21）. Data was compared to 42 eyes of normally sighted, non-diabetic, healthy individuals with similar age, gender and race distributions.RESULTS：Mean baseline BCVA was 0.59±0.04 and 0.32± 0.03 log MAR（P〈0.001） after treatment and resolution of DME, with all, but 3 eyes, showing BCVA improvement. Mean CSFT before treatment was 422.0±20.0 μm, and after treatment, decreased to 241.6±4.6 μm（P〈0.001）, which is significantly thinner than CSFT found in control subjects（272.0±3.4 μm; P〈0.001）. Moreover, in 33/42 DM eyes（79%）, CSTF was thinner than the matched control eye. Macular volume showed comparable results, but with lower differences between groups（control：8.5±0.4 mm^3; DME：8.2±1.0 mm^3; P=0.0267）.CONCLUSION：DME eyes show significantly lower foveal thickness than matched controls after DME resolution achieved with one-year anti-VEGF therapy. Further investigation into the reasonsfor this presumable retinal atrophy using fluorescein angiography and functional parameters as well as establishing possible predictors is warranted. This finding should be considered during the treatment of DME.
文摘目的系统评价“补虚化浊法”中药联合抗血管内皮生长因子(VEGF)治疗湿性年龄相关性黄斑变性(wAMD)的临床疗效。方法检索PubMed、Web of Science、Embase、中国知网、万方、维普、中国生物医学文献数据库中应用“补虚化浊法”中药治疗wAMD的随机对照试验文献,检索时间为建库至2023年5月31日,对文献按照纳入标准与排除标准进行筛选和数据录取,采用Cochrane软件评价文献质量,采用RevMan 5.4软件进行统计分析。结果共纳入13项研究,包括患者1,002例(1,041只眼),其中采用“补虚化浊法”联合抗VEGF治疗的治疗组501例(523只眼),单纯抗VEGF治疗的对照组501例(518只眼)。治疗组在提高国际标准视力[MD=0.100,95%CI(0.050,0.140),Z=4.310,P=0.000]、LogMAR视力[MD=-0.080,95%CI(-0.110,-0.050),Z=5.560,P=0.000]、视力总有效率[OR=2.070,95%CI(1.280,3.340),Z=2.970,P=0.000]、降低黄斑中心凹厚度[MD=-19.130,95%CI(-24.940,-13.310),Z=6.450,P=0.000]、提高荧光渗漏吸收率[OR=4.910,95%CI(2.870,8.400),Z=5.800,P=0.000]、提高临床总有效率[OR=3.810,95%CI(1.990,7.310),Z=4.030,P=0.000]方面优于对照组,差异均有统计学意义。结论“补虚化浊法”中药联合抗VEGF治疗wAMD疗效优于单纯抗VEGF治疗。
文摘AIM: To evaluate the efficacy of intravitreal injection of conbercept(IVC) and ranibizumab(IVR) in patients with diabetic macular edema.METHODS: Reviewers have searched 12 databases, including PubMed, Medline, EMBASE, Web of Science, Springer, ScienceDirect, OVID, Cochrane Library, Clinical Trials.gov, cqVIP, WanFangdata and China National Knowledge Infrastructure(CNKI), up to December 28, 2018. Rev Man 5.3(Cochrane Library Software, Oxford, UK) was employed for statistical analysis. Fixed and random effects models were applied to assess heterogeneity. Odds ratio(OR) was applied for dichotomous variables;weighted mean difference(WMD) was applied for continuous variables. The confidence interval(CI) was set at 95%. Central macular thickness(CMT) and best-corrected visual acuity(BCVA) were employed to analyze the improvement of DME patients. Inclusion criteria for picking out studies were retrospective studies and randomized controlled trials(RCTs) that compared IVC and IVR for the treatment of diabetic macular edema.RESULTS: Four retrospective studies and five RCTs were included with a total of 609 patients. No statistically significant difference was observed in mean CMT and mean BCVA in the baseline parameters [BCVA(WMD:-0.48;95%CI:-1.06 to 0.10;P=0.1), CMT(WMD:-0.83;95%CI:-15.15 to 13.49;P=0.91). No significant difference was found in the improvement of BCVA and adverse event(AE) in IVC group, compared with IVR group after treatment of loading dosage [the 1 st month BCVA(WMD: 0.01;95%CI:-0.26 to 0.27;P=0.96), the 3 rd month BCVA(WMD:-0.04;95%CI:-0.14 to 0.06;P=0.46);the 6 th month BCVA(WMD:-0.24;95%CI:-1.62 to 1.14;P=0.73)], AE(OR: 0.84;95%CI: 0.38 to 1.84;P=0.66)]. A slight difference was found in the effectiveness rate(OR: 1.70;95%CI: 0.97 to 2.96;P=0.06), There were statistically significant differences between IVC and IVR treatment in terms of CMT (1 st month CMT(WMD:-19.88;95%CI:-27.94 to-11.82;P<0.001), 3 rd month CMT(WMD:-23.31;95%CI:-43.30 to-3.33;P=0.02), 6 th month CMT(WMD:-74.74;95%CI:-106.22 to-43.26;P<0.001))CONCLUSION: Pooled evidence suggests that both IVC and IVR are effective in the therapy of diabetic macular edema and affirms that IVC presents superiority over IVR therapy in regard of CMT in patients with diabetic macular edema, but no statistically significant difference with regard to visual improvement. Relevant RCTs with longerterm follow-up are necessary to back up our conclusion.
文摘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.
