PURPOSE:To probe the dosage and effect of lasers in panretinal photocoagulation.
METHODS:Three kinds of ocular diseases,e, g., neovascular glaucoma(NVG)in 52 eyes ,central retinal vein occlusion(CRVO)in 47 eyes ,and preproliferative and proliferative diabetic retinopathies(PDR)in 231 eyes ,treated with krypton red and argon blue green laser panretinal photocoagulation in ocular clinic of our hospital,were analysed clinically and retropectively.
RESULTS:The effetive average numbers of laser burns in panretinal photocoagulation in this series after clinical analysis statistically were found to
be 1 500 in NVG,and 1 000 in PDR and CRVO respectively.
CONCLUSION:To select the proper laser,its wave length,therapeutic position and volume of laser burns in accordance with the specific circumstances of various retinopthies is of extreme importance in success of laser panretinal photocoagulation.
（Chin J Ocul Fundus Dis,1997,13: 195-196）
ObjectiveTo investigate the influence of high activity of CYP2C9 (Cytochrome P450 proteins 2C9)and VKORC (Vitamin K epoxide reductase C)on warfarin anticoagulation of patients after heart valve replacement (HVR).
MethodsFrom February 2010 to May 2013, 40 patients with high activity of CYP2C9 and VKORC underwent HVR in the Department of Cardiac Surgery, the First Affiliated Hospital of Zhengzhou University. There were 18 male and 22 female patients with their age of 40-51 (45.18±2.93)years. There were18 patients receiving mitral valve replacement (MVR), 14 patients receiving MVR and tricuspid valvuloplasty (TVP), and 8 patients receiving double valve replacement (DVR). Depen-ding on whether they received preoperative genetic polymorphism detection of CYP2C9 and VKORC1, all the patients were divided into 2 groups with 20 patients in each group. Patients in group A didn't receive preoperative genetic polymorphism detection of CYP2C9 and VKORC1, while patients in group B received preoperative genetic polymorphism detection of CYP2C9 and VKORC1. Postoperatively, periodic examination of international normalized ratio (INR)was performed to adjust warfarin dosage. Time to reach expected INR value and morbidity were collected. All the patients were followed up for 3-12 months after discharge. Monthly telephone follow-up was performed to record INR values, morbidity and general recovery.
ResultsPostoperatively, in group A, 2 patients had cerebral infarction, 2 patients had popliteal artery throm-bosis, 1 patient had pulmonary embolism, and 1 patient had thrombosis in the annulus. Expected INR was achieved 15-20 days after warfarin treatment among the other 14 patients without thromboembolism. Three months after surgery, CYP2C9 and VKORC1 gene polymorphism was examined to find 17 patients with positive CYP2C9*1/*1 (*2CC/*3AA)and positive VKORC1-1639 GA, and 3 patients with positive CYP2C9*1/*1 (*2CC/*3AA)and positive VKORC1-1639 GG. In Group B, patients received aspirin (100 mg/d)and low molecular heparin (0.4 ml/d)in addition to warfarin since the second posto-perative day. Expected INR was achieved 5-9 days after warfarin treatment, and then aspirin and low molecular heparin were discontinued. During the 6 months follow-up period, no obvious thromboembolism was found, and only 1 patient had epistaxis who was cured with nasal tamponade.
ConclusionPreoperative detection of genetic polymorphisms of CYP2C9 and VKORC1 can provide important guidance for warfarin anticoagulation after HVR.
ObjectiveTo evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs combined with retinal laser photocoagulation and anti-VEGF drugs alone in the treatment of retinal vein occlusion (RVO) combined with macular edema (ME). MethodsA evidence-based medicine study. Retinal vein occlusion (obstruction), macular edema, anti-vascular endothelial growth factor, bevacizumab, ranibizumab, conbercept, aflibercept, and retinal laser photocoagulation were the Chinese and English search terms. Related literature was searched in China National Knowledge Infrastructure, Wanfang, Weipu, PubMed, Embase, Cochrane Library. RVO combined with ME was selected as the research object, and the treatment plan was a clinical randomized controlled study comparing intravitreal injection of anti-VEGF drugs combined with laser photocoagulation and anti-VEGF drugs alone. The search time range was from January 2011 to February 2021. Repeated, incomplete or irrelevant literature, case reports and review literature were excluded. Review Manager 5.4 statistical software was used to conduct a meta-analysis of the literature. The weighted mean difference (WMD) and 95% confidence interval (CI) were selected as the estimated value of effect size, and the fixed effect model was used for analysis. The evaluation indicators were best corrected visual acuity (BCVA), center macular thickness (CMT), and the number of injections. ResultsAccording to the search strategy, 461 articles were initially retrieved, and 21 articles were finally included for meta-analysis. A total of 1156 patients were enrolled, of which 576 were treated with anti-VEGF drugs combined with laser photocoagulation (combined treatment group), and 580 were treated with anti-VEGF drugs alone (drug treatment group). Meta-analysis results showed that there was no statistically significant difference in BCVA and CMT between the drug treatment group and the combination treatment group at 6, 9, and 12 months after treatment (BCVA: WMD =－0.82, 95%CI －2.38-0.74, P=0.30; CMT: WMD=－3.12, 95%CI －17.25-11.01, P=0.67). For patients with branch retinal vein occlusion and ME, combined therapy can reduce the number of injections more effectively than drug therapy alone (WMD=－0.80, 95% CI －1.18-－0.42, Z=4.10, P＜0.000 1). ConclusionCompared with pure intravitreal injection of anti-VEGF drugs, combined retinal laser photocoagulation can not better improve BCVA and CMT in patients with RVO and ME. For patients with branch retinal vein occlusion and ME, combined retinal laser photocoagulation can effectively reduce the resistance. The number of VEGF injections.
Fundus disease is a kind of common ophthalmic disease with high blindness rate and great harm. Although great breakthroughs have been made in medical treatment, laser photocoagulation, radiotherapy and gene therapy of fundus disease, with the further understanding of the essence of fundus disease, there are higher requirements for the treatment of fundus disease. To strengthen scientific research on the etiology, pathological mechanism and clinical treatment of fundus diseases, to control the quality of research, to develop reasonable treatment plans and explore new treatment methods under the guidance of evidence-based medicine theory, to further improve the level of medical treatment and benefit patients with fundus diseases will still be a formidable challenge in the future.
ObjectiveTo observe the clinical characteristics of retinoblastoma (RB) in Southwest China.MethodsA retrospective clinical study. From January 2010 to December 2017, 66 RB patients diagnosed in Ophthalmology Department of West China Hospital of Sichuan University were included in the study. All the patients underwent ocular B-ultrasound, orbital CT or MRI examination. Ten patients underwent RetCam examination at the same time. Twenty-nine patients were diagnosed by histopathological examination, and 37 patients were diagnosed by clinical symptoms and imaging examination. According to whether the tumor invaded the orbit and optic nerve, it could be divided into extraocular stage and intraocular stage. Intraocular tumors were divided into A-E stages according to the international intraocular RB classification. Treatments were performed according to different stages. The general information, age at diagnosis, course of diseases (the time between onset symptoms and diagnosis), causes of visiting a doctor, classification, treatment methods and eyeball preservation rate were retrospectively analyzed.ResultsPatients all came from Southwest China (56 patients from Sichuan Province, 2 patients from Yunnan Province, 2 patients from Guizhou Province, and 6 patients from Tibet). The permanent residence were identified in 43 patients, including 27 patients (62.8%) from rural areas. There were 38 males (57.6%); 50 unilateral tumors (75.8%) and 16 bilateral tumors (24.2%); 51 first-visiting patients (77.3%) and 15 re-visiting patients (22.7%). The average diagnostic age of first-visiting patients was 20.9±14.4 months, with 23.2±14.7 and 11.2±7.6 months for unilateral and bilateral tumors, respectively. There were 41 patients had definite course and causes, of whom the average course was 90.6±115.2 days. The most common cause was leucocoria in 32 patients (62.7%), followed by redness and swelling in 4 patients (9.8%), and other causes in 5 patients (12.2%). Among the 15 re-visiting patients, the average diagnostic age was 63.6±46.8 months, the average course was 32.8±45.5 months. Recurrence was occurred in 5 patients (33.3%), leucocoria in 4 patients (26.7%), postoperative complication in 3 patients (20.0%), protrusion in 2 patients (13.3%) and redness in 1 (6.7%) patient, respectively. Fifty out of 82 eyes were admitted to hospital, including 37 eyes of first-visiting patients and 13 eyes of re-visiting patients. Among 37 first-visiting eyes, there were 5 eyes (13.5%) in stage A-C, 26 eyes (70.3%) in stage D-E, 6 eyes (16.2%) in extraocular stage. Five eyes in stage A-C were treated with laser photocoagulation and (or) cryotherapy combined with systemic chemotherapy. Four eyes in stage D were treated with intraocular arterial chemotherapy. Nineteen eyes (51.3%) were performed with enucleation, 2 eyes (5.4%) with evisceration and 7 eyes (18.9%) abandoned treatment. Among 13 re-visiting eyes, 6 eyes (46.2%, with 5 eyes of recurrence) had been enucleated before, 4 eyes (30.8%) were in extraocular stage and 3 eyes (23.1%) in stage D-E. Five eyes (38.5%) were treated with evisceration, 4 eyes (30.8%) with enucleation, 1 eye with oculoplastic surgery and 3 eyes (23.1%) abandoned treatment. The rate of eye preservation was 18.0%, 29.0% for intraocular stage and 0% for extraocular stage, respectively.ConclusionRB patients in Southwest China have a longer course between onset symptoms and diagnosis, more advanced classification and lower rate of eye preservation.
ObjectiveTo research the influence of anticoagulation to blood clotting function in patients who experienced cardiopulmonary bypass surgery under continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA), low molecular weight heparin (LMWH) anticoagulation and non-anticoagulation.MethodsWe retrospectively analyzed the clinical data of 146 patients who underwent CRRT after cardiopulmonary bypass surgery between January 2014 and December 2016. There were 98 males and 48 females at age of 60.51±14.29 years. All CRRT patients were allocated into three groups including a RCA group, a LMWH group, and a non-anticoagulation group, which were compared in terms of convention coagulation tests, platelet counts, thromboelastography, circuit lifespan and transfusion.ResultsThree hundred and fifty four CRRT patients were selected from patients above, including 152 patients in the LMWH group, 160 in the RCA group, and 42 in the non-anticoagulation group. The difference of CRRT circuits time among three groups was statistically different (P=0.023). And multiple comparison showed that the circuit lifespan of the RCA group was significantly longer than that of the non-anticoagulation group (34.50 h ranged 14.00 h to 86.00 h vs.15.00 h ranged 12.00 h to 50.88 h, P=0.033). One hundred and fifty-five CRRT patients last beyond 24 hours with same anticoagulation were selected, the results of coagulation tests, and the difference between CRRT starting and after 24 hours were compared. The difference of Angle and maximum amplitude(MA) of pre- and post-CRRT were significantly different among three groups by one-way ANOVA (P=0.004, 0.000), as well as between the RCA group and the LMWH group by multiple comparison (P=0.004, 0.000). There was no statistical difference in frequencies and doses of the transfusion of fresh frozen plasma and platelet among three groups.ConclusionRCA is an effective anticoagulation which may prolong circuit lifespan and has small impact on the coagulation function of patients who undergo CRRT after cardiopulmonary bypass surgery.
Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.
ObjectiveTo investigate the clinical outcome and therapeutic efficacy of short-pulse pattern scan laser (PASCAL) photocoagulation for diabetic retinopathy (DR).
MethodsForty-three DR patients (70 eyes) including 19 males (32 eyes) and 24 females (38 eyes) underwent short-pulse PASCAL pan-retinal photocoagulation (PRP). There were 24 patients (42 eyes) with proliferative diabetic retinopathy (PDR) and 19 patients (28 eyes) with severe non-proliferative diabetic retinopathy (NPDR). The best corrected visual acuity was better than or equal to 0.1 in 62 eyes, worse than 0.1 in 8 eyes. Diabetic macular edema was found in 18 eyes. Short-pulse PASCAL PRP was applied with multi-spot arrays. Macular edema was treated by PASCAL macular mode (MAC A + MAC B) and/or single spot. Visual acuity and fundus examinations were analyzed at the one-year follow-up procedure.
ResultsOne year after short-pulse PASCAL treatment, the final visual acuity was improved in 10 eyes, stable in 53 eyes, decreased in 7 eyes; macular edema was relieved in 38 eyes, aggravated in 12 eyes, and stable in 20 eyes. Of 42 eyes with PDR, neovascularization were regressed in 20 eyes, uncontrolled in 11 eyes which experienced additional photocoagulation (1-2 times) during the follow-up. Among the 11 uncontrolled eyes, 3 eyes (3/11) received vitrectomy due to vitreous hemorrhage.
ConclusionPASCAL might stabilize the progress of diabetic retinopathy safely and effectively.
ObjectiveTo compare clinical results of different anticoagulation methods for patients with large left atrium in the early period after mitral valve replacement (MVR) in order to optimize anticoagulation therapy for them.
MethodsA total of 144 patients with large left atrium who underwent MVR in Union Hospital of Tongji Medical College from January 2012 to September 2013 were included in this study. There were 76 male and 68 female patients with their age of 36-60 (47.4±7.0) years. All the patients were divided into 2 groups according to different anticoagulation methods after MVR. Group A patients received warfarin anticoagulation since the 2nd postoperative day. Group B patients received warfarin and aspirin (0.1 g daily) since the 2nd postoperative day. Morbidity and mortality during follow-up were compared between the 2 groups.
ResultsInternational normalized ratio (INR) was 2.03±0.11 in group A and 2.01±0.11 in group B,and there was no statistical difference between the 2 groups (t=0.804,P>0.05). Twenty patients (13.9%) had hemorrhagic complications. There was no statistical difference in INR between patients with hemorrhagic complications in group A and B (t=0.496,P>0. 05) and there was no statistical difference in hemorrhagic rate between group A and B(P>0. 05). There was no thromboembolic complication in group B,and 9 patients (6.3%) in group A had thromboembolic complications. Three patients (2%) died of intracranial hemorrhage in group A during follow-up. Two patients died in group B,including 1 patient with recurrent pericardial effusion and pericardial tamponade who died 60 days after surgery,and another patient who died of unknown reason during follow-up.
ConclusionFor MVR patients with large left atrium,anticoagulation with warfarin and aspirin can significantly decrease the incidence of thromboembolic complications but does not increase the incidence of hemorrhagic complications.
