In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the workingage population.In the next 15 years,the number o...In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the workingage population.In the next 15 years,the number of patients suffering from diabetes mellitus is expected to increase significantly.By the year 2030,about 440 million people in the age-group 20-79 years are estimated to be suffering from diabetes mellitus worldwide(prevalence 7.7%),while in 2010 there were 285 million people with diabetes mellitus(prevalence 6.4%).This accounts for an increase in patients with diabetes in industrializednations by 20% and in developing countries by 69% until the year 2030.Due to the expected rise in diabetic patients,the need for ophthalmic care of patients(i.e.,exams and treatments) will also increase and represents a challenge for eye-care providers.Development of optimized screening programs,which respect available resources of the ophthalmic infrastructure,will become even more important.Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy.Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels.Additionally,regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy.In this way,the risk of blindness can considerably be reduced.In advanced stages of diabetic retinopathy,pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment.In recent years,the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema.展开更多
Diabetic retinopathy(DR) is the leading cause of blindness in industrialized countries. Remarkable advances in the diagnosis and treatment of DR have been made during the past 30 years, but several important managemen...Diabetic retinopathy(DR) is the leading cause of blindness in industrialized countries. Remarkable advances in the diagnosis and treatment of DR have been made during the past 30 years, but several important management questions and treatment deficiencies remain unanswered. The global diabetes epidemic threatens to overwhelm resources and increase the incidence of blindness, necessitating the development of innovative programs to diagnose and treat patients. The introduction and rapid adoption of intravitreal pharmacologic agents, particularly drugs that block the actions of vascular endothelial growth factor(VEGF) and corticosteroids, have changed the goal of DR treatment from stabilization of vision to improvement. Anti-VEGF injections improve visual acuity in patients with diabetic macular edema(DME) from 8-12 letters and improvements with corticosteroids are only slightly less. Unfortunately, a third of patients have an incomplete response to anti-VEGF therapy, but the best second-line therapy remains unknown. Current first-line therapy requires monthly visits and injections; longer acting therapies are needed to free up healthcare resources and improve patient compliance. VEGF suppression may be as effective as panretinal photocoagulation(PRP) for proliferative diabetic retinopathy, but more studies are needed before PRP is abandoned. For over 30 years laser was the mainstay for the treatment of DME, but recent studies question its role in the pharmacologic era. Aggressive treatment improves vision in most patients, but many still do not achieve reading and driving vision. New drugs are needed to add to gains achieved with available therapies.展开更多
AIMTo evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagu...AIMTo evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy.展开更多
AIM：To evaluate the efficacy and safety of intravitreal ranibizumab（IVR）with panretinal photocoagulation（PRP）followed by trabeculectomy compared with Ahmed glaucoma valve（AGV）implantation in neovascular glaucom...AIM：To evaluate the efficacy and safety of intravitreal ranibizumab（IVR）with panretinal photocoagulation（PRP）followed by trabeculectomy compared with Ahmed glaucoma valve（AGV）implantation in neovascular glaucoma（NVG）.METHODS：This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included：diabetic retinopathy（25 eyes）,and retinal vein occlusion（20 eyes）.All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities（BCVA）were converted to the logarithms of the minimum angle of resolution（log MAR）for the statisitical analyses.Intraocular pressure（IOP）,the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS：A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery（F=545.468,P〈0.05）,and the mean postoperative log MAR BCVA was also significantly improved（F=10.964,P〈0.05）with no significant difference between two groups.CONCLUSION：It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR＋A展开更多
AIM： To evaluate the effects of panretinal photocoagulation （PRP） compared with PRP plus intravitreal bevacizumab （IVB） in patients with high-risk proliferative diabetic retinopathy （PDR） according to the Early...AIM： To evaluate the effects of panretinal photocoagulation （PRP） compared with PRP plus intravitreal bevacizumab （IVB） in patients with high-risk proliferative diabetic retinopathy （PDR） according to the Early Treatment Diabetic Retinopathy Study criteria.METHODS： The data were collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. After treated with standard PRP, the eyes were randomly assigned to receive only PRP （PRP group） or PRP plus intravitreal injection of 1.25 mg of bevacizumab （PRP-Plus group）. Patients underwent complete ophthalmic evaluation, including best corrected visual acuity （BCVA）, intraocular pressure （IOP）, and new vessel size in fluorescein angiography （FA） and optical coherence tomography for the assessment of central subfield macular thickness （CSMT） at baseline and at weeks 12 （±2）, 16 （±2）, 24 （±2） and 48 （±2）. Main outcome measures also included vitreous clear-up time and neovascularization on the disc （NVD） regression time. Adverse events associated with intravitreal injection were investigated.RESULTS： Thirty consecutive patients （n=36 eyes） completed the 48-week follow-up. There was no significant difference between the PRP and PRP-Plus groups with respect to age, gender, type or duration of diabetes, area of fluorescein leakage from active neovascularizations （NVs）, BCVA or CSMT at baseline. The mean vitreous clear-up time was 12.1±3.4wk after PRP and 8.4±3.5wk after PRP combined with IVB. The mean time interval from treatment to complete NVD regression on FA examination was 15.2±3.5wk in PRP group and 12.5±3.1wk in PRP-Plus group. No significant difference in CSMT was observed between the groups throughout the study period. However, the total area of actively leaking NVs was significantly reduced in the PRP-Plus group compared with the PRP group （P〈0.05）. Patients received an average of 1.3 injections （range： 1-2）. Ten eyes （27.8%） underwent展开更多
Background：Neovascular glaucoma （NVG） is a refractory glaucoma.The management of NVG is very difficult,and it is more difficult when combined with vitreous hemorrhage.The aim of this study was to investigate the ef...Background：Neovascular glaucoma （NVG） is a refractory glaucoma.The management of NVG is very difficult,and it is more difficult when combined with vitreous hemorrhage.The aim of this study was to investigate the effects of ranibizumab plus combined surgery for NVG with vitreous hemorrhage.Methods：A total of 26 eyes of 26 NVG patients with vitreous hemorrhage were recruited in this study.The patients aged from 36 to 63 years with a mean age of 51.97 ± 7.60 years.The mean intraocular pressure （IOP） was 46.38 ± 5.75 mmHg （1 mmHg =0.133 kPa） while being treated with the maximum medical therapy.The mean best-corrected visual acuities converted to logarithm of the minimum angle of resolution （logMAR BCVA） was 2.62 ± 0.43.All the patients underwent intravitreal injection of 0.5 mg （0.05 ml） ranibizumab combined with pars plana vitrectomy （PPV）,pars plana lensectomy （PPL） with a preserved anterior capsule,panretinal photocoagulation （PRP）,and trabeculectomy （intravitreal ranibizumab [IVR] ＋ PPV ＋ PPL ＋ PRP ＋ trabeculectomy）.The IOP and logMAR BCVA were the main outcome measures in this study.Results：The follow-up period was 12 months.The mean postoperative IOPs were 26.38 ± 3.75 mmHg,21.36 ± 3.32 mmHg,1 8.57 ± 3.21 mmHg,and 16.68 ± 2.96 mmHg,respectively at 7 days,1 month,3 months,and 12 months after PPV ＋ PPL ＋ PRP ＋ trabeculectomy.At the last follow-up,the mean IOP was significantly lower than the preoperative one （t =6.612,P =0.001）.At 7 days,1 month,3 months,and 12 months after PPV ＋ PPL ＋ PRP ＋ trabeculectomy,the mean logMAR BCVA were 1.30 ± 0.36,1.29 ± 0.37,1.29 ± 0.39,and 1.26 ± 0.29,respectively.At the last follow-up,the mean logMAR BCVA was significantly improved,and the difference was statistically significant compared with preoperative one （t =6.133,P =0.002）.The logMAR BCVA improved in 22 eyes （84.62%）,and remained stable in 4 eyes （15.38%）.The neovascularization in the iris and the angle regressed significantly in all pa展开更多
The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retin...The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retinal rupture is the most important. Retinopathy is caused by a gap between the neurosensory retina and the retinal pigment epithelium, which severely damages the visual function of the patient. Therefore, early clinical discovery, prevention and selection of an appropriate treatment are important. This article reviews progress in the treatment of retinal detachment.展开更多
文摘In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the workingage population.In the next 15 years,the number of patients suffering from diabetes mellitus is expected to increase significantly.By the year 2030,about 440 million people in the age-group 20-79 years are estimated to be suffering from diabetes mellitus worldwide(prevalence 7.7%),while in 2010 there were 285 million people with diabetes mellitus(prevalence 6.4%).This accounts for an increase in patients with diabetes in industrializednations by 20% and in developing countries by 69% until the year 2030.Due to the expected rise in diabetic patients,the need for ophthalmic care of patients(i.e.,exams and treatments) will also increase and represents a challenge for eye-care providers.Development of optimized screening programs,which respect available resources of the ophthalmic infrastructure,will become even more important.Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy.Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels.Additionally,regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy.In this way,the risk of blindness can considerably be reduced.In advanced stages of diabetic retinopathy,pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment.In recent years,the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema.
文摘Diabetic retinopathy(DR) is the leading cause of blindness in industrialized countries. Remarkable advances in the diagnosis and treatment of DR have been made during the past 30 years, but several important management questions and treatment deficiencies remain unanswered. The global diabetes epidemic threatens to overwhelm resources and increase the incidence of blindness, necessitating the development of innovative programs to diagnose and treat patients. The introduction and rapid adoption of intravitreal pharmacologic agents, particularly drugs that block the actions of vascular endothelial growth factor(VEGF) and corticosteroids, have changed the goal of DR treatment from stabilization of vision to improvement. Anti-VEGF injections improve visual acuity in patients with diabetic macular edema(DME) from 8-12 letters and improvements with corticosteroids are only slightly less. Unfortunately, a third of patients have an incomplete response to anti-VEGF therapy, but the best second-line therapy remains unknown. Current first-line therapy requires monthly visits and injections; longer acting therapies are needed to free up healthcare resources and improve patient compliance. VEGF suppression may be as effective as panretinal photocoagulation(PRP) for proliferative diabetic retinopathy, but more studies are needed before PRP is abandoned. For over 30 years laser was the mainstay for the treatment of DME, but recent studies question its role in the pharmacologic era. Aggressive treatment improves vision in most patients, but many still do not achieve reading and driving vision. New drugs are needed to add to gains achieved with available therapies.
文摘AIMTo evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy.
文摘AIM：To evaluate the efficacy and safety of intravitreal ranibizumab（IVR）with panretinal photocoagulation（PRP）followed by trabeculectomy compared with Ahmed glaucoma valve（AGV）implantation in neovascular glaucoma（NVG）.METHODS：This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included：diabetic retinopathy（25 eyes）,and retinal vein occlusion（20 eyes）.All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities（BCVA）were converted to the logarithms of the minimum angle of resolution（log MAR）for the statisitical analyses.Intraocular pressure（IOP）,the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS：A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery（F=545.468,P〈0.05）,and the mean postoperative log MAR BCVA was also significantly improved（F=10.964,P〈0.05）with no significant difference between two groups.CONCLUSION：It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR＋A
文摘AIM： To evaluate the effects of panretinal photocoagulation （PRP） compared with PRP plus intravitreal bevacizumab （IVB） in patients with high-risk proliferative diabetic retinopathy （PDR） according to the Early Treatment Diabetic Retinopathy Study criteria.METHODS： The data were collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. After treated with standard PRP, the eyes were randomly assigned to receive only PRP （PRP group） or PRP plus intravitreal injection of 1.25 mg of bevacizumab （PRP-Plus group）. Patients underwent complete ophthalmic evaluation, including best corrected visual acuity （BCVA）, intraocular pressure （IOP）, and new vessel size in fluorescein angiography （FA） and optical coherence tomography for the assessment of central subfield macular thickness （CSMT） at baseline and at weeks 12 （±2）, 16 （±2）, 24 （±2） and 48 （±2）. Main outcome measures also included vitreous clear-up time and neovascularization on the disc （NVD） regression time. Adverse events associated with intravitreal injection were investigated.RESULTS： Thirty consecutive patients （n=36 eyes） completed the 48-week follow-up. There was no significant difference between the PRP and PRP-Plus groups with respect to age, gender, type or duration of diabetes, area of fluorescein leakage from active neovascularizations （NVs）, BCVA or CSMT at baseline. The mean vitreous clear-up time was 12.1±3.4wk after PRP and 8.4±3.5wk after PRP combined with IVB. The mean time interval from treatment to complete NVD regression on FA examination was 15.2±3.5wk in PRP group and 12.5±3.1wk in PRP-Plus group. No significant difference in CSMT was observed between the groups throughout the study period. However, the total area of actively leaking NVs was significantly reduced in the PRP-Plus group compared with the PRP group （P〈0.05）. Patients received an average of 1.3 injections （range： 1-2）. Ten eyes （27.8%） underwent
文摘Background：Neovascular glaucoma （NVG） is a refractory glaucoma.The management of NVG is very difficult,and it is more difficult when combined with vitreous hemorrhage.The aim of this study was to investigate the effects of ranibizumab plus combined surgery for NVG with vitreous hemorrhage.Methods：A total of 26 eyes of 26 NVG patients with vitreous hemorrhage were recruited in this study.The patients aged from 36 to 63 years with a mean age of 51.97 ± 7.60 years.The mean intraocular pressure （IOP） was 46.38 ± 5.75 mmHg （1 mmHg =0.133 kPa） while being treated with the maximum medical therapy.The mean best-corrected visual acuities converted to logarithm of the minimum angle of resolution （logMAR BCVA） was 2.62 ± 0.43.All the patients underwent intravitreal injection of 0.5 mg （0.05 ml） ranibizumab combined with pars plana vitrectomy （PPV）,pars plana lensectomy （PPL） with a preserved anterior capsule,panretinal photocoagulation （PRP）,and trabeculectomy （intravitreal ranibizumab [IVR] ＋ PPV ＋ PPL ＋ PRP ＋ trabeculectomy）.The IOP and logMAR BCVA were the main outcome measures in this study.Results：The follow-up period was 12 months.The mean postoperative IOPs were 26.38 ± 3.75 mmHg,21.36 ± 3.32 mmHg,1 8.57 ± 3.21 mmHg,and 16.68 ± 2.96 mmHg,respectively at 7 days,1 month,3 months,and 12 months after PPV ＋ PPL ＋ PRP ＋ trabeculectomy.At the last follow-up,the mean IOP was significantly lower than the preoperative one （t =6.612,P =0.001）.At 7 days,1 month,3 months,and 12 months after PPV ＋ PPL ＋ PRP ＋ trabeculectomy,the mean logMAR BCVA were 1.30 ± 0.36,1.29 ± 0.37,1.29 ± 0.39,and 1.26 ± 0.29,respectively.At the last follow-up,the mean logMAR BCVA was significantly improved,and the difference was statistically significant compared with preoperative one （t =6.133,P =0.002）.The logMAR BCVA improved in 22 eyes （84.62%）,and remained stable in 4 eyes （15.38%）.The neovascularization in the iris and the angle regressed significantly in all pa
文摘The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retinal rupture is the most important. Retinopathy is caused by a gap between the neurosensory retina and the retinal pigment epithelium, which severely damages the visual function of the patient. Therefore, early clinical discovery, prevention and selection of an appropriate treatment are important. This article reviews progress in the treatment of retinal detachment.
