Objective:To compare the clinical efficacy and safety of intravitreal injection of faricimab and conbercept in the treatment of diabetic macular edema(DME).Methods:A total of 50 patients diagnosed with DME in our hosp...Objective:To compare the clinical efficacy and safety of intravitreal injection of faricimab and conbercept in the treatment of diabetic macular edema(DME).Methods:A total of 50 patients diagnosed with DME in our hospital from January 2023 to May 2025 were selected and randomly divided into an observation group and a control group,with 25 cases in each group,using a random number table method.The observation group received intravitreal injection of faricimab,while the control group received intravitreal injection of conbercept.Both groups adopted a loading phase plus maintenance phase treatment regimen.The best-corrected visual acuity(BCVA,expressed in logMAR)and central subfield thickness(CST)of the two groups were compared before treatment and at 1,3,and 6 months after treatment,and the incidence of adverse events during treatment was recorded.Results:The logMAR BCVA in the observation group was lower than that in the control group at 3 and 6 months after treatment(both p<0.05).The CST in the observation group was smaller than that in the control group at 1,3,and 6 months after treatment(all p<0.05).There was no statistically significant difference in the overall incidence of adverse events between the two groups(χ^(2)=0.189,p=0.663).Conclusion:Both intravitreal injections of faricimab and conbercept are effective in improving visual acuity and reducing macular edema in patients with DME,with good safety profiles.However,faricimab demonstrates superior efficacy in the medium to long term(3 and 6 months)compared to conbercept,making it more suitable for long-term treatment of patients with DME.展开更多
AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabe...AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.展开更多
Background:Diabetic macular edema is a prevalent retinal condition and a leading cause of visual impairment among diabetic patients’Early detection of affected areas is beneficial for effective diagnosis and treatmen...Background:Diabetic macular edema is a prevalent retinal condition and a leading cause of visual impairment among diabetic patients’Early detection of affected areas is beneficial for effective diagnosis and treatment.Traditionally,diagnosis relies on optical coherence tomography imaging technology interpreted by ophthalmologists.However,this manual image interpretation is often slow and subjective.Therefore,developing automated segmentation for macular edema images is essential to enhance to improve the diagnosis efficiency and accuracy.Methods:In order to improve clinical diagnostic efficiency and accuracy,we proposed a SegNet network structure integrated with a convolutional block attention module(CBAM).This network introduces a multi-scale input module,the CBAM attention mechanism,and jump connection.The multi-scale input module enhances the network’s perceptual capabilities,while the lightweight CBAM effectively fuses relevant features across channels and spatial dimensions,allowing for better learning of varying information levels.Results:Experimental results demonstrate that the proposed network achieves an IoU of 80.127%and an accuracy of 99.162%.Compared to the traditional segmentation network,this model has fewer parameters,faster training and testing speed,and superior performance on semantic segmentation tasks,indicating its highly practical applicability.Conclusion:The C-SegNet proposed in this study enables accurate segmentation of Diabetic macular edema lesion images,which facilitates quicker diagnosis for healthcare professionals.展开更多
AIM:To analyze the effect of conbercept treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME)using optical coherence tomography(OCT)images.METHODS:This retrospective study included ...AIM:To analyze the effect of conbercept treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME)using optical coherence tomography(OCT)images.METHODS:This retrospective study included patients who first received conbercept injections for RVO-ME at Yijishan Hospital of Wannan Medical College from December 1,2017,to March 31,2022.Data on disease duration,age,hypertension,OCT images,central macular thickness(CMT),and best-corrected visual acuity(BCVA)were collected before and at 4-6 wk after treatment.Patients were divided into 4 groups according to different types of macular edema:cystoid macular edema(CME),sponge-like diffuse retinal thickening(SDRT),serous retinal detachment(SRD),and mixed type(FULL).Changes in CMT and visual acuity before and after treatment were compared among the groups to analyze differences in the effect of conbercept treatment on different ME types,and the effect of baseline CMT and visual acuity on post-treatment visual acuity.RESULTS:Totally 139 patients(139 eyes)were classified as having macular edema,including 62 males(44.6%)and 77 females(55.4%),with a mean age of 58.9±10.9 years,and they were divided into 4 groups based on different types of macular edema,including 54 cases(54 eyes)(mean age 59.6±11.1 years)in the CME group,23 cases(23 eyes;mean age 56.6±10.2 years)in the SDRT group,22 cases(22 eyes;mean age 57.8±12.0 years)in the SDR group,and 40 cases(40 eyes;mean age 60.0±10.7 years)in the FULL group.There were no significant differences in the duration of disease or age between groups(P>0.05).There was a significant difference in preoperative CMT between groups(P=0.01,one-way ANOVA),with the CMT in the FULL group being significantly greater than that in the SDRT group(P=0.03).There were no significant differences in pre-treatment visual acuity between the four groups(P=0.26).After conbercept treatment,the macular central recess thickness was reduced and visual acuity was improved in all four groups,among which the CMT in the CME and FULL groups was reduced significantly compared with the other two groups(P<0.05),and the visual acuity in the CME and SRD groups was improved significantly compared with the other two groups(P<0.05).Postoperative visual acuity was negatively correlated with preoperative CMT(P=0.044)and positively correlated with preoperative visual acuity(P<0.01).CONCLUSION:The efficacy of intravitreal conbercept in the treatment of RVO and macular edema may be related to the type of edema observed on OCT images,in which the efficacy is best in patients with CME but poor in patients with SDRT.展开更多
Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deteri...Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deterioration in cases of poor blood glucose regulation.Changes in vascular permeability are key trigger points for diabetic macular edema(DME),a condition characterized by the accumulation of fluid in the macula.The development of vascular endothelial growth factor(VEGF)pathway inhibitors has provided a pathogenesis-based treatment approach for DME.Optical coherence tomography(OCT)provides highresolution imaging of the anatomy,including the aging of DME and its structural damage,in distinct morphologic subtypes of macular edema,thereby supporting the assessment of macular edema treatment.The availability of repeated OCT monitoring provides clinical reassurance through the treatment.OCT angiography(OCTA)provides retinal blood flow maps with high spatial resolution.The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods.This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME,as well as their respective therapeutic applications.展开更多
Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in th...Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in the leakage of plasma and lipids[1].Nowadays,laser photocoagulation,intravitreal injections of anti-vascular endothelial growth factor(anti-VEGF)drugs and dexamethasone implant.展开更多
AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RV...AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RVO-ME).METHODS:This was a prospective,interventional,and open-label clinical trial.There were two groups:naïve and refractory patients(received≥5 times of previous IVR within one year prior to enrollment)enrolled.Patients received IVR and Dex-I concurrently and re-combination therapy was required if one or more retreatment criteria were met.IVR and Dex-I were given pro re nata(PRN).The mean changes in best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured as main outcomes.RESULTS:Totally 63 patients(63 eyes)completed the entire follow-up(31 naïve and 32 refractory patients).At month 12,the change in BCVA was greater in the naïve group than in the refractory group[19.67±11.7(95%CI:15.03,24.31)letters vs 11.74±11.18(95%CI:7.32,16.16)letters,P=0.014].There was no difference between the two groups of mean macular thickness reduction[364.26±215.29(95%CI:279.09,449.43)μm vs 410.19±204.34(95%CI:329.35,491.02)μm,P=0.43].The mean co-injection numbers were 2.52±0.58(95%CI:2.29,2.75)and 2.33±0.55(95%CI:2.11,2.55)in both groups(P=0.24),respectively.The retreatment interval was 115.81±13.79 d(95%CI:110.36,121.27)and 122.74±14.06 d(95%CI:119.93,133.56)in both groups(P=0.073).There was no significant difference in the incidence of glaucoma or the progression of cataracts between the two groups.CONCLUSION:In both naïve and refractory RVO-ME patients,IVR combined with Dex-I is effective.The initial combination therapy for naïve patients demonstrates more efficient improvement in BCVA and may reduce total injection numbers compared to refractory patients.展开更多
AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMe...AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.展开更多
Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter le...Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.展开更多
AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).ME...AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.展开更多
AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retr...AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retrospective cohort study,the data about best corrected visual acuity(BCVA),central macular thickness(CMT),serous macular detachment(SMD),hard exudate,hyperreflective foci(HRF),cystoid degeneration,pearl necklace sign,epiretinal membrane(ERM),disorganization of retinal inner layers(DRIL),ellipsoid zone and external limiting membrane(EZ-ELM)integrity,intraocular pressure(IOP)and lens condition were recorded.RESULTS:Thirty-eight eyes of 38 patients were included in the study.Thirteen patients presented with central RVO(CRVO)and 25 with branch RVO(BRVO).The mean follow-up time was 69.9±15.8mo,and the mean number of injections was 7.9±4.0.The mean BCVA gain was 25.0±36 letters,and this difference was statistically significant(P=0.021).The BCVA gain was 19.4±20.4 letters in the CRVO group,and 26.5±38.6 letters in the BRVO group(P=0.763).Besides,21(55.2%)of the patients achieved≥15 letters improvement.At the end of the follow-up period,SMD was not observed in any of the patients(P=0.016).Hard exudate,HRF number were decreased;while DRIL,ERM and EZ-ELM defects were increased but not significantly.CONCLUSION:Intravitreal dexamethasone monotherapy is an effective and safe treatment option for the treatment-naive RVO-ME patients in the long-term follow-up.展开更多
AIM:To investigate the optimal anti-vascular endothelial growth factor(VEGF)treatment time in patients with diabetic macular edema(DME)scheduled for cataract surgery.METHODS:The study was designed to include 4 groups....AIM:To investigate the optimal anti-vascular endothelial growth factor(VEGF)treatment time in patients with diabetic macular edema(DME)scheduled for cataract surgery.METHODS:The study was designed to include 4 groups.Twenty-six eyes of 26 patients with diabetes but no retinopathy(DR;group 1),17 eyes of 17 patients with DR but no DME(group 2),and 19 eyes of 19 patients with DME who received anti-VEGF therapy concurrently with cataract surgery(group 3),and 21 eyes of 21 patients who received anti-VEGF therapy for DME 1wk before cataract surgery(group 4).The patients’best corrected visual acuity,intraocular pressure,central and mean macular thickness(CMT and MMT)values were noted on the day of surgery,postoperative day 1,week 1,and month 1.RESULTS:There was a significant increase of CMT after cataract surgery in groups 1,2,and 3(P<0.001,P=0.044,and P=0.034,respectively)but not in group 4(P=0.948).The change in MMT was the same as CMT(P=0.009,P=0.006,P=0.011,and P=0.172,respectively).There was a higher increase in CMT and MMT in group 2 compared to group 1 at the 1st month after surgery(P=0.002 and P=0.001,respectively).CONCLUSION:In eyes with DME undergoing cataract surgery,preoperative anti-VEGF treatment may be more effective than simultaneous intravitreal anti-VEGF with surgery.展开更多
AIM：To assess possible benefits of intravitreal triamcinolone acetonide（IVTA）injection as pretreatment for macular laser photocoagulation（MLP）in patients with diabetic macular edema（DME）.·METHODS：Publishe...AIM：To assess possible benefits of intravitreal triamcinolone acetonide（IVTA）injection as pretreatment for macular laser photocoagulation（MLP）in patients with diabetic macular edema（DME）.·METHODS：Published randomized controlled trials（RCTs）concerning MLP with or without IVTA pretreatment for DME were retrieved from databases CNKI,Medline,EMbase,Web of Science,and the Cochrane Library.A Meta-analysis on eligible studies was conducted using Rev Man 5.0 software.Two investigators independently assessed the quality of the trials and extracted data.Main outcome measures included the change in best-corrected visual acuity（BCVA）,difference in central macular thickness（CMT）and adverse events reporting in particular elevated intraocular pressure within the follow-up period.The results were pooled using weight mean difference（WMD）or odds risk（OR）with their corresponding 95%confidence intervals（CI）.A fixed-or random-effect model was employed depending on the heterogeneity of the inclusion trials.·R ESULTS：Finally,five independent RCTs were identified and used for comparing MLP with IVTA pretreatment（131 eyes）with MLP alone（133 eyes,control group）.The overall study quality was relatively higher according to the modified Jadad scale.The Metaanalysis showed that MLP with IVTA pretreatment significantly reduced CMT at one,three and six months（=0.002,0.0003 and 0.04,respectively）,compared with MLP alone.The IVTA pretreatment group showed statistically significant improvements in BCVA at the one-month follow up as compared with the control group（=0.03）.At three-and six-month follow up,there was a beneficial trend towards improving visual acuity in the IVTA pretreatment group without statistical significance between groups（=0.06 and 0.20,respectively）.The incidence of elevation of intraocular pressure was significantly higher in the IVTA pretreatment group than in the control group（〈0.0001）.No evidence of publication bias was present according to Begg’s test and Egger’s test.There was a low level of heterogeneity in the included studies.·CONCLUSION：This Meta-analysis indicates that MLP with IVTA pretreatment has a better therapeutic effect in terms of CMT reduction and earlier（1mo）visual improvement for patients with DME as compared with MLP alone.Further confirmation with rigorously welldesigned multi-center trials is needed.展开更多
AIM： To respectively evaluate macular morphological features and functional parameters by using spectraldomain optical coherence tomography（SD-OCT） and macular integrity assessment（MAIA） in patients with diabetic...AIM： To respectively evaluate macular morphological features and functional parameters by using spectraldomain optical coherence tomography（SD-OCT） and macular integrity assessment（MAIA） in patients with diabetic macular edema（DME）. METHODS： This prospective, non-controlled, open study included 61 eyes of 38 consecutive patients with DME. All patients underwent best-corrected visual acuity（BCVA） measurement, MAIA microperimetry, and SDOCT. DME morphology, including central retinal thickness（CRT） and central retinal volume（CRV）; integrity of the external limiting membrane（ELM） and photoreceptor inner segment/outer segment（IS/OS） junction; and the deposition of hard macular exudates were assessed within a 1000-μm central subfield area. MAIA microperimetry parameters evaluated were average threshold（AT）-retinal sensitivity, macular integrity index（MI）, fixation points within a circle of radius 1°（P1） and 2°（P2）, and bivariate contour ellipse area considering 63% and 95% of the fixation points（A63 and A95, respectively）. RESULTS： MI was significantly higher in eyes with disrupted ELM or IS/OS, compared with eyes with intact ELM and IS/OS. Values of BCVA（log MAR）, total AT, AT within 1000-μm diameter, P2, A63, A95, and CRT were significantly worse in eyes with disrupted IS/OS, compared with eyes with intact IS/OS. The values of BCVA（log MAR）, AT within 1000-μm diameter, and CRT were significantly worse in eyes with disrupted ELM, compared with eyes with intact ELM. These parameters were not significantly different between eyes with or without hard macular exudate deposition. CRV was not significantly different in the presence or absence of the integrity of ELM, IS/OS, or deposition of hard macular exudates. At the center, nasal and temporal sectors of the fovea, significant negative correlations were observed between retinal thickness and AT of the corresponding area. At the inferior and superior sectors of the fovea, no correlations were observed between retinal thickness and AT of the corresponding area. In the intact IS/OS group, significant negative correlations were observed between CRT and central AT. There was no correlation between retinal sensitivity and thickness when the IS/OS layer was disrupted. Multiple linear regression analyses revealed that IS/OS integrity was an independent factor affecting MI. CONCLUSION： Functional（BCVA and visual field） and morphological parameters（retinal thickness） were significantly associated with an intact IS/OS. Local photoreceptor integrity was a strong predictor of local visual function throughout the retina. MI revealed the functional status in DME, reflecting the IS/OS juction status in the macula.展开更多
AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese ...AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS: In group 1, the mean BCVA improved from 37.78 +/- 6.14 (baseline) to 48.06 +/- 3.86, 46.48 +/- 4.77 and 44.18 +/- 5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92 +/- 6.20 (baseline) to 50.69 +/- 4.22, 48.76 +/- 5.59 and 45.70 +/- 6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.展开更多
AIMTo compare the efficacy of the sole intravitreal triamcinolone (IVT) versus intravitreal bevacizumab (IVB) alone or IVB combined with IVT in the treatment of diabetic macular edema (DME).
Diabetic macular edema(DME)is a very important and well-known cause of visual loss in diabetics.Blood-retina barrier disruption and consequent intraretinal fluid accumulation may lead to retinal thickening at the post...Diabetic macular edema(DME)is a very important and well-known cause of visual loss in diabetics.Blood-retina barrier disruption and consequent intraretinal fluid accumulation may lead to retinal thickening at the posterior pole namely DME.Even though it is not clearly understood,current evidence suggests that chronic low-grade inflammation characterized with various cytokines has a major role in the occurrence of DME.Clinical trials are continuously shaping our treatment approaches for the eyes with DME.Today,vascular endothelial growth factor(VEGF)inhibitor and steroid administrations are the main alternatives in DME treatment.Dexamethasone(DEX)implant(Ozurdex®;Allergan,Inc.,Irvine,CA,United States)was approved by the United States Food&Drug Administration in 2014 for DME treatment.The implant is made up of a biodegradable solid copolymer that is broken down by releasing its active ingredient into the vitreous cavity over time.Biphasic release feature of this sustained-release drug delivery system ensures its efficacy for up to 6 mo with an acceptable and manageable safety profile.DEX implant provides a favorable anatomical and functional outcome in DME as shown in several randomized-controlled studies but has a relatively higher ocular side-effect profile such as increased risk of cataract formation and raised intraocular pressure when compared to the gold standard anti-VEGF agents.Thus,DEX implant becomes the second-line treatment option demonstrating inadequate clinical response to anti-VEGF therapy.However,it can be preferred as the first-line treatment in vitrectomized and pseudophakic eyes.Even in some selected conditions DEX implant is favored over anti-VEGF agents where the use of VEGF-inhibitors is either inappropriate or contraindicated such as the patients with a recent history of a major cardiovascular or cerebrovascular event,pregnancy and noncompliant to frequent visits.This mini-review briefly overviews the efficacy,safety profile and complications of DEX implant and summarizes the outcome of DEX implant administration in major clinical studies on DME treatment.展开更多
Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision lo...Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation.展开更多
AIM: To evaluate the two-year outcomes of patients treated for diabetic macular edema(DME) with intravitreal Conbercept(IVC).METHODS: The clinical data of 30 DME patients(36 eyes) were retrospectively reviewed. The pa...AIM: To evaluate the two-year outcomes of patients treated for diabetic macular edema(DME) with intravitreal Conbercept(IVC).METHODS: The clinical data of 30 DME patients(36 eyes) were retrospectively reviewed. The patients were treated with IVC for 3 mo. Additional IVC was given at subsequent monthly visits, if needed(3+PRN). The patients were followed up for 24 mo.RESULTS: The best-corrected visual acuity(BCVA) at 24 mo significantly increased(66.7±15.3 letters) in comparison with the baseline(54.4±15.4 letters, P<0.0001). The mean improvement in BCVA was 11.0±2.9 letters. At 24 mo, 44.1% of the eyes surveyed gained ≥15 letters, 52.9% of the eyes gained ≥10 letters, and 70.6% of the eyes gained ≥5 letters. No vision loss was noted in 96.8% of the eyes, and 5.9% of the eyes lost ≥5 letters, but ≤10 letters. The central retinal thickness(CRT) at 24 mo was significantly reduced(277.1±122.9 μm) in comparison with the baseline(510.9±186.1 μm, P<0.0001). At 24 mo, 43.3% of the patients had a CRT ≤250 μm. The mean number of injections over 24 mo was 10.6±2.0. No severe eye or systemic adverse events related to either the drug or injection were noted.CONCLUSION: IVC is safe and effective for the treatment of DME.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
文摘Objective:To compare the clinical efficacy and safety of intravitreal injection of faricimab and conbercept in the treatment of diabetic macular edema(DME).Methods:A total of 50 patients diagnosed with DME in our hospital from January 2023 to May 2025 were selected and randomly divided into an observation group and a control group,with 25 cases in each group,using a random number table method.The observation group received intravitreal injection of faricimab,while the control group received intravitreal injection of conbercept.Both groups adopted a loading phase plus maintenance phase treatment regimen.The best-corrected visual acuity(BCVA,expressed in logMAR)and central subfield thickness(CST)of the two groups were compared before treatment and at 1,3,and 6 months after treatment,and the incidence of adverse events during treatment was recorded.Results:The logMAR BCVA in the observation group was lower than that in the control group at 3 and 6 months after treatment(both p<0.05).The CST in the observation group was smaller than that in the control group at 1,3,and 6 months after treatment(all p<0.05).There was no statistically significant difference in the overall incidence of adverse events between the two groups(χ^(2)=0.189,p=0.663).Conclusion:Both intravitreal injections of faricimab and conbercept are effective in improving visual acuity and reducing macular edema in patients with DME,with good safety profiles.However,faricimab demonstrates superior efficacy in the medium to long term(3 and 6 months)compared to conbercept,making it more suitable for long-term treatment of patients with DME.
文摘AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.
基金supported by the Guangdong Pharmaceutical University 2024 Higher Education Research Projects(GKP202403,GMP202402)the Guangdong Pharmaceutical University College Students’Innovation and Entrepreneurship Training Programs(Grant No.202504302033,202504302034,202504302036,and 202504302244).
文摘Background:Diabetic macular edema is a prevalent retinal condition and a leading cause of visual impairment among diabetic patients’Early detection of affected areas is beneficial for effective diagnosis and treatment.Traditionally,diagnosis relies on optical coherence tomography imaging technology interpreted by ophthalmologists.However,this manual image interpretation is often slow and subjective.Therefore,developing automated segmentation for macular edema images is essential to enhance to improve the diagnosis efficiency and accuracy.Methods:In order to improve clinical diagnostic efficiency and accuracy,we proposed a SegNet network structure integrated with a convolutional block attention module(CBAM).This network introduces a multi-scale input module,the CBAM attention mechanism,and jump connection.The multi-scale input module enhances the network’s perceptual capabilities,while the lightweight CBAM effectively fuses relevant features across channels and spatial dimensions,allowing for better learning of varying information levels.Results:Experimental results demonstrate that the proposed network achieves an IoU of 80.127%and an accuracy of 99.162%.Compared to the traditional segmentation network,this model has fewer parameters,faster training and testing speed,and superior performance on semantic segmentation tasks,indicating its highly practical applicability.Conclusion:The C-SegNet proposed in this study enables accurate segmentation of Diabetic macular edema lesion images,which facilitates quicker diagnosis for healthcare professionals.
文摘AIM:To analyze the effect of conbercept treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME)using optical coherence tomography(OCT)images.METHODS:This retrospective study included patients who first received conbercept injections for RVO-ME at Yijishan Hospital of Wannan Medical College from December 1,2017,to March 31,2022.Data on disease duration,age,hypertension,OCT images,central macular thickness(CMT),and best-corrected visual acuity(BCVA)were collected before and at 4-6 wk after treatment.Patients were divided into 4 groups according to different types of macular edema:cystoid macular edema(CME),sponge-like diffuse retinal thickening(SDRT),serous retinal detachment(SRD),and mixed type(FULL).Changes in CMT and visual acuity before and after treatment were compared among the groups to analyze differences in the effect of conbercept treatment on different ME types,and the effect of baseline CMT and visual acuity on post-treatment visual acuity.RESULTS:Totally 139 patients(139 eyes)were classified as having macular edema,including 62 males(44.6%)and 77 females(55.4%),with a mean age of 58.9±10.9 years,and they were divided into 4 groups based on different types of macular edema,including 54 cases(54 eyes)(mean age 59.6±11.1 years)in the CME group,23 cases(23 eyes;mean age 56.6±10.2 years)in the SDRT group,22 cases(22 eyes;mean age 57.8±12.0 years)in the SDR group,and 40 cases(40 eyes;mean age 60.0±10.7 years)in the FULL group.There were no significant differences in the duration of disease or age between groups(P>0.05).There was a significant difference in preoperative CMT between groups(P=0.01,one-way ANOVA),with the CMT in the FULL group being significantly greater than that in the SDRT group(P=0.03).There were no significant differences in pre-treatment visual acuity between the four groups(P=0.26).After conbercept treatment,the macular central recess thickness was reduced and visual acuity was improved in all four groups,among which the CMT in the CME and FULL groups was reduced significantly compared with the other two groups(P<0.05),and the visual acuity in the CME and SRD groups was improved significantly compared with the other two groups(P<0.05).Postoperative visual acuity was negatively correlated with preoperative CMT(P=0.044)and positively correlated with preoperative visual acuity(P<0.01).CONCLUSION:The efficacy of intravitreal conbercept in the treatment of RVO and macular edema may be related to the type of edema observed on OCT images,in which the efficacy is best in patients with CME but poor in patients with SDRT.
文摘Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deterioration in cases of poor blood glucose regulation.Changes in vascular permeability are key trigger points for diabetic macular edema(DME),a condition characterized by the accumulation of fluid in the macula.The development of vascular endothelial growth factor(VEGF)pathway inhibitors has provided a pathogenesis-based treatment approach for DME.Optical coherence tomography(OCT)provides highresolution imaging of the anatomy,including the aging of DME and its structural damage,in distinct morphologic subtypes of macular edema,thereby supporting the assessment of macular edema treatment.The availability of repeated OCT monitoring provides clinical reassurance through the treatment.OCT angiography(OCTA)provides retinal blood flow maps with high spatial resolution.The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods.This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME,as well as their respective therapeutic applications.
基金Supported by National Natural Science Foundation of China(No.82171062No.82301222)Zhejiang Provincial Natural Science Foundation of China(No.LY20H120002).
文摘Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in the leakage of plasma and lipids[1].Nowadays,laser photocoagulation,intravitreal injections of anti-vascular endothelial growth factor(anti-VEGF)drugs and dexamethasone implant.
基金Supported by the National Nature Science Foundation of China(No.82301211)Beijing Natural Science Foundation(No.J230028).
文摘AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RVO-ME).METHODS:This was a prospective,interventional,and open-label clinical trial.There were two groups:naïve and refractory patients(received≥5 times of previous IVR within one year prior to enrollment)enrolled.Patients received IVR and Dex-I concurrently and re-combination therapy was required if one or more retreatment criteria were met.IVR and Dex-I were given pro re nata(PRN).The mean changes in best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured as main outcomes.RESULTS:Totally 63 patients(63 eyes)completed the entire follow-up(31 naïve and 32 refractory patients).At month 12,the change in BCVA was greater in the naïve group than in the refractory group[19.67±11.7(95%CI:15.03,24.31)letters vs 11.74±11.18(95%CI:7.32,16.16)letters,P=0.014].There was no difference between the two groups of mean macular thickness reduction[364.26±215.29(95%CI:279.09,449.43)μm vs 410.19±204.34(95%CI:329.35,491.02)μm,P=0.43].The mean co-injection numbers were 2.52±0.58(95%CI:2.29,2.75)and 2.33±0.55(95%CI:2.11,2.55)in both groups(P=0.24),respectively.The retreatment interval was 115.81±13.79 d(95%CI:110.36,121.27)and 122.74±14.06 d(95%CI:119.93,133.56)in both groups(P=0.073).There was no significant difference in the incidence of glaucoma or the progression of cataracts between the two groups.CONCLUSION:In both naïve and refractory RVO-ME patients,IVR combined with Dex-I is effective.The initial combination therapy for naïve patients demonstrates more efficient improvement in BCVA and may reduce total injection numbers compared to refractory patients.
基金Supported by Natural Science Foundation of Chongqing(No.CSTB2024NSCQ-MSX0900No.CSTB2023NSCQ-MSX0593).
文摘AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
文摘Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project(No.TJYXZDXK-037A)Tianjin Key Laboratory of Retinal Functions and Diseases Independent and Open Project(No.2023tjswmm004)Tianjin Medical University Eye Hospital High-level Innovative Talent Programme(No.YDYYRCXM-B2023-02).
文摘AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.
文摘AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retrospective cohort study,the data about best corrected visual acuity(BCVA),central macular thickness(CMT),serous macular detachment(SMD),hard exudate,hyperreflective foci(HRF),cystoid degeneration,pearl necklace sign,epiretinal membrane(ERM),disorganization of retinal inner layers(DRIL),ellipsoid zone and external limiting membrane(EZ-ELM)integrity,intraocular pressure(IOP)and lens condition were recorded.RESULTS:Thirty-eight eyes of 38 patients were included in the study.Thirteen patients presented with central RVO(CRVO)and 25 with branch RVO(BRVO).The mean follow-up time was 69.9±15.8mo,and the mean number of injections was 7.9±4.0.The mean BCVA gain was 25.0±36 letters,and this difference was statistically significant(P=0.021).The BCVA gain was 19.4±20.4 letters in the CRVO group,and 26.5±38.6 letters in the BRVO group(P=0.763).Besides,21(55.2%)of the patients achieved≥15 letters improvement.At the end of the follow-up period,SMD was not observed in any of the patients(P=0.016).Hard exudate,HRF number were decreased;while DRIL,ERM and EZ-ELM defects were increased but not significantly.CONCLUSION:Intravitreal dexamethasone monotherapy is an effective and safe treatment option for the treatment-naive RVO-ME patients in the long-term follow-up.
文摘AIM:To investigate the optimal anti-vascular endothelial growth factor(VEGF)treatment time in patients with diabetic macular edema(DME)scheduled for cataract surgery.METHODS:The study was designed to include 4 groups.Twenty-six eyes of 26 patients with diabetes but no retinopathy(DR;group 1),17 eyes of 17 patients with DR but no DME(group 2),and 19 eyes of 19 patients with DME who received anti-VEGF therapy concurrently with cataract surgery(group 3),and 21 eyes of 21 patients who received anti-VEGF therapy for DME 1wk before cataract surgery(group 4).The patients’best corrected visual acuity,intraocular pressure,central and mean macular thickness(CMT and MMT)values were noted on the day of surgery,postoperative day 1,week 1,and month 1.RESULTS:There was a significant increase of CMT after cataract surgery in groups 1,2,and 3(P<0.001,P=0.044,and P=0.034,respectively)but not in group 4(P=0.948).The change in MMT was the same as CMT(P=0.009,P=0.006,P=0.011,and P=0.172,respectively).There was a higher increase in CMT and MMT in group 2 compared to group 1 at the 1st month after surgery(P=0.002 and P=0.001,respectively).CONCLUSION:In eyes with DME undergoing cataract surgery,preoperative anti-VEGF treatment may be more effective than simultaneous intravitreal anti-VEGF with surgery.
文摘AIM：To assess possible benefits of intravitreal triamcinolone acetonide（IVTA）injection as pretreatment for macular laser photocoagulation（MLP）in patients with diabetic macular edema（DME）.·METHODS：Published randomized controlled trials（RCTs）concerning MLP with or without IVTA pretreatment for DME were retrieved from databases CNKI,Medline,EMbase,Web of Science,and the Cochrane Library.A Meta-analysis on eligible studies was conducted using Rev Man 5.0 software.Two investigators independently assessed the quality of the trials and extracted data.Main outcome measures included the change in best-corrected visual acuity（BCVA）,difference in central macular thickness（CMT）and adverse events reporting in particular elevated intraocular pressure within the follow-up period.The results were pooled using weight mean difference（WMD）or odds risk（OR）with their corresponding 95%confidence intervals（CI）.A fixed-or random-effect model was employed depending on the heterogeneity of the inclusion trials.·R ESULTS：Finally,five independent RCTs were identified and used for comparing MLP with IVTA pretreatment（131 eyes）with MLP alone（133 eyes,control group）.The overall study quality was relatively higher according to the modified Jadad scale.The Metaanalysis showed that MLP with IVTA pretreatment significantly reduced CMT at one,three and six months（=0.002,0.0003 and 0.04,respectively）,compared with MLP alone.The IVTA pretreatment group showed statistically significant improvements in BCVA at the one-month follow up as compared with the control group（=0.03）.At three-and six-month follow up,there was a beneficial trend towards improving visual acuity in the IVTA pretreatment group without statistical significance between groups（=0.06 and 0.20,respectively）.The incidence of elevation of intraocular pressure was significantly higher in the IVTA pretreatment group than in the control group（〈0.0001）.No evidence of publication bias was present according to Begg’s test and Egger’s test.There was a low level of heterogeneity in the included studies.·CONCLUSION：This Meta-analysis indicates that MLP with IVTA pretreatment has a better therapeutic effect in terms of CMT reduction and earlier（1mo）visual improvement for patients with DME as compared with MLP alone.Further confirmation with rigorously welldesigned multi-center trials is needed.
基金Supported by the Independent Subject of China Academy of Chinese Medical Sciences(No.ZZ0808008)the Independent Subject of the Eye Hospital of China Academy of Chinese Medical Sciences(No.201705)Key Research Project of the Capital Health Development Research Fund(No.2016-1-4181)
文摘AIM： To respectively evaluate macular morphological features and functional parameters by using spectraldomain optical coherence tomography（SD-OCT） and macular integrity assessment（MAIA） in patients with diabetic macular edema（DME）. METHODS： This prospective, non-controlled, open study included 61 eyes of 38 consecutive patients with DME. All patients underwent best-corrected visual acuity（BCVA） measurement, MAIA microperimetry, and SDOCT. DME morphology, including central retinal thickness（CRT） and central retinal volume（CRV）; integrity of the external limiting membrane（ELM） and photoreceptor inner segment/outer segment（IS/OS） junction; and the deposition of hard macular exudates were assessed within a 1000-μm central subfield area. MAIA microperimetry parameters evaluated were average threshold（AT）-retinal sensitivity, macular integrity index（MI）, fixation points within a circle of radius 1°（P1） and 2°（P2）, and bivariate contour ellipse area considering 63% and 95% of the fixation points（A63 and A95, respectively）. RESULTS： MI was significantly higher in eyes with disrupted ELM or IS/OS, compared with eyes with intact ELM and IS/OS. Values of BCVA（log MAR）, total AT, AT within 1000-μm diameter, P2, A63, A95, and CRT were significantly worse in eyes with disrupted IS/OS, compared with eyes with intact IS/OS. The values of BCVA（log MAR）, AT within 1000-μm diameter, and CRT were significantly worse in eyes with disrupted ELM, compared with eyes with intact ELM. These parameters were not significantly different between eyes with or without hard macular exudate deposition. CRV was not significantly different in the presence or absence of the integrity of ELM, IS/OS, or deposition of hard macular exudates. At the center, nasal and temporal sectors of the fovea, significant negative correlations were observed between retinal thickness and AT of the corresponding area. At the inferior and superior sectors of the fovea, no correlations were observed between retinal thickness and AT of the corresponding area. In the intact IS/OS group, significant negative correlations were observed between CRT and central AT. There was no correlation between retinal sensitivity and thickness when the IS/OS layer was disrupted. Multiple linear regression analyses revealed that IS/OS integrity was an independent factor affecting MI. CONCLUSION： Functional（BCVA and visual field） and morphological parameters（retinal thickness） were significantly associated with an intact IS/OS. Local photoreceptor integrity was a strong predictor of local visual function throughout the retina. MI revealed the functional status in DME, reflecting the IS/OS juction status in the macula.
文摘AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS: In group 1, the mean BCVA improved from 37.78 +/- 6.14 (baseline) to 48.06 +/- 3.86, 46.48 +/- 4.77 and 44.18 +/- 5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92 +/- 6.20 (baseline) to 50.69 +/- 4.22, 48.76 +/- 5.59 and 45.70 +/- 6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.
基金National Natural Science Foundation of China (No.81100637)Jinan University Scientific Research Creativeness Cultivation Project for Outstanding Undergraduates Recommended for Postgraduate Study (No.50503592)
文摘AIMTo compare the efficacy of the sole intravitreal triamcinolone (IVT) versus intravitreal bevacizumab (IVB) alone or IVB combined with IVT in the treatment of diabetic macular edema (DME).
文摘Diabetic macular edema(DME)is a very important and well-known cause of visual loss in diabetics.Blood-retina barrier disruption and consequent intraretinal fluid accumulation may lead to retinal thickening at the posterior pole namely DME.Even though it is not clearly understood,current evidence suggests that chronic low-grade inflammation characterized with various cytokines has a major role in the occurrence of DME.Clinical trials are continuously shaping our treatment approaches for the eyes with DME.Today,vascular endothelial growth factor(VEGF)inhibitor and steroid administrations are the main alternatives in DME treatment.Dexamethasone(DEX)implant(Ozurdex®;Allergan,Inc.,Irvine,CA,United States)was approved by the United States Food&Drug Administration in 2014 for DME treatment.The implant is made up of a biodegradable solid copolymer that is broken down by releasing its active ingredient into the vitreous cavity over time.Biphasic release feature of this sustained-release drug delivery system ensures its efficacy for up to 6 mo with an acceptable and manageable safety profile.DEX implant provides a favorable anatomical and functional outcome in DME as shown in several randomized-controlled studies but has a relatively higher ocular side-effect profile such as increased risk of cataract formation and raised intraocular pressure when compared to the gold standard anti-VEGF agents.Thus,DEX implant becomes the second-line treatment option demonstrating inadequate clinical response to anti-VEGF therapy.However,it can be preferred as the first-line treatment in vitrectomized and pseudophakic eyes.Even in some selected conditions DEX implant is favored over anti-VEGF agents where the use of VEGF-inhibitors is either inappropriate or contraindicated such as the patients with a recent history of a major cardiovascular or cerebrovascular event,pregnancy and noncompliant to frequent visits.This mini-review briefly overviews the efficacy,safety profile and complications of DEX implant and summarizes the outcome of DEX implant administration in major clinical studies on DME treatment.
文摘Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation.
文摘AIM: To evaluate the two-year outcomes of patients treated for diabetic macular edema(DME) with intravitreal Conbercept(IVC).METHODS: The clinical data of 30 DME patients(36 eyes) were retrospectively reviewed. The patients were treated with IVC for 3 mo. Additional IVC was given at subsequent monthly visits, if needed(3+PRN). The patients were followed up for 24 mo.RESULTS: The best-corrected visual acuity(BCVA) at 24 mo significantly increased(66.7±15.3 letters) in comparison with the baseline(54.4±15.4 letters, P<0.0001). The mean improvement in BCVA was 11.0±2.9 letters. At 24 mo, 44.1% of the eyes surveyed gained ≥15 letters, 52.9% of the eyes gained ≥10 letters, and 70.6% of the eyes gained ≥5 letters. No vision loss was noted in 96.8% of the eyes, and 5.9% of the eyes lost ≥5 letters, but ≤10 letters. The central retinal thickness(CRT) at 24 mo was significantly reduced(277.1±122.9 μm) in comparison with the baseline(510.9±186.1 μm, P<0.0001). At 24 mo, 43.3% of the patients had a CRT ≤250 μm. The mean number of injections over 24 mo was 10.6±2.0. No severe eye or systemic adverse events related to either the drug or injection were noted.CONCLUSION: IVC is safe and effective for the treatment of DME.
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.
