ObjectiveTo observe the clinical features of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration (nAMD) and its response to anti-vascular endothelial growth factor (VEGF) therapy. MethodsA retrospective clinical study. From July 2019 to July 2024, 188 patients (188 eyes) with nAMD who were continuously admitted to Tianjin University Aier Eye Hospital and received anti-VEGF drug treatment were included in the study. All eyes underwent best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. Treatment consisted of intravitreal anti-VEGF injections monthly for 3 months, followed by a pro re nata regimen. Based on the presence of BALAD on baseline OCT, eyes were divided into a BALAD group and a control group. BCVA was measured using a standard logarithmic visual acuity chart and converted to the logarithm of the minimum angle of resolution; central retinal thickness (CRT) was measured by OCT. Patients were followed for ≥12 months. Differences in CRT, BCVA, macular neovascularization (MNV) subtypes, and treatment outcomes at 12 months were compared between the two groups. The Scheirer-Ray-Hare test was used for non-normally distributed repeated measures data to compare interactions between time and group for BCVA and CRT; Spearman's rank correlation was used for correlation analysis of continuous variables between groups. ResultsThe number of eyes in the BALAD group and the control group was 33 (17.55%, 33/188) and 155 (82.45%, 155/188) respectively. Among the 33 eyes in the BALAD group, 21 eyes (63.64%, 21/33) had type 1 MNV, among which 18 eyes had polypoid choroidal vascular disease (PCV). There was no statistically significant difference in the gender composition ratio and MNV classification between the two groups of patients (χ2=2.09, 1.87; P＞0.05). There were statistically significant differences in age (t=?2.63), the proportion of PCV (χ2=13.73), and CRT (Z=?3.03) (P＜0.05). Twelve months after treatment, the cystic cavities of 84.85% (28/33) of the affected eyes in the BALAD group subsided. The BCVA of both groups of affected eyes improved over time (H=17.93, P＜0.05), but the overall BCVA of the BALAD group was still worse than that of the control group (H=17.80, P＜0.05). There was a significant difference in the improvement degree of CRT between the two groups (H=43.87, P＜0.05), and only in the control group was a significant positive correlation between BCVA and CRT (r=0.24, P＜0.05). ConclusionsIn nAMD, BALAD is associated with type 1 MNV, particularly the PCV subtype, and may serve as a biomarker for predicting anti-VEGF response. Although the BALAD structure is sensitive to anti-VEGF therapy and readily resolves, the limited functional improvement suggests it may be an imaging indicator of poor prognosis.
ObjectiveTo observe the clinical features of high myopia domed-shaped macula (DSM) complicated with choroidal neovascularization (CNV) and the efficacy of intravitreal injection of anti-vascular endothelial growth factor (VEGF). MethodsA retrospective clinical study. A total of 23 eyes of 23 patients with high myopia DSM combined with CNV diagnosed by ophthalmology examination in Department of Ophthalmology of The Second People's Hospital of Foshan from January 2019 to December 2023 were included in the study.Best corrected visual acuity (BCVA), intraocular pressure, optical coherence tomography (OCT) were performed in all eyes. BCVA tests are performed using the international standard visual acuity chart, which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. DSM height, central macular thickness (CMT) and choroidal thickness (ChT) were measured by OCT. According to OCT image features, DSM was divided into horizontal and vertical elliptic bulges and circular bulges. According to the literature standard, CNV was divided into subfoveal CNV and parafoveal CNV. All patients were treated with 0.05 ml intravitreal injection of ranibizumab or conbercept (IVR or IVC). The treatment regimen was 1+ on-demand treatment. The first IVR and IVC treatment were performed on 17 eyes and 6 eyes, respectively, and were divided into IVR group and IVC group. Follow-up time ≥1 month after treatment. The clinical features of the patients and the changes of BCVA, intraocular pressure, CMT and ChT after treatment were observed. Independent sample t test was used for comparison between groups. ResultsThere were 23 eyes in 23 cases, 7 males had 7 eyes and 16 females had 16 eyes. There were 11 and 12 eyes in the right and left eyes respectively. Age were (49±16) years old; logMAR BCVA was 0.94±0.39. Shapes of DSM were in 13 (56.52%, 13/23), 6 (26.09%, 6/23), and 4 (17.39%, 4/23) eyes, respectively. The dome height was (97.83±46.14) μm. CMT and ChT were (276.39±98.35) and (49.48±31.66) μm, respectively. There were 17 eyes in the IVR group, including 4 males and 13 females. There were 6 cases in the IVC group, 3 cases were male and 3 cases were female. At the last follow-up, logMAR BCVA and CMT were 0.60±0.39 and (209.96±71.38) μm, respectively. BCVA was significantly increased and CMT was significantly decreased compared with before treatment, with statistical significance (t=2.98, 2.62; P=0.005, 0.010). One month after treatment and at the last follow-up, there were no significant differences in the degree of BCVA improvement (t=1.47, 1.35), intraocular pressure change (t=?0.20, ?0.56) and ChT reduction thickness (t=0.80, ?0.62) between IVR group and IVC group (P＞0.05). At 1 month after treatment and last follow-up, the CMT of patients in IVR group and IVC group was decreased by (57.94±67.61), (83.17±78.37) μm and (13.33±9.73), (18.17±17.88) μm compared with that before treatment, respectively, and the differences were statistically significant (t=2.64, 3.21; P＜0.05). ConclusionsIVR or IVC in the treatment of high myopia DSM combined with CNV can effectively improve BCVA. The reduction of CMT with ranibizumab is better than conbercept.
Retinal vein occlusion (RVO) is a closely related disease of ophthalmology and systemic diseases. The Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China (consensus) emphasizes that etiological diagnosis and treatment should be paid primary attention to, and etiological exploration should be placed in an important position in the diagnosis and treatment path. In addition to etiological treatment, the consensus emphasizes that clinical attention should be paid to the management of anterior segment neovascularization, neovascular glaucoma and macular edema. Especially for patients with short course of central retinal vein occlusion, the occurrence of 100-day glaucoma should be vigilant, and active anti-vascular endothelial growth factor (VEGF) drugs, laser photocoagulation and intraocular pressure treatment should be taken. For the treatment of macular edema, the consensus points out that anti-VEGF drugs and intraocular glucocorticoid sustained-release agents are effective, but the latter should be used cautiously to avoid problems such as high intraocular pressure glaucoma and accelerated cataract formation. For deficient RVO, the consensus defines its concept, defines the time point of treatment when combined with macular edema, and clarifies the applicable conditions of laser therapy.
