Objective To investigate the clinical characteristics of retinal degeneration (RD) with retinal holes and the therapeutic effect of argon laser therapy. Methods The data of argon laser therapy in 210 RD patients (224 eyes) with retinal holes who underwent the treatment in our department were retrospectively analyzed, which was compared with the data of argon laser therapy in 173 RD patients (198 eyes) without retinal holes. Results In RD patients with retinal holes, 89.7% of the patients were less than 60 years old (53.3% males and 46.7% females). Grid-like degeneration was found in 65.6% of the patients in whom 87.5% had the range of degeneration less than 1 quardrant. There were oval-shaped holes in 60.7% of the patients and accompanied with limited rhegmatogenous retinal detachment (LRRD) in 23.7%. Compared with RD patients without retinal holes, the ratio of patients with the age ofge;35 years, cystic degeneration, retinal lengthways small plica, and subjective symptoms was higher in RD patients with retinal holes; while the therapeutic effect of argon laser therapy on patients with LRRD was obviously less than whom without retinal holes (Plt;0.01 ). Conclusions RD with retinal holes often occurs in youth, most of whom have grid-like degeneration with the range of le;1 qua drant. The major types of retinal holes are oval-shaped degeneration without retinal detachment. There was no sex difference in RD patients with retinal holes and most of the patients have no subjective symptoms. The therapeutic effect of prophylactic argon laser therapy on RD patients with retinal holes but no retinal detachment is satisfying. (Chin J Ocul Fundus Dis, 2006, 22: 39-41)
Panretinal photocoagulation (PRP) and macular photocoagulation (MPC) are the gold standard treatments for proliferative diabetic retinopathy (DR) and diabetic macular edema. With the development of equipment and technology advancement, photocoagulation has been gradually applied in many Eye Centers all over China. However, there are still several problems such as no standardized guideline and undesirable therapeutic effects. In this article we will summarize the indications and techniques of photocoagulation, and when and how to apply drug treatments for retinal diseases; aim at improving the criterion and clinical effects of photocoagulation.
ObjectiveTo investigate the prognosis and differences of visual function and fundus structure in retinopathy of prematurity (ROP) undergoing anti-vascular endothelial growth factor agents (VEGF) or laser photocoagulation treatment with long-term follow-up. MethodsRetrospective case control series. From January 2010 to December 2021, A total of 35 children (63 eyes) with ROP who were first diagnosed in Department of Ophthalmology, Peking University People's Hospital and followed up for as long as 5 years were included. Among them, 21 males (36 eyes) and 15 females (27 eyes) were enrolled. The average gestational age (GA) of the children at birth was 29.30±1.77 weeks. Among the included 12 aggressive ROP (A-ROP) eyes and 51 pre-threshold type 1 ROP eyes, no retinal detachment occurred. Each eye received only intravitreal injection of anti-VEGF agents or laser monotherapy after diagnosis, and divided into anti-VEGF group or laser group according to the treatment. Thirty-five eyes of 20 infants were included in the anti-VEGF group and 28 eyes of 15 infants were included in the laser group. GA, birth weight (BW) and postmenstrual age receiving first treatment were compared and no significant difference between the two groups was defined (P=0.844, 0.859, 0.694). The number of A-ROP, pre-threshold type 1 ROP eyes were also compared, and statistically significance can be defined (P=0.005). During the follow-up period, best corrected visual acuity (BCVA), refractive status, visual field, optical coherence tomography (OCT) and fluorescein fundus angiography (FFA) were performed. The BCVA examination was carried out using the international standard decimal visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity for statistics. Refractive status was calculated as spherical equivalent (SE). Comparative observation of 5-year outcomes including BW, GA, fundus examination at the initial diagnosis, and BCVA, refractive status, visual field defect, central foveal thickness (CFT), subfoveal choroidal thickness (SFCT) and abnormality of peripheral retina in FFA were performed between the two groups. Differences between groups were compared using t test or nonparametric test for measurement data, and χ2 test was used for comparison between groups in enumeration data. ResultsFive years after treatment, retinal avascular areas were seen around the eyes in the anti-VEGF treatment group, with a size of 2.32±1.84 optic disc diameters, and 1 eye had fluorescein leakage at the junction of the peripheral avascular areas; eyes in the laser treatment group old photocoagulation spots were seen in the peripheral retina, and no fluorescein leakage was seen. The logMAR BCVA of the eyes in the anti-VEGF treatment group and laser treatment group were 0.15 (0.00, 0.20), 0.10 (0.00, 0.16), respectively; SE were 0.50 (－1.25, 1.31), 0.38 (－4.25, 1.75) D, respectively; mean defect (MD) values of visual field were 2.70 (1.20, 4.80), 4.25 (2.83, 6.98) dB; CFT, SFCT were 225.00±29.31, 287.18±68.56 μm and 237.17±32.81, 279.79±43.61 μm. There was no significant difference in logMAR BCVA, CFT and SFCT between the two groups (P=0.363, 0.147, 0.622); the lower quartile of SE and visual field MD value in the laser treatment group were significantly higher than those in the laser treatment group, but there was no significant difference in the median SE (P=0.109), and there was a statistically significant difference in the median MD value of the visual field (P=0.037). ConclusionsAnti-VEGF agents and laser therapy can achieve similar good visual prognosis for early ROP, and the peripheral visual field can be preserved to a greater extent, however, the peripheral visual field defect in the laser group is more significant than that in the anti-VEGF group. For ROP without retinal detachment, the thickness of the retina and choroid in the fovea is generally normal.
Objective To observe the short-term effect of changing the sequence of PRP and MLP on the pre-proliferative or proliferative diabetic retinopathy patients with clinical significant macular edema (CSEM). Methods Sixty-three consecutive pre-proliferative or proliferative diabetic retinopathy outpatients (103 eyes) with clinical significant macular edema were selected and divided into two groups: 54 eyes in patients of group A accepted MLP one month prior to PRP and 49 eyes in patients of group B accepted the photocoagulative therapies in a contrary sequence. All the patients were followed up for 3 to 13 months and visual acuity. Light sensitivity of 5deg;macular threshold, and FFA were performed pre- and post-photocoagution. Results The improvement of visual acuity was found to be better in group A than that of group B (Plt;0.01) 2 months after the therapy, since then, there was no significant defference (Pgt;0.05) in both groups. Three and 4 months after the treatment, there was no significant difference in change of light sensitivity of 5deg;macular threshold in both groups. The macular leakages of 59 eyes, 32 ingroup A and 27 in group B, were well controlled. Conclusion Among the pre-proliferative or proliferative diabetic retinopathy patients with CSEM, visual acuity of those who accept MLP prior to PRP more rapidly than those who accept contrary sequence of photocoagulation, but the changing of therapeutic sequence might have no dramatic influence on light sensilivity of 5deg;macular threshold. (Chin J Ocul Fundus Dis,2000,16:150-152)
Hemorrhage and thromboembolism are the most important long-term complications of anticoagulation therapy after mechanical heart valve replacement. The anticoagulation therapy intensity should be lowered in order to decrease the hemorrhagic complication. In recent years, the chief progresses of anticoagulation therapy are the using of International Normalized Ratio (INR) in anticoagulation therapy monitoring and the low intensity anticoagulation therapy. The proper anticoagulation intensities at home are INR 1.5-2.0 and prothrombin time ratio (PTR) 1.3-1.5. It is beneficial to adopt this low intensity anticoagulation therapy for decreasing the death rate from hemorrhage, protecting pregnant women and new borns from hemorrhage and malformation, and improving the life qualities of the patients.
ObjectiveTo compare the effect of catheter-directed thrombolysis (CDT) combined with anticoagulation (AC) and AC in the treatment of acute proximal deep venous thrombosis (APDVT) of the lower extremities. MethodsThe clinical data of 184 APDVT patients treated in Guizhou Provincial People’s Hospital from January 2017 to December 2022 were retrospectively collected. According to the treatment methods, the patients were divided into CDT group (n=82, CDT combined with AC) and AC group (n=102, AC alone). The prognosis indicators such as the incidence of bleeding events, the incidence of post-thrombotic syndrome (PTS), Villalta score, venous clinical severity score (VCSS) and chronic lower limb venous insufficiency questionnaire (CIVIQ) score were compared between the two groups. ResultsCompared with the AC group, the CDT group had a higher incidence of bleeding events [11.0% (9/82) vs. 2.9% (3/102)], a shorter time to detumescent [(2.8±1.2) d vs. (7.2±1.9) d], and lower VS score [3 (2,4) vs. 3 (2, 7)], VCSS score [2.0 (1.7, 4.0) vs. 3.0 (2.0, 5.2)] and postoperative venous patency score [1 (1, 2) vs. 2 (1, 3)], and higher CIVIQ score [80.0 (77.0, 86.0) vs. 71.5 (68.0, 78.0)], P<0.05. However, there were no significant differences in the incidence of PTS [28.2% (22/78) vs. 36.5% (35/96)] and thrombosis recurrence rate [9.0% (7/78) vs. 11.5% (11/96)] between the two groups (P>0.05). ConclusionCDT can relieve the symptoms and improve the quality of life of APDVT faster than AC, but it is necessary to strictly grasp the indications of thrombolysis to reduce the risk of bleeding.
Purpose To investigate the effects of intervention with Tanakan on anterior ocular segment in diabetic retinopathy (DR) after retinal photocoagulation． Methods Prospective random controlled study was performed on 72 patients (72 eyes) with ultrasound biomicroscopy (UBM),by obtaining and quantitatively analyzing the changes of anterior ocular segment including anterior chamber, anterior chamber angle, ciliary body and choroids before and the 3rd day and the 7th day after retinal photocoagulation. Results Three days after photocoagulation, significant elev ated IOP and narrowed chamber angle were observed in control group and 4 eyes (1 1.11%) in Tanakan group (Plt;0.01)． Choroidal detachment in 32 eyes (88.89%) in control group and in 2 eyes (5.56%) in Tanakan group and the severity of ciliochoroidal detachment in tanakan group was significantly lower than that in control group． Conclusion Tanakan is effective to prevent the complications of anterior segment, such as ciliochoroidal detachment, elevation of IOP, narrowing of chamber angle occurring early after retinal photocoagulation and reduce the severity of ciliochoroidal detachment． (Chin J Ocul Fundus Dis, 2001,17:187-189)
ObjectiveTo investigate the efficacy of laser photocoagulation and intravitreal ranibizumab treatment of retinopathy of premature(ROP). MethodsThis study included 49 ROP infants (96 eyes), including type 1 pre-threshold ROP (7 infants, 14 eyes), threshold ROP (38 infants, 44 eyes) and aggressive posterior ROP (AP-ROP, 4 infants, 8 eyes). According to the treatments received, all patients were divided into laser photocoagulation (LP) group (40 infants, 78 eyes) and intravitreal ranibizumab (IVR) treatment group (9 infants, 18 eyes). Generally, zoneⅡand stage 3 ROP with clear refractive media received laser photocoagulation, zoneⅠROP and AP-ROP, or eyes with unclear refractive media or infants with poor general condition received IVR. The infant gestational age, birth weight, corrected gestational age at first treatment and the cure rate of the first treatment were analyzed between the two groups, and between three disease types (type 1 pre-threshold, threshold and AP-ROP). ResultsThe gestational age and birth weight was no difference between the LP group and IVR group (t=0.827, 1.911; P > 0.05). The corrected gestational age at first treatment of LP group was significantly smaller than that in the IVR group (t=3.041, P < 0.05). In the LP group, 75 of 78 eyes (96.15%) was cured by the first treatment, 3 of 78 eyes (3.85%) progressed to stage 4A after the first treatment and was controlled by vitrectomy. In the IVR group, 8 of 18 eyes (44.44%) was cured by the first treatment, 10 of 18 eyes (55.56%) progressed to next stage after the first treatment and was controlled by additional laser photocoagulation or repeated IVR. The gestational age and birth weight was no difference between type 1 pre-threshold, threshold and AP-ROP infants (t=2.071, 0.664; P > 0.05). The corrected gestational age at first treatment of type 1 pre-threshold infants was the same of the threshold lesion infants (t=2.054, P > 0.05). The corrected gestational age at first treatment of AP-ROP infants was significantly smaller than that of type 1 pre-threshold and threshold lesion infants (t=3.250, P < 0.05). The cure rate was statistically significant (χ2=24.787, P < 0.05) between there three ROP lesions. ConclusionIVR treatment is suitable for zoneⅠlesions, AP-ROP and Plus lesions, while laser photocoagulation is appropriate for zoneⅡlesions with fibrosis and less vascular proliferation.
Objective To investigate the value of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy. Methods Information of 203 patients with thyroid neoplasms who underwent thyroidectomy in Longyan First Hospital from January 2014 to July 2015, were collected retrospectively. Patients were divide into control group (98 patients who had received conventional thyroidectomy) and observation group (105 patients who had received bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy) according to the surgery type. Then comparison of 2 groups in incidence of recurrent laryngeal nerve injury, temporary hypocalcemia, temporary or permanent hypoparathyroidism, serum parathyroid hormone (PTH) and serum calcium was performed. Results All the operation of 203 patients went smoothly, and no operative death happened. Operation time of control group and observation group showed no obvious difference〔(68.24±16.59) minvs. (64.78±14.20) min,P>0.05〕, but the intraoperative blood loss of control group was more than observation group〔(25.44±8.35) mLvs. (16.58±5.44) mL,P<0.05〕. There were 25 patients suffered from temporary hypocalcemia after operation, including 18 patients in control group and 7 patients in observation group. There were 38 patients suffered from temporary hypoparathyroidism after operation. including 24 patients in control group and 14 patients in observation group. The incidences of temporary hypocalcemia (χ2=6.426,P<0.05) and temporary hypoparathyroidism (χ2=4.147,P<0.05) were both lower in observation group than corresponding index of control group. But no one suffered from permanent hypoparathyroidism. There were 17 patients existent hoarseness in the control group and 14 patients in observation group, but no one had cough caused by superior laryngeal nerve injury of all the patients, and the incidence of hoarseness of 2 groups had no significant difference (χ2=0.637,P>0.05). Conclusions Bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy could reduce the temporary hypocalcemia and temporary hypoparathyroidism, and provide the better protection to the blood supply of parathyroid. In addition, bipolar coagulation forceps could reduce thermal injury and heighten hemostasis. So, it is worthy to perform bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy.
ObjectiveTo investigate the efficacy and safety of traditional laser photocoagulation, laser combined with intravitreal injection of anti-vascular endothelial factor (anti-VEGF) drugs and intravitreal injection of anti-VEGF drugs alone in Coats disease. MethodsThe patients diagnosed as Coats disease stage 2B-3A2 in Department of Ophthalmology, Eye and ENT Hospital of Shanghai Medical College of Fudan University from December 2016 to November 2019 were included in this study. Patients were divided into three groups, including laser group, combined group and drug group, according to the different treatment. In the laser group, the initial treatment was traditional laser photocoagulation alone. In the drug group, the anti-VEGF drug was injected into vitreous once a month for three months. The initial treatment of the eyes in the combined group was laser combined with intravitreal injection of anti-VEGF drugs, or laser treatment within 1 week after anti-VEGF drug treatment. The follow-up time was more than 6 months, and best-corrected visual acuity (BCVA), ultra-wide-angle fundus photography, and fluorescein fundus angiography were performed during follow-up. The treatment efficiency, subretinal fluid (SRF), macular edema, BCVA and complications were compared among the three groups. ResultsAmong 60 patients (60 eyes), there were 55 males (55 eyes) and 5 females (5 eyes), with the mean age of 17.1±2.0 years. Among 60 eyes, there were 26 eyes in 2B stage, 23 eyes in 3A1 stage, and 11 eyes in 3A2 stage. Twenty patients (20 eyes) was in the laser group, combined group and drug group, respectively. After the initial treatment of all eyes in the drug group, the abnormal blood vessels did not regress significantly; the absorption and increase of SRF were 4 (20.0%, 4/20) and 5 (25.0%, 5/20) eyes, respectively. Supplementary laser therapy was given to 16 eyes, and vitrectomy (PPV) was given to 4 eyes. Among the 16 eyes treated by laser, 10 eyes were effective (50.0%, 10/20); vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract occurred in 1, 1, and 2 eyes during the treatment, respectively, and PPV was given again in all eyes. Recurrent and persistent macular edema occurred in 4 and 1 eyes, respectively. Among the eyes in the combined group, treatment were effective in 11 eyes (55.0%, 11/20); 5, 2, and 2 eyes had SRF, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again; the edema was repeated and persisted in 1 eye, respectively. Among the affected eyes in the laser group, 15 eyes (75.0%, 15/20) were treated effectively; 2, 2, and 1 eyes developed a large number of vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again. ConclusionsAnti-VEGF drugs alone are ineffective in the treatment of Coats disease, and ablation of other abnormal blood vessels is needed. In the treatment of Coats disease, anti-VEGF drugs can not only promote the absorption of SRF, but also may lead to its increase, and the application should be cautious.