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Efficacy of internal limiting membrane peeling for diabetic macular edema after preoperative anti-vascular endothelial growth factor injection

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International Journal of Ophthalmology(English edition) 2020年第11期13卷 1758-1764页

作者： Jing Guo Xue Bi Shan-Na Chen Song Chen Guang-Hui He Bin Wu Wei Zhang Jian Wang Clinical College of Ophthalmology Tianjin Medical UniversityTianjin 300070China Tianjin Eye Hospital Tianjin Eye InstituteTianjin Key Lab of Ophthalmology and Visual ScienceTianjin 300020China Department of Ophthalmology Guangdong Hospital of Traditional Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Xiamen Kehong Eye Hospital Xiamen 361000Fujian ProvinceChina

AIM:To explore the efficacy of minimally invasive vitrectomy(MIV)with or without internal limiting membrane(ILM)peeling on the treatment of diabetic macular edema(DME)in proliferative diabetic retinopathy(PDR)combining with preoperative anti-vascular endothelial growth factor(anti-VEGF)***:Totally 132 eyes(132 patients)diagnosed PDR with DME were included between June 2015 and June 2018 in Tianjin Eye *** single MIV treatment group included 68 eyes and the MIV combined with ILM peeling group included 64 ***-VEGF drugs were injected intravitreally 1wk before the operation and the period of follow-up was 1 to ***-corrected visual acuity(BCVA),central retinal thickness(CRT),total macular volume(TMV),macular edema(ME)severity,intraocular pressure(IOP),and complications were *** factors of visual acuity following ILM peeling were ***:The BCVA was higher than preoperative values at 1,3,6,and 12mo after surgery in both groups(all P<0.05).At 6 and 12mo,the BCVA of the combined group was significantly higher than that of the MIV only group(0.52±0.23 v/s 0.64±0.29 IogMAR,P=0.011 in 6mo;0.41±0.25\/s 0.52±0.25 IogMAR,P=0.008 in 12mo).Mean CRT values postoperative were significantly lower than preoperative values in both groups from the 1^(st) month(lmo 397.65±106.18 vs 451.94±118.88 μm in MIV only group;388.88±108.68 v/s 464.36±111.53 μm in combined group;both P<0.05)and decreased *** differences between the two groups were statistically significant at 3,6,and 12mo(P=0.004,0.003,0.00 respectively).The TMV was decreased from the 3^(rd) month in the single treatment group(3mo 11.14±1.66 vs 12.20±2.09 mm^(3),P<0.05).At 12mo,the proportion of eyes with edema that had CRT more than 350μm was significantly lower than before surgery(13.24%vs 77.94%in MIV only group;1.56%vs 81.25%in combined group;both P<0.05).There was no significant difference in the recurrence incidence of macular epiretinal membrane,ME,transien

关键词： proliferative diabetic retinopathy macular edema vitreous macular traction internal limiting membrane minimally invasive vitrectomy anti-vascular endothelial growth factor

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Correlation of vascular endothelial growth factor Production with Photochemical Reaction-induced Retinal Edema

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Chinese Medical Journal 2016年第24期129卷 2944-2950页

作者： Liang Shan Mi Zheng Yuan Zhang Yuan Qu Tian Niu Qing Gu Xin Xia Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200080 China Shanghai Key Laboratory of Fundus Disease Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200080 China Department of Ophthalmology Fujian Provincial Hospital Fuzhou Fujian 350004 China

Background： Retinal edema is the major complication of retinal vein occlusion and diabetic retinopathy; it can damage visual function by influencing macular region. This study was to establish a rat retinal edema model and explore the related VEGF expression and observe the responses to anti-VEGF drugs in this model. Methods： A rat retinal edema model was established by inducing photochemical reaction using a 532 nm laser after the intravenous injection of Erythrosin B. Immediately after the laser treatment, models were given intravitreal injections of Ranibizumab or Conbercept to inhibit VEGF expression, and the changes of retinal thickness were measured. Retinal edema was observed using fundus photography （FP）, optical coherence tomography （OCT）, and fluoresce in fundus angiography （FFA） at 0, 1, 2, 4, 7 and 14 days after intervention. The retinal VEGF expression was measured using enzyme-linked immunosorbent assay （ELISA） and western blotting at each time point. The rat retinal edema model was also used to verify the function of anti-VEGF polypeptide ZY1. Results： Both retinal edema and vascular leakage were clearly observed at 1, 2 and 4 days after photochemical induction and the retinal thickness increased notably over the same period. The retinal VEGF expression peaked at day 1 and retina became thickening simultaneously. After the interventions, the VEGF expression of the Ranibizumab and Conbercept groups decreased at each time point compared to the edema group （26.90 ± 3.57 vs. 40.29 ± 6.68, F = 31.269 on day 1 and 22.36 ± 1.12 vs. 29.92 ± 0.93 F = 163.789 on day 2, both P 〈 0.01）; the mean RT （278 ± 4 vs. 288 ± 3, F = 134.190 on day 1 and 274 ± 7 vs. 284 ± 6, F = 64.367 on day 2, both P 〈 0.05） and vascular leakage in these groups also decreased. The same results were observed in the ZY1 group, particularly at day 2 （P 〈 0.05）. Conclusions： This retinal edema model induced by a photochemical reaction is reliable and repeatable. Induced edema increases expre

关键词： Animal Model anti-vascular endothelial growth factor Erythrosin B Photochemical Reaction Retinal Edema

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Bilateral same-session intravitreal injections of antivascular endothelial growth factors

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International Journal of Ophthalmology(English edition) 2014年第6期7卷 1017-1021页

作者： Nakhleh E.Abu-Yaghi Ahmed N Shokry Rami H Abu-Sbeit Department of Ophthalmology Faculty of Medicinethe University of Jordan

AIMTo document the indications, safety and possible complications of bilateral same-session intravitreal anti-vascular endothelial growth factor (VEGF) injections performed in the ophthalmic operating room.

关键词： anti-vascular endothelial growth factor diabetic macular edema age-related macular degeneration endophthalmitis visual acuity

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Effect of anti-VEGF treatment on nonperfusion areas in ischemic retinopathy

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International Journal of Ophthalmology(English edition) 2021年第11期14卷 1647-1652页

作者： Zi-Yi Zhu Yong-An Meng Bin Yan Jing Luo Department of Ophthalmology the Second Xiangya HospitalCentral South UniversityChangsha 410011Hunan ProvinceChina Hunan Clinical Research Center of Ophthalmic Disease Changsha 410011Hunan ProvinceChina

In recent years,retinal ischemia such as that which occurs in diabetic retinopathy(DR)and retinal vein occlusion(RVO)has become a hotspot of ischemic retinopathy *** levels of vascular endothelial growth factor(VEGF)are recognized as a major cause of macular edema(ME)in DR and *** concentrations of VEGF in the vitreous can lead to serious retinal ischemia and hypoxia and form retinal nonperfusion areas(NPAs).Different levels of retinal ischemia can represent disease severity and ***-VEGF therapy as the first-line treatment for ME has been found to be effective in improving vision,but there are still disputes about whether anti-VEGF therapy could improve retinal ischemia and achieve reper fusion of previously developed retinal ***,we review and summarize studies of the effects of anti-VEGF drugs on retinal ischemia,especially NPAs.

关键词： anti-vascular endothelial growth factor retinal nonperfusion areas ischemic retinopathy macular ischemia

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Sequencing of treatment in metastatic colorectal cancer:Where to fit the target?

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World Journal of Gastroenterology 2014年第8期20卷 1993-2004页

作者： Sally Temraz Deborah Mukherji Ali Shamseddine Division of Hematology/Oncology Department of Internal MedicineAmerican University of Beirut Medical Center (AUBMC)Riad El Solh 110 72020BeirutLebanon

Colorectal cancer is a lethal disease if not discovered *** though appropriate screening and preventive strategies are in place in many countries,a significant number of patients are still diagnosed at late stages of the *** management of metastatic colorectal cancer remains a significant clinical challenge to oncologists *** cytotoxic regimens constitute the main treatment of choice in this patient population,addition of the five biologics(bevacizumab,cetuximab,aflibercept,panitumumab and regorafenib)to these regimens has improved clinical *** most commonly used cytotoxic regimens include doublet combinations(FOLFOX/XELOX or FOLFIRI).Many clinical trials have been published and others are underway to compare the biologic agents with one another in order to prove the superiority of one regimen over *** colorectal cancer patients have many treatment options;however,the optimal use and sequence of targeted agents remain to be *** review entails concise and updated clinical data on the management of metastatic colorectal *** aim of the review is to determine where to fit the five biologic targets into the treatment algorithm of metastatic colorectal cancer patients and to derive treatment sequences that would achieve best clinical outcome based on the current available data.

关键词： Metastatic colorectal cancer Chemotherapy anti-epithelial growth factor receptor anti-vascular endothelial growth factor Treatment sequence

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Triamcinolone as an adjunct to the combination of anti-VEGF for the management of diabetic macular edema

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International Journal of Ophthalmology(English edition) 2021年第6期14卷 869-874页

作者： Ying-Ying Yu Yong Cheng Li-Bin Chang Hui-Ka Xia Xiao-Xin Li Department of Ophthalmology Peking University People’s HospitalEye diseases and Optometry InstituteBeijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid DiseasesCollege of OptometryPeking University Health Science CenterBeijing 100044China Department of Ophthalmology Beijing Jingmei Group General HospitalBeijing 102300China Department of Ophthalmology Hebei General HospitalShijiazhuang 050051Hebei ProvinceChina Xiamen Eye Center of Xiamen University Xiamen 361003Fujian ProvinceChina

AIM:To assess the efficacy of intravitreal triamcinolone(IVTA)as an adjunct to the combination of anti-vascular endothelial growth factor(VEGF)for the management of diabetic macular edema(DME).METHODS:A total of 51 patients with visual disabilities causing by DME from two sites were retrospectively collected and assigned to two groups according to the therapeutic method:intravitreal conbercept(IVC)combined with focal laser(24 eyes)and IVC combined with focal laser and IVTA(27 eyes).Best-corrected visual acuity(BCVA),the required number of IVCs,central retinal thickness(CRT),the mean costs of treatment burden and safety were compared over 12 ***:From baseline to month 1 through month 12,IVC combined with focal laser and IVTA improved the mean average change in BCVA superior to IVC combined with focal laser(+5.20 vs+2.71 letters).At month 12,20.83%of the IVC combined with focal laser and 37.04%of IVC combined with focal laser and IVTA arms gained more than 10 BCVA *** the period,the mean CRT decreased significantly in the IVC combined with focal laser and IVTA arm(-245.9μm)compared to the IVC combined with focal laser arm(-98.45μm).The average of 6.45 and 1.25 conbercept injections performed in the IVC combined with focal laser and IVC combined with focal laser and IVTA arms,*** mean cost of treatment burden for 12 mo was$6247.44±4069.18 in the IVC combined with focal laser arm and$1679.19±542.73 in the IVC combined with focal laser and IVTA arm,with a statistically significant *** from occasional minor subconjunctival hemorrhage,no other significant ocular adverse events(AEs)were observed in either group during the 12-month ***:It is effective and cost-effective to treat DME by utilizing triamcinolone as an adjunct to the combination of anti-VEGF.

关键词： diabetic macular edema intravitreal triamcinolone anti-vascular endothelial growth factor

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Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

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International Journal of Ophthalmology(English edition) 2023年第6期16卷 897-903页

作者： Fang-Fang Fan Xing Ge Dan-Dan Liu Teng-Yu Xu Rui-Xue Wang Xiao-Ya Chen Su-Yan Li The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University Xuzhou 221000Jiangsu ProvinceChina Department of Ophthalmology Xuzhou First People’s HospitalXuzhou 221000Jiangsu ProvinceChina Eye Disease Prevention and Treatment Institute of Xuzhou Xuzhou 221000Jiangsu ProvinceChina

·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both Panti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

关键词： ultrasound cycloplasty Ahmed glaucoma drainage valve implantation anti-vascular endothelial growth factor neovascular glaucoma intraocular pressure

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Inflammation in diabetic retinopathy: possible roles in pathogenesis and potential implications for therapy

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Neural Regeneration Research 2023年第5期18卷 976-982页

作者： Lei Tang Guo-Tong Xu Jing-Fa Zhang Department of Ophthalmology of Tongji Hospital Tongji Eye InstituteDepartment of Regenerative Medicineand Department of PharmacologyTongji University School of MedicineShanghaiChina Department of Ophthalmology Shanghai General Hospital(Shanghai First People’s Hospital)Shanghai Jiao Tong UniversityShanghaiChina National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus DiseasesShanghai Engineering Center for Visual Science and PhotomedicineShanghai Engineering Center for Precise Diagnosis and Treatment of Eye DiseasesShanghaiChina

Diabetic retinopathy, characterized as a microangiopathy and neurodegenerative disease, is the leading cause of visual impairment in diabetic patients. Many clinical features observed in diabetic retinopathy, such as capillary occlusion, acellular capillaries and retinal non-perfusion, aggregate retinal ischemia and represent relatively late events in diabetic retinopathy. In fact, retinal microvascular injury is an early event in diabetic retinopathy involving multiple biochemical alterations, and is manifested by changes to the retinal neurovascular unit and its cellular components. Currently, intravitreal anti-vascular endothelial growth factor therapy is the firstline treatment for diabetic macular edema, and benefits the patient by decreasing the edema and improving visual acuity. However, a significant proportion of patients respond poorly to anti-vascular endothelial growth factor treatments, indicating that factors other than vascular endothelial growth factor are involved in the pathogenesis of diabetic macular edema. Accumulating evidence confirms that low-grade inflammation plays a critical role in the pathogenesis and development of diabetic retinopathy as multiple inflammatory factors, such as interleukin-1β, monocyte chemotactic protein-1 and tumor necrosis factor-α, are increased in the vitreous and retina of diabetic retinopathy patients. These inflammatory factors, together with growth factors such as vascular endothelial growth factor, contribute to blood-retinal barrier breakdown, vascular damage and neuroinflammation, as well as pathological angiogenesis in diabetic retinopathy, complicated by diabetic macular edema and proliferative diabetic retinopathy. In addition, retinal cell types including microglia, Müller glia, astrocytes, retinal pigment epithelial cells, and others are activated, to secrete inflammatory mediators, aggravating cell apoptosis and subsequent vascular leakage. New therapies, targeting these inflammatory molecules or relate

关键词： anti-inflammation therapy anti-vascular endothelial growth factor diabetic retinopathy hyperreflectivity foci inflammation inflammatory cells inflammatory cytokines leukostasis microglia Müller cells

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Clinical efficacy of intravitreal corticoid as an adjunctive therapy to anti-VEGF treatment of neovascular age-related macular degeneration:a Meta-analysis

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International Journal of Ophthalmology(English edition) 2021年第7期14卷 1092-1099页

作者： Bo-Hao Cui Wei Zhou Wen-Wen Wang Hao Yang Ya-Lan Dong Yuan-Yuan Liu Hua Yan Department of Ophthalmology Tianjin Medical University General HospitalTianjin 300052China Laboratory of Molecular Ophthalmology Tianjin Medical UniversityTianjin 300070China Graduate School Tianjin Medical UniversityTianjin 300070China Department of Obstetrics and Gynecology Tianjin Medical University General HospitalTianjin 300052China

AIM:To evaluate the efficacy and safety of intravitreal cor ticoid as an adjunctive therapy to anti-vascular endothelial growth factor(VEGF)treatment of neovascular age-related macular degeneration(nvAMD).METHODS:Four databases including Pub Med,Embase,Cochrane Library,and the *** were comprehensively searched for studies comparing intravitreal corticoid plus anti-VEGF(IVC/IVA)vs anti-VEGF monotherapy(IVA)in patients with *** profiler was used to assess the quality of ***-corrected visual acuity(BCVA),central macular thickness(CMT)and adverse events including the occurrence of severe elevation of intraocular pressure(IOP)and the progress of cataract were extracted from the eligible *** Manager(Rev Man)5.3 was used to analyze the ***:There was no statistic difference of mean change in BCVA at 6 and 12 mo between IVC/IVA and IVA group[95%confidence interval(CI):-2.28 to 4.24,P=0.55;95%CI:-3.01 to 8.70,P=0.34].No statistic difference was found in the change of CMT between two groups at 6 mo time point(95%CI:-17.98 to 16.42,P=0.93)while the CMT reduction in IVC/IVA group was significantly more obvious than IVA group at 12 mo time point[mean difference(MD)=-44.08,95%CI:-80.52 to-7.63,P=0.02].The risk of occurrence of severe elevation of IOP in the IVC/IVA group was higher than that in the IVA group(95%CI:1.92 to 9.48;P=0.0004).Cataract progression risk was calculated no statistic difference between two groups(95%CI:0.74 to 4.66;P=0.18).CONCLUSION:No visual or anatomical benefits are observed in IVC/IVA group at 6 *** 12 mo,the CMT of the IVC/IVA group is significantly lower than that of the IVA *** of severe elevation of IOP is significantly higher when treated by IVC/IVA.

关键词： age-related macular degeneration dexamethasone triamcinolone anti-vascular endothelial growth factor Meta-analysis

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Fixed bimonthly aflibercept in nave and switched neovascular age-related macular degeneration patients:one year outcomes

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International Journal of Ophthalmology(English edition) 2016年第8期9卷 1156-1162页

作者： Alasdair N Warwick Hannah H Leaver Andrew J Lotery Srini V Goverdhan Clinical Neurosciences Research Group Clinical and Experimental Sciences Faculty of Medicine University of Southampton Southampton Eye Unit University Hospital Southampton NHS Foundation Trust

AIM: To determine real life clinical outcomes in poorly responsive and treatment-nave neovascular age-related macular degeneration(nv AMD) patients using bimonthly fixed dosing aflibercept ***: This was a retrospective study of 165 eyes with nv AMD started on aflibercept at Southampton Eye Unit between June 2013 and June 2014. Patients were either switched from pro re nata(PRN) ranibizumab/bevacizumab due to poor response(107 eyes), or treatment- nave( 58 eyes). Patients initially received 3-monthly intravitreal aflibercept injections followed by 2-monthly fixed doses. Clinic visits were scheduled at month 0, 4, 10 and 12. Mean change in best-corrected visual acuity(BCVA) and central retinal thickness(CRT)from baseline were assessed using the Wilcoxon signedrank test. The proportion of patients maintaining BCVA(<15 letters loss) at 12 mo was also ***: Mean BCVA change at month 12 was +3.29 and +4.67 letters in the switched and nave aflibercept groups respectively(P <0.01). BCVA was maintained in 95.3% of switched and 96.6% of nave patients. CRT at month 12 showed a decrease of -6.16 μm in the switched group and -35.36 μm in the nave group(P <0.01).Patients previously treated with ranibizumab/bevacizumab had on average received 7.4 ranibizumab/bevacizumab injections over 12.6 mo, attending 10 clinic visits. The fixed dosing aflibercept regimen required an average of 7.1 injections(nave group), 7.5 injections(switched group) and 4 clinic visits per ***: Fixed bimonthly aflibercept is effective in both treatment-nave and poorly responsive nv AMD patients. Adopting a fixed dosing regimen can reduce patient burden without compromising on outcomes.

关键词： age-related macular degeneration ranibizumab aflibercept anti-vascular endothelial growth factor

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