ObjectiveTo observe the changes of macular microvascular structure in eyes with macular edema secondary to branch retinal vein occlusion (BRVO-ME) after intravitreal injection of conbercept and analyze its relationship with visual function and central retinal thickness (CRT).MethodsA prospective clinical study. From July 2018 to June 2019, 21 eyes of 21 patients with unilateral temporal BRVO-ME diagnosed in the Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 14 eyes of 14 males and 7 eyes of 7 females; the average age was 58.0±8.3 years. There were 13 eyes and 8 eyes with occlusion of the superior temporal and inferior temporal branches of the retinal vein, respectively. The affected area was defined as the side of the venous obstruction. All the affected eyes underwent best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) examination. The BCVA was tested using the international standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistical analysis. All the eyes were treated with intravitreal injection of conbercept once a month for 3 months, and then treated as needed. A 3 mm × 3 mm scan centered on fovea was obtained and the vascular density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), fovea avascular zone (FAZ) area, perimeter of FAZ (PERIM), acircularity index (AI), foveal vascular density in a 300 μm wide region around FAZ (FD-300) and central retinal thickness (CRT) were measured. The follow-up time after treatment was 6 months. The vascular density and FAZ parameters were compared before and after treatment by paired t test. The correlations of BCVA, CRT and vascular density, FAZ area and the other parameters at 6 months after treatment were analyzed by linear regression analysis. ResultsBefore treatment, the logMAR BCVA of the eyes was 0.506±0.159, and the CRT was 375.4±81.3 μm; 6 months after treatment, the logMAR BCVA of the eyes was 0.294±0.097, and the CRT was 266.3±46.7 μm. There was a statistically significant difference of logMAR BCVA and CRT between the eyes before and after treatment (t=8.503, 9.843; P＜0.05). There was no statistically significant difference in the overall vascular density of SCP and DCP before and 6 months after treatment (t=－0.091, －0.320; P＞0.05). The foveal vascular density decreased, and the difference was statistically significant (t=8.801, 3.936; P＜0.05). The vascular density of DCP of the affected area increased, and the difference was statistically significant (t=－2.198, P＜0.05). Compared with those before treatment, the FAZ area and PERIM of the affected eyes had an increasing trend, while AI and FD-300 had a decreasing trend, and the differences were statistically significant (t=－18.071, －12.835, 2.555, 8.610; P＜0.05). The linear regression analysis showed that BCVA and FAZ area 6 months after treatment have significant correlation (t=2.532, P=0.024). ConclusionCRT decreased and BCVA increased after intravitreal injection of conbercept in BRVO-ME eyes. After treatment, the foveal vascular density of SCP and DCP decreased while the vascular density of DCP of the affected area increased. The FAZ increased and the PERIM and AI decreased during follow-up. The BCVA was significantly correlated with the FAZ area 6 months after treatment.
Objective To observe the serum homocysteine (Hcy) levels in retinal branch vein occlusion (BRVO) patients with with hypertension or non-hypertension. Methods A total of 120 patients (120 eyes) with BRVO were divided into hypertension group [72 eyes, blood pressure 140 - 175/90 - 105 mmHg (1 mmHg=0.133 kPa)] and non-hypertension group (48 eyes, blood pressure 100 - 139/70 - 88 mmHg). According to the sex and age, 78 patients with hypertensive non-retinal vascular diseases and 48 patients with non-hypertensive and non-retinal vascular diseases were collected by a way of same-size ratio as hypertension control group and non-hypertension control group, respectively. Fasting venous blood was collected from all patients in the morning and serum Hcy levels were measured by rate method. The total Hcy concentration over 15.0 μ mol/L was defined as high level Hcy. Fasting serum glucose and fasting serum lipid were also measured. Measurement data among groups were compared with t test. Results The serum Hcy levels were (26.82±28.0), (8.39±3.11), (21.37±4.24), (9.25±3.31) μmol/L in the hypertension group, hypertension control group, non-hypertension group and non-hypertension control group, respectively. The serum Hcy levels of patients in the hypertension group was significantly higher than that in the hypertension control group (t=3.324, P=0.004). The serum Hcy levels of patients in the non-hypertension group was significantly higher than that in the non-hypertension control group (t=2.216, P=0.049). The serum Hcy levels of patients in the hypertension group was significantly higher than that in the non-hypertension group, but the difference had not statistical significance (t=0.581, P=0.566). Among 120 patients, there were 68 patients (56.67%) with high level of Hcy (40 patients in the hypertension group and 28 patients in the non-hypertension group). Among the 40 patients with high levels of Hcy in the hypertension group, 36 patients were older than 50 years old (90.00%) and 4 patients were less or equal than 50 years old (10.00%). Among the 28 patients with high levels of Hcy in the non-hypertension group, 16 patients were older than 50 years old (57.14%); 12 patients were less or equal than 50 years old (42.86%), whose indexes of serum glucose and serum lipid were not abnormal. There was significant difference in age distribution of patients with high level of Hcy between the hypertension group and the non-hypertension group (χ2=9.882, P=0.002), but there was no significant difference in sex distribution (χ2=2.052, P=0.216). Conclusions The level of serum Hcy increased both in BRVO patients with hypertension and non-hypertension. The indexes of serum glucose and serum lipid were not abnormal in BRVO patients aged less or equal than 50 years old with non-hypertensive except for the increase of serum Hcy level.
Pharmaceutical therapy, including anti-vascular endothelial growth factor treatment and intravitreal corticosteroids, is the most common treatment for branch retinal vein occlusion (BRVO) and its complications, however there are confusing ideas about the protocol, patient selection, timing and endpoint of this treatment. The disease is easy to relapse with these drugs therapy. Collateral vessel formation was found in patients receiving intravitreal injection of ranibizumab or triamcinolone for BRVO and secondary macular edema. The mechanism of collateral vessel formation has not been carefully investigated. In the past thrombolysis, arteriovenous fasciostomy and laser choroidal retinal vascular anastomosis were used to reconstruct the retinal circulation, but their rationality, effectiveness and safety need to be further were studied. In recent years, because of the key technology is still immature, the artificial vascular bypass surgery experiment is not yet practical, but provides us a new idea worth looking forward to for the treatment of BRVO.
ObjectiveTo observe the clinical features of retinal arterial occlusion (RAO) in youth.MethodsThis is a retrospective case review. Nine patients (9 eyes) with RAO were enrolled in this study. There were 6 males (6 eyes) and 3 females (3 eyes). The average age was (14.22±3.93) years. The best-corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus color photography and fundus fluorescein angiography were performed. All patients underwent systemic evaluation including blood routine, erythrocyte sedimentation rate, blood lipids, vasculitis screening, homocysteine level, antiphospholipid antibody, blood coagulation, neck vascular ultrasound, and cardiac color ultrasound and electrocardiogram examination. All patients received oxygen therapy, blood medications and symptomatic treatment. Meanwhile, the patients with autoimmune diseases were received systemic glucocorticoid therapy. The follow-up was ranged from 6 to 12 months. The visual acuity and fundus change before and after treatment were compared.Resultsamong 9 patients, one patient had systemic lupus erythematosus, one patient had congenital heart disease, one patient had hypergammaglobulinemia, and carotid artery color ultrasonography showed that the internal carotid artery vessels faltered in 2 cases. The BCVA was 0.01 - 0.12. Among 9 eyes, there were 5 eyes (55.6%) with retinal branch artery occlusion (BRAO), 2 eyes (22.2%) with central retinal artery occlusion (CRAO), 2 eyes (22.2%) with ciliary retinal artery occlusion (CLAO). CRAO eyes showed positive RAPD (relative afferent pupillary defect), fine retinal artery and the corresponding vein, pale white retinal edema in posterior area and macular cherry-red spot. BRAO eyes manifested as inferior temporal artery occlusion and pale white retinal edema around them. CLAO eyes showed temporal ligulate grey-white retinal edema. At the last follow-up, BCVA improved and retinal vessels returned to normal in 7 eyes (77.8%); BCVA unchanged and no improvement in fundus in 2 eyes (22.2%).ConclusionAdolescent RAO is mostly partial occlusion, the prognosis is generally good after early active treatment.
Retinal vein occlusion (RVO) is one of the most common retinal vascular diseases causing blindness, macular edema (ME) is often secondary to it, which causes serious visual impairment to patients. Imaging biomarkers in the changes of retina and choroid of ME secondary to RVO (RVO-ME) have important clinical value in the evaluation of condition, curative effect and visual acuity prediction of patients with RVO-ME. Among them, the disorganization of the retinal inner layers, the integrity of external limiting membrane and ellipsoid zone, and the change of central macular thickness are reliable indexes to evaluate the prognosis of visual acuity; hyperreflective foci, subretinal fluid and intraretinal fluid can be used as important parameters to reflect the level of inflammation; prominent middle limiting membrane and paracentral acute middle maculopathy are the objective basis for judging the degree of retinal ischemia; the changes of choroidal vascular index and choroidal thickness also have potential advantages in evaluating the progress of the disease. Accurately grasp the characteristics of biological markers of RVO-ME related optical coherence tomography is conducive to its reasonable and accurate use in the clinical diagnosis and treatment of RVO-ME, and helpful to further explore the pathogenesis of the disease.
Objective To evaluate the efficacy and safety of transthoracic minimally invasive occlusion operation for the treatment of congenital atrial and ventricular septal defects. Methods The clinical data of 88 patients who underwent surgical occlusion operation from December 2015 to February 2017 were summarized. There were 52 males and 36 females, aged 6.8±7.5 years ranging from 1.6 to 24.0 years. All the patients were followed up by ultrasound and electrocardiogram at postoperative 3, 6 and 12 months. The efficacy of minimally invasive thoracotomy was analyzed by statistical methods. Results The patients were followed up for 3-15 (6.8±2.3) months, and the follow-up rate was 92.0%. Ultrasound showed occluder fixed well and no residual shunt, valve regurgitation, thrombosis or other complications occurred. The heart was reduced, the ejection fraction was greater than 55%, and heart function rating for all patients was grade Ⅰ. Conclusion Transthoracic mini-invasive surgical occlusion of atrial and ventricular septal defects is safe and effective. The short and middle-term effect is satisfying. It can be widely used in clinical, but multi-center and long-term follow-up and assessment still need to be carried out.
Objective To investigate the surgical therapy for chronic total occlusion (CTO) of coronary artery with offpump coronary artery bypass grafting (OPCAB). Methods From Aug. 1999 to Oct. 2007, 696 patients with 853 totally occluded coronary arteries (127 coronary arteries lack of opacification while the other 726 arteries with reverse flow showed by coronary angiography) underwent OPCAB. A total of 2 231 grafts were constructed including 136 placed to coronary endarterectomy (CE) targets and 28 arterialized middle cardiac veins. Blood flow was detected during operation in 26 coronary arteries with no opacification in preoperative angiography, while no blood flow was detected in 63 coronary arteries with opacification in preoperative angiography. Cardiopulmonary bypass was applied in 15 cases because of a poor hemodynamics and 6 of which were assisted with intraaortic balloon pump(IABP). Results All patients survived the operation. 6 died in hospital because of low cardiac output (2 cases), renal failure (2 cases), perioperative cardiac infarction (1 case) or cerebrovascular accident (1 case). Stress ulceration occurred in one case, mediastinal infection occurred in another case after operation. Both were treated medically and recovered. 692 patients were followed up and the rate of flup was 99.42%(685/686)， with 4 withdrawal. Freedom from cardiac angina was 99.85%(685/686) and cardiac functional grading (NYHA) was Ⅰ-Ⅱ. Conclusion OPCAB can be well performed in patients with chronic total occlusion of coronary arteries. The ralue of coronary angiography for evaluating totally occluded coronary artery is limited, and endoscope or intravascular ultrasound techniques may be helpful.
Full thickness macular hole (FTMH) is a rare complication of retinal vein occlusion (RVO). These have different characteristics, and may associate with complications of RVO, such as cystoid macular edema and epiretinal membrane, and treatments like intravitreal injection. Although anatomical closure is often obtained with vitrectomy and inner limiting membrane peeling, visual improvement is often variable. Regularly follow-up, medical examination, and vitrectomy can improve the outcomes of patients. In the future, randomized controlled clinical trials with larger sample size are still needed to further explore the pathogenesis, clinical characteristics and treatment methods of FTMH after RVO, so as to improve the clinical prognosis of these patients.
By using the different light stimuli, the flash ERG of 32 cases of central retinal vein occlusion(CRVO) (13 of ischemic type,19 of non-ischemic type) during acute phase were examined. The results showed that the a-wave and b-wave latency of CRVO elongated,while the b-wave amplitude of ischemie type decreased and that of non-ischemic type varied in different stimulus: decreased,increased or normal.Therefore,b-wave amplitude and b/a ratio,and selection of suitable ERG condition of stimulus are thought to be important in differetiating ischemic from non-ischemic CRVO. (Chin J Ocul Fundus Dis,1994,10:7-10）
Objective To investigate the relationship between age-adjusted Charlson comorbidity index (aCCI) and ischemic stroke in patients with ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO). MethodsA single center retrospective cohort study. Seventy-four patients with OAO or RAO diagnosed by ophthalmology examination in Shenzhen Second People's Hospital from June 2004 to December 2020 were included in the study. The baseline information of patients were collected and aCCI was used to score the patients’ comorbidity. The outcome was ischemic stroke. The median duration of follow-up was 1 796.5 days. According to the maximum likelihood ratio of the two-piecewise COX regression model and the recursive algorithm, the aCCI inflection point value was determined to be 6, and the patients were divided into low aCCI group (＜6 points) and high aCCI group (≥6 points). A Cox regression model was used to quantify the association between baseline aCCI and ischemic stroke. ResultsAmong the 74 patients, 53 were males and 21 were females, with the mean age of (55.22±14.18) (19-84) years. There were 9 patients of OAO and 65 patients of RAO. The aCCI value ranges from 1 to 10 points, with a median of 3 points. There were 63 patients (85.14%, 63/74) in the low aCCI group and 11 patients (14.86%, 11/74) in the high aCCI group. Since 2 patients could not determine the time from baseline to the occurrence of outcome events, 72 patients were included for Cox regression analysis. The results showed that 16 patients (22.22%, 16/72) had ischemic stroke in the future. The baseline aCCI in the low aCCI group was significantly associated with ischemic stroke [hazard ratio (HR)=1.76, 95% confidence interval (CI) 1.21-2.56, P=0.003], and for every 1 point increase in baseline aCCI, the risk of future ischemic stroke increased by 76% on average. The baseline aCCI in the high aCCI group had no significant correlation with the ischemic stroke (HR=0.66, 95%CI 0.33-1.33, P=0.247). ConclusionsaCCI score is an important prognostic information for patients with OAO or RAO. A higher baseline aCCI score predicts a higher risk of ischemic stroke, and the association has a saturation effect.