Corticosteroids, anti-vascular endothelial growth factor, antibiotics and antiviral were the main 4 classes of drugs for intravitreal injection. Depending on the class and volume of medication, age and gender of patients, ocular axial lengths or vitreous humour reflux, intraocular pressure (IOP) can be elevated transiently or persistently after intravitreal injection. Transient IOP elevation occurred in 2 weeks after intravitreal injection, and can be reduced to normal level for most patients. Only a small portion of such patients have very high IOP and need intervention measures such as anterior chamber puncture or lowering intraocular pressure by drugs. Long term IOP elevation is refers to persistent IOP increase after 2 weeks after intravitreal injection, and cause optic nerve irreversible damage and decline in the visual function of patients. Thus drug or surgical intervention need to be considered for those patients with high and long period of elevated IOP. Large-scale multicenter clinical trials need to be performed to evaluate the roles of the drug and patients factors for IOP of post-intravitreal injection, and to determine if it is necessary and how to use methods reducing IOP before intravitreal injection.
ObjectiveTo observe the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and vitreous injection of mouse never growth factor (mNGF) in the high myopia macular hole (HMMH). MethodsA prospective study. Thirty-one patients (33 eyes) with HMMH diagnosed in Affiliated Eye Hospital of Nanchang University from August 2020 and February 2021 were selected. Before surgery, all included patients were subjected to a complete ophthalmologic evaluation including best corrected visual acuity (BCVA), optical coherence tomography (OCT), macular microperimetry and axial length measurement. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of minimum resolution angle (logMAR) visual acuity during statistics. The included subjects were accepted the treatment of PPV combined with ILM peeling and vitreous injection of mNGF (combined group) or PPV united with ILM peeling (simple group), 15 cases with 16 eyes, 16 cases with 17 eyes, respectively. There were no significant differences in logMAR BCVA (t=0.836), macular hole (MH) diameter (t=0.657), visual acuity (VA) (t=0.176), the missing length of external limting membrane (ELM) and ellipsoid zone (EZ) (t=1.255, 0.966) between two groups (P＞0.05). The follow-up time was at least 6 months. The BCVA, closure rate of MH, integrity of ELM and EZ and recovery of VA in macular area were compared and observed between the two groups after surgery. The logMAR BCVA, VA, the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group. Fisher test was performed for comparison of count data. ResultsSix months after surgery, MH closure rates in the simple group and the combined group were 88.24% (15/17) and 93.75% (15/16), respectively, with no significant difference (P=0.523). At 3 and 6 months after surgery, the integrity recovery of ELM in the combined group was better than that in the simple group, and the difference was statistically significant (t=2.282, 3.101; P＜0.05). At 1, 3 and 6 months after surgery, EZ deletion length in the combined group was lower than that in the simple group, and the difference was statistically significant (t=1.815, 2.302, 2.784; P＜0.05). Compared with 1 week after surgery, VA in macular area of the combined group increased at 1, 3 and 6 months, and the difference was statistically significant (P=0.007, ＜0.001, ＜0.001). At 3 and 6 months after surgery, VA in macular area of affected eyes in the combined group was higher than that in the simple group, and the difference was statistically significant (t=1.897, 2.250; P＜0.05). There was an interaction effect between the surgical method and the follow-up time. The postoperative time was prolonged, and the VA in macular area was decreased in the simple group and increased in the combined group, with statistical significance (F=12.963, P＜0.001). The BCVA and BCVA changes in the two groups increased with the extension of postoperative time. The improvement of BCVA and the difference of BCVA changes in the combined group were significantly higher than those in the simple group at different time points after surgery, with statistically significant differences (F=12.374, 21.807, 5.695, 4.095; P＜0.05). ConclusionPPV combined with ILM peeling and vitreous injection of mNGF is more effective than PPV with ILM peeling for HMMH, improving both anatomical and functional outcomes.
ObjectiveTo observe the ocular clinical features and efficacy of young infants with incontinentia pigmenti (IP). MethodsA retrospective study. Clinical data of 18 young infants with IP aged 0-3 months in the Department of Ophthalmology of Henan Children's Hospital from October 2017 to February 2019 were collected in this study. All patients were underwent fundus examination under topical anesthesia or general anesthesia. Among them, 9 cases were underwent genetic testing. Patients were determined whether to treated with retinal laser photocoagulation (LIO) or intravitreal conbercept (IVC, 0.25 mg/0.025 ml) according to the condition of eyes. The followed-up time ranged from 4months to 43 months. The ocular clinical features and treatment were observed. ResultsThere were 1 male and 17 females of the 18 patients. The age of first visit were 1.2±1.0 months (2 d-3 months). All cases had typical skin lesions, 4 cases had neurological symptoms, 10 cases had tooth abnormalities, and 4 cases had cicatricial alopecia. Among the 9 cases that were underwent genetic testing, 5 cases were deleted in exons 4-10 of the IKBKG gene and 1case were a heterozygous mutation c.1124delT in exon 9 of the IKBKG gene. Among the 36 eyes, 21 eyes of 13 cases with incontinentia pigmenti-associated ocular diseases were all retinopathy (58.3%,21/36). Retinopathy of 9 cases were asymmetrical (69.2%,9/13). Among the 21 eyes, 3 eyes were simple retinal pigment abnormalities (14.3%,3/21) and 18 cases had retinal vascular lesion (85.7%, 18/21). Among the 36 eyes, 8 eyes were treated; 4 eyes were underwent LIO; 3 eyes were treated with IVC; 1 eye was treated with LIO combined with IVC. They were all improved significantly after the operation without serious complications. 1 eye with retinal detachment did not undergo surgical treatment due to guardian reasons. Perceptual exotropia and eyeball atrophy was found during the follow-up. ConclusionsThe onset of IP-related ocular anomalies is early. The early anomalies were mainly retinal vascular abnormalities. Treatment in early time is effective.
Endophthalmitis caused by intravitreal injection is a rare disease which impair patients’s vision. In recent years, with the increase of the diseases and frequency of intravitreal injections, the incidence of endophthalmitis has increased. Standardizing each step of intravitreal injections is an important method to reduce postoperative endophthalmitis. Despite the current availability of prevention strategies providing by a lot of clinical trials, there are considerable variations and a lack of consensus and inconsistencies in clinical practice. Understanding the existing key measures, standardizing the operation of intravitreal injection in my country, and minimizing the incidence of infective endophthalmitis are of positive significance for improving the treatment of ophthalmology, especially fundus diseases.
Primary vitreoretinal lymphoma (PVRL) is a rare type of non-Hodgkin's lymphoma with poor prognosis and the optimal treatment has yet to be determined. Its treatment has evolved from enucleation to ocular radiotherapy, systemic chemotherapy and intravitreal chemotherapy. Radiotherapy can effectively eradicate tumor cells but ocular recurrences are common. Systemic chemotherapy has become the mainstream option but there are problems with only-partial response of PVRL and high rate of recurrence. Intravitreal chemotherapy, primarily used as adjunctive to systemic chemotherapy, has achieved high remission rate and low rate of recurrence as well as with limited ocular complications. The tumor cells were cleared and the visual function preserved. However, issues about the drug applied, treatment protocols and goals of intravitreal chemotherapy, whether for visual preservation or survival improvement, are worthy for further study.
ObjectiveTo evaluate the efficacy of intravitreal injection (IVI) of expansile gas alone to treat idiopathic full-thickness macular hole (FTMH).MethodsThis is a prospective interventional case series. Twenty FTMH patients (26 eyes) who underwent IVI with expansile gas alone were enrolled in this study. There were 5 males (5 eyes) and 21 females (21 eyes), with the mean age of (59±12) years. All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus color photography and three-dimensional optical coherence tomography (OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. The diameters of macular holes and the interface between vitreous and macular were observed by OCT (Topcon, OCT-2000). Based on the diameter, the holes were classified as small FTMH (equal or lesser than 250 μm), medium FTMH (more than 250 μm but equal or lesser than 400 μm) and large FTMH (more than 400 μm). The mean BCVA was 0.85±0.29. There were 7, 10 and 9 eyes with small, medium and large FTMH. There were 10 eyes with vitreous- macular traction (VMT). All the eyes received IVI of 0.2 ml C3F8 followed facedown positioning for 7-14 days. The follow-up ranged from 1 to 23 months. The BCVA, FTMH closure and complications were observed. If holes failed to close at 1 month after IVI, vitrectomy combined with internal limiting membrane (ILM) peeling and C3F8 tamponade would be performed for these eyes.ResultsFTMHs was able to close in 17/26 eyes (65.4%) had hole closure, failed to close in 9 /26 eyes (34.6%). All 10 eyes with VMT achieved vitreous-macula separation after IVI of gas. The eyes failed in the closure initially with IVI of gas alone, all succeed with hole closure after vitrectomy combined with ILM peeling and C3F8 tamponade. The closure rate of small (6 eyes), medium (8 eyes) and large FTMH (3 eyes) was 85.7%, 80.0% and 33.3% respectively. The diameter of FTMHs in holes-closure eyes and failed-closure eyes was (307.8±122.8), (431.6±128.4) μm respectively, the difference was significant (t=?2.407, P=0.024). VMT was found in 6 eyes and 4 eyes in holes-closure group and failed-closure group, respectively, the difference was significant (t=?2.196, P=0.038). The mean preoperative BCVA was 0.51±0.36. There was a significant difference between pre-and postoperative BCVA (t=4.758, P＜0.05). Two eyes developed local retinal detachment, which achieved hole closure and retinal reattachment after vitrectomy.ConclusionIVI of expansile gas alone is an effective way in treating FTMH with a diameter smaller than 400 μm and with VMT before surgery.
Objective To observe and analyze the risk factors of positive conjunctival capsule microbial culture in patients with intravitreal injection treatment (IVT) before treatment. MethodsA prospective study. A total of 1 092 patients who received IVT at the Vitreous Injection Center of Tianjin Medical University Eye Hospital from February 2021 to February 2024 were included in the study. Among them, 539 were males and 553 were females. The age was (62.29±13.61) years. Hypertension and diabetes were 661 and 576 cases, respectively. There were 742 cases of urban residence and 350 cases of rural residence. Three and one days before IVT, 364 patients received antibiotics and 364 patients did not receive antibiotics. Patients' gender, age, history of hypertension and diabetes, pre-IVT antibiotic eye drops use history, and differences in residence (town/country) were collected in detail. Samples were collected after the conjunctival sac was rinsed, and microbial culture was performed. The differences in conjunctival microbial culture positivity rates was compared between those who did not use antibiotic eye drops before IVT, those who used them 1 day before IVT, and those who used them 3 days before IVT. The positive rate of conjunctival sac microbial culture were compared among individuals of different ages, genders, with/without hypertension, with/without diabetes, with different IVT times, and from different living areas (urban/rural). The clinical baseline of positive conjunctival capsule bacterial culture was compared and observed. χ2 test was used to compare the positive rate of conjunctival capsule microbial culture among different clinical baselines. Logistic binary regression analysis was used to analyze the influencing factors. ResultsAmong the 1 092 patients, 54 cases (4.95%, 54/1 092) were positive for microbial culture of conjunctival sac. There was no significant difference (P＞0.05) in the positive rate of conjunctival sac microbial culture among patients of different ages (χ2=5.599), gender (χ2=0.549), residence (χ2=0.153), with or without hypertension and diabetes (χ2=3.545, 0.044), and with or without diabetic macular edema (χ2=0.180). There was no significant difference (P＞0.05) in the positive rate of conjunctival sac microbial culture between patients with different numbers of IVT (χ2=0.961) or between those who received antibiotic eye drops before IVT and those who did not (χ2=5.600). Logistic binary regression analysis showed that none of the above factors were risk factors for positive conjunctival capsule microbial culture (P＞0.05). No infective endophthalmitis occurred in all patients during the observation period. ConclusionThe use of antibiotics before IVT is not the decisive factor for positive microbial culture in conjunctival sac.
Intravitreal drug injection is a treatment for common chronic fundus diseases such as age-related macular degeneration and diabetic retinopathy. The “14th Five-Year” National Eye Health Plan (2021-2025) recommends focusing on fundus diseases and improve the management mode of patients with chronic eye diseases. Therefore, it is imperative to explore how to further optimize the service process of intravitreal injection under the premise of guaranteeing patients' medical safety, to promote medical service efficiency and standardized management level and improve the medical experience of patients. Based on the quality control standard of vitreous cavity injection for retinopathy in China, Chinese fundus disease and related field experts developed the present expert consensus on the establishment of a one-stop intravitreal injection model and the management of its organization after a serious, comprehensive, and complete discussion, focusing on a standardized operation process, quality control, and safety management, providing more references for establishing a suitable intravitreal injection management model for ophthalmology and promoting the development of diagnostic and treatment models for fundus disease in China.
ObjectiveTo observe the efficacy of dexamethasone intravitreal implant (DEX) combined with pars plana vitrectomy (PPV) in eyes with severe idiopathic epimacular membrane (IMEM). MethodsA prospective clinical case study. From December 2018 to May 2021, 24 patients with 25 eyes of severe IMEM diagnosed in Tianjin Medical University Eye Hospital were included in the study. Among them, 7 males had 7 eyes, 17 females had 18 eyes. Age was 57 to 84 years old. The IMEM stage was 3 to 4 examined by spectral domain optical coherence tomography (SD-OCT). All eyes were performed best corrected visual acuity (BCVA) and central macular thickness (CMT) by SD-OCT. The patients were randomly divided into PPV group (11 eyes) and PPV+DEX group (14 eyes). Standard PPV by three-channel 25G was performed. Phacoemulsification, membrane stripping and intraocular lens implantation were combined during the operation. Patients received vitreous injection of 0.7 mg DEX in PPV+DEX group at the end of the operation. At 1 week, 1 month, 3 months and 6 months after operation, the same equipments and methods were used to perform relevant examinations. The changes of BCVA and CMT were compared between the two groups by t test. ResultsCompared with before operation, at 1, 3 and 6 months after operation, the BCVA of the eyes in the PPV+DEX group was significantly improved (t=3.974, 4.639, 4.453), CMT was significantly decreased (t=2.955, 3.722, 4.364), the differences were statistically significant (P＜0.05); at 3 and 6 months after surgery, the BCVA of the eyes in the PPV group was significantly improved (t=2.983, 4.436), CMT was significantly decreased (t=2.983, 3.461), the differences were statistically significant (P＜0.05). ConclusionIn the treatment of severe IMEM, DEX can accelerate the early postoperative visual recovery and reduce CMT.
ObjectiveTo observe the differences in the positive rate of conjunctival sac microbial culture after different methods of preventing infection before intravitreal injection (IVI). MethodsA prospective case-control study. A total of 1 200 participants with fundus diseases who received IVI injection at Tianjin Medical University Eye Hospital from July 2021 to December 2023 were included. Patients were randomly divided into 6 groups according to eye spot with antibiotic solution 3, 1 and 0 days before IVI and local eye disinfection with povidone-iodine (PVI) 3 min and 30 s before IVI: the first 3 days of antibiotics+3 min PVI group, the first 1 day of antibiotics+3 min PVI group, the first 0 days of antibiotics+3 min PVI group, the first 3 days of antibiotics+30 s PVI group, the first 1 day of antibiotics+30 s PVI group, the first 0 days of antibiotics+30 s PVI group, there were 200 cases in each group. Microbial sampling and cultivation of conjunctival sac were conducted before IVI to compare the differences in positive rates among different groups. Multiple group comparisons were conducted using one-way analysis of variance. The comparison of count data is conducted using χ2 test. ResultsAmong the 1 200 patients, there were 566 males and 634 females. Age (62.59±13.44) years old. There were 397 cases of diabetes and 482 cases of hypertension. IVI frequency (2.35±2.34). 64 cases were positive for conjunctival sac culture before IVI. The age (F=1.468), sex composition ratio (χ2=2.876), diabetes (χ2=10.002), hypertension (χ2=6.019), times of IVI (χ2=4.507), and positive rate of conjunctival sac bacterial culture (χ2=6.272) of patients in each group had no statistical significance (P＞0.05). Using the duration of antibiotic application before IVI as a stratified factor, there was no statistically significant difference in the positive rate of conjunctival sac culture between groups with different durations of antibiotic application before IVI [χ2=0.414, P=0.52, combined odds ratio (OR)=0.819, 95% confidence interval (CI) 0.493-1.360]. Using the duration of PVI application as a stratified factor, there was no statistically significant difference in the positive rate of conjunctival sac culture between different PVI disinfection times [χ2=0.000, P=1.000, combined OR=1.00, 95%CI 0.503-1.988]. ConclusionsPre IVI treatment with 0.5% PVI for 30 s can inhibit the growth of microbial colonies in the conjunctival sac. The application of local antibiotic eye fluid in the anterior eye of IVI cannot reduce the positive rate of conjunctival sac bacteria.