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Anti-vascular endothelial growth factor drugs combined with laser photocoagulation maintain retinal ganglion cell integrity in patients with diabetic macular edema: study protocol for a prospective, non-randomized, controlled clinical trial

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Neural Regeneration Research 2024年第4期19卷 923-928页

作者： Xiangjun Li Chunyan Li Hai Huang Dan Bai Jingyi Wang Anqi Chen Yu Gong Ying Leng Department of Ophthalmology Affiliated Hospital of Beihua University Department of Endocrinology Affiliated Hospital of Beihua University

The integrity of retinal ganglion cells is tightly associated with diabetic macular degeneration that leads to damage and death of retinal ganglion cells,affecting vision.The major clinical treatments for diabetic macular edema are anti-vascular endothelial growth factor drugs and laser photocoagulation.However,although the macular thickness can be normalized with each of these two therapies used alone,the vision does not improve in many patients.This might result from the incomplete recovery of retinal ganglion cell injury.Therefore,a prospective,non-randomized,controlled clinical trial was designed to investigate the effect of anti-vascular endothelial growth factor drugs combined with laser photocoagulation on the integrity of retinal ganglion cells in patients with diabetic macular edema and its relationship with vision recovery.In this trial,150 patients with diabetic macular edema will be equally divided into three groups according to therapeutic methods,followed by treatment with anti-vascular endothelial growth factor drugs,laser photocoagulation therapy,and their combination.All patients will be followed up for 12 months.The primary outcome measure is retinal ganglion cell-inner plexiform layer thickness at 12 months after treatment.The secondary outcome measures include retinal ganglion cell-inner plexiform layer thickness before and 1,3,6,and 9 months after treatment,retinal nerve fiber layer thickness,best-corrected visual acuity,macular area thickness,and choroidal thickness before and 1,3,6,9,and 12 months after treatment.Safety measure is the incidence of adverse events at 1,3,6,9,and 12 months after treatment.The study protocol hopes to validate the better efficacy and safety of the combined treatment in patients with diabetic macula compared with the other two monotherapies alone during the 12-month follow-up period.The trial is designed to focus on clarifying the time-effect relationship between imaging measures related to the integrity of retinal ganglion cells and best-corrected visual acuity.

关键词： choroidal thickness diabetic macular edema laser photocoagulation retinal ganglion cell-inner plexiform layer thickness retinal ganglion cells retinal nerve fiber layer thickness thickness of the macular area vascular endothelial growth factor visual acuity

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Conbercept combined with laser photocoagulation in the treatment of diabetic macular edema and its influence on intraocular cytokines

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World Journal of Diabetes 2023年第8期14卷 1271-1279页

作者： Hui-Qin Zhan Ji-Lin Zhou Jun Zhang De Wu Chun-Yan Gu Department of Ophthalmology The Third People’s Hospital of ChangzhouChangzhou 213001Jiangsu ProvinceChina

BACKGROUND The prevalence of diabetes mellitus(DM)in China is high,and the base is broad.Diabetic retinopathy(DR)is a critical condition affecting the life and health of a nation and its economic development.DR is a common complication of DM.AIM To investigate the efficacy of laser photocoagulation combined with intravitreal injection of conbercept for treating macular edema.METHODS Overall,130 patients with diabetic macular edema(DME)hospitalized in The Third People’s Hospital of Changzhou from January 2019 to June 2022 were retrospectively included.According to the treatment plan,130 patients with DME were categorized into an observation and a control group,with 65 patients in each group.The control group received laser photocoagulation,and the observation group received laser photocoagulation with intravitreal injection of conbercept.Observe changes in vision,cytokines in the eye and so on.RESULTS The total efficacy rate in the observation group(93.85%)was higher than that in the control group(78.46%)(Plaser photocoagulation and intravitreal injections of conbercept for DME is a more effective and safer strategy to improve vision,and lower intraocular cytokine levels.

关键词： Conbercept laser photocoagulation Diabetes treatment Diabetic retinopathy Diabetic macular edema Intraocular cytokines

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Short-term effects of intravitreal Conbercept injection combined with laser photocoagulation on macular edema secondary to ischemic retinal vein occlusion

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International Journal of Ophthalmology(English edition) 2021年第5期14卷 732-736页

作者： Zheng-Feng Liu Xing-Rong Wang Xiao-Yan Zhang Xue-Mei Pan Rui-Xue Zhang Hong-Sheng Bi Ying Wen Medical School of Ophthalmology&Optometry Shandong University of Traditional Chinese MedicineJinan 250355Shandong ProvinceChina Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine Jinan 250002Shandong ProvinceChina Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases in Universities of ShandongEye Institute of Shandong University of Traditional Chinese MedicineJinan 250002Shandong ProvinceChina

AIM:To observe changes in the best-corrected visual acuity(BCVA),central macular thickness(CMT),and central choroidal thickness(CCT)of patients with macular edema(ME)secondary to ischemic retinal vein occlusion(i RVO)following intravitreal Conbercept injection.METHODS:This retrospective study included 33 eyes from 33 patients who received intravitreal injections of Conbercept for ME secondary to i RVO.Treatments were performed on a 3+pro re nata(3+PRN)basis.All of the patients were examined by fundus fluorescein angiography and spectral domain optical coherence tomography at the first visit.laser photocoagulation was performed in the nonperfusion area of the retina of all eyes after the first injection.BCVA,CMT,and CCT were observed before and after 6 mo of treatment.The number of injections necessary to achieve improved vision was also noted.RESULTS:Following Conbercept treatment,the mean BCVA significantly improved from 0.81±0.39 at baseline to 0.41±0.25 and 0.43±0.29 log MAR in the third and sixth months,respectively(both P=0.000).The CMT of the patients at baseline was 556.75±98.57μm;304.78±68.53 and 306.85±76.77μm 3 and 6 mo after treatment,respectively(both P=0.000 vs baseline).The CCTs of the patients at baseline,3 and 6 mo after treatment were 304.63±57.83,271.31±45.53,and 272.29±39.93μm,respectively(P=0.026 and 0.035 vs baseline).No severe adverse event relevant to the therapy was noted,and the average number of injections delivered was 3.35.CONCLUSION:Intravitreal Conbercept injection combined with laser photocoagulation appears to be a safe and effective treatment for ME secondary to i RVO in the short-term.

关键词： Conbercept laser photocoagulation macular edema ischemic retinal vein occlusion

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Effects of laser photocoagulation on serum angiopoietin-1, angiopoietin-2, angiopoietin-1/angiopoietin-2 ratio, and soluble angiopoietin receptor Tie-2 levels in type 2 diabetic patients with proliferative diabetic retinopathy

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International Journal of Ophthalmology(English edition) 2014年第4期7卷 648-653页

作者： Qiao-Ying You Fu-Yuan Zhuge Qi-Qian Zhu Xu-Wei Si Department of Endocrine and Metabolism Shaoxing People's Hospital

·AIM: To determine the effects of laser photocoagulation on serum levels of angiopoietin-1(Ang-1),angiopoietin-2(Ang-2), soluble angiopoietin receptor Tie-2(Tie-2), Ang-1/Ang-2 ratio and vascular endothelial growth factor(VEGF) in patients with type 2diabetes mellitus(T2DM) and proliferative diabetic retinopathy(PDR). We also explored the role of the Ang/Tie system in PDR.·METHODS:Totally 160patientswithT2 DM, including50 patients with non-diabetic retinopathy(NDR), 58 patients with non-proliferative diabetic retinopathy(NPDR), and52 patients with PDR were enrolled in this study. Serum Ang-1, Ang-2, Tie-2 receptor and VEGF levels were measured using enzyme-linked immunosorbent assays for all patients and were repeated in 26 patients who underwent laser photocoagulation two months after the procedure.·RESULTS:ThemedianlevelsofAng-2andVEGFinserum were significantly higher in the NPDR group(4.23 ng/mL and 303.2 pg/mL, respectively) compared to the NDR group(2.67 ng/mL and 159.8 pg/mL, respectively, P 0.05).Ang-2 was positively correlated with VEGF and Tie-2 in the PDR and NPDR groups(both P laser photocoagulation, serum Ang-2 and VEGF levels significantly decreased(both P 0.05). The median levels of Ang-2 and VEGF in serum were highest in PDR group,however, Ang-1/Ang-2 ratio of PDR group was lowest in three groups.·CONCLUSION: laser photocoagulation can reduce serum Ang-2 and VEGF

关键词： angiopoietin receptor protein tyrosine kinase diabetes mellitus type 2 retinopathy laser photocoagulation

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Progress in the Treatment of DME

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Journal of Biosciences and Medicines 2024年第2期12卷 80-97页

作者： Xunyu Zou Yuxuan Liu[] Shizhou Cheng[] Zuhai Zhang Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou China

Diabetic macular edema (DME) is a common ocular complication of diabetes mellitus (DM) and an important cause of vision loss. The pathogenesis of DME is complex and can occur at any time of diabetic retinopathy (DR). Effective methods of treating DME are essential to prevent irreversible damage to visual function. To date, laser photocoagulation, vascular endothelial growth factor (VEGF) inhibitors, and corticosteroids have demonstrated their therapeutic efficacy in large randomized controlled trials and real-life observational studies. Clinicians need to consider various factors, such as efficacy, safety, accessibility, and cost, in the selection of various options. This review summarizes the current therapeutic approaches for DME to provide new references for the treatment of DM.

关键词： Diabetic Macular Edema Anti-Vascular Endothelial Growth Factor Corticosteroids laser photocoagulation Vitrectomy

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Improved external valvuloplasty, intravenous laser photocoagulation and local sclerotheraphy treatment of primary deep venous valvular insufficiency:long term result

Improved external valvuloplasty, intravenous laser photocoag...

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2007亚洲光电子会议保健与生物医学光学分会场

作者： WANG Chun-xi PhDa HAN Li-na PhDb GU Ying MDb* LIANG Fa-qi MS.a ZHANG Li MS.b LIU Hong-yi PhDa ZHAO Wen-guang MS.c WANG Qi MD c WANG Xiao-ling MS.d aDepartment of General Surgery Chinese PLA General Hospital 100853 Chinab Department of laser Medicine Chinese PLA General Hospital c Department of Vascular Surgery the First Hospital Affiliated Jilin University d Department of General Surgery Beijing Changfeng Hospital

The purpose of this article is to report long-term follow-up of improved external vulvuloplasty, intravenous laser photocoagulation and local sclerotherapy treatment of primary deep venous valvular insufficiency in eight hundred and seventy-two patients from Nov. 2000 to May 2006. Patients were evaluated clinically and with duplex ultrasound at 1, 3, and 12 months, and yearly thereafter until the fifth year to assess treatment efficacy and adverse reactions. Successful occlusion of the great saphenous vein and absence of deep vein reflux on color Doppler imaging, were noted in 956 limbs of 852 cases（ 1 month follow-up）, 946 limbs of 842 cases （6 month to 1 year follow-up）, 717 of 626 （1～2 year follow-up）, 501 of 417 （2～3 year follow-up）, 352 of 296 （3～5year follow-up）, 142 of 106 （5 year follow-up） after initial treatment. The cumulative total number of recurrence of reflux was fifteen cases. The respective competence rate was 95.18%, 96.23%, 94.23%, 95.25%, 94.23% and 94.12%. Of note, all recurrence occurred before 9 months, with the majority noted before 3 months. Bruising was noted in 0.7% of patients, tightness along the course of treated vein in 1.0% of limbs. There have been no paresthesia of cases, skin burns and deep vein thrombosis.

关键词： improved external valvuloplasty laser photocoagulation local sclerotherapy deep venous valve insufficiency

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Preoperative laser reduces silicone oil use in primary diabetic vitrectomy

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International Journal of Ophthalmology(English edition) 2022年第4期15卷 591-597页

作者： Wen-Bin Zheng Xiao-Hu Ding Kun-Bei Lai Ji-Zhu Li Yu-Qing Wu Yuan Ma Zi-Ye Chen Shi-Da Chen Sai-Nan Xiao Bing-Qian Liu Ying Lin Tao Li State Key Laboratory of Ophthalmology Zhongshan Ophthalmic CenterSun Yat-sen UniversityGuangdong Provincial Key Laboratory of Ophthalmology and Visual ScienceGuangdong Provincial Clinical Research Center for Ocular DiseasesGuangzhou 510060Guangdong ProvinceChina

AIM: To identify the predictive factors and laser photocoagulation associated with the use of silicone oil as endotamponade during primary diabetic vitrectomy. METHODS: The medical and surgical records of 690 patients(798 eyes) who underwent primary diabetic vitrectomy at a tertiary eye hospital in China from January 2018 to December 2018 were reviewed in this retrospective cohort study. The patients’ baseline characteristics and preoperative treatments were recorded. The binary Logistic regression model was used to evaluate the risk factors for the use of silicone oil as endotamponade agent during primary vitrectomy for proliferative diabetic retinopathy(PDR)-related complications.RESULTS: Among 690 patients with mean age of 52.1±10.5 y(range: 18-85 y), 299/690(43.3%) were female. The 31.6% of the eyes received preoperative laser treatment, and 72.4% of the eyes received preoperative anti-VEGF adjuvant therapy. Non-clearing vitreous haemorrhage(VH) alone or combined with retinal detachment was the main surgical indication(89.5%) for primary vitrectomy. Silicone oil was used as endotamponade in 313(39.2%) eyes. Lack of preoperative laser treatment [odds ratio(OR) 0.66, 95% confidence interval(CI): 0.48-0.92;P=0.015] and older age(OR 0.96, 95%CI: 0.95-0.98;Plaser treatment is a significant predictor of silicone oil tamponade during primary vitrectomy for PDR. However, the severity of PDR relevant to silicone oil use should be further evaluated.

关键词： proliferative diabetic retinopathy vitrectomy laser photocoagulation silicone oil tamponade predictive factors

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Foveal structure changes in infants treated with anti-VEGF therapy or laser therapy guided by optical coherence tomography angiography for retinopathy of prematurity

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International Journal of Ophthalmology(English edition) 2022年第1期15卷 106-112页

作者： Xun Deng Yong Cheng Xue-Mei Zhu Dan-Dan Linghu Hua Xu Jian-Hong Liang Peking University People’s Hospital Eye Diseases and Optometry InstituteBeijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid DiseasesDepartment of Ophthalmology&Clinical Centre of OptometryCollege of OptometryPeking University Health Science CenterBeijing 100044China Department of Ophthalmology Children’s Hospital of Soochow UniversitySuzhou 215003Jiangsu ProvinceChina

AIM: To evaluate foveal vessel density(VD) and foveal thickness using optical coherence tomography angiography(OCTA) in retinopathy of prematurity(ROP) children treated with laser photocoagulation or anti-vascular endothelial growth factor(VEGF) injection. Additionally, we assessed the relationship between foveal microvascular anomalies and different therapies in ROP children.METHODS: This was a single-center, retrospective study of patients with a diagnosis of type 1 ROP. Twenty-three eyes(14 patients) treated with anti-VEGF injection and twentynine eyes(17 patients) treated with laser coagulation were included in this study. The foveal VD, inner thickness and full thickness were measured at the central 0°, 2° to 8°, and 8° of the retina(centered on the fovea) using OCTA and cross-sectional OCT, respectively.RESULTS: Foveal VD, inner thickness and full thickness were significantly smaller within the central 8° of the retina in ROP children treated with anti-VEGF injection than in those treated with laser photocoagulation(P=0.013, 0.009, 0.036, respectively). The full thickness was also smaller in the anti-VEGF group than in the laser group at the central 0° of the retina(P=0.010). The grade of foveal hypoplasia is lower in the anti-VEGF group than in the laser group(P=0.045). Multivariable analysis did not find any risk factors associated with visual acuity in our study.CONCLUSION: In children with type 1 ROP, the better structural development of fovea in those who were treated with anti-VEGF injection compared with laser photocoagulation are identified. However, visual acuity outcomes are similar 70 mo after the treatments.

关键词： retinopathy of prematurity optical coherence tomography angiography anti-vascular endothelial growth factor laser photocoagulation

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Tracking of CFSE-labeled endothelial progenitor cells in laser-injured mouse retina

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Chinese Medical Journal 2011年第5期124卷 751-757页

作者： SHI Hui YANG Wei CUI Zhi-hua LU Cheng-wei LI Xiao-hong LIANG Ling-ling SONG E Department of Ophthalmology First Hospital Jilin University Changchun Jilin 130021 China

Background Endothelial progenitor cells （EPCs） transplantation is a promising therapeutic strategy for ischemic retinopathy. The current study aimed to establish a simple, reliable and fluorescent labeling method for tracking EPCs with 5-（and-6）-carboxyfluorescein diacetate succinimidyl ester （CFSE） in laser-injured mouse retina. Methods EPCs were isolated from human umbilical cord blood mononuclear cells, cultivated, and labeled with various concentrations of CFSE. Based on fluorescence intensity and cell morphology, a 15 minutes incubation with 5 μmol/L CFSE at 37℃ was selected as the optimal labeling condition. The survival capability and the apoptosis rate of CFSE-labeled EPCs were measured by Trypan blue staining and Annexin V/PI staining assay respectively. Fluorescence microscopy was used to observe the label stability during the extended culture period. Labeled EPCs were transplanted into the vitreous cavity of pigmented mice injured by retinal laser photocoagulation. Evans Blue angiography and flat mounted retinas were examined to track the labeled cells.Results EPCs labeled with 5 μmol/L CFSE presented an intense green fluorescence and maintained normal morphology, with no significant changes in the survival capability or apoptosis rate after being labeled for 2 days, 1 and 4 weeks, The fluorescence intensity gradually decreased in the cells at the end of 4 weeks. Evans Blue angiography of the retina displayed the retinal capillarity network clearly and fluorescence leakage was observed around photocoagulated spots in the laser-injured mouse model. One week after transplantation of labeled EPCs, the fluorescent cells were identified around the photocoagulated lesions. Four weeks after transplantation, fluorescent tube-like structures were observed in the retinal vascular networks.Conclusion EPCs could be labeled by CFSE in vitro and monitored in vivo for at least 4 weeks, and participate in the repair of injured retinal vessels.

关键词： endothelial progenitor cells 5-（and-6）-carboxyfluorescein diacetate succinimidyl ester cell tracking retina laser photocoagulation cell transplantation

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Pregnancy and diabetic retinopathy-considerations for evaluation and treatment:a review

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Annals of Eye Science 2023年第3期8卷 11-18页

作者： Tahreem A.Mir Avni P.Finn Department of Ophthalmology Vanderbilt University Medical CenterNashvilleTNUSA

The prevalence of diabetic retinopathy(DR)continues to increase in pregnant females;these individuals are also at a higher risk of disease progression.The lack of evidence regarding the safety and efficacy of current treatment options in pregnancy makes disease management particularly challenging.All pregnant women with diabetes should have a prenatal DR screening,as well as receive counseling regarding the progression and management of DR during pregnancy.Optimal blood glucose and blood pressure control should be encouraged.For patients with proliferative diabetic retinopathy(PDR)in the absence of visually significant diabetic macular edema(DME),panretinal photocoagulation(PRP)remains a safe and effective treatment option.Visually significant DME can be treated with focal laser if areas of focal leakage are identified in the macula on fluorescein angiogram,intravitreal steroids or anti-vascular endothelial growth factor(VEGF)agents,The theoretical risk of anti-VEGF agents to the fetus should be considered and the patients should be extensively counselled regarding the risks and benefits of initiating anti-VEGF therapy before initiating treatment.When the decision is made to treat with anti-VEGF agents,Ranibizumab should be the agent of choice.In conclusion,ophthalmologists should make treatment decisions in pregnant patients with DR on a case-by-case basis taking into consideration disease severity,risk of permanent threat to vision,gestational age,and patient preferences.

关键词： Diabetic retinopathy(DR) pregnancy laser photocoagulation intravitreal steroids anti-vascular endothelial growth factor

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