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.
目的 研究鞏膜外墊壓手術聯合視網膜激光光凝對硅油眼視網膜脫離的治療效果。 方法 回顧性分析2009年1月－2012年1月，用鞏膜外墊壓聯合視網膜光凝手術治療36例硅油眼視網膜脫離的視網膜復位效果。 結果 全部患者均順利完成鞏膜外墊壓手術及隨后的視網膜激光光凝，行鞏膜外放液5只眼，手術中未發生視網膜嵌頓、眼內出血和眼壓顯著升高等并發癥；手術后1周視網膜復位21只眼（58.33%），剩下15只眼1個月后復位7只眼（19.44%），視網膜脫離總復位率為28只眼（77.77%）；未復位8只眼（22.23%），改用玻璃體切割手術方式，視網膜成功復位；6個月后取出硅油，隨訪6個月視網膜無脫離或者脫離范圍增加；手術后眼壓≥30 mm Hg （1 mm Hg=0.133 kPa）3只眼，≥20 mm Hg 7只眼，對癥治療1周后眼壓均恢復到正常范圍。 結論 鞏膜外墊壓聯合視網膜激光光凝治療硅油眼視網膜脫離，手術簡單，復位率高，可為硅油眼視網膜脫離首選手術方式，對于鞏膜外墊壓手術失敗和復雜的硅油眼視網膜脫離，應當選擇玻璃體切割手術方式。
Purpose To evaluate the efficacy of vitreous surgery and endolaser in a series of patients with retinal vein occlusion(RVO)with vitreous hemorrhage,neovascular membranes(NVM) and/or traction retinal detachment(TRD). Methods Clinical records were reviewed on 37 consecutive patients(38 eyes)who underwent vitreous surgery and endolaser for RVO with persistent vitreous hemorrhage,NVM and/or TRD.There were 19 patients(20 eyes)with retinal branch vein occlusion (BRVO)and 18 patients(18 eyes)with central retinal vein occlusion(CRVO). Results NVM and TRD were confirmed during operation in 27 and 23 eyes,respectively.Visual acuity improved postoperatively in 34 eyes(89.5%)including 22 eyes with 0.1 or better vision,and 4 eyes remained unchanged.CRVO group had longer history and less visual improvement after surgery. Conclusions Vitreous surgery and endolaser photocoagulation can improve the outcome in the majority of patients with RVO with vitreous hemorrage,NVM and/or TRD. (Chin J Ocul Fundus Dis,1998,14:3-6)
Objective To evaluate the single-use of laser photocoagulation (LP) and the combined-use of laser photocoagulation plus intravitreal triamcinolone (LP+IVTA) for diabetic macular edema (DME) in terms of clinical therapeutic effect and safety. Methods Such databases as The Cochrane Library, Medline, Embase, CBM, CNKI and Wanfang Data were searched from the date of their establishment to September 2011, and the references of all included studies were also traced, so as to identify the randomized controlled trials (RCTs) on LP vs. LP+IVTA for DME. The quality assessment and data extraction were conducted in accordance with the Cochrane Handbook 5.0 by two reviewers independently, and then Meta-analyses were conducted using RevMan 5.0 software. Results Ten RCTs involving 525 ill eyes were included, and all of them were classified as Grade B in methodological quality. Results of meta-analysis showed that: at the end of follow-up, there were significant differences between the LP+IVTA group and the LP group in the best corrected visual acuity (BCVA) (RR=–0.14, 95%CI –0.20 to –0.08, Plt;0.000 01), and the central macular thickness (CMT) (RR=–56.78, 95%CI –84.03 to –29.54, Plt;0.000 1). In comparison with the LP group, there were more people in the LP+IVTA group who needed to be treated for their elevated intraocular pressure and to have surgery for the progression of cataract. But no significant difference was found between the two groups in vitreous hemorrhage, retinal detachment, retinal vein occlusion and macular epiretinal membrane. Conclusion Current evidence of clinical research shows that the LP+IVTA is superior to LP in reducing macular edema and improving vision in the treatment of diabetic macular edema, but it may also result in a high incidence of elevated intraocular pressure and cataract. Because the methodological quality limitation of included studies may affect the authenticity of outcomes, this conclusion has to be further proved by more high-quality and large-scale clinical trials.