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).

Differential analysis of aqueous humor cytokine levels in patients with macular edema secondary to diabetic retinopathy or retinal vein occlusion

AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:This is a retrospective case control study.The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor(VEGF)for patients diagnosed with macular edema secondary to DR(DME)or RVO(RVO-ME)at Xijing Hospital from August 2021 to July 2022.Meanwhile,aqueous humor samples during vitrectomy from patients with idiopathic macular hole(IMH)were also collected and served as controls.The aqueous humor concentrations of VEGF,platelet-derived factor(PDGF),interleukin(IL)-6,IL-8,IL-18,tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein 1(MCP-1)were measured with Human Premixed Multi-Analyte Kit(Luminex).The difference of the aqueous cytokines and the correlation between the two diseases were analyzed.RESULTS:A total of 40 eyes of 38 patients were enrolled in the study,including 13 eyes of 11 DME patients(DME group),16 eyes of 16 RVO-ME patients(RVO-ME group)and 11 eyes of 11 IMH patients(control group).The VEGF,PDGF,IL-6,IL-8,and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group(all P<0.05),the levels of TNF-αwas higher in the DME group than in the control group(P<0.05).The VEGF,IL-6,MCP-1,and TNF-αlevels in the aqueous humor were significantly higher in the DR group than those in the RVO group(all P<0.05).Correlation analyses revealed that there were complex positive correlations between IL-6,IL-8,IL-18,MCP-1,and TNF-αlevels in the aqueous humor of eyes with two diseases.CONCLUSION:Although ischemic and inflammatory factors are similarly involved in the pathogenesis of DME and RVO-ME,the roles of these factors are more significant or more likely to be activated in DR patients,suggesting different treatment strategies should be considered for the two diseases.

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.

Evaluation of outer retinal tubulations in diabetic macular edema underwent anti-VEGF treatment

AIM: To investigate the incidence and subsequent changes of outer retinal tubulations(ORTs) in diabetic macular edema(DME) underwent anti-vascular endothelial growth factor(VEGF) therapy, and to assess the possibility of ORT as a biomarker of DME severity or response to anti-VEGF therapy.METHODS: This retrospective and descriptive study included a total of 228 patients(435 eyes) with DME and treated with intravitreal anti-VEGF agents between March 2016 and January 2018. Patients were divided into 2 groups according to the presence of ORTs. High-resolution spectral-domain optical coherence tomography(SD-OCT) images acquired by vertical and horizontal scans and over consecutive visits were analyzed. The evolution of ORT over time, type of fluid and subfoveal photoreceptor integrity on OCT imaging was also assessed. RESULTS: ORTs were identified in 108 eyes of 435 eyes with an overall incidence rate of 24.83% at baseline. ORTs were prone to locate adjacent to the lesions of exudation and/or cystoid edema and possibly situated in outer nuclear layer(ONL), outer plexiform layer(OPL) and/or inner nuclear layer(INL) in eyes with DME. The formation process of ORT led to focal downward displacement of OPL and INL toward RPE near the lesion. During the follow up, 45 eyes had steady ORTs and 63 eyes had dynamic variants in ORTs, including disappearance, reappearance, collapse, diminution, and enlargement. There were higher proportion of closed ORTs and fewer proportion of forming ORTs in eyes with steady ORTs, which showed a statistically significance when compared with eyeswith variant ORTs(P=0.006, P=0.017, respectively). The eyes without ORTs had significantly better final best corrected visual acuity(BCVA) and more BCVA change than those eyes with ORTs in DME patients after antiVEGF therapy(P=0.023, P=0.009, respectively). The disruption of subfoveal photoreceptor integrity in eyes with ORTs was more serious than that in eyes without ORTs(P=0.013). The proportion of stable vision in eyes with ORTs was significantly higher than that in eyes without ORTs, showing statistical significance(P=0.016). ORTs were associated with worse visual prognosis due to damage of the subfoveal photoreceptor integrity. CONCLUSION: ORTs have a high incidence and changes over time in DME with anti-VEGF treatment and may be located at various retinal layers. Persistent ORT can be as a negative biomarker of outcome of DME.

Malfunction of outer retinal barrier and choroid in the occurrence and progression of diabetic macular edema

Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.

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.

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.

The thickness and volume of the choroid,outer retinal layers and retinal pigment epithelium layer changes in patients with diabetic retinopathy

AIM: To evaluate the thickness and volume changes of the choroidal, outer retinal layers(ORL) and retinal pigment epithelium(RPE) in patients with diabetic retinopathy(DR) using optical coherence tomography(OCT) and correlate them with visual acuity.METHODS: We carried out a retrospective observational case series. Consecutive DR patients were recruited for color fundus photography and OCT assessment. The RPE, ORL and choroidal thickness were measured. The correlation with the best-corrected visual acuity(BCVA) was also investigated.RESULTS: The study included 128 eyes, comprising 45 eyes of 25 diabetic macular edema(DME) patients, 34 eyes of 20 DR without DME(non-DME) patients, and 49 eyes of 25 age-matched normal individuals. The choroidal thickness in DR patients were decreased statistically significantly compared with the control group(P<0.05). The mean macular ORL thickness in DME(73.02±15.34 μm) and non-DME groups(76.35±7.32 μm) were decreased statistically significantly compared with the control group(80.20±5.85 μm; P=0.006, P=0.013, respectively). In both the non-DME and DME groups, the RPE thickness were decreased compared with the control group(P<0.05), except in the macular and central ring. The BCVA were significant interactions with the total inner retinal volume and macular RPE thickness in the DME group(r=0.115, P<0.001, r=-0.013, P=0.017, respectively).CONCLUSION: The choroid, ORL and RPE thickness are significantly decreased in DR patients compared with controls in different segments.

Infl iximab relieves blood retinal barrier breakdown through the p38 MAPK pathway in a diabetic rat model

AIM： To clarify the mechanism of infliximab treatment in diabetic macular edema （DME） and to provide a new alternative therapy for DME. METHODS： Rats were randomly divided into the control group, the model group and the infliximab treatment group. A diabetic rat model was created. The concentration of TNF-α in the vitreous body was detected by ELISA. The expressions of B-Raf, p38, claudin-1 and occludin in the retina were detected by Western blot. The integrity of the blood retinal barrier （BRB） was measured using Evan＇s blue as a tracer. RESULTS： After three months and six months of the diabetes model, the vitreous TNF-α level in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant （at 3mo, F=857.098, P〈0.001; 6mo, F=1261.897, P〈0.001）. The retina B-Raf and p38 levels in the model group were higher than that of the control group. They were also higher in treated group than that of the control group but were lower than that of the model group. The differences among the three groups were statistically significant （B-Raf at 3mo, F=106.596, P〈0.001 and at 6mo, F=200.681, P〈0.001; p38 at 3mo, F=41.662, P〈0.001 and at 6mo, F=67.979, P〈0.001）. The retina claudin-1 and occludin levels in the model group were lower than that of the control group. They were also lower in treated group than that of the control group but were higher than that of the model group. The differences among three groups were statistically significant （claudin-1 at3mo, F=-139.088, P〈0.001 and at 6mo, F=128.415, P〈0.001; occludin at 3mo, F=-92.733, P〈0.001 and at 6mo, F--104.478, P〈0.001）. The retinal Evans blue leakage in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant （at 3mo, F=-447.946, P〈0.001; at 6mo, F＇=-1610.732, P〈0.001）. CONCLUSION： In-α diabetic rat model, infliximab may relieve TNF-α induced BRB breakdown via the B-Raf and p38 signaling pathway.

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。

雷珠单抗两种给药策略对糖尿病黄斑水肿视觉功能、中心凹视网膜厚度、角膜内皮细胞密度的影响

目的探讨雷珠单抗不同给药策略对糖尿病黄斑水肿(DME)视觉功能、中心凹视网膜厚度(FT)、角膜内皮细胞密度的影响。方法选取2020年6月至2022年6月郑州市第二人民医院眼科收治的60例DME患者作为研究对象,采用随机数表法分为常规组(30例39眼)和强化组(30例42眼),所有患者均予以玻璃体内注射雷珠单抗治疗,常规组患者予以3+按需治疗(PRN)给药方案,强化组予以5+PRN给药方案,两组患者均随访12个月观察疗效。比较两组患者PRN治疗期间患眼注射次数、补救性光凝次数,以及治疗3个月、6个月、9个月、12个月后的最佳矫正视力(BCVA)较基线提高字母数、黄斑中心凹厚度(FT)和治疗3个月、6个月、12个月后的角膜内皮细胞密度、六角形细胞比例、角膜神经变化,同时比较两组患者治疗期间的不良反应发生情况。结果强化组患者PRN治疗期间患眼注射次数、补救性光凝次数分别为(2.40±0.80)次、(1.12±0.30)次,明显少于常规组的(4.10±1.00)次、(1.97±0.64)次,差异均有统计学意义(P<0.05);强化组患者治疗6个月、9个月、12个月后患眼BCVA较基线提高字母数分别为(5.06±0.82)个、(7.83±1.21)个、(10.20±3.14)个,明显高于常规组的(4.30±0.77)个、(5.64±1.30)个、(8.96±2.55)个,差异均有统计学意义(P<0.05);强化组患者治疗12个月后患眼BCVA提高>10个字母患眼占66.67%,明显多于常规组的43.59%,差异均有统计学意义(P<0.05);强化组治疗9个月、12个月后患眼FT分别为(276.25±83.40)μm、(242.34±77.59)μm,明显低于常规组的(325.86±56.04)μm、(296.27±53.00)μm,差异均有统计学意义(P<0.05);两组患者治疗前后患眼角膜内皮细胞密度、六角形细胞比例、神经纤维长度、神经纤维密度比较差异均无统计学意义(P>0.05);两组患者治疗期间均未观察到不良反应发生。结论雷珠单抗3+PRN、5+PRN给药方案可安全治疗DME,且对角膜内皮细胞密度无明显影响,而在视觉功能、中心凹视网膜厚度、给药次数、药物经济性方面,5+PRN给药方案作用效果更优。

加味五苓肾气汤治疗糖尿病黄斑水肿的疗效及机制研究

目的:观察加味五苓肾气汤治疗脾肾阳虚型糖尿病黄斑水肿(DME)的临床疗效,并探究相关机制。方法:将120例DME患者按随机数字表法分为观察组和对照组各60例。两组患者均予黄斑区格栅光凝治疗,观察组在此基础上予加味五苓肾气汤治疗,两组均以1周为1个疗程,共治疗4个疗程。比较两组治疗后的临床疗效,以及治疗前后中医证候积分、视网膜中央动脉(CRA)血流动力学参数[收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)]、最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)、疾病相关因子[白细胞介素-1β(IL-1β)、载脂蛋白B/载脂蛋白A-1(ApoB/ApoA-1)]水平。结果:治疗后,观察组总有效率95.00%,高于对照组(P<0.05);两组中医证候积分、CRT、IL-1β水平、ApoB/ApoA-1均低于本组治疗前(P<0.05),且观察组低于对照组(P<0.05);两组PSV、BCVA均高于本组治疗前(P<0.05),且观察组高于对照组(P<0.05)。结论:加味五苓肾气汤治疗DME疗效确切,可有效缓解患者中医症状、提升视力,其机制可能与改善视网膜血流动力学、减轻机体炎症及调节脂代谢紊乱有关。

OCTA评估康柏西普联合PRP治疗sNPDR合并DME对黄斑区血流密度的影响

目的:分析康柏西普联合全视网膜光凝术(PRP)在重度非增殖期糖尿病视网膜病变(sNPDR)合并糖尿病性黄斑水肿(DME)患者中的效果。方法:将sNPDR合并DME患者50例(50眼)随机分为对照组和观察组,各25例(25眼)。对照组单纯行PRP治疗,观察组予以PRP+康柏西普治疗,随访至治疗后1个月。比较两组视力变化情况、黄斑区血流密度、黄斑中心凹厚度(CMT)改善情况。结果:治疗后,观察组最佳矫正视力优于对照组,CMT低于对照组,黄斑区深层毛细血管丛(DCP)血流密度高于对照组(P<0.05);两组黄斑区浅层毛细血管丛血流密度比较,差异无统计学意义(P>0.05)。结论:康柏西普联合PRP治疗sNPDR合并DME患者效果良好,可减轻黄斑水肿,增加黄斑区DCP血流密度,改善患者的视力。

Multicolor pattern scan laser for diabetic retinopathy with cataract

· AIM: To evaluate the ability of various laser wavelengths in delivering sufficient burns to the retina in eyes with cataract using a new multicolor pattern scan laser with green(532 nm), yellow(577 nm), and red(647 nm)lasers.·METHODS: The relationship between the Emery-Little(EL) degree of cataract severity and the laser wavelength required to deliver adequate burns was investigated in102 diabetic eyes. Treatment time, total number of laser shots, and intra-operative pain were assessed as well.·RESULTS: All EL-1 grade eyes and 50% of EL-2 eyes were successfully treated with the green laser, while 50%of EL-2 eyes, 96% of EL-3 eyes, and 50% of EL-4 eyes required the yellow laser. The red laser was effective in the remaining 4% of EL-3 and 50% of EL-4 eyes.·CONCLUSION: Longer wavelength lasers are more effective in delivering laser burns through cataract when we use a multicolor pattern scan laser system.

Outer retinal tubulation in diabetic macular edema following anti-VEGF treatment

Background:To address the presence and features of outer retinal tubulation(ORT)found in diabetic macular edema(DME)treated with anti-vascular endothelial growth factor(anti-VEGF)and to differentiate between ORT and cystoid DME,which have different plans of management.Methods:This was a retrospective review of a total of 514 patients investigated with spectral domain optical coherence tomography(OCT)in patients with diabetic macular edema treated with anti-VEGF.ORT was seen in 12 eyes of 11 patients.The morphologic characteristics of ORT and its progress over time were examined using OCT data.The retinal images were obtained by horizontal and vertical scans to analyze the possible presence of ORT and to explore their morphologic features and location in the retinal layers.Results:ORT was seen in DME treated with anti-VEGF.ORT was shown as round or ovoid hyporeflective spaces with hyperreflective borders on the B-scans,measuring 30 to 120μm high and 30 to 1775μm wide.The tubules generally remained stable over time.In a retinal practice specializing in advanced diabetic retinopathy clinic,this ORT was seen in 12 eyes of 11 patients during a 12-month period.ORT presented either after receiving 0.05 mL open-label intravitreal injections of 0.5 mg ranibizumab or 1.25 mg bevacizumab.Conclusion:ORT is found in DME treated with anti-VEGF that may show damage to the outer retina secondary to the severity and chronicity of the DME.ORT may be a result of underlying chronic and severe diabetic macular edema that may occur later possibly secondary to retinal layers rearrangement after several anti-VEGF injections.It is important to differentiate between ORT and cystoids DME.The presence of the ORT entity alone without the presence of DME does not require further anti-VEGF re-injections.

Surgical considerations in diabetic vitrectomy

High speed and small gauge vitrectomy systems have made surgical intervention in complications of diabetic retinopathy(DR)safer.The availability of anti-vascular endothelial growth factor(anti-VEGF)compounds for use in DR has significantly improved intraoperative and postoperative outcomes.This review discusses the indications for surgical intervention in DR.The role of anti-VEGF compounds is discussed as surgical adjuvants with an emphasis on timing of treatment before surgery.

康柏西普治疗不同OCT分型糖尿病性黄斑水肿对视网膜椭圆体带影响

目的探讨康柏西普(Conbercept)治疗不同相干光层析成像术(OCT)分型糖尿病性黄斑水肿(DME)对视网膜椭圆体带的影响。方法前瞻性病例对照研究。选择2021年6月至2022年12月95例(95只眼)DME患者作为研究对象,根据眼底检查及OCT分型分组,A组为弥漫水肿型(DRT),共30例(30只眼);B组为囊样水肿型(CME),共33例(33只眼);C组为浆液性视网膜脱离(SRD),共32例(32只眼);均行玻璃体腔注射康柏西普治疗,对比治疗前与治疗后3、6、12个月患眼的平均最小分辨角对数(logMAR)最佳矫正视力(BCVA)、平均黄斑中心视网膜厚度(CRT),观察治疗前、治疗后3、6、12个月不同视力分段中椭圆体带完整性情况。结果单因素方差分析显示,治疗前,3组logMAR BCVA比较,差异无统计学意义(P<0.05);治疗后3、6、12个月,3组logMAR BCVA比较,具有统计学差异(P<0.05);治疗前和治疗后3、6、12个月,3组CRT比较具有统计学差异(P<0.05)。两两比较显示,治疗后3、6、12个月,A组的logMAR BCVA、CRT低于B组和C组(P<0.05)。A组治疗后3、6、12个月不同logMAR BCVA分段患眼椭圆体带完整性比较存在显著差异(P<0.05);B组和C组治疗后6、12个月不同logMAR BCVA分段患眼椭圆体带完整性比较存在显著差异(P<0.05)。结论康柏西普治疗DME患者中具有明显疗效,有利于改善患者视力和降低CRT,其中DRT患者改善效果最佳。

康柏西普联合眼底激光治疗糖尿病视网膜病变合并视网膜静脉阻塞黄斑水肿的临床研究

目的 分析康柏西普联合眼底激光治疗糖尿病视网膜病变(DR)合并视网膜静脉阻塞(RVO)黄斑水肿的效果。方法 97例DR合并RVO黄斑水肿患者,按照随机数字表法分为对照组(48例)与研究组(49例)。对照组接受眼底激光治疗,研究组接受康柏西普联合眼底激光治疗。比较两组患者症状改善与消退时间、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)、低视力生活质量量表(CLVQOL)评分及并发症发生情况。结果 研究组黄斑水肿改善时间(4.30±0.36)周、眼底出血吸收时间(2.35±0.25)周、渗出吸收时间(10.25±0.93)周均短于对照组的(5.56±0.40)、(3.20±0.30)、(12.20±1.25)周,差异有统计学意义(P<0.05)。治疗后4周,研究组BCVA(0.82±0.15)高于对照组的(0.55±0.12), CMT(245.65±22.50)μm低于对照组的(273.38±28.44)μm,差异有统计学意义(P<0.05)。治疗后3个月,研究组CLVQOL评分(80.35±4.52)分高于对照组的(72.65±5.00)分,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论 康柏西普联合眼底激光治疗DR合并RVO黄斑水肿可以有效改善患者的黄斑厚度与视力水平,促进症状快速改善与消退,保障其生活质量,适于临床推广。

抗VEGF治疗眼底新生血管性疾病的临床研究进展

抗血管内皮生长因子(VEGF)是治疗新生血管性眼底病变(糖尿病黄斑水肿、视网膜静脉阻塞、以及新生血管性年龄相关性黄斑变性)的主流方案。抗VEGF治疗优点在于:足以帮助患者减少新生血管渗漏以恢复视力,但存在频繁注射和治疗不应答的问题。目前针对这些问题的解决方式有:增强抗VEGF药物耐久性及有效性,提出新的治疗方案、给药方式以及寻找新的抗VEGF治疗靶点等。相关临床研究已经取得一定的进展。这些研究成果将在未来的眼底新生血管性疾病治疗中发挥重要的作用,以帮助减少患者以及卫生保健系统的负担。