Pharmaceutical therapy, including anti-vascular endothelial growth factor treatment and intravitreal corticosteroids, is the most common treatment for branch retinal vein occlusion (BRVO) and its complications, however there are confusing ideas about the protocol, patient selection, timing and endpoint of this treatment. The disease is easy to relapse with these drugs therapy. Collateral vessel formation was found in patients receiving intravitreal injection of ranibizumab or triamcinolone for BRVO and secondary macular edema. The mechanism of collateral vessel formation has not been carefully investigated. In the past thrombolysis, arteriovenous fasciostomy and laser choroidal retinal vascular anastomosis were used to reconstruct the retinal circulation, but their rationality, effectiveness and safety need to be further were studied. In recent years, because of the key technology is still immature, the artificial vascular bypass surgery experiment is not yet practical, but provides us a new idea worth looking forward to for the treatment of BRVO.
ObjectiveTo observe the changes of peripapillary vessel density and retinal nerve fiber layer parameters (RNFL) in diabetic mellitus (DM) patients with early diabetic retinopathy (DR).MethodsA retrospective clinical study. From January to December 2018, twenty-eight DM patients (47 eyes, DM group) and 20 normal subjects (40 eyes, control group) in Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. There was no significant difference between the two groups in age (t=－1.397, P=0.169) and sex composition ratio (χ2=0.039, P=0.843). The optic nerve head was scanned by OCT angiography (OCTA) with HD 4.5 mm ×4.5 mm imaging scanning mode for all subjects. The peripapillary radial peripapillary capillaries vessel density (ppVD) and peripapillary retinal nerve fiber layer (pRNFL) thickness were measured. The changes of ppVD and pRNFL thickness between the two groups were observed. Pearson correlation analysis was used to analyze the correlation between ppVD and pRNFL in each quadrant.ResultsCompared with the control group, the mean ppVD and superior-hemi part, inferior-hemi part, superior, nasal, inferior and temporal quadrant ppVDs of DM group were all significantly lower than those of control group (t=5.107, 4.360, 3.713, 4.007, 2.806, 4.046, 2.214; P＜0.05). The mean and all quadrants pRNFL thickness were lower in eyes of DM group compared with the control, and the superior and inferior quadrant pRNFL thickness were statistically significant (t=2.117, 2.349; P＜0.05), while the mean pRNFL and superior-hemi, inferior-hemi part, nasal and temporal quadrant were not statistically significant (t=1.867, 1.717, 1.869, 0.720, 0.303; P＞0.05). Pearson correlation analysis showed that the significant high-positive correlation was found between ppVD and pRNFL thickness in the nasal quadrant (r=0.734, P＜0.001).ConclusionIn early DR patients, ppVD decreased and pRNFL thinned.
ObjectiveTo observe the short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide (PSTA) in the treatment of macular edema due to ischemic retinal vein occlusions (RVO). MethodsA retrospective clinical study. A total of 53 eyes of 53 patients with RVO macular edema diagnosed by fundus color photography, fundus fluorescein angiography and optical coherence tomography (OCT) were included in the study. The best corrected visual acuity (BCVA) was detected by the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by OCT. Among 53 eyes, there were 27 eyes with ischemic RVO macular edema (ischemic group) and 26 eyes with non-ischemic RVO macular edema (non-ischemic group). The mean logMAR BCVA was 0.82±0.37, mean CMT was (662.1±216.7) μm in ischemic group. The mean logMAR BCVA was 0.41±0.23, mean CMT was (548.0±161.9) μm. The differences of logMAR BCVA and CMT between the two groups were both statistically significant (t=4.745, 2.258; P<0.05). All eyes were treated with a single sub-Tenon injection of 0.4 ml triamcinolone acetonide suspension (100 mg/ml).The mean logMAR BCVA, CMT before and 1, 3 months after the treatment between the two groups were observed and compared. ResultsOn 1 and 3 months after treatment, the mean logMAR BCVA in the non-ischemic group (0.32±0.25 and 0.27±0.29) were improved compared with ischemic group (0.76±0.37 and 0.41±0.79), the difference was statistically significant (t=5.052, 5.240; P<0.05). The mean logMAR BCVA before and after treatment had no statistically significant difference in ischemic group (F=0.516, P>0.05), but had a statistically significant difference in non-ischemic group (F=7.685, P<0.05). On 1 and 3 months after treatment, the mean CMT in the ischemic group were (534.7±223.4), (470.8±234.7) μm, which were lower (127.4±28.28), (191.4±34.55) μm before treatment. In the non-ischemic group, the average CMT was (426.2±188.8), (371.3±200.6) μm, which were lower (103.1±33.1), (164.9±49.6) μm. There were statistically significant differences in the mean CMT between the ischemic group and the non-ischemic group (F=17.040, 10.360; P<0.05). In non-ischemic group, CMT had a bigger reduction compared to the the ischemic group (t=2.056, 2.103; P<0.05). The difference of CMT decrease value between two groups was not statistically significant (t=0.560, 0.441; P>0.05). On 1 month after the treatment, there were 3 and 5 eyes had a higher intraocular pressure than 21 mmHg (1 mmHg=0.133 kPa) in ischemic and non-ischemic group, respectively; but all of them returned to normal after drug treatment. There were no drugs and ocular injection related complications. ConclusionPSTA of ischemic RVO macular edema can lower the CMT in the short term, but can't significant improve the visual acuity.