Perifoveal exudative vascular anomalous complex (PEVAC) is a very rare macular vascular disease characterized by an isolated large aneurysmal lesion in the fovea, with accompanied by small retinal hemorrhage and exudation. The main clinical symptoms of the patients are various degree of impaired vision. Clinically, it is often confused with type 1 macular telangiectasia and type 3 macular neovascularization. A thorough understanding of the clinical features of PEVAC is particularly important for its differential diagnosis. Due to the unclear pathogenesis of PEVAC, there is no specific treatment for the cause of disease. Most scholars use intravitreal injection against vascular endothelial growth factor drugs for treatment, but can not improve patients' visual acuity. At present, many attempts have been made to eliminate abnormal exudation of the lesion, maintain visual function and achieve a good prognosis by simple or combined laser photocoagulation. At present, it is still necessary to explore the pathogenesis of PEVAC, improve the understanding of the disease, and find a better treatment plan.
ObjectiveTo observe the clinical efficiency of intravitreal Conbercept on exudative age-related macular degeneration (eAMD). MethodsThis is an open and prospective study without control trial. Twenty eyes from 20 patients (19 males and 1 female) with eAMD diagnosed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were enrolled in this study. Before the injection, best-corrected visual acuity (BCVA) of early treatment of diabetic retinopathy study (ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, fundus fluorescein angiograph (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were examined. The initial average letters of ETDRS acuity were 41.20±22.61, range from 8 to 80. The initial average central retina thickness (CRT) was (345.25±131.96) μm, range from 152 to 770 μm.All affected eyes were treated with intravitreal conbercept 0.05 ml (10 mg/ml). The patients were followed up for 6 to 9 months, with the mean time of (7.35±0.99) months.The BCVA, CRT after treatment were compared with baseline using paired t-test. ResultsDuring the 1, 3, 6, 12 months after treatment and the latest follow up, the mean BCVA were all improved with statistically significant difference (t=5.85, 7.09, 7.44, 7.25; P < 0.05). At 1 month ater treatment, the mean BCVA was obviously improved in 6 eyes (30%), improved in 8 eyes (40%), stable in 6 eyes (30%). At latest follow up, the mean BCVA was obviously improved in 6 eyes (30%), improved in 9 eyes (45%), stable in 5 eyes (25%). During the 1, 3, 6, 12 months after treatment and the latest follow up, the mean CRT were all decreased with statistically significant difference (t=3.34, 3.78, 3.47, 3.44; P < 0.05). At latest follow up, the leakage in macula lutea disappeared in 6 eyes (30%), decreased in 11 eyes (55%) and increased in 3 eyes (15%). No adverse events such as secondary retinal detachment or endoophthalmitis were found during the follow-up duration. ConclusionIntravitreal conbercept is a safe and effective approach for eAMD, may improve visual acuity, exudation and macular edema.
ObjectiveTo observe the changes of eotaxin-1(CCL11), eotaxin-2(CCL24)and eotaxin-3(CCL26)in ranibizumab treated light-injured human retinal pigment epithelium (RPE) cells ARPE-19 and investigate the effects of vascular endothelial growth factor (VEGF) antagonist to the expressions of eotaxins. MethodsCultured human RPE cells(8th-12th generations)were divided into light-injured group, ranibizumab treated group and normal control group. Cells of the three groups were exposed to the blue light at the intensity of(600±100) Lux for 12 h to establish the light injured model, while cell culture dishes of the normal control group were wrapped with double-layer foil. The cells of ranibizumab treated group were treated with VEGF-A antagonist(ranibizumab)at the final concentration of 0.125 mg/ml for 24 hours directly after the illumination. The mRNA and protein of VEGF-A, eotaxin-1, eotaxin-2, eotaxin-3, NF-κB were determined by Real time-PCR, enzyme-linked immunosorbent assay, Western blot, immunohistochemical staining at 0, 3, 6, 12, 24 hours after light damage. ResultsThe mRNA and protein level of VEGF-A, eotaxin-1, eotaxin-2, eotaxin-3, NF-κB in the light-injuried group increased significantly compared to that in normal control group (P < 0.05). After treating with ranibizumab, the expression of eotaxin-1, eotaxin-2, eotaxin-3, NF-κB were significantly suppressed (P < 0.05). ConclusionThe suppression of over-expression of VEGF in human RPE may down-regulate the expression of eotaxins, via the suppression of NF-κB.
ObjectiveTo observe the characteristics of optical coherence tomography (OCT) angiography (OCTA) in retinal vein occlusion (RVO). MethodsProspective and observational study. Clinical examination of 81 consecutive patients (86 eyes) diagnosed with RVO were included in the study, in which the branch retinal vein occlusion in 47 eyes, central retinal vein occlusion in 39 eyes. Forty-five patients were male and 36 patients were female. Aged from 28 to 76 years old, the mean age was (55.36±10.01) years old. Comprehensive optical and imaging examination were performed, including fundus photography, fundus fluorescein angiography (FFA), spectral domain OCT, en face OCT and OCTA. The retinal blood flow imaging scan mode and the optic disc blood flow imaging scan mode were performed, the scanning region in the macular area were 3 mm×3 mm, 6 mm×6 mm, 8 mm×8 mm respectively, around the optic disc were 3 mm×3 mm and 4.5 mm×4.5 mm. Each region scans 2 times. The characteristics of foveal avascular zone change, macular edema, non-perfusion and optical disc edema in OCTA and their corresponding FFA and en face OCT were observed. ResultsBy OCTA, 67 eyes (77.9%) for foveal avascular zone change, 23 eyes (26.7%) for macular edema, 40 eyes (46.5%) for non-perfusion, and 33 eyes (38.4%) for optical disc edema can be detected. The foveal avascular zone change can be indentified as the tranformation, destruction and even vanish of the arch in superfacial layer of retinal macular area, acompanied with the dilatation and thickening of capillary vessels, the occlusion and expanding of capillary vessels arounded the foveal avascular zone in the deep layer of macular area. Those performances were more clear than FFA. The main expression of macular edema was low signal and was not as clear as en face OCT. The tortuosity and expansion of retinal vessels, density decreasing and even occlusion or abnormal traffic branch of capillary vessels can be observed in non-perfusion. These observations were similar to FFA. However, pieces of highly signal identical with non-perfusion area can be detected in chroid capillary. The representation of optical disc edema was the brush-like expanding of capillary vessels aroud optical disc. ConclusionsOCTA can help for observing the abnormal changing of capillary vessels in foveal avascular zone and macular edema, non-perfusion and optical disc edema. Foveal avascular zone change showed occlusion and expanding of capillary vessels around the foveal avascular zone in the deep layer of macular area. Macular edema showed the weak signal. Non-perfusion showed tortuosity and expansion of retinal vessels, density decreasing and even occlusion or abnormal traffic branch of capillary vessels. Optical disc edema showed brush-like expanding of capillary vessels around optical disc.
Objective To observe the angiographic features of patients with retinal vein occlusion (RVO) by ultra-wide-field fluorescein angiography (UWFA) and compare with the conventional 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Fifty-eight eyes of 56 RVO patients were included. There were 25 males (26 eyes) and 31 females (32 eyes). The age ranged from 25 to 69 years, with a mean age of (48.12±18.56) years. The course of disease was from 2 days to 25 months, with a mean course of (12.78±11.35) months. Thirty eyes were diagnosed with central RVO (51.72%), 26 eyes were diagnosed with branch RVO (44.83%) and 2 eyes were diagnosed with hemicentral RVO (3.45%). Retinal laser photocoagulation was performed in 11 eyes (18.97%). All patients received examinations of UWFA (British Optomap 200Tx imaging system) and optical coherence tomography (OCT). Using the protocol for obtaining 7SF images as described in the Early Treatment Diabetic Retinopathy Study, 7 circular regions with a range of 30 degrees were combined as the 7SF template to determine the observation area. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. The visualized retinal area, retinal non-perfusion area, retinal neovascularization area, and laser spot area of UWFA and 7SF were quantified by a retinal specialist. In addition, the OCT images of the affected eye were observed and analyzed to confirm the existence of macular edema. Correlation analysis was done between retinal non-perfusion, retinal neovascularization and macular edema detected by UWFA. Results The results of UWFA and 7SF examination were the same. Compared with 7SF, UWFA showed 3.53 times more retinal visual area, 3.31 times more non-perfusion area, 1.94 times more neovascularization area, and 3.59 times more laser spots (t=72.13, 4.69, 1.76, 5.78;P=0.000, 0.005, 0.102, 0.000). Lesions of 11 eyes (18.97%) were found outside the range of 7SF images. By UWFA, non-perfusion area correlated with neovascularization and macular edema (χ2=12.13, 4.82;P=0.000, 0.028;C=0.42, 0.28). Non-perfusion area anterior to the equator have significantly correlations with macular edema (χ2=6.32,P=0.012,C=0.31), but non-perfusion posterior to the globe equator have no relevance with macular edema (χ2=2.88,P=0.090, C=0.22). Conclusions UWFA can detect more peripheral retinal lesions than 7SF images. By UWFA, non-perfusion area has correlation with neovascularization and macular edema.