ObjectiveTo observe the changes of macular microvascular structure in eyes with macular edema secondary to branch retinal vein occlusion (BRVO-ME) after intravitreal injection of conbercept and analyze its relationship with visual function and central retinal thickness (CRT).MethodsA prospective clinical study. From July 2018 to June 2019, 21 eyes of 21 patients with unilateral temporal BRVO-ME diagnosed in the Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 14 eyes of 14 males and 7 eyes of 7 females; the average age was 58.0±8.3 years. There were 13 eyes and 8 eyes with occlusion of the superior temporal and inferior temporal branches of the retinal vein, respectively. The affected area was defined as the side of the venous obstruction. All the affected eyes underwent best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) examination. The BCVA was tested using the international standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistical analysis. All the eyes were treated with intravitreal injection of conbercept once a month for 3 months, and then treated as needed. A 3 mm × 3 mm scan centered on fovea was obtained and the vascular density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), fovea avascular zone (FAZ) area, perimeter of FAZ (PERIM), acircularity index (AI), foveal vascular density in a 300 μm wide region around FAZ (FD-300) and central retinal thickness (CRT) were measured. The follow-up time after treatment was 6 months. The vascular density and FAZ parameters were compared before and after treatment by paired t test. The correlations of BCVA, CRT and vascular density, FAZ area and the other parameters at 6 months after treatment were analyzed by linear regression analysis. ResultsBefore treatment, the logMAR BCVA of the eyes was 0.506±0.159, and the CRT was 375.4±81.3 μm; 6 months after treatment, the logMAR BCVA of the eyes was 0.294±0.097, and the CRT was 266.3±46.7 μm. There was a statistically significant difference of logMAR BCVA and CRT between the eyes before and after treatment (t=8.503, 9.843; P＜0.05). There was no statistically significant difference in the overall vascular density of SCP and DCP before and 6 months after treatment (t=－0.091, －0.320; P＞0.05). The foveal vascular density decreased, and the difference was statistically significant (t=8.801, 3.936; P＜0.05). The vascular density of DCP of the affected area increased, and the difference was statistically significant (t=－2.198, P＜0.05). Compared with those before treatment, the FAZ area and PERIM of the affected eyes had an increasing trend, while AI and FD-300 had a decreasing trend, and the differences were statistically significant (t=－18.071, －12.835, 2.555, 8.610; P＜0.05). The linear regression analysis showed that BCVA and FAZ area 6 months after treatment have significant correlation (t=2.532, P=0.024). ConclusionCRT decreased and BCVA increased after intravitreal injection of conbercept in BRVO-ME eyes. After treatment, the foveal vascular density of SCP and DCP decreased while the vascular density of DCP of the affected area increased. The FAZ increased and the PERIM and AI decreased during follow-up. The BCVA was significantly correlated with the FAZ area 6 months after treatment.
Full thickness macular hole (FTMH) is a rare complication of retinal vein occlusion (RVO). These have different characteristics, and may associate with complications of RVO, such as cystoid macular edema and epiretinal membrane, and treatments like intravitreal injection. Although anatomical closure is often obtained with vitrectomy and inner limiting membrane peeling, visual improvement is often variable. Regularly follow-up, medical examination, and vitrectomy can improve the outcomes of patients. In the future, randomized controlled clinical trials with larger sample size are still needed to further explore the pathogenesis, clinical characteristics and treatment methods of FTMH after RVO, so as to improve the clinical prognosis of these patients.
Objective To investigate the relationship between age-adjusted Charlson comorbidity index (aCCI) and ischemic stroke in patients with ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO). MethodsA single center retrospective cohort study. Seventy-four patients with OAO or RAO diagnosed by ophthalmology examination in Shenzhen Second People's Hospital from June 2004 to December 2020 were included in the study. The baseline information of patients were collected and aCCI was used to score the patients’ comorbidity. The outcome was ischemic stroke. The median duration of follow-up was 1 796.5 days. According to the maximum likelihood ratio of the two-piecewise COX regression model and the recursive algorithm, the aCCI inflection point value was determined to be 6, and the patients were divided into low aCCI group (＜6 points) and high aCCI group (≥6 points). A Cox regression model was used to quantify the association between baseline aCCI and ischemic stroke. ResultsAmong the 74 patients, 53 were males and 21 were females, with the mean age of (55.22±14.18) (19-84) years. There were 9 patients of OAO and 65 patients of RAO. The aCCI value ranges from 1 to 10 points, with a median of 3 points. There were 63 patients (85.14%, 63/74) in the low aCCI group and 11 patients (14.86%, 11/74) in the high aCCI group. Since 2 patients could not determine the time from baseline to the occurrence of outcome events, 72 patients were included for Cox regression analysis. The results showed that 16 patients (22.22%, 16/72) had ischemic stroke in the future. The baseline aCCI in the low aCCI group was significantly associated with ischemic stroke [hazard ratio (HR)=1.76, 95% confidence interval (CI) 1.21-2.56, P=0.003], and for every 1 point increase in baseline aCCI, the risk of future ischemic stroke increased by 76% on average. The baseline aCCI in the high aCCI group had no significant correlation with the ischemic stroke (HR=0.66, 95%CI 0.33-1.33, P=0.247). ConclusionsaCCI score is an important prognostic information for patients with OAO or RAO. A higher baseline aCCI score predicts a higher risk of ischemic stroke, and the association has a saturation effect.
Objective To observe the levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and monocyte chemotactic protein-1 (MCP-1) in aqueous humor of patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods Forty eyes of 40 consecutive patients with macular edema secondary to CRVO (CRVO group) were enrolled in this study. The patients included 25 males and 15 females. The patient age ranged from 38 to 76 years. The control group was 20 patients with senile cataract who underwent phacoemulsification, including 10 males and 10 females. The levels of VEGF165, VEGF165b, IL-6 and MCP-1 in aqueous humor were determined by enzymelinked immunosorbent assay. The correlation of VEGF, and IL-6, and MCP-1 were analyzed. Results The median aqueous level of VEGF165, IL-6 and MCP-1 were 1089.0, 165.6, 1253.0 pg/ml respectively in CRVO group, which were higher than the control group's results (168.2, 4.7, 216.4 pg/ml respectively), the differences were statistically significant (Z=-4.549, -6.008, -5.343;P＜0.001). The VEGF165b in CRVO group and control group were 834.0, 915.9 pg/ml respectively, the difference was not statistically significant (Z=-0.207，P＞0.05). The ratio of VEGF165b to VEGF165 in CRVO group and control group were 2.71, 7.28 respectively, the difference was statistically significant (t=-3.007，P＜0.05). There was a highly positive correlation between IL-6 and VEGF in CRVO group (r=0.526,P=0.001) and also mild positive correlation in control group (r=0.425，P=0.070). No correlation between MCP-1 and VEGF was observed in both groups (CRVO group: r=0.211,P＞0.05. Control group: r=-0.019,P＞0.05). Conclusions VEGF165, IL-6 and MCP-1 levels were increased in CRVO patients while the VEGF165b was normal. The ratio between VEGF165b and VEGF165 in aqueous humor of patients with macular edema secondary to CRVO was decreased.
Abstract： Objective To investigate videoassisted thoracoscopic surgery (VATS) and percutaneous catheter occlusion (PCO) in interruption of patent ductus arteriosus (PDA), in order to achieve minimally invasive surgical injuries and better clinical results. Methods From November 1995 to September 2009, 312 cases of PDA were treated in Fujian provincial hospital, among whom 252 patients were interrupted with VATS(VATS group) and 60 patients with PCO technique(PCO group). For the VATS group, there were 78 males and 174 females aged from 7 d to 31 years old (9.16±8.91 years), while there were 17 males and 43 females aged from 4 to 57 years old (25.55±14.10 years) in the PCO group. We used titanium clip to interrupt PDA under videoassisted thoracoscope for patients in the VATS group, and adopted Amplatzer method for patients in the PCO group. The clinical results, complications and hospital cost in the two groups were compared in this study. Results In the VATS group, all the PDA were successfully interrupted with no residual shunt. In the PCO group, 5% (3/60) of the patients had minor residual shunt after the procedure. No mortality occurred in both groups. Time of the procedure and hospital stay in the PCO group were shorter than that in the VATS group (70.20±31.20 min vs. 112.50±16.30 min, t=6.344,P=0.002; and 4.70±2.20 d vs. 6.50±2.80 d, t=3.241, P=0.022, respectively). However, the hospital cost for each patient in the PCO group was much higher than that in the VATS group (23 222.00±4 333.40 yuan RMB vs. 8 904.50±2 634.60 yuan RMB,t=25.360, P=0.000). Conclusion Compared with PCO, VATS in interrupting PDA can achieved not only excellent clinical results, especially in the newborn and baby cases, but also very satisfying cost which is just a little more than one third of the PCO cost.
ObjectiveTo compare the efficacy and safety of three different modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma.MethodsThe clinical data of 152 patients with primary hepatocellular carcinoma who underwent hepatectomy and postoperative pathology examination in our department in recent 3 years (2017–2020) were retrospectively analyzed. According to the modes of intraoperative hepatic blood flow occlusion, the patients were divided into three groups: intermittent Pringle method (IPM) group (41 cases), IPM was applied only; hemihepatic group (35 cases), hemihepatic blood flow blocking method was used only; and combined group (76 cases), combined hemihepatic blood flow blocking method and IPM. SPSS software was used to compare the differences of the three groups’ general data, intraoperative blood loss and postoperative liver function indexes. The changes of transaminase levels in the three groups were observed dynamically.ResultsBaseline data of the three groups were not statistically significant (P>0.05). There were no statistically significant differences in operative time, the number of resected liver segments, blood transfusion rate, incidence of complications, and postoperative length of stay among the three groups (all P>0.05). The intraoperative blood loss of the combined group and the IPM group were significantly less than that of the hemihepatic group (P<0.05). There was no difference in blood loss between the combined group and the IPM group (P>0.05). However, the blocking times in the combined group were significantly less than those in the IPM group (P<0.05). The transaminases in the three groups were close to the preoperative level on the fifth day after operation. Conclusions In hepatectomy of primary hepatocellular carcinoma, the three blocking modes are safe and effective. The combined application of hemihepatic blood flow blocking method and intermittent Pringle method can significantly reduce intraoperative blood loss, reduce the number of blocking, and do not aggravate the liver function injury.
Objective To observe the morphologic characters of macular lesions in patients with central retinal vein occlusion(CRVO) in optical coherence tomography(OCT). Methods Thirty-eight patients with the clinical diagnosis of CRVO were examined by OCT.Four scan lines traversing the fovea with the same length and the same angle gap were performed as the basic scan in every eye.Additional scan were selected according to individuals including changing the length or angle of the scan lines and selecting different diameter circle pattern scan. Results Cystoid macular edema (CME) was found in 15 eyes,detachment of the neurosensory retina in 6 eyes，thickened neurosesory retina in 11 eyes,slight intraretinal fluid in 4 eyes,and markedly thichened neurosensory retina in 2 eyes with secondary premacular membrane and intraretinal fluid. Conclusions The major OCT morphologic characters of macular lesions in patinets with CRVO may include:cystoid macular edema,detachment of neurosensory retina,and secondary premacular membrane and pigmentary epithelial changes.These would be helpful for diagnosing and evaluating macular lesion in CRVO. (Chin J Ocul Fundus Dis, 1999, 15: 201-204)
Objective To investigate the clinical characteristics of retinalve in occlusion caused by systemic lupus erythematosus (SLE).Methods Visual acuities, fundus examination, antinuclear antibody (ANA), anti-double-stranded DNA（anti-dsDNA）, complement 3 (C3), complement 4 (C4) and erythrocyte sedimentation rate (ESR) were detected in 9 patients (12 eyes) with retinal vein occlusions caused by SLE. Fundus fluorescein angiography (FFA) was performed on 3 patients. Patients with other ocular or general lesions were analyzed.Results Central re tinal vein occlusion (CRVO) in 6 patients (8 eyes) and branch retinal vein occlusion (BRVO) in 3 (4 eyes) were found. The results of FFA showed that 5 eyes of 3 patients had extensive leakage of retinal vein and capillary. Four contralateral eyes of 6 patients with unilateral retinal vein occlusion had SLE fundus alte rations such as cotto-wool spot and retinal hemorrhage. Four patients had xerotic keratitis or ulcerative blepharitis and 8 had general lesions. Positive ANA and anti-dsDNA, and ESR gt;50 mm/h were detected in all the patients. Decreasing C3 in 6 patients and C4in 5 were found. Conclusions SLE is one of the general conditions causing retinal vein occlusion. Visual acuity and barrier of retinal vein and capillary are damaged seriously in patients with retinal vein occlusion caused by SLE, which may be accompanied with other ocular or general lesions. It is suggested that retinal vein occlusion is relative with SLE activity. (Chin J Ocul Fundus Dis，2003，19：201-268)
ObjectiveTo observe the clinical effect of radial optic neurotomy (RON) for central retinal vein occlusion (CRVO).MethodsThe clinical data of 5 patients with CRVO who had undergone RON after a standard three-port vitrectomy were analyzed retrospectively. In the 5 patents, CRVO was diagnosed in 2 before the surgery, and the examination of visual acuity, fundus photography, fundus fluorescein angiography (FFA), color doppler imaging (CDI), and examination of perimeter and optic coherence tomography (OCT) were performed on them before and after the operations, respectively. Three patients underwent the operation because of the vitreous hemorrhage and CRVO was diagnosed during the surgery. All of the 5 patients suffered from severe macular edema. The results of post-operative visual acuities, fundus examination, fundus photography and OCT were compared with those of the pre-operative ones. The follow-up after the surgery was 12 months. ResultsThe visual acuities improved in 4 patients and decreased in 1. The results of fundus photography and (or) FFA, and OCT revealed that the macular edema was evidently alleviated 1 month after the surgery and the retinal hemorrhage was absorbed ultimately 2 months after the surgery. The result of examination of perimeter performed on 1 case showed the improvement of visual field. In addition, vitreous hemorrhage occurred in 1 patient postoperatively and hemorrhage occurred in 2 in the operation puncturing the optic disk.ConclusionsRON is helpful to ameliorate the macular edema, reduce the retinal hemorrhages, prevent the neovascularization and enhance the visual acuity to some extent, which maybe clinically feasible and valuable in treating CRVO，but more prospective, randomized, and multi-center researches are still needed to verify the efficacy.(Chin J Ocul Fundus Dis, 2005,21:6-9)
Objective To evaluate the effectiveness of repeated intravitreal conbercept injection in patients with macular edema (ME) of retinal vein occlusion (RVO), guided by optic coherence tomography (OCT). Methods It is a retrospective case study. Forty patients (40 eyes) diagnosed as ME secondary to RVO were enrolled in this study. There were 19 males (19 eyes) and 21 females (21 eyes), with the mean age of (53.58±13.19) years and the mean course of 1.5 months. The best corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus fluorescein angiography (FFA) and OCT were performed. The mean baseline of BCVA, central macular thickness (CMT) were 0.25±0.18 and (509.48±170.13) μm respectively. All the patients were treated with 10.00 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg). Follow-up of these patients was 1 to 6 months after treatments, the BCVA, fundus manifestations, OCT were retrospectively observed by every month, the FFA was retrospectively observed by every 3 months. When there was retinal edema or CMT ≥50 μm by OCT during follow-up, those patients were retreated with intravitreal conbercept injection. The changes of the BCVA, CMT were evaluated before and after treatment. Meanwhile, complications in eyes related to medicine and treatment methods were evaluated too. Results At the 6 months, the BCVA was improved (increase≥2 lines) in 25 eyes (62.50%), stabilized (±1 line) in 13 eyes (32.50%) and decreased 2 lines in 2 eyes (5.00%). Retinal hemorrhage and exudates were absorbed in most patients. FFA showed no fluorescein leakage in 11 eyes (27.50%), minor fluorescein leakage in 26 eyes (65.00%), and retinal capillary non-perfusion in 3 eyes (7.50%). OCT showed absorption of the subretinal fluid. The mean CMT were (235.20±100.44) μm at 6 months. Intravitreal injection of conbercept was applied for 4 times in 8 eyes (20.00%), 3 times for 18 eyes (45.00%), and 2 times for 14 eyes (35.00%). The mean number of intravitreal injection was 2.85 times. There were no ocular or systemic adverse events observed in all patients. Conclusion Intravitreal conbercept injection is an efficacy and safe treatment for the patients with ME of RVO guided by OCT. It can stabilize and improve the visual acuity.