ObjectiveTo compare difference of therapeutic effects between endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet (FREDDY) laser and endoscopic traditional mechanical lithotripsy in treatment of common bile duct stones (CBDs).MethodsThe clinical data of 207 patients with CBDs treated with ERCP and lithotripsy in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2009 to March 2019 were analyzed retrospectively, of which 71 cases treated by FREDDY (FREDDY group) and 136 cases treated by mechanical lithotripsy (mechanical group). The success rate of stone removal, operation time, postoperative hospitalization time, hospitalization cost, consumables cost, and complications were compared between the two groups.ResultsThere were no significant differences in the general condition and the preoperative clinical data between the two groups (P>0.05). There was no perioperative death in the two groups. There were no significant differences in terms of the postoperative routine laboratory biochemical indexes, consumables cost, hospitalization cost, and rates of the bleeding, postoperative pancreatitis, perforation and biliary tract infection between the two groups (P>0.05). Although the operation time of the FREDDY group was significantly longer than that of the mechanical group (P<0.05), the success rate of stone removal was significantly higher, the postoperative hospitalization time was shorter, the total complications rate and stone residual rate were significantly lower in the FREDDY group as compared with the mechanical group (P<0.05).ConclusionEndoscopic FREDDY laser lithotripsy has a better curative effect and less complications in treatment of large CBDs than mechanical lithotripsy, but operation time needs further to be improved.
ObjectiveTo observe the clinical efficacy and safety of full macular coverage micropulse laser in the treatment of refractory macular edema secondary to Irvine-Gass syndrome.MethodsA retrospective case study. From April 2018 to November 2019, 21 cases of Irvine-Gass syndrome patients with 24 eyes were included in the study. Among them, there were 11 females with 12 eyes and 10 males with 12 eyes; the average age was 54.5±10.1 years. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA was performed using a standard logarithmic visual acuity chart, and the results were converted into the logarithmic minimum angle of resolution (logMAR) visual acuity when recording. The frequency domain OCT instrument was used to measure the foveal retinal thickness (CMT) and the retinal volume (MRV) of the macular area with a diameter of 1, 6 mm. All the affected eyes were treated with a micropulse laser under the threshold of 577 nm, with a spot diameter of 200 μm, an exposure time of 200 ms, a power of 400 mW, and a 5% duty cycle. The treatment scope was in the upper and lower vascular arches of the macula, covering the entire macula (including the fovea). One or 3 months after treatment, the eyes with macular edema were treated twice with micropulse laser, the method was the same as before. 1, 3, and 6 months after the treatment, the same equipment and methods as before the treatment were used for related inspections. The changes of BCVA, CMT, MRV and the occurrence of complications in the affected eye were observed.ResultsThe average logMAR BCVA of the eyes before treatment and 1, 3, and 6 months after treatment were 0.440±0.320, 0.333±0.286, 0.250±0.245, 0.166±0.184, and the average CMT were 395.88±79.21, 349.17±78.07, 317.67±53.72, 285.29±37.03 μm, respectively; the average MRV of diameter 1, 6 mm were 0.310±0.063, 0.275±0.060, 0.245±0.035, 0.221±0.219 mm3 and 9.866±0.846, 9.494±1.002, 9.005±0.885, 8.190±0.850 mm3. Compared with before treatment, the BCVA of the eyes at 1, 3, and 6 months after treatment was significantly increased (t=5.060, 5.564, 6.466), and CMT was significantly decreased (t=4.854, 5.777, 7.349), and the differences were statistically significant (P＜0.01); the average MRV of diameters 1, 6 mm decreased significantly, and the difference was statistically significant (1 mm diameter: t=4.527, 5.394, 7.380; P＜0.01; diameter 6 mm: t=4.577, 7.980, 11.209; P＜0.01). The average number of micropulse laser treatments for the affected eye was 1.25 times.ConclusionFull macular coverage micropulse laser can safely and effectively treat refractory macular edema secondary to Irvine-Gass syndrome and can be used as an alternative treatment.
ObjectiveTo observe the efficacy of intravitreal injection of conbercept (IVC) combined with subthreshold micropulse laser photocoagulation (SMLP) in the treatment of diabetic macular edema (DME). MethodsA randomized controlled trial. From December 2020 to January 2022, 100 patients (100 eyes) with DME diagnosed by examination in Shanxi Aier Eye Hospital were included in the study. The patients were randomly divided into IVC group (50 eyes) and IVC+SMLP group (50 eyes). All the eyes were treated with IVC once a month for 3 times, and the eyes in IVC+SMLP group were treated with SMLP within 2 weeks after IVC. All affected eyes were examined by best corrected visual acuity (BCVA), which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by optical coherence tomography. Before the treatment, the logMAR BCVA of patients in IVC group and IVC+SMLP group were 0.56±0.04 and 0.55±0.03, respectively. The CMT were (437.36±11.35) μm and (434.58±10.88) μm, respectively. There was no significant difference in logMAR BCVA and CMT between the two groups (t= 0.476, 1.027; P＞0.05). The patients were followed up for 12 months after treatment. The times of IVC and the changes of BCVA and CMT were compared between the two groups. Independent sample t-test was used to compare the logMAR BCVA, CMT and times of IVC between groups. ResultsAfter 12 months treatment, the logMAR BCVA of IVC group and IVC+SMLP group were (241.63±29.79) μm and (240.47±30.46) μm, respectively. Compared with those before treatment, 12 months after treatment, the BCVA of the two groups increased significantly (t=7.014, 5.608; P＜0.001), while CMT decreased significantly (t=8.126, 6.013; P＜0.001). There was no significant difference in BCVA and CMT between the two groups (t=0.835, 0.764; P＞0.05). The number of IVC in IVC group and IVC+SMLP group were (8.15±2.04) times and (5.91±1.80) times, respectively, and the difference was statistically significant (t=5.210, P＜0.001). ConclusionsBoth IVC+SMLP and IVC alone can effectively reduce CMT and increase BCVA in patients with DME. Combination therapy can reduce the number of IVC.
Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.
Central serous chorioretinopathy (CSC) is a common macular disease, which can lead to the loss of central vision in young patients. Although the disease is self-limited to some extent, there is no shortage of patients with prolonged course and recurrent attacks, eventually leading to irreversible visual impairment. Therefore, taking reasonable treatment in a certain period is particularly important for the visual prognosis of patients. Although thermal laser photocoagulation of leakage points and photodynamic therapy (PDT) have achieved good effects, there are risks of retinal damage and retinal pigment epithelium atrophy. Subthreshold micropulse laser (SMLP) is a kind of subthreshold short pulse laser, which does not cause visible damage to the retina and is safer. In the era of lack of PDT drugs, SMLP has gradually become an important means of clinical treatment for CSC, especially for patients with no obvious leakage point or subfoveal leakage point. An in-depth understanding of the mechanism of action of SMLP and its efficacy and safety in the treatment of CSC is helpful for the promotion and application of SMLP in the clinical treatment of CSC.