AIM: To compare the efficacy and safety of photodynamic therapy(PDT) with overlapping multiple spots and single spot for treating circumscribed choroidal hemangioma. · METHODS: Twenty-two patients(22 eyes) with s...AIM: To compare the efficacy and safety of photodynamic therapy(PDT) with overlapping multiple spots and single spot for treating circumscribed choroidal hemangioma. · METHODS: Twenty-two patients(22 eyes) with symptomatic circumscribed choroidal hemangioma received PDT treatment. Fourteen patients received overlapping spots(two to three spots) PDT,whereas eight patients received single-spot PDT. Laser was used at 50J/cm2for 83s in the overlapping-spot group and 50J/cm2for 166s in the single-spot group. Clinical examination,funduscopy,fluorescein angiography,and ultrasonography were performed at baseline and after treatment. ·RESULTS: The mean follow-up time was 28.5 ±8.0 months in the overlapping-spot group and 27.0 ±5.0 months in the single-spot group. Nine patients(64.2%) had their vision improved over two lines on the Snellen chart,and five patients showed stable visual acuity in the overlapping-spot group. The mean thickness of tumor decreased from 2.7 ±0.8mm to 1.2±0.9mm,and the mean greatest tumor linear dimension decreased from 7.4 ± 1.5mm to 4.5 ±3.5mm after treatment. In the single-spot group,two patients(25%) had their vision improved over two lines on the Snellen chart,and six patients had unchanged stable vision. The mean tumor thickness in this group decreased from 2.5±0.7mm to 1.4±1.0mm,and the mean greatest tumor linear dimension decreased from 7.2±1.3mm to 4.7±3.6mm. No significant differences in visual improvement and tumor regression were found between the two groups. ·CONCLUSION:Overlapping-spotPDTunderappropriate treatment parameters and strategies is as effective andsafe as single-spot PDT for treating symptomatic circumscribed choroidal hemangioma. Improved or stabilized visual acuity was achieved as a result of tumor regression.展开更多
AIM:To evaluate the efficacy of ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal hemangioma(DCH)in Sturge-Weber syndrome(SWS).METHODS:A total of 8 patients with DCH in SWS managed with plaque ...AIM:To evaluate the efficacy of ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal hemangioma(DCH)in Sturge-Weber syndrome(SWS).METHODS:A total of 8 patients with DCH in SWS managed with plaque brachytherapy were retrospectively included.Patients were treated with ruthenium-106 plaque therapy(median apex dose:83 Gy)at the thickest tumor region.On follow-up,we recorded the tumor thickness,the best-corrected visual acuity(BCVA),subretinal fluid(SRF)status,and complications following treatment.RESULTS:At a median follow-up of 43 mo,tumor regression was observed in all cases,with a complete resolution of SRF and reduction in tumor-thickness.No radiation complications were recorded during the follow up time.CONCLUSION:Ruthenium-106 plaque therapy to the thickest portion of the tumor seems to be a useful treatment in patients with DCH in SWS.展开更多
AIM:To evaluate the efficacy and safety of ruthenium-106(106Ru)plaque radiotherapy at a dose(>50 Gy)higher than recommended(29-50 Gy)for treatment of circumscribed choroidal hemangioma(CCH)in Chinese patients.METHO...AIM:To evaluate the efficacy and safety of ruthenium-106(106Ru)plaque radiotherapy at a dose(>50 Gy)higher than recommended(29-50 Gy)for treatment of circumscribed choroidal hemangioma(CCH)in Chinese patients.METHODS:This retrospective study included 25symptomatic CCH patients undergoing 106Ru plaque brachytherapy involving 25 eyes between January 2005and August 2016.Ophthalmic examination was performed at the baseline and at each post-treatment follow-up visit,using best-corrected visual acuity(BCVA),dilated fundus examination,and B-scan ultrasonography.The primary efficacy outcome measures included the changes in BCVA and hemangioma dimensions at the last followup visit from the baseline.RESULTS:The mean follow-up duration was 28.0±26.6(range,12-110)mo.All the hemangiomas were located in the posterior pole except for two involving the fovea.The mean apex dose of 106Ru plaque radiotherapy was84.4±19.7 Gy.The mean BCVA improved from 41.4±29.3(0-97)at the baseline to 53.0±33.8(0-97)ETDRS letters at the last visit(P=0.01).The mean hemangioma height declined from 3.98±0.88(2.40-5.50)mm to 0.84±1.63(0-6.47)mm(P≤0.001),and the greatest linear diameter(GLD)reduced from 9.36±2.23(6.80-15.00)to 7.40±2.45(0-13.00)mm(P≤0.001).Hemangioma size increased in one(4%)eye with a worsened vision,and subretinal fluid completely resolved in all but one patient(4%).Radiationrelated retinopathy was observed in two patients at posttreatment 9 and 11mo,respectively.CONCLUSION:106Ru plaque brachytherapy at a dose(>50 Gy)higher than recommended(29-50 Gy)is an effective treatment regimen for symptomatic CCH associated with significantly improved visual acuity and a favorable safety profile in Chinese patients.展开更多
Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal ...Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.展开更多
AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interven...AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections(0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity(VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy(PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity(BCVA), central foveal thickness(CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS: A total of 56 eyes(56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters(P<0.001) at 12 mo, while CFT decreased significantly from 457.41±207.86 μm to 247.98±127.08 μm(P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12 mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION: Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.展开更多
AIMTo compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV).METHODSA systematic sear...AIMTo compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV).METHODSA systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis.RESULTSThree RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study.CONCLUSIONIVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.展开更多
AIM:To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF),photodynamic therapy(PDT),and laser treatment(LT)for anatomical and functional improvement in myopic choroid...AIM:To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF),photodynamic therapy(PDT),and laser treatment(LT)for anatomical and functional improvement in myopic choroidal neovascularization(mCNV)patients.METHODS:Two researchers independently searched PubMed,Cochrane Library,Web of Science,and other databases to screen studies comparing best-corrected vision acuity(BCVA)and foveal center thickness(FCT)changes after mCNV treatment.Post-treatment chorioretinal atrophy(CRA)is a secondary outcome indicator.The retrieval time limit is from the database construction to January 30,2023.RESULTS:A total of 1072 eyes in 16 articles were included.In the RCTs,intravitreal bevacizumab(IVB)and intravitreal ranibizumab(IVR)were superior to PDT(MD=0.18,95%CI:0.02,0.40,MD=0.18,95%CI:0.01,0.42)in improving BCVA of mCNV patients(P<0.05).The relative effectiveness in improving BCVA,from high to low,appeared to be IVR,intravitreal aflibercept(IVA),IVB,LT,PDT,and sham first followed by IVA(Sham/IVA).While improving the FCT from high to low was IVA,IVR,IVB,PDT.In retrospective studies,the results of BCVA after long-term treatment showed that all the therapeutic effects from high to low was IVA,intravitreal conbercept(IVC),IVR,IVB,IVB/IVR,PDT with IVB/IVR,PDT.The effect of improving FCT was IVA,IVR,IVC,PDT,and IVB from high to low.And in the effects of improving CRA,the IVB appeared to be higher than IVR,while the PDT was the smallest,but none of the differences in the results were statistically significant.CONCLUSION:Anti-VEGF has the best effect on longterm vision improvement in mCNV patients,using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT.There is no significant difference in the improvement of visual acuity,macular edema,and CRA in mCNV patients treated with any different anti-VEGF drugs.展开更多
We present a case of circumscribed choroidal hemangioma (CCH) in Sturge-Weber syndrome in a 30-year-old woman with congenital port-wine stains on the left side of face involving the upper eyelid, cheek and the nose, a...We present a case of circumscribed choroidal hemangioma (CCH) in Sturge-Weber syndrome in a 30-year-old woman with congenital port-wine stains on the left side of face involving the upper eyelid, cheek and the nose, and she had undergone facial hemangioma surgery 3 years ago suggestive of Sturge-Weber syndrome. She presented with a 1-month history of rapidly decreased visual acuity (VA) to counting fingers in the left eye which had no prior history of visual problem. And there was no evidence of glaucoma. At 3 months after the treatment of the standard photodynannic therapy (PDT) the VA was 20/200. For some reasons, we have no idea about the changes of tumor thickness and subretinal fluid. We confirmed the curative effect of PDT treatment for CCH because of the significantly improved VA in the bad eye.展开更多
AIM: To evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy (PCV). MET...AIM: To evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy (PCV). METHODS: We conducted a Meta-analysis of 9 studies to compare the efficacy and safety between combined therapy and anti-VEGF monotherapy for PCV. The programs of RevMan 5.3 and Stata 12.0 were used to analyze data. RESULTS: The best corrected visual acuity (BCVA) in combined therapy group were significantly better than those of anti-VEGF monotherapy group at 6, 24 and 36mo, with pooled weighted means differences (WMDs) of 0.12 (0.06, 0.18), 0.25 (0.12, 0.38) and 0.28 (0.13, 0.43), respectively. The central retinal thickness (CRT) reductions in combined therapy group were higher than that in anti- VEGF monotherapy group at 1, 3, 6 and 9mo, with pooled WMDs of 63.90 (20.41, 107.38), 33.47 (4.69, 62.24), 30.57 (0.12, 60.01) and 28.00 (2.51, 53.49), respectively. The regression rate of polyps in combined therapy group was much higher than that in anti-VEGF monotherapy group [RD: 0.47 (0.26, 0.68); P〈0.0001]. The adverse event retinal hemorrhage did not differ significantly between the two groups. CONCLUSION: Our findings clearly document that anti- VEGF combined with PDT is a more effective therapy for PCV compared with anti-VEGF monotherapy. Furthermore, combined therapy does not increase the incidence of retinal hemorrhage.展开更多
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 ...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.展开更多
AIM: To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia and the impact of novel risk factors affecting the final visual outcome. ·METHODS: Interventional case s...AIM: To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia and the impact of novel risk factors affecting the final visual outcome. ·METHODS: Interventional case series of 18 consecutive patients with pathological myopia treated with photodynamic therapy (PDT). Inclusion criteria were spherical equivalent -6D or worse or features of pathological myopia on retinal examination. The main outcome measure was final best -corrected visual acuity (BCVA). ·RESULTS: Of 18 eyes, 13 (72.2%) avoided moderate visual loss (≥3 lines of LogMAR BCVA) and 5 eyes (27.8%) improved by at least 1 line after 1 year. Patients with LogMAR BCVA ≤0.3 (Snellen equivalent 20/40) at one year were younger than those with BCVA 】0.3 (mean age 39.0 vs 61.6 years, P =0.001). A higher proportion of eyes with greatest linear dimension (GLD) of ≤1 000μm avoided moderate visual loss (100% vs 50%, P =0.026). Among patients who were treated within 2 weeks of visual symptoms, 88.9% avoided the loss of 3 or more lines compared to 55.6% for those who presented later. The mean improvement in LogMAR BCVA of those with GLD ≤1 000μm was +0.12 compared to a loss of 0.55 LogMAR units for those with GLD 】1 000μm (P =0.02). Visual outcomes were not associated with gender or refractive error.·CONCLUSION: Good visual outcome in myopic CNV is associated with younger age, smaller lesion size and earlier initiation of treatment. These factors are relevant for ophthalmologists considering treatment options for myopic CNV.展开更多
Plaque brachytherapy has been a mainstay of treatment for choroidal melanoma to achieve intraocular tumor control. The most common radioisotopes used for treating smaller sized tumors are Iodine-125 in North America a...Plaque brachytherapy has been a mainstay of treatment for choroidal melanoma to achieve intraocular tumor control. The most common radioisotopes used for treating smaller sized tumors are Iodine-125 in North America and Ruthenium-106 in Europe. Proton beam radiotherapy is available at a few centers and may also be used to achieve local tumor control. Both plaque and proton beam therapy are known to be associated with a range of complications that may affect visual outcome and quality of life. These include radiation retinopathy, optic neuropathy, neovascular glaucoma and local treatment failure, requiring enucleation. While differences in the rates of these complications have not been well established in the literature for patients treated with plaque versus proton beam therapy for choroidal melanoma, certain geographic regions prefer one treatment modality over the other. The purpose of this qualitative systematic review was to compare and contrast reported complications that developed with plaque and proton beam therapy for the treatment of choroidal melanoma in studies published over a ten-year period. Reported rates suggest that patients with proton beam therapy had potentially higher rates of complications, including vision loss, enucleation, and neovascular glaucoma compared to those with plaque therapy. The rates of optic neuropathy, radiation retinopathy, and cataract formation were widely variable for the two treatment modalities and rates of metastasis and metastasis-free survival appeared similar with both treatments. The most common reported predictors of ocular complications following both types of therapy were tumor distance from the optic nerve, tumor thickness, and radiation dose, suggesting that inherent tumor characteristics play a role in visual prognosis.展开更多
INTRODUCTION Non-small cell lung cancer(NSCLC)is a common malignant disease with an extremely poor prognosis.Lung cancer has been reported to metastasize to the eye in 0.2%to7%of patients based on clinical studies,a...INTRODUCTION Non-small cell lung cancer(NSCLC)is a common malignant disease with an extremely poor prognosis.Lung cancer has been reported to metastasize to the eye in 0.2%to7%of patients based on clinical studies,and in 6%to 7%of patients based on postmortem histopathologic studies.展开更多
Myopic choroidal neovascularization(m CNV), one of the complications of pathological myopia, is also one of the leading causes of visual impairment worldwide. The socioeconomic impact of mC NV in Asian countries is pa...Myopic choroidal neovascularization(m CNV), one of the complications of pathological myopia, is also one of the leading causes of visual impairment worldwide. The socioeconomic impact of mC NV in Asian countries is particularly significant due to the rising incidence of pathological myopia. There have been major advances in the treatment of mC NV in the past few years. Previous treatment modalities, such as thermal laser photocoagulation and photodynamic therapy, aimed to prevent vision loss;however, newer modalities such as intravitreal anti-vascular endothelial growth factor(VEGF) agents have been shown to successfully restore vision in many patients. Challenges remain as long term safety and efficacy of anti-VEGF agents are unknown. This article aims to provide a review of the literature of the epidemiology, progression, clinical course and treatment modalities as well as areas of future developments related to myopic CNV.展开更多
AIM To investigate the source of blood supply of carvenous hemangioma of liver (CHL) and provide a feasibile treatment for CHL via hepatic artery. METHODS Ⅰ. Origin of blood supply of CHL: portovenography, hepatic...AIM To investigate the source of blood supply of carvenous hemangioma of liver (CHL) and provide a feasibile treatment for CHL via hepatic artery. METHODS Ⅰ. Origin of blood supply of CHL: portovenography, hepatic arteriography and portal vein staining were performed in 5 patients. Two casts of hepatic blood vessels from resected specimen were observed. Ⅱ. Clinical data: Among 75 patients (30 males, 45 females, aged 25~57 years with a mean of 37 4). 56 were of solitary type (44 on the right lobe, 12 on the left with 4 having intraparenchymatoma) and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty two patients were treated by sclerosis, 50 by embolization via hepatic artery and 3 were excised. RESULTS In 5 cases with portography, the contrast medium did not enter the tumor, the tumor appeared as low denty area and the intrahepatic branches of portal vein were pushed aside. In 5 cases with portal vein staining, the normal liver parenchyma was stained deep blue, and the tumor was not stained. The tumor area appeared as a round vacant cavity in 2 specimen casts. In 72 patients treated with sclerosis a or embolization via hepatic artery or through interventional method, the tumors diminished by 10%~30% in diameter and no tumors grew larger. CONCLUSION The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and emblization decreased in size or got fiberized.展开更多
基金Supported by the Zhejiang Medical Science Research Foundation of China(No.2009A108)Zhejiang Key Innovation Team Project of China(No.2011R09039-02)Zhejiang Key Laboratory Fund of China(No.2011E10006)
文摘AIM: To compare the efficacy and safety of photodynamic therapy(PDT) with overlapping multiple spots and single spot for treating circumscribed choroidal hemangioma. · METHODS: Twenty-two patients(22 eyes) with symptomatic circumscribed choroidal hemangioma received PDT treatment. Fourteen patients received overlapping spots(two to three spots) PDT,whereas eight patients received single-spot PDT. Laser was used at 50J/cm2for 83s in the overlapping-spot group and 50J/cm2for 166s in the single-spot group. Clinical examination,funduscopy,fluorescein angiography,and ultrasonography were performed at baseline and after treatment. ·RESULTS: The mean follow-up time was 28.5 ±8.0 months in the overlapping-spot group and 27.0 ±5.0 months in the single-spot group. Nine patients(64.2%) had their vision improved over two lines on the Snellen chart,and five patients showed stable visual acuity in the overlapping-spot group. The mean thickness of tumor decreased from 2.7 ±0.8mm to 1.2±0.9mm,and the mean greatest tumor linear dimension decreased from 7.4 ± 1.5mm to 4.5 ±3.5mm after treatment. In the single-spot group,two patients(25%) had their vision improved over two lines on the Snellen chart,and six patients had unchanged stable vision. The mean tumor thickness in this group decreased from 2.5±0.7mm to 1.4±1.0mm,and the mean greatest tumor linear dimension decreased from 7.2±1.3mm to 4.7±3.6mm. No significant differences in visual improvement and tumor regression were found between the two groups. ·CONCLUSION:Overlapping-spotPDTunderappropriate treatment parameters and strategies is as effective andsafe as single-spot PDT for treating symptomatic circumscribed choroidal hemangioma. Improved or stabilized visual acuity was achieved as a result of tumor regression.
文摘AIM:To evaluate the efficacy of ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal hemangioma(DCH)in Sturge-Weber syndrome(SWS).METHODS:A total of 8 patients with DCH in SWS managed with plaque brachytherapy were retrospectively included.Patients were treated with ruthenium-106 plaque therapy(median apex dose:83 Gy)at the thickest tumor region.On follow-up,we recorded the tumor thickness,the best-corrected visual acuity(BCVA),subretinal fluid(SRF)status,and complications following treatment.RESULTS:At a median follow-up of 43 mo,tumor regression was observed in all cases,with a complete resolution of SRF and reduction in tumor-thickness.No radiation complications were recorded during the follow up time.CONCLUSION:Ruthenium-106 plaque therapy to the thickest portion of the tumor seems to be a useful treatment in patients with DCH in SWS.
文摘AIM:To evaluate the efficacy and safety of ruthenium-106(106Ru)plaque radiotherapy at a dose(>50 Gy)higher than recommended(29-50 Gy)for treatment of circumscribed choroidal hemangioma(CCH)in Chinese patients.METHODS:This retrospective study included 25symptomatic CCH patients undergoing 106Ru plaque brachytherapy involving 25 eyes between January 2005and August 2016.Ophthalmic examination was performed at the baseline and at each post-treatment follow-up visit,using best-corrected visual acuity(BCVA),dilated fundus examination,and B-scan ultrasonography.The primary efficacy outcome measures included the changes in BCVA and hemangioma dimensions at the last followup visit from the baseline.RESULTS:The mean follow-up duration was 28.0±26.6(range,12-110)mo.All the hemangiomas were located in the posterior pole except for two involving the fovea.The mean apex dose of 106Ru plaque radiotherapy was84.4±19.7 Gy.The mean BCVA improved from 41.4±29.3(0-97)at the baseline to 53.0±33.8(0-97)ETDRS letters at the last visit(P=0.01).The mean hemangioma height declined from 3.98±0.88(2.40-5.50)mm to 0.84±1.63(0-6.47)mm(P≤0.001),and the greatest linear diameter(GLD)reduced from 9.36±2.23(6.80-15.00)to 7.40±2.45(0-13.00)mm(P≤0.001).Hemangioma size increased in one(4%)eye with a worsened vision,and subretinal fluid completely resolved in all but one patient(4%).Radiationrelated retinopathy was observed in two patients at posttreatment 9 and 11mo,respectively.CONCLUSION:106Ru plaque brachytherapy at a dose(>50 Gy)higher than recommended(29-50 Gy)is an effective treatment regimen for symptomatic CCH associated with significantly improved visual acuity and a favorable safety profile in Chinese patients.
文摘Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.
文摘AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections(0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity(VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy(PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity(BCVA), central foveal thickness(CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS: A total of 56 eyes(56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters(P<0.001) at 12 mo, while CFT decreased significantly from 457.41±207.86 μm to 247.98±127.08 μm(P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12 mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION: Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.
基金Supported by the National Natural Science Foundation of China(No.81373826,No.81100658)Development Project of Science and Technology of Traditional Chinese Medicine of Shandong Province(No.2013ZDZK-083)Development Project of Medicine and Health Science Technology of Shandong Province(No.2013WS0251)
文摘AIMTo compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV).METHODSA systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis.RESULTSThree RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study.CONCLUSIONIVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.
基金Supported by 2023 Research Fund of Aier Ophthalmology Research Institute(No.AEI202310LC01).
文摘AIM:To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF),photodynamic therapy(PDT),and laser treatment(LT)for anatomical and functional improvement in myopic choroidal neovascularization(mCNV)patients.METHODS:Two researchers independently searched PubMed,Cochrane Library,Web of Science,and other databases to screen studies comparing best-corrected vision acuity(BCVA)and foveal center thickness(FCT)changes after mCNV treatment.Post-treatment chorioretinal atrophy(CRA)is a secondary outcome indicator.The retrieval time limit is from the database construction to January 30,2023.RESULTS:A total of 1072 eyes in 16 articles were included.In the RCTs,intravitreal bevacizumab(IVB)and intravitreal ranibizumab(IVR)were superior to PDT(MD=0.18,95%CI:0.02,0.40,MD=0.18,95%CI:0.01,0.42)in improving BCVA of mCNV patients(P<0.05).The relative effectiveness in improving BCVA,from high to low,appeared to be IVR,intravitreal aflibercept(IVA),IVB,LT,PDT,and sham first followed by IVA(Sham/IVA).While improving the FCT from high to low was IVA,IVR,IVB,PDT.In retrospective studies,the results of BCVA after long-term treatment showed that all the therapeutic effects from high to low was IVA,intravitreal conbercept(IVC),IVR,IVB,IVB/IVR,PDT with IVB/IVR,PDT.The effect of improving FCT was IVA,IVR,IVC,PDT,and IVB from high to low.And in the effects of improving CRA,the IVB appeared to be higher than IVR,while the PDT was the smallest,but none of the differences in the results were statistically significant.CONCLUSION:Anti-VEGF has the best effect on longterm vision improvement in mCNV patients,using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT.There is no significant difference in the improvement of visual acuity,macular edema,and CRA in mCNV patients treated with any different anti-VEGF drugs.
文摘We present a case of circumscribed choroidal hemangioma (CCH) in Sturge-Weber syndrome in a 30-year-old woman with congenital port-wine stains on the left side of face involving the upper eyelid, cheek and the nose, and she had undergone facial hemangioma surgery 3 years ago suggestive of Sturge-Weber syndrome. She presented with a 1-month history of rapidly decreased visual acuity (VA) to counting fingers in the left eye which had no prior history of visual problem. And there was no evidence of glaucoma. At 3 months after the treatment of the standard photodynannic therapy (PDT) the VA was 20/200. For some reasons, we have no idea about the changes of tumor thickness and subretinal fluid. We confirmed the curative effect of PDT treatment for CCH because of the significantly improved VA in the bad eye.
文摘AIM: To evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy (PCV). METHODS: We conducted a Meta-analysis of 9 studies to compare the efficacy and safety between combined therapy and anti-VEGF monotherapy for PCV. The programs of RevMan 5.3 and Stata 12.0 were used to analyze data. RESULTS: The best corrected visual acuity (BCVA) in combined therapy group were significantly better than those of anti-VEGF monotherapy group at 6, 24 and 36mo, with pooled weighted means differences (WMDs) of 0.12 (0.06, 0.18), 0.25 (0.12, 0.38) and 0.28 (0.13, 0.43), respectively. The central retinal thickness (CRT) reductions in combined therapy group were higher than that in anti- VEGF monotherapy group at 1, 3, 6 and 9mo, with pooled WMDs of 63.90 (20.41, 107.38), 33.47 (4.69, 62.24), 30.57 (0.12, 60.01) and 28.00 (2.51, 53.49), respectively. The regression rate of polyps in combined therapy group was much higher than that in anti-VEGF monotherapy group [RD: 0.47 (0.26, 0.68); P〈0.0001]. The adverse event retinal hemorrhage did not differ significantly between the two groups. CONCLUSION: Our findings clearly document that anti- VEGF combined with PDT is a more effective therapy for PCV compared with anti-VEGF monotherapy. Furthermore, combined therapy does not increase the incidence of retinal hemorrhage.
文摘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.
基金Dr. Tan receives travel support from BayerBayer. Dr. Lim receives travel support from Novartis, Bayer and Heidelberg Engineering
文摘AIM: To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia and the impact of novel risk factors affecting the final visual outcome. ·METHODS: Interventional case series of 18 consecutive patients with pathological myopia treated with photodynamic therapy (PDT). Inclusion criteria were spherical equivalent -6D or worse or features of pathological myopia on retinal examination. The main outcome measure was final best -corrected visual acuity (BCVA). ·RESULTS: Of 18 eyes, 13 (72.2%) avoided moderate visual loss (≥3 lines of LogMAR BCVA) and 5 eyes (27.8%) improved by at least 1 line after 1 year. Patients with LogMAR BCVA ≤0.3 (Snellen equivalent 20/40) at one year were younger than those with BCVA 】0.3 (mean age 39.0 vs 61.6 years, P =0.001). A higher proportion of eyes with greatest linear dimension (GLD) of ≤1 000μm avoided moderate visual loss (100% vs 50%, P =0.026). Among patients who were treated within 2 weeks of visual symptoms, 88.9% avoided the loss of 3 or more lines compared to 55.6% for those who presented later. The mean improvement in LogMAR BCVA of those with GLD ≤1 000μm was +0.12 compared to a loss of 0.55 LogMAR units for those with GLD 】1 000μm (P =0.02). Visual outcomes were not associated with gender or refractive error.·CONCLUSION: Good visual outcome in myopic CNV is associated with younger age, smaller lesion size and earlier initiation of treatment. These factors are relevant for ophthalmologists considering treatment options for myopic CNV.
文摘Plaque brachytherapy has been a mainstay of treatment for choroidal melanoma to achieve intraocular tumor control. The most common radioisotopes used for treating smaller sized tumors are Iodine-125 in North America and Ruthenium-106 in Europe. Proton beam radiotherapy is available at a few centers and may also be used to achieve local tumor control. Both plaque and proton beam therapy are known to be associated with a range of complications that may affect visual outcome and quality of life. These include radiation retinopathy, optic neuropathy, neovascular glaucoma and local treatment failure, requiring enucleation. While differences in the rates of these complications have not been well established in the literature for patients treated with plaque versus proton beam therapy for choroidal melanoma, certain geographic regions prefer one treatment modality over the other. The purpose of this qualitative systematic review was to compare and contrast reported complications that developed with plaque and proton beam therapy for the treatment of choroidal melanoma in studies published over a ten-year period. Reported rates suggest that patients with proton beam therapy had potentially higher rates of complications, including vision loss, enucleation, and neovascular glaucoma compared to those with plaque therapy. The rates of optic neuropathy, radiation retinopathy, and cataract formation were widely variable for the two treatment modalities and rates of metastasis and metastasis-free survival appeared similar with both treatments. The most common reported predictors of ocular complications following both types of therapy were tumor distance from the optic nerve, tumor thickness, and radiation dose, suggesting that inherent tumor characteristics play a role in visual prognosis.
文摘INTRODUCTION Non-small cell lung cancer(NSCLC)is a common malignant disease with an extremely poor prognosis.Lung cancer has been reported to metastasize to the eye in 0.2%to7%of patients based on clinical studies,and in 6%to 7%of patients based on postmortem histopathologic studies.
文摘Myopic choroidal neovascularization(m CNV), one of the complications of pathological myopia, is also one of the leading causes of visual impairment worldwide. The socioeconomic impact of mC NV in Asian countries is particularly significant due to the rising incidence of pathological myopia. There have been major advances in the treatment of mC NV in the past few years. Previous treatment modalities, such as thermal laser photocoagulation and photodynamic therapy, aimed to prevent vision loss;however, newer modalities such as intravitreal anti-vascular endothelial growth factor(VEGF) agents have been shown to successfully restore vision in many patients. Challenges remain as long term safety and efficacy of anti-VEGF agents are unknown. This article aims to provide a review of the literature of the epidemiology, progression, clinical course and treatment modalities as well as areas of future developments related to myopic CNV.
文摘AIM To investigate the source of blood supply of carvenous hemangioma of liver (CHL) and provide a feasibile treatment for CHL via hepatic artery. METHODS Ⅰ. Origin of blood supply of CHL: portovenography, hepatic arteriography and portal vein staining were performed in 5 patients. Two casts of hepatic blood vessels from resected specimen were observed. Ⅱ. Clinical data: Among 75 patients (30 males, 45 females, aged 25~57 years with a mean of 37 4). 56 were of solitary type (44 on the right lobe, 12 on the left with 4 having intraparenchymatoma) and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty two patients were treated by sclerosis, 50 by embolization via hepatic artery and 3 were excised. RESULTS In 5 cases with portography, the contrast medium did not enter the tumor, the tumor appeared as low denty area and the intrahepatic branches of portal vein were pushed aside. In 5 cases with portal vein staining, the normal liver parenchyma was stained deep blue, and the tumor was not stained. The tumor area appeared as a round vacant cavity in 2 specimen casts. In 72 patients treated with sclerosis a or embolization via hepatic artery or through interventional method, the tumors diminished by 10%~30% in diameter and no tumors grew larger. CONCLUSION The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and emblization decreased in size or got fiberized.