ObjectiveTo systematically review the efficacy and safety of photodynamic therapy (PDT) and intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV), and to investigate the primary treatment tentatively.
MethodsA systematic search of Pubmed, Embase, the Cochrane Library and the Wanfang Data was performed to identify all comparative studies that compared the outcomes of PDT alone, intravitreal VEGF inhibitors alone and combined intravitreal VEGF inhibitors and photodynamic therapy. Outcomes of interest included the regression and recurrence rate of polypoidal lesions, best corrected visual acuity (BCVA), central retinal thickness (CRT), therapeutic times, and the occurrence rate of adverse events. 2 randomized controlled trials (RCT) and 19 non-RTCs were identified. According to treatment methods, the data extracted was classified to 3 groups, analyzed with odds ratio (OR), weighted mean difference (WMD) and 95%confidence interval (95%CI).
ResultsMeta-analysis suggests that the regression rate of polypoidal lesions (OR=0.34, 0.07; 95%CI=0.13-0.88, 0.02-0.36) and BCVA (WMD=0.25, 0.11; 95%CI=0.14-0.36, 0.01-0.21) in combined therapy group were significantly better than those in PDT group and intravitreal VEGF inhibitors group (P < 0.05). The recurrence rate of polypoidal lesions in PDT group was significantly lower than intravitreal VEGF inhibitors group (OR=0.35, 95%CI=0.16-0.74, P=0.006). BCVA (P=0.025) and the occurrence rate of adverse events (OR=60.36, 95%CI=6.04-603.50, P=0.000 5) in intravitreal VEGF inhibitors group were significant better than PDT group.
ConclusionsCombined treatment appeared to be superior to PDT alone or intravitreal VEGF inhibitors alone. Combined treatment takes priority over all others in the primary treatment of PCV.
Paediatric retinal disease is the most important part of paediatric ophthalmology. It usually manifests as leukocoria or yellow pupil, typically in retinopathy of prematurity, familial exudative vitreoretinopathy, persistent hyperplastic primary vitreous, Coats disease and retinoblastoma. It also can be manifested as nystamus poor visual fixation or progressive worsening of visual function, typically in Leber congenital amaurosis, Stargardt disease, Best disease and cone and rod dystrophy. Paediatric retinal diseases can be roughly divided into acquired, hereditary and congenital developmental abnormalities. With the development of gene and stem cell technologies, the advent of new medicine, equipments and new techniques, the concept of diagnosis and treatment in paediatric retinal diseases is also changing. In China, the level is improving progressively in both clinical and research areas of paediatric retinal diseases.
ObjectiveTo further compare the effect of intravitreal injection of bevacizumab (IVB) and photodynamic therapy (PDT) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia by meta-analysis.
MethodsPertinent publications were identified through systemic searches of PubMed, EMBASE and the Cochrance Controlled Trials Register. All clinical comparative studies of IVB or PDT as initial treatment for CNV secondary to pathologic myopia were included. Meta analysis of these clinical trials was performed to analyze the effect of IVB and PDT for CNV secondary to pathologic myopia. Measurements included best corrected visual acuity (BCVA) and central foveal thickness (CFT).
ResultsA total of 6 comparative studies involving 351 eyes were included. There were 196 eyes in IVB group and 215 eyes in PDT group. Funnel plots, Egger linear regression and Begg method did not show publication bias. Compared with PDT group, at 3, 6 and 12 months after IVB treatment, BCVA significantly increased . However, change of CFT at 3, 6 and 12 months did not vary significantly between IVB group and PDT group (3 months: WMD=-22.49, 95% CI=-93.49 to 48.52, P=0.53; 6 months: WMD=-17.34, 95% CI=-56.00 to 21.31, P=0.38; 12 months: WMD=-5.32, 95% CI=-56.37 to 45.74, P=0.84).
ConclusionPatients with CNV secondary to pathologic myopia experienced a significant benefit of visual improvement after IVB, but reduction in CFT after the IVB or PDT did not vary significantly.
ObjectiveTo observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV).
MethodsEighty-six eyes of 79 patients with PCV were enrolled in this study. There were 60 males (65 eyes) and 19 females (21 eyes). The average age was (64.48±13.15) years old. Best corrected visual acuity (BCVA), slit lamp ophthalmoscopy, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured. The average BCVA was 0.19±0..20. There were three groups in this study including photodynamic therapy (PDT) group (group A, 45 eyes), PDT and intravitreal ranibizumab injection group (group B, 31 eyes), and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C, 10 eyes). Follow up begun at 1 month after the treatment. 40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months. 9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months. Patients with recurrent or worsen lesions were followed by FFA or ICGA. Pre- and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed.
ResultsAll eyes (100.0%) in group A, 20 eyes (64.52%) in group B and 9 eyes (90.00%) in group C received treatment only once. The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061, 3.262, 3.258; P<0.05), but no significant difference was found between the 3 groups (t=1.345, 0.683, 0.168; P>0.05). Compared to pre-treatment measures, the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239, 4.334; P<0.05), but not changed in group C (t=2.286, P>0.05) at 1 month after treatment. Thirteen eyes in group A were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED), 4 eyes with partial closed PCV, 3 eyes with stable PCV and 3 eyes with worsen PCV. Ten eyes in group B were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV, 3 eyes with partial closed PCV, 4 eyes with recurrence PCV. Five eyes in group C were followed by FFA and (or) ICGA, which showed that there were 4 eyes with complete closed PCV, 1 eyes with recurrence PCV.
ConclusionAll 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree.
Objective To evaluate the efficacy and safety of intravitreal anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) vs. photodynamic therapy for polypoidal choroidal vasculopathy (PCV).Methods A computerized search was conducted in Pubmed, OVID, Chinese Biological Medicine Database（CBM）,China National Knowledge Infrastructure （CNKI） by using key words ldquo;polypoidal choroidal vasculopathy, photodynamic therapy, intravitreal anti-VEGFrdquo; in Chinese and/or English combined with manually searching of bibliographies of pertinent articles, journals and literature reference proceedings. Randomized controlled trials (RCT) and non-RCT were collected. The search time was ranged from establishment of each database to September, 2011. The search was no 1imitation in language. The best corrected visual acuity (BCVA),resolution and recurring of lesions, decrease or complete resolution of pigment epithelial detachment （PED）,visual extinction or blindness rate,the rate of subretinal hemorrhage were analyzed by RevMan 5.0 software. Results In total, one RCT and four non-RCTs (273 patients) were included in the meta-analysis involving 148 patients in single treatment group and 125 patients in combined treatment group. The results of metaanalyses showed that there was no significant difference between two groups in the mean logarithm of minimal angle of resolution BCVA at six months ［standard mean difference=0.01, 95% confidence interval (CI): -0.12- 0.14,P=0.84］and 12 months ［standard mean difference = 0.04, 95%CI: -0.16-0.25,P=0.69 after treatment. There was no significant difference between two groups in the resolution of lesions ［odds ratio (OR)=1.38,95%CI:0.74-2.55,P=0.31］ at the months after treatment and decrease or complete resolution of PED (OR=0.67,95%CI:0.12-3.69,P=0.65) at 12 months after treatment. There was no significant difference between two groups in the recurring of lesions (OR=1.14, 95% CI:0.58-2.24,P=0.71) and lost of ge; three lines vision or blindness rate (OR=1.20, 95%CI:0.34-4.18,P=0.78) at 12 months after treatment. The rate of subretinal hemorrhage in combine treatment group was significant lower than single treatment group (OR=0.41, 95%CI:0.18 -0.94,P=0.04). Conclusions The incidence of subretinal hemorrhage occurred in patients with PCV after intravitreal anti-VEGF combined with PDT is much lower than that after single PDT.But the visual improvement, resolution of lesions and recurring of lesions of combined treatment need further studied to see if it is better than single PDT.
Eye and nervous system are anatomically and physiologically very close. About 40% of the nerve fibers in brain are correlated with visual function. Seven of twelve cranial nerves are straightly correlated with visual afferent or eye movement. Neurological diseases can affect eye in many different ways. Furthermore, systemic disorders can cause secondary neurological lesions or even primary neurological disorders, which sequentially show ocular symptoms a nd signs. Better understanding of the close relationship between eye and brain, together with intimate cooperation between ophthalmologists, neurologists, neuro surgeons and other specialties, are the key point to improve our neuro-ophthalm ology service in China.
(Chin J Ocul Fundus Dis,2008,24:82-85)
Idiopathic intracranial hypertension (IIH) is a neurological disease, characterized by increased intracranial pressure and papilledema, and often associated with headache, transient loss of vision and pulsatile tinnitus. IIH typically occurs in women of childbearing age. Over 90.0% of patients are with obesity or over weighted. Loss of sensory visual function is the major morbidity associated with IIH and some patients even develop into blindness. Most patients will have varied degrees of visual impairment, or even a few become blind. Frisén grading system, visual field examination and spectral-domain optical coherence tomography can be used to evaluate and monitor the IIH papilledema functionally and morphologically. In recent years, IIH treatment trials in other countries confirmed that, weight loss and low-salt diet combined with acetazolamide treatment has a clear improvement for IIH patients with mild visual impairment. In-depth understanding of the etiology, clinical manifestations, diagnostic criteria and the main treatment has important clinical significance for IIH patients
ObjectiveTo observe the efficacy and safety of combined photodynamic therapy (PDT) with intravitreal ranibizumab injection in patients with polypoidal choroidal vasculopathy (PCV).
MethodsTwenty-four PCV patients (24 eyes) were enrolled in this retrospective case study.All patients were assessed by the examinations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart, color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT). The mean visual acuity was (33.41±19.43) letters; the mean macular retinal thickness was (343.63±88.60) μm. Patients received PDT first, and intravitreal injected ranibizumab 0.5 mg (0.05 ml) 72 hours later. Treatments were repeated as a single intravitreal injection of ranibizumab combined with or without PDT if the monthly follow-up indicated that it was necessary. The average follow-up period was 13.1 months. The average treatment times were analyzed for each eye. Systemic and ocular adverse events were observed. Visual acuity, macular retinal thickness and leakage of PCV before and after the treatment were analyzed.
ResultsIntravitreal ranibizumab injections was repeated (2.8±1.6) times per eye on average, and intravitreal injection of ranibizumab combined with PDT was repeated (0.4±0.5) times per eye on average. No systemic and ocular adverse effects were found during and after combined therapy. In the last follow-up, the mean visual acuity of ETDRS was (44.21±17.24) letters, improved by 10.8 letters (t=-4.77, P<0.01).Visual acuity was improved in 11 eyes (45.8%) and stable in 13 eyes (54.2%). FFA and ICGA showed complete closed PCV in 17 eyes (70.8%), partial closed PCV in 7 eyes (29.2%). OCT image showed that the retinal edema was disappeared in 19 eyes (79.2%) and alleviated in 5 eyes (20.8%). The mean macular retinal thickness was (171.33±38.06) μm, which was 172.30 μm less than that of pre-treatment values (t=11.96, P<0.05).
ConclusionPhotodynamic therapy combined with intravitreal ranibizumab injections for PCV is safe and effective, with visual acuity improvement, reduction of retinal edema and PCV leakage.
Objective To observe the characteristics of optical coherence tomography（OCT）in polypoidal choroidal vasculopathy (PCV) before and after photodynamic therapy (PDT), and investigate its relationship with visual acuity. Methods Thirty-four PCV patients (40 eyes) diagnosed by fundus fluoresce angiography and indocyanine green angiography who had underwent the treatment of PDT, were enrolled in this study. The logMAR corrected visual acuity (CVA) were detected and the height and the base diameter of retinal pigment epithelium detachment (PED）and retinal detachment (RD), central subfield thickness (CST), macular volume (MV) were measured by OCT before and after treatment. Before the treatment, the mean logMAR CVA was 0.66plusmn;0.32 and visible PED and RD were seen on OCT images. The OCT characteristics and relationship with visual acuity were comparatively analyzed. Results One, three, six and 12 months after treatment, the mean logMAR CVA were 0.58plusmn;0.27, 0.48plusmn;0.38, 0.51plusmn;0.37 and 0.50plusmn;0.36. The differences of CVA were statistically significant between beforetreatment and three, 12 months after treatment(t=2.32,2.10; P＜0.05),but not between beforetreatment and one,six months after treatment (t=1.22,1.961;P＞0.05). The differences of the height and the base diameter of PED were statistically significant between before treatment and six,12 months after treatment (t=2.34,2.03;P＜0.05),but not between before treatment and one, three months after treatment (t=1.07,1.50;P＞0.05). The differences of the height (t=2.22,2.99,3.30,3.95) and the base diameter (t=2.55,3.33,3.11,3.92) of RD were statistically significant between before treatment and one, three, six and 12 months after treatment (P＜0.05). The differences of CST (t=2.71,3.55,3.81,3.21) and MV (t=2.10,3.30,3.62,4.18) were statistically significant between before treatment and one, three, six and 12 months after treatment (P＜0.05). CVA had negative correlation with the base diameter of PED, the height and the base diameter of RD, CST and MV (r=-0.88,-0.89,-0.92,-0.86,-0.94;P＜0.05), no correlation with the height of PED (r=-0.70,P＞0.05). Conclusions The height and the base diameter of PED and RD, CST, MV of PCV are decrease after PDT. There is a negative correlation between CVA and the base diameter of PED,the height and the base diameter of RD,CST and MV.
ObjectiveTo observe the clinical effect of intravitreal injection of tissue plasminogen activator (t-PA), ranibizumab and C3F8 in the treatment of early submacular hemorrhage (SMH) induce to polypoid choroidal vasculopathy (PCV).MethodsThe clinical data of 20 eyes of 20 patients with early SMH induce to PCV were enrolled in this study. The duration of bleeding in the eye was 7 to 28 days, and the mean duration of bleeding was 14.8±5.6 days. All eyes are measured using the Snellen chart best corrected visual acuity (BCVA), logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. Measure central retinal thickness (CRT) and central retinal pigment epithelial detachment (PED) thickness using frequency-domain optical coherence tomography. The average logMAR BCVA of eyes was 1.73±0.91; the mean CRT was 620.0±275.8 μm; the average central PED thickness was 720.3±261.9 μm. All eyes receive intravitreal injection of t-PA, ranibizumab and C3F8. The intravitreal injection of ranibizumab was administered once a month for 3 consecutive months, followed by an on-demand treatment plan. Mean follow-up time was 9.9±3.6 months. The changes in BCVA, CRT, central PED thickness and clearance degree of SMH at 6 months after treatment were observed.ResultsOn the 6 months after treatment, the average logMAR BCVA, CRT and central PED thickness of the eyes were respectively 0.42±0.37, 290.2±97.4 μm and 41.6±78.1 μm. Compared with baseline, the after treatment BCVA was significantly increased (F=38.14, P=0.000), but the CRT and central PED were significantly decreased (F=7.48, 75.94; P=0.000, 0.000). Among the 20 eyes, 16 eyes of SMH was completely cleared, accounting for 80%;4 eyes was partially cleared, accounting for 20%. No recurrence and systemic or local complications occurred during follow-up of all eyes.ConclusionIntravitreal injection of t-PA, ranibizumab, and C3F8 in the treatment of early SMH induce to PCV can effectively remove SMH, improve vision, reduce CRT and central thickness of PED.
