Objective To investigate the effect of photodynamic therapy (PDT) combined with intravitreal bevacizumab on wet age-related macular degeneration (AMD). Methods In this retrospective study, 34 eyes (28 cases) diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab, including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography; On optical coherence tomography (OCT), 23 eyes showed intraretinal fluid (IRF) and 11 eyes presented subretinal fluid (SRF). After signing informed consent, all patients underwent initial standard PDT followed by intravitreal bevacizumab (1.25 mg) within succeeding 3 to 7 days. Best corrected visual acuity (BCVA) and OCT with routine eye examinations were evaluated monthly. Additional bevacizumab (1.25 mg) was injected intravitreally if new or increasing fluid appreciated on OCT, or BCVA lowered more than 5 letters even with stabilized fluid. Injection was discontinued if no fluid was showed on OCT (quot;dry macularquot;), or BCVA was stabilized even with fluid after two consecutive injections. BCVA and central retinal thickness (CRT) were analyzed and compared between baseline and 6 month follow-up. The correlation between parameters such as baseline BCVA, greatest linear dimension (GLD), type of CNV, SRF or IRF and posttreatment BCVA will be analyzed. The injection number of bevacizumab and complications were recorded. Results Compared to baseline, BCVA improved (9.4plusmn;10.2) letters and reach 44.9plusmn;21.3 letters (t=5.438，P＜0.01) and CRT decreased (184.6plusmn;214.6) mu;m (t=4.810，P＜0.01) at 6 month visit. The average of injection number was 1.9plusmn;0.9 (including initial injection of combination therapy). With multiple lineal regression analysis, only baseline BCVA correlated to posttreatment BCVA at 6 month visit (r=0.802.P＜0.01). The type of CNV, GLD, SRF or IRF on OCT and CRT at baseline were not associated to post-treatment BCVA (r=0.053, -0.183, 0.139 and 0.053, respectively.P＞0.05). BCVA of eyes with SRF (14.7 letters) increased more than eyes with IRF (6.9 letters) on OCT (t=-2.207，P=0.035). The change of BCVA after treatment (t=-0.076), change of CRT (t=-1.028) and number of injections (Z=-1.505) were not different between classic CNV and minimally classic CNV (P＞0.05). The change of CRT (t=-0.020) and number of injections (Z=-0.237) did not present difference between SRF and IRF (P＞0.05). The change of BCVA (t=1.159) and number of injections (Z=-1.194) were not correlated to whether residual fluid or not at 6 month visit (P＞0.05). No severe complications were noticed during follow-up.Conclusion For wet AMD patients, PDT combined intravitreal bevacizumab could improve visual acuity, reduce retinal thickness and control CNV progress in a short-term.
ObjectiveTo observe clinical outcomes of laser photocoagulation on retinopathy of prematurity (ROP). MethodsClinical data of 64 cases of ROP infants (127 eyes) were studied retrospectively. Fifteen infants (30 eyes) were diagnosed of pre-threshold ROP (type Ⅰ, 23.6%) and 49 cases (97 eyes) of threshold ROP (76.4%). All the eyes underwent photocoagulation through binocular indirect ophthalmoscope (532 nm or 810 nm) within 72 hours after the confirmation ROP. In all the 15 cases (30 eyes) of pre-threshold ROP (type Ⅰ), 6 of them (12 eyes) were photocoagulated by laser of 532 nm, and the other 9 ones (18 eyes) were treated with 810 nm. In 49 threshold ROP infants (97 eyes), 37 cases (73 eyes) and 12 ones (24 eyes) were treated with laser of 532 nm or 810 nm respectively. All the infants were followed up 12-36 months (18.4 months) since photocoagulation to investigate regression of ROP. All the data of ROP infants photocoagulated, such as recovery rate of one-time photocoagulation, repeat rate, unfavorable outcomes, and complications, were analyzed statistically according to the severity of ROP and wave length of laser employed. ResultsIn all the 127 photocoagulation treated eyes, ROP regressed completely in 125 eyes (98.4%), temporal retinal traction remained in 2 eyes (1.6%), and no retinal detachment was found. ROP regressed completely in 118 eyes (92.9%) after one-time photocoagulation, recovered totally in 6 eyes (4.7%) after repeating photocoagulation 2-3 times, and resorted to cryotherapy in 3 eyes (2.4%). Subconjunctiva hemorrhage, found in 12 eyes (9.4%), was the most common complication. During photocoagulation, anesthetic accident occurred in 1 infant (1.6%), and 1 eye developed cataract (0.8%). It was suggested from statistical analysis that there was no significant difference on efficiency or safety between pre-threshold (type Ⅰ) and threshold ROP photocoagulated by laser of 532 nm or 810 nm. However, almost all of the ROP infants need repeat photocoagulation or additional cryotherapy, and patients with unfavorable outcomes or severe complications, occurred in threshold ROP treated with 532 nm laser. ConclusionPhotocoagulation with 532 nm or 810 nm laser is effective for type Ⅰ pre-threshold or threshold ROP.
ObjectiveTo investigate the fundus fluorescein angiography (FFA) characteristics of spontaneous regression in retinopathy of prematurity (ROP) and the range of retinal vascularization. MethodsA clinical retrospective study. A total of 82 eyes of 41 infants with ROP, who underwent FFA from January 2019 to December 2021 in Department of Ophthalmology of Xijing Hospital after completion of ROP regression, were included. There were 25 males (50 eyes) and 16 females (32 eyes). ROP was diagnosed in Zone Ⅱ in 44 eyes, with 38 eyes in stage 2 and 6 eyes in stage 3, and in zone Ⅲ in 38 eyes of stage 2. All patients underwent FFA examination under general anesthesia, at postmenstrual age of 70.70±12.25 weeks, after the natural regression of ROP was completed. Focus on the retinal vascular development, as well as choroid circulation and macular abnormalities, and compare and observe the differences between zone Ⅱ and Ⅲ after spontaneous regression. The extent of retinal vascularization was determined by the ratio between the distance of the center of the disc to the border of the vascularized zone (DB) and the center of the disc to the fovea distance (DF). The width of avascular area, recorded as the distance from the ora serrata to the vascular termination, was counted by disc diameters (DD). The measurement data between zone Ⅱ and zone Ⅲ ROP were compared by the independent sample t-test, and the count data were compared by χ2 test or Fisher exact probability test. ResultsThe linear choroidal pattern was present in 9 eyes (21.95%, 9/41), and the tortuous arteries in the posterior retina were detected in 32 eyes (39.02%, 32/82). It was noted that increased branching of vessels presented in 45 eyes (54.88%, 45/82), straight shape of vessels shown in 27 eyes (32.93%, 27/82), circumferential vessels arisen in 45 eyes (54.88%, 45/82), arteriovenous shunt appeared in 18 eyes (21.95%, 18/82), and capillary bed lost in 46 eyes (56.10%, 46/82) in areas from initial ridge to vascular termini. Punctate or linear dye leakage was observed in 23 eyes (28.05%, 23/82) during the late phase of FFA. Macular abnormalities, such as the absence of foveal avascular zone and hypoperfusion, were observed in 28 eyes (34.15%, 28/82), of which the macular ectopia presented in 1 eye. The mean DB/DF ratio of all the 82 eyes on the temporal side was 4.63±0.29 and 3.77±0.23 in the nasal. The mean avascular area on the temporal retina was 1.74±1.00 DD. Compared with ROP in zone Ⅲ, increased branching of vessels and dye leakage were more common (χ2=9.303, 10.774; P=0.002, 0.001), the extent of temporal retinal vascularization was smaller (t=－2.285, P=0.026), and the avascular area of the retina was more significant (t=5.491, P＜0.001) in zone Ⅱ ROP. ConclusionsEven after completion of spontaneous regression in ROP, incomplete retinal vascularization and vascular abnormalities may exist permanently in FFA, including those such as the tortuous arteries in the posterior retina, increased branching and straight shape of vessels, circumferential vessels, capillary bed lost and macular abnormality. Further appropriate follow-up is needed for long-term safety.