Thanks to the treatment of retinoblastoma (RB) having improved significantly in recent years, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum mortality. RB therapy is a long-term systemic treatment in clinical practice. Although there are many treatment options for RB therapy, such as cryotherapy, photocoagulation, systemic chemotherapy, enucleation and ophthalmic chemotherapy, it is recommended to consider in accordance with the following key points in gaining a reasonable treatment strategies: to make sure that RB is an intraocular period; to determine whether the intraocular RB to be treated with eye preservation or enucleation; what is the case of eye preservation therapy combined with chemotherapy and how to arrange the follow-up of RB patients. It's more complicated to choice the therapeutic measures for RB in clinical practice. So, the patient's condition, economic capability and medical condition should be evaluated comprehensively. The principle of RB treatment should be followed, which is protecting eyeball and visual function without life damage.
Prevention and treatment of infants and young children can avoid blindness, effectively reduce the incidence of children's blindness and vision loss. Eye diseases causing blindness in infants and young children mainly include retinopathy of prematurity, retinoblastoma, familial exudative retinopathy, persistent embryonic blood vessels, vitreous hemorrhage, congenital cataract, etc. Most of them are preventable and controllable, however, many diseases have strict requirements for the effective treatment time window. The basic form and path to carry out the prevention and control of blinding eye diseases in infants and young children are building a prevention and control system with a combination of multi-party medical forces, referral to pediatric eye disease institutions with relevant technical resources for further diagnosis and treatment, so as to achieve early detection, standardized treatment and visual training.
ObjectiveTo observe the clinical effect of small-gauge vitrectomy (SGV) treatment for proliferative diabetic tractional (PDR) with retinal detachment (TRD).
MethodsThe data of 42 patients (50 eyes) with PDR combined with TRD who had received SGV treatment were retrospectively analyzed. There were 22 males and 20 females, with an average age of (44.5±11.2) years. There were 16 eyes with TRD involving the macular area, 34 eyes without TRD involving the macular area. The eyes with rhegmatogenous retinal detachment or retinal hole were excluded. The best corrected visual acuity (BCVA) was worse than finger counting in 18 eyes, worse than 0.1 in 15 eyes, 0.1-0.3 in 16 eyes and better than or equal to 0.3 in 1 eye. Post-operative tamponade was delivered for patients with iatrogenic retinal breaks, including 5 eyes with long-acting gas and 7 eyes with silicone oil. The mean follow-up time was 9.7 months. The visual outcome, rate of retinal reattachment and complications were analyzed.
ResultsThe visual acuity improved in 34 eyes (68.0%), unchanged in 12 eyes (24.0%) and decreased in 4 eyes (8.0%). The difference of visual acuity before and after surgery was statistically significant (t=7.087, P<0.01).The total rate of retinal reattachment was 96%, and 84% of eyes achieved anatomic reattachment after single surgery. The rate of retinal reattachment was 89.5% (34/38) for these eyes without iatrogenic retinal breaks, 4/38 eyes without iatrogenic retinal breaks still had retinal detachment in 3 months after surgery and received tamponade of long-acting gas or silicone oil. The rate of retinal reattachment was 66.7% (8/12) for these eyes with iatrogenic retinal breaks and received post-operative tamponade. There were 17 eyes experienced postoperative vitreous hemorrhage, which were treated with anti-vascular endothelial growth factor (VEGF) antibodies or vitreous cavity lavage. There were 9 eyes with transient ocular hypertension, and 4 eyes with neovascular glaucoma (NVG). Among 4 eyes with NVG, 2 of which were controlled through anti-VEGF treatment or laser treatment, and 2 eyes of 2 patients refused to have further treatment.
ConclusionSGV is safe and effective treatment for PDR combined with TRD, and intraocular tamponade is not necessary in the absence of iatrogenic retinal break.
Objective
To observe the effects of intravitreal injection of conbercept for aggressive posterior retinopathy of prematurity (AP-ROP).
Methods
It is a retrospective case study. Twenty-one patients (40 eyes) with AP-ROP were enrolled in this study. There were 9 males (18 eyes) and 12 females (22 eyes), with the mean gestational age of (28.30±1.79) weeks and the mean birth weight of (1 021.40±316.70) g. All the lesions of 40 eyes were located in posterior zone, with 24 eyes in zone I and 16 eyes in zone II. All the eyes were treated with intravitreal injection of conbercept 0.025 ml (0.25 mg). During follow-up, nonresponders or patients with deterioration were retreated with intravitreal injection of conbercept or photocoagulation; patients with progressive deterioration to stage 4 had received vitrectomy. At the 1, 2, 4, 8, 12, 16, 20, 24 weeks after treatments, the disappearance or decrease of retinal vessel tortuosity and neovascularization, and the growth of the normal retinal vessels toward the peripheral retina were evaluated.
Results
Thirty-six eyes were cured for only one injection, the cured rate was 90.00%. However, 2 eyes (5.00%) had progressed to stage 4 with contractive retinal detachment, which underwent vitrectomy. Two eyes (5.00%) had received twice injections, whose remaining avascular zone area treated by photocoagulation. No major systemic or ocular complications after injection appeared. All lens remained transparent and no iatrogenic retinal hole was occurred during the follow-up.
Conclusion
Intravitreal injection of conbercept is effective in the treatment of AP-ROP.
