Objective To investigate the clinical characteristics of patients with polypoidal choroidal vasculopathy (PCV) from Central China . Methods This was a retrospective study, and 403 eyes of 362 patients diagnosed as PCV by ocular fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were enrolled. The general clinical data, fundus manifestation and ocular fundus examinations were statistically analyzed. Results Three hundred and sixty-two cases included 249 males (68.8%) and 113 females (31.2%). Age ranged from 45 to 91 years old, and mean age was (64.81plusmn;9.31) years old. Bilateral lesions were observed in 41 patients (11.3%) and unilateral lesions were observed in 321 patients (88.7%)． In these 403 eyes, typical orangered lesions were observed in 162 eyes (40.2%); yellowishwhite exudate could be found in 185 eyes (45.9%); 268 eyes (66.5%) showed variable degrees of subretinal hemorrhage. Drusen was found in 23 eyes (5.7%), pigment proliferation in 20 eyes (5.0%) and fiber vascular scar in 96 eyes (23.8%). The lesions of 386 eyes (95.8%) located in macular region, 53 eyes (13.2%) in peripapillary area. Lesions presented multifoci in 67 eyes (16.6%). Three hundred and four eyes (75.4%) presented typical polypoidal lesions and 152 eyes (37.7%) with abnormal branching choroidal networks. Hemorrhagic retinal pigment epithelial detachments (PED) were found in 200 eyes (49.6%) and serous PED in 96 eyes (23.8%), both existed in 25 eyes（6.2%）. OCT showed 56 eyes (13.9%) presented cystoid dark chamber between the neurosensory retina and 109 eyes (27.0%) with double-layer sign formed by the separation of retinal pigment epithelium and Bruchprime;s membrane (27.0%). Two hundred and seventy-four eyes (68.0%) were found with conelike elevation beneath the RPE layer and 151 eyes (37.6%) with neurosensory detachment. Conclusions In Central China, the majority of PCV patients were male, unilateral. Most PCV lesions were located in the macula. Subretinal hemorrhage, polypoidal lesions and abnormal choroidal vascular networks were common in the PCV patients. Hemorrhagic PED presented a higher ratio than serous PED.
Objective To compare the clinic therapeutic effect of intravitreal ranibizumab injection versus photodynamic therapy (PDT) combined with intravitreal ranibizumab injection for idiopathic choroidal neovascularizatio (ICNV), and to investigate the clinical effect and safety of treatment. Methods A randomized controlled clinical prospective study was performed for 27 patients (27 eyes) diagnosed as ICNV. Fourteen patients were assigned to receive PDT and intravitreal ranibizumab injection (combination roup.n=14); the control group was treated with only intravitreal ranibizumab injection (single group, n=13).The combination group was treated with an intravitreal injection of ranibizumab (0.5 mg/0.05 ml) 1 week after PDT. The bestcorrected visual acuity (BCVA) (logMAR), examination of the ocular fundus, fluorescence fundus angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were performed respectively at 1, 2, 3, 6 and 12 months after treatment. If choroidal neovascularization (CNV) was only partially regressed or the leakage went on during follow-up, those patients were re-injected with ranibizumab. Results After 12 months, the average vision is 0.22plusmn;0.11 in single group, and 0.21plusmn;0.12 in combination group, and the differences were not significant (t=0.187, P=0.853). In single group FFA and ICGA showed completely closed CNV in 10 eyes (77.92%), and almost closed CNV in 3 eyes (23.08%) with obvious reduction of fluorescence leakage. In combination group FFA and ICGA showed completely closed CNV in 12 eyes (85.71%), and almost closed CNV in 2 eyes (14.29%) with obvious reduction of fluorescence leakage; OCT showed the subretinal fluid absorption and reduction of CNV. The average macular retinal thickness (MRT) in single groups is （167.96plusmn;10.69） m, and in combination groups is （171.64plusmn;11.30）m. In single and combination groups MRT decreased significantly at the final follow-up, but no significant differences in both groups (t=-0.887.P=0.389). The average number of intravitreal injection was （1.5plusmn;0.7） in combination group and （2.4plusmn;1.0） in single group (t=2.821，P=0.009). There were no ocular or systemic adverse events observed except for one patient with subconjunctival hemorrhage in the single group.Conclusions Intravitreal ranibizumab injection and PDT combined with intravitreal bevacizumab injection are both effective and safe for the patients with ICNV. The combined therapy can induce CNV regression, fundus hemorrhage and exudation absorption more effectively, and have less recurred CNV and side effects.
Objective To investigate the triggering mechanisms of retinal ganglion cells (RGCs) alterations in retinally degenerative rats. Methods Retinal dystrophic Royal College of Surgeons (RCS-p+) and control RCS rats (RCS-rdy+-p+) were divided into three groups according to postnatal days, including postnatal 21 days (P21d), P60d and P90d, with six rats in each group. Fluorogold was injected into superior colliculus and lateral geniculate body for retrograde labeling RGCs. Then retinal flat mounts were observed under fluorescence microscope to investigate the morphological and RGC changes in density during retinal degeneration. Living retinal mounts or sections were prepared to investigate the calcium concentration of RGCs using a laser confocal microscope. Results At P90d RGCs of control rats were distributed throughout entire retina and appeared uniform. The soma and processes were apparent and clear. But at P90d RGCs of RCS-p+ rats were distributed sparsely in retina. The soma seemed messy and the number and dendritic fields decreased greatly, and some baculiform or broken cells appeared. RGC density was 5 421.0plusmn;72.1/mm2 at P21d, 4 195.0plusmn;136.4/mm2 at P60d and 2 906.0plusmn;133.2/mm2 at P90d. At P21d there were no obvious differences in RGCs density between RCS-p+ and control rats (t=-1.301, P＞0.05). At P60d and P90d there were significant differences in RGC density (t=16.172, 30.131; P＜0.01). At P21d there was no significant differences in RGC intracellular calcium fluorescence intensity between RCSp+ and control rats (t=-1.545, P＞0.05). At P60d and P90d the intracellular calcium fluorescence intensity decreased obviously and the differences were significant (t=-18.058,-15.015; P＜0.01). Conclusions RGCs were secondarily impaired following the loss of photoreceptors at late stages of retinal degeneration, and the morphological and cell density of RGCs were affected. The overloading of intracellular calcium concentration may be the triggering factor of degeneration and death of RGCs in retinally dystrophic rats.
ObjectiveTo compare the visual outcomes of treatment with intravitreal ranibizumab alone or in combination with photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). MethodsIn this retrospective and comparative study, 36 eyes of 36 patients with PCV were enrolled. Eighteen eyes received 0.5 mg (0.05 ml) ranibizumab injection only (simple injection group) and the other 18 eyes underwent combination therapy of ranibizumab injection and PDT (combination treatment group). Intravitreal ranibizumab was given at the third day after PDT. Re-treatment was considered in clinic examination. The minimum re-treatment interval was 3 months for combination therapy and 1 month for ranibizumab. Best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) at baseline and each follow-up visit at 1, 3, 6, 12 month was measured as a primary outcome, and complications also observed in every follow-up. ResultsNo complications occurred in these 36 patients during the treatment or follow-up, such as retinal detachment, sustained high intraocular pressure, retinal holes, intraocular inflammation, and systemic adverse reactions. The average times of ranibizumab injections of simple injection group and combined treatment group were (3.00±0.84) and (1.89±0.68) times respective, and the difference was significant (t=4.370, P=0.000). The logMAR BCVA of the first and third month after initial treatment between two groups were significant different (t=0.668, 0.940; P>0.05). However, there was no significant difference between them at the 6th and 12th month (t=2.188, 2.547; P<0.05). In the last follow-up, the logMAR BCVA were improved in simple injection group and combination treatment group compared to the pre-treatment values (t=3.351, 9.408; P=0.012, 0.000). In simple injection group, visual acuity was improved in 3 eyes (16.7%), stable in 13 eyes (72.2%) and decreased in 2 eyes (11.1%). In combination treatment group, visual acuity was improved in 4 eyes (22.2%), stable in 13 eyes (72.2%) and decreased in 1 eyes (5.6%). ConclusionsIntravitreal ranibizumab injection and combined with PDT are both effective to improve vision in patients with PCV. Visual acuity was the same between the two treatments in 3 months after initial treatment; however 6 to 12 months after first treatment, patients received PDT combined with intravitreal ranibizumab injection had better visual acuity than those received the intravitreal ranibizumab injection only.
ObjectiveTo compare the efficacy of photodynamic therapy (PDT) alone or in combined with ranibizumab versus ranibizumab monotherapy (intravitreal injection, IVR) in patients with polypoidal choroidal vasculopathy (PCV). Methods80 eyes of 72 patients with PCV were enrolled into this retrospective and comparative study according to their therapeutic plan. 30 eyes of 28 patients, 28 eyes of 30 patients and 22 eyes of 21 patients were divided into PDT group, ranibizumab 0.5 mg group (IVR group) or the combination group, respectively. The patients with PCV were diagnosed according to clinical symptoms, optical coherence tomography (OCT) and fluorescent indocyanine green angiography (ICGA). The baseline best-corrected visual acuity (BCVA) before treatment was more than 0.05, and there was no retinal fibrosis and scar for all patients. There was no statistical difference of age (F=0.187), gender (χ2=0.423), average BCVA (F=1.120) and central retinal thickness (CRT) (F=0.431) among three groups (P > 0.05). They had not received any treatment before. Patients received verteporfin PDT in PDT group, 3 consecutive monthly IVRs starting day 1 in IVR group, and 3 IVRs after 3 days, 1 month, 2 months of PDT starting day 1 in combination group. Re-treatment was considered 3 months later if the follow up shown no changes in fundus photography, OCT and ICGA. The average follow-up time was 19 months. BCVA at baseline and follow-up visit at 1, 3, 6, 12 months was measured, and the proportion of patients with ICGA-assessed complete regression of polyps at month 6 was recorded as primary outcome. The CRT was measured at baseline and 6 months as secondary outcome. ResultsThere were significant difference of BCVA at 1, 3, 6 and 12 months among three groups(F=5.480, 5.249, 3.222, 4.711; P < 0.05). The average BCVA was significantly better at 1, 3, 6, 12 month than that at baseline(t=-6.632, -4.127, -3.904, -4.494; P < 0.05) in combination group, and was significantly better at 3, 6, 12 months than that at baseline (t=-5.636, -3.039, -3.833; P < 0.05) in IVR group. However there was no significant difference of the average BCVA in PDT group between follow-up at 1, 3, 6, l 2 months and baseline (t=1.973, 0.102, -0.100, -0.761; P > 0.05). The proportion of patients with complete regression of polyps at 6 months was higher in PDT (76.7%) or combination group (68.2%) than IVR group (35.7%) (χ2=0.003, 0.025; P < 0.05). There was no significant difference of CRT among 3 groups at baseline (P=0.651). The mean CRT decreased in all 3 treatment groups over 6 months (t=5.120, 3.635, 5.253; P < 0.05), but there was no significant difference of CRT among 3 groups (F=1.293, P > 0.05). ConclusionsThree therapies could effectively decrease CRT. IVR or IVR combined with PDT are both more effective than PDT therapy to improve vision of PCV patients. PDT or PDT combined with IVR was superior to IVR pnly in achieving complete regression of polyps in 6 months in PCV patients.
ObjectiveTo observe the characteristics of optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) patients with different symptom duration before and after photodynamic therapy (PDT), and investigate its relationship with vision prognosis. Methods93 CSC patients (103 eyes) who had undergone the treatment of PDT were enrolled in this study. The eyes were divided into 3 groups according to symptom duration including group A (< 4 months, 28 eyes), group B (4-6 months, 42 eyes), group C (> 6 months, 33 eyes). The best corrected visual acuity (BCVA) and OCT were performed before and after treatment. Before the treatment, the percentage of patients with regular retinal pigment epithelium (RPE), irregular bump or detachment of RPE and disordered RPE were 63.0%, 37.0%, 0.0% in group A; 41.9%, 53.5%, 4.7% in group B and 24.2%, 57.6%, 18.2% in group C, respectively. The difference of percentage of RPE structure was no significance among the three groups (χ2=19.88, P=0.001). The outer nuclear layer (ONL) thickness was (220.42±49.88), (145.81±19.65), (98.15±33.02) μm in group A, B, C respectively, the difference between three groups was significant (P=0.000). The BCVA differences in different RPE structure and the relationship between ONL thickness and vision prognosis were recorded and analyzed. ResultsThe difference of ONL thickness in eyes with regular RPE and irregular bump or detachment of RPE in group A, B and C were not significant (P=0.599, 0.151, 0.789). The ONL thickness in eyes with disordered RPE were decreased significantly compared to eyes with irregular bump or detachment of RPE in group B and C (P=0.025, 0.036). The ONL thickness were (139.14±26.23), (119.14±21.09), (97.61±29.92) μm after PDT, respectively. Compared with ONL thickness before PDT, there was statistically significant decreasing after PDT in group A and B (P=0.000, 0.010), but there was no statistically significant difference after PDT in group C (P=0.192). After PDT, BCVA was negatively related to ONL thickness before PDT in group A (r=-0.684, P=0.000), and was positively related to ONL thickness after PDT in group C (r=0.413, P=0.017), but was neither related to ONL thickness before nor after PDT in group C (r=0.278, 0.117; P=0.074, 0.462). ConclusionsWith the duration of symptom being longer, the rate of irregular bump or detachment of RPE and disordered RPE are increased gradually, ONL thickness is getting thinner. After PDT, the ONL thickness became thinner in eyes with symptom duration less than 6 months and has no difference in eyes with symptom duration more than 6 months. The difference of BCVA in eyes with different RPE structure is significant. The vision prognosis of CSC with duration less than 4 months or more than 6 months are related to ONL thickness.
ObjectiveTo compare the short-term efficacy of conbercept and ranibizumab for macular edema in central retinal vein occlusion (CRVO)and explore the relationship between the integrity of ellipsoidal zone and visual acuity. MethodsForty-four eyes of 44 patients with macular edema in CRVO were enrolled into this retrospective and comparative study. There were 15 eyes of 15 males, 29 eyes of 29 females; age ranged from 49-61 years old,with an average age of (54.65±3.10) years. All patients were examined with best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp, fundus photograph, fundus fluorescein angiography (FFA), optical coherence tomography(OCT). BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution acuity. Twenty-three eyes were intravitreal injected with conbercept 0.5 mg (group A) and 21 eyes were intravitreal injected with ranibizumab 0.5 mg (group B). There was no statistical difference of age (t=-1.41), gender (χ2= 0.55),the percentage of hypertension patients (χ2=0.27), average BCVA (t=-2.06), IOP (t=-2.52), central macular thickness (CMT) (t=-1.96), number of different integrity of ellipsoidal zone patients (χ2=1.00) and number of different types of macular edema patients (χ2=1.03) among the two groups (P > 0.05). The change in BCVA and CMT at 3, 6 months between the two groups were compared. The relationship between BCVA at 6 months and BCVA, CMT at baseline were explored. The relationship between three groups of ellipsoidal zone and BCVA at baseline were evaluated. The change of BCVA after treatment between the three groups of ellipsoidal zone were Compared. The number of intravitreal injections between two groups was compared. ResultsDuring the 3, 6 months after treatment, the mean BCVA were all improved with statistically difference in group A (t=5.13, 7.39; P < 0.05) and group B (t=6.60, 11.52; P < 0.05). There was no significant difference of BCVA at 3, 6 moths between group A and group B (t=-0.99, -0.40; P > 0.05). During the 3, 6 months after treatment, the mean CMT were all decreased with statistically difference in group A (t=11.58, 15.96; P < 0.05) and group B (t=18.77, 35.16; P < 0.05). There was no significant difference of CMT at 3, 6 months between group A and group B (t=-1.52, -1.63; P > 0.05). In both groups,BCVA at 6 months was related to BCVA at baseline (r= 0.44, 0.62; P < 0.05), but not related to CMT at baseline (r=0.19, 0.01; P > 0.05). In the two groups, BCVA at baseline was related to the integrity of ellipsoidal zone (r=0.97, 0.70; P < 0.05). There was statistical difference of the number of intravitreal injections in the two groups (t=-6.88, P < 0.05). There was no systemic or ocular serious side effects during the follow up. ConclusionsComparing to ranibizumab, conbercept has the same effective to the treatment of macular edema in CRVO, but the number of intravitreal injections is less. The integrity of ellipsoidal zone is related to BCVA.
ObjectiveTo assess the consistency of diagnostic results using optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) in the central retinal vein occlusion (CRVO). MethodsThis is a retrospective case series of 26 eyes of 26 patients with CRVO. There were 10 females (10 eyes) and 16 males (16 eyes). The mean age was (49.19±10.50) years. The mean course of the disease was (27.81±21.60) days. Simultaneous OCTA and FFA were performed in all patients using 7-standard field of Early Treatment Diabetic Retinopathy Study (ETDRS) to evaluate the microaneurysms, nonperfused areas, optical disc/retinal neovascularization and macular edema. The consistency was evaluated using weighted Kappa statistic values. Kappa≥0.75, consistency is excellent; 0.60≤Kappa < 0.75, consistency is good; 0.40≤Kappa < 0.60, consistency is general; Kappa < 0.40, consistency is poor. ResultsBased on OCTA, microaneurysms were found in 23 eyes, nonperfused areas in 16 eyes, optical disc/retinal neovascularization in 8 eyes and macular edema in 21 eyes. Based on FFA, 23 eyes were diagnosed to have microaneurysms, 14 eyes have nonperfused area, 8 eyes have optical disc/retinal neovascularization, 22 eyes have macular edema. The consistency was excellent for microaneurysms and optical disc/retinal neovascularization (Kappa=0.772, 0.766; P < 0.01), good for nonperfused areas and macular edema (Kappa=0.703, 0.600,P < 0v01). ConclusionThere is high consistency between OCTA and FFA in the diagnosis of microaneurysms, macular edema, nonperfused areas and optical disc/retinal neovascularization in CRVO patients.