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Bevacizumab versus bevacizumab and macular grid photocoagulation for macular edema in eyes with non-ischemic branch retinal vein occlusion: results from a prospective randomized study
摘要： Background The objective of the study was the investigation of the effects of intravitreal bevacizumab (BEV) with or without additional macular grid laser photocoagulation (GRID) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods Prospective, randomized, monocentric study. Thirty-two patients were included. Initially, all eyes in both groups received three monthly injections of BEV, followed by additional injections if re-treatment criteria were met. In the BEV + GRID group, photocoagulation was performed 2 weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38 weeks. Main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Changes of foveal avascular zone (FAZ) and of retinal ischemia, as well as the number of injections were also evaluated. Results Sixteen eyes were randomized into each group. At baseline, BCVA was similar in both groups (BEV + GRID: 20/71; BEV: 20/60; P = 0.51). At 38 weeks, BCVA significantly improved in the two groups (BEV + GRID gain of 9 ± 11.2 letters and 16.25 ± 10.08 letters in the BEV) with no difference between them (P < 0.06). With regard to anatomical findings, initial CRT in BEV + GRID was 496.2 μm ± 138.4 μm and 538.9 μm ± 156.9 μm in BEV (P < 0.1697). At 38 weeks, CRT decreased in both groups significantly, 98.2 μm in the BEV + GRID (P = 0.02) and 141.7 μm in the BEV group (P = 0.01), with no significant difference between groups (P < 0.17). The area of FAZ a significantly increased in both groups (41% (P = 0.04) in BEV + GRID; 35% (P = 0.03) in BEV) during the study and the grade of peripheral ischemia remained unchanged. The mean number of injections was 3.8 (range 3–6) with no significant difference between groups. Conclusions Our data demonstrate a beneficial effect of bevacizumab in ME in eyes with BRVO. A loading phase of three injections led to a significant improvement in vision in both groups, which persisted at week 38. Additional grid laser photocoagulation exhibited no beneficial functional or anatomical effect during the study, nor did it reduce the number of injections. The FAZ area increased significantly in both groups, but overall retinal ischemia did not. Further studies investigating more numerous eyes and longer follow-up are needed to confirm these data.
关键词： Anti-VEGF,Grid laser photocoagulation,Macular edema,Branch retinal vein occlusion,Bevacizumab
更新于2025-09-23 15:22:29
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Comparison of OCT angiography in children with a history of intravitreal injection of ranibizumab versus laser photocoagulation for retinopathy of prematurity
摘要： Purpose To compare the foveal microvascular structure characteristics in children with a history of intravitreal injection of ranibizumab (IVR) versus laser photocoagulation (LP) for retinopathy of prematurity by optical coherence tomography angiography (OCTA). Methods In this cross- sectional study, a total of 17 children (28 eyes) underwent IVR and 20 children (37 eyes) underwent LP were recruited. The age of doing OCTA examination of the two groups are 5.4±1.1 years and 6.3±1.8 years, respectively (p=0.07). Spectral- domain OCTA was performed for all the eyes with a scan size of 3×3 mm. The data of the superficial retinal layer were analysed. The foveal avascular zone (FAZ) and vessel density (including vessel length density (VLD) and perfusion density (PD)) were measured using the software of OCTA (Cirrus AngioPlex 5000, Carl Zeiss, Meditec, Dubin, California, USA). The central foveal thicknesses (CFT) were measured by cross- sectional OCT. results In the central fovea, the retinal VLD and PD of patients with IVR were 13.82±2.99 mm/ mm2 and 0.25±0.05 mm2/mm2, respectively, which were significantly lower than those of the LP group (15.64±2.71 mm/mm2 and 0.28±0.05 mm2/mm2, p=0.01 and p=0.006). The FAZ area of patients with IVR and LP were 0.13±0.09 mm2 and 0.09±0.07 mm2, respectively (p=0.048). The CFT of patients with IVR and LP were 200.7±16.7 μm and 220.9±22.7 μm, respectively (p<0.01). The logarithm of the minimal angle of resolution best- corrected visual acuity of patients with IVR and LP were 0.2±0.1 and 0.1±0.1, respectively (p=0.01). There was no significant difference in the parafoveal and foveal VLD and PD, FAZ morphological index and spherical equivalent refraction (SER) between the two groups. Conclusion The IVR might contribute to microvascular changes in the macular zone, such as reducing the central foveal VLD and PD, while the LP might contribute to microstructural changes, such as smaller FAZ and thicker CFT.
关键词： intravitreal injection of ranibizumab,foveal microvascular structure,OCT angiography,laser photocoagulation,retinopathy of prematurity
更新于2025-09-23 15:21:01
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Efficacy of navigated focal laser photocoagulation in diabetic macular edema planned with en face optical coherence tomography versus fluorescein angiography
摘要： Aim To analyze the efficacy of navigated focal laser photocoagulation (FLP) of microaneurysms in diabetic macular edema (DME) planned using en face optical coherence tomography (OCT) as against fluorescein angiography (FA). Methods Twenty-six eyes of 21 DME patients (12 males, 9 females, 69.5 ± 12.3 years) with mean BCVA of 0.52 ± 0.44 LogMAR were included. En face OCT images of deep capillary plexus slab and FA images were used to plan FLP targeting of leaky microaneurysms. The primary outcome measures were central retinal thickness (CRT) and macular volume. The secondary outcome measure was best-corrected visual acuity (BCVA). Results The difference in the change of CRT and macular volume between en face OCT and FA-planned FLP after 1 month and at the end of follow-up was not statistically significant (p > 0.05), except for a higher CRT reduction in the en face OCT-planning group (p = 0.007) at the end of mean follow-up of 2.6 ± 0.9 months. There was no difference in BCVA change between the two planning options (p = 0.42). Conclusion En face OCT is a non-inferior alternative for FA in the planning of navigated FLP of microaneurysms in DME.
关键词： Navigated laser,Optical coherence tomography,Diabetic macular edema,Focal laser photocoagulation,Optical coherence tomography angiography,Fluorescein angiography,Microaneurysms
更新于2025-09-23 15:19:57
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Foveal microvasculature, refractive errors, optical biometry and their correlations in school-aged children with retinopathy of prematurity after intravitreal antivascular endothelial growth factors or laser photocoagulation
摘要： Aims To compare the differences and to assess the correlations regarding to foveal microvasculature, refractive errors and optical biometry in children with history of type 1 retinopathy of prematurity (ROP) treated with either laser photocoagulation or intravitreal injection of antivascular endothelial growth factors (anti-VEGF). Methods This is a retrospective and comparative case series. Measurements of fovea microvasculature included the retinal thickness and subfoveal choroid thickness, the size of fovea avascular zone (FAZ), the fovea, parafovea and perifoveal vessel density (VD). Measurements of refractive errors and optical biometry included spherical equivalent, astigmatism, cornea curvature, anterior chamber depth (ACD), lens thickness and axial length (AXL). Results A total 47 eyes in 25 children were studied (22 laser-treated eyes from 12 children and 25 anti-VEGF treated eyes from 13 children). Laser-treated eyes had significantly smaller FAZ (p=0.004), higher fovea VD, lower parafoveal VD (p=0.02 and 0.01 in superficial capillary plexus; p=0.05 and 0.01 in deep capillary plexus), thicker inner retinal thickness (p=0.002). Laser-treated eyes had significantly higher degree of myopia (p=0.01). Regarding to optical biometry, laser-treated eyes had significant steeper cornea curvature, shallower ACD and thicker lens (p=0.01, 0.01 and 0.02, respectively) but no differences in AXL was noted (p=0.58). Significant correlations presented between inner retina thickness and FAZ to anterior segment variables. Conclusion In school-aged children with history of type 1 ROP, despite similar visual acuity outcome, those who underwent anti-VEGF injection had favourable developmental outcomes compared with laser photocoagulation. Significant correlations exist between fovea microvasculature and optical biometric components.
关键词： laser photocoagulation,anti-VEGF,foveal microvasculature,retinopathy of prematurity,optical biometry,refractive errors
更新于2025-09-23 15:19:57
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Retinale Lasertherapie a?? Fehler vermeiden; Retinal laser treatmenta??avoiding mistakes;
摘要： Even in the era of intravitreal injection therapy (intravitreal operative injection of medication, IVOM) for the treatment of macular and retinal diseases, such as age-related macular degeneration (AMD), proliferative diabetic retinopathy (DR) and diabetic macular edema (DME) as well as proliferative stages and/or macular edema due to retinal vein occlusion (RVO), conventional retinal laser treatment is still of importance. It can be focally performed on an on-label basis for DME and macular edema due to branch RVO (BRVO) and its use as panretinal treatment for proliferative stages in retinal diseases as well as for the treatment of retinal holes is undisputed. The spectrum is extended by the treatment of less common diseases, such as retinal hemangioblastoma, macroaneurysms and subhyaloid macular hemorrhage. There is cause for concern that knowledge about the correct performance of retinal laser application might be shifted into the background due to an increase of IVOM treatment, which could lead to an increase in unnecessary errors. The aim of this manuscript is to increase awareness for the correct indications and execution of retinal laser treatment based on case examples of flawed or insufficient treatment.
关键词： Retinal detachment,Macular hemorrhage,Laser retinopexy,Laser photocoagulation,Horseshoe foramen
更新于2025-09-19 17:13:59
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Assessment of the Dynamic Alteration of Choriocapillaris Vessel Density after Focal Laser Photocoagulation with OCT Angiography
摘要： Purpose. To evaluate the changes of choriocapillaris blood ?ow beneath laser lesions in noncenter-involved diabetic macular edema patients using optical coherence tomography angiography (OCTA). Methods. This was a retrospective case-series study. We used OCTA to analyze the characteristics of the choriocapillaris blood ?ow beneath laser lesions before laser treatment and at several intervals after treatment. The choriocapillaris vessel density (CCVD) beneath the laser lesions was based on the OCTA images and was de?ned as the proportion of ?ow pixels in the selected area calculated using FIJI software through automatic binarization processing based on threshold methods. Results. A total of 63 laser lesions in 8 eyes of 5 patients were included in this study. There was a signi?cant decrease in the CCVD at 1 hour and 1 day following laser treatment (24.25% ± 5.04% and 22.00% ± 4.71%, respectively) when compared with the baseline value (39.09% ± 3.71%, all p < 0.001). The CCVD was 31.82% ± 4.53% in 1 week after laser treatment, which was signi?cantly higher than that in 1 day after treatment (p < 0.001), and then continued to improve at 1 month after treatment (34.44% ± 4.16%). Additionally, in the group with smaller spot size and lower energy, the CCVD recovery at 1 month after laser was signi?cantly better than that in the group with larger spot size and higher energy (p ? 0.006). Conclusions. OCTA image analysis can re?ect changes in the choriocapillaris blood ?ow beneath laser lesions at di?erent times following laser treatment in vivo. Spot size and laser energy may a?ect blood ?ow recovery.
关键词： laser photocoagulation,choriocapillaris,diabetic macular edema,OCT angiography
更新于2025-09-19 17:13:59
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PDG31 COST-EFFECTIVENESS OF RANIBIZUMAB VERSUS LASER PHOTOCOAGULATION OR OBSERVATION FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION: FROM CHINESE SOCIETAL PERSPECTIVE
摘要： To evaluate the cost-effectiveness of ranibizumab compared with laser photocoagulation or no treatment (observation) in patients with macular edema secondary to branch retinal vein occlusion (BRVO-ME) and macular edema secondary to central retinal vein occlusion (CRVO-ME), respectively, from the Chinese societal perspective. Methods: A Markov model was constructed to simulate the long-term outcomes and costs of Chinese BRVO-ME and CRVO-ME patients. Model health states were de?ned by increments of 10 letters in best corrected visual acuity (BCVA) ranging from # 25 letters to 86-100 letters, with an extra absorbing state ’death’. Lifetime horizon was used, with a 1-month cycle length. Transition probabilities were calculated from the BLOSSOM clinical trial and CAMELLIA clinical trial. Health state utilities were estimated through literature, and costs were estimated from experts consultation of 6 hospitals in China and published literature. The primary outcomes of the model were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Uncertainty was addressed via univariate and probabilistic sensitivity analyses. Results: For BRVO-ME patients, lifetime costs of ranibizumab and laser photocoagulation were U80,834 and U44,799, respectively; lifetime QALYs gained were 8.95 and 8.31, respectively. Adopting a willingness to pay of U180,000/ QALY (3 times per-capita GDP, 2017 China) as the threshold, ranibizumab was found to be cost-effective compared with laser photocoagulation, with the ICER of U56,303/QALY. For CRVO-ME patients, lifetime costs of ranibizumab and observation were U120,246 and U117,757, respectively; lifetime QALYs gained were 9.48 and 8.93, respectively. Ranibizumab was found to be cost-effective compared with observation, with the ICER of U4,525/QALY. Univariate and probabilistic sensitivity analysis demonstrated the robustness of the results. Conclusions: From Chinese societal perspective, ranibizumab is the cost-effective therapy for both the treatment of BRVO-ME and CRVO-ME when compared to laser photocoagulation and observation, respectively.
关键词： ranibizumab,retinal vein occlusion,cost-effectiveness,macular edema,laser photocoagulation
更新于2025-09-16 10:30:52
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Long Term Follow-up of Intralesional Laser Photocoagulation for Head and Neck Lymphatic Malformations Using Neodymium-Yttrium-Aluminium-Garnet Laser
摘要： Lymphatic malformations remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional laser photocoagulation (ILP) for treating vascular anomalies. The objective of our study is to review the long-term results of a large series of lymphatic malformations in patients treated with ILP. A retrospective review of 190 head and neck lymphatic malformations in patients were treated by ILP with an neodymium-yttrium-aluminum-garnet (Nd:YAG) laser (1064 nm) over a period of 20 years (January 1997–January 2016). Patients' ages ranged from 10 months to 12 years and 6 months (mean, 1 year and 11 months). The patient group consisted of 98 female and 92 male patients. Patients were treated with an Nd:YAG laser (Sharplan Inc, Allendale, New Jersey) delivered through a 600-μm optical fiber. Laser power was set at 7 to 15 W and delivered with a pulse duration of 7 to 15 seconds. All patients demonstrated improvement as judged by clinical assessment of the reduction in lesion size (range, 65%–100%; mean reduction, 85%). One hundred fifty-two (80%) patients had a more than 65% reduction of the volume in lymphatic malformations at 3 months after 1 treatment, and 171 (90%) patients had a more than 85% reduction of the volume after 2 treatments. Excellent results were seen in 19 (10%) patients after 3 treatments. Postoperative complications were related to photocoagulation that was delivered too extensively or superficially, with resultant ulceration, infection, induration, and scarring. Throughout the course of our long-term study, ILP using an Nd:YAG laser is an effective treatment modality for lymphatic malformations. Complications can be avoided if the potential for harm is kept in mind.
关键词： lymphatic malformation,Nd:YAG laser,intralesional laser photocoagulation (ILP)
更新于2025-09-12 10:27:22
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FAILED LASER RETINOPEXY IN A PATIENT UNDERGOING PAZOPANIB THERAPY
摘要： To report a case of failed endolaser retinopexy in patient taking pazopanib and possible association with impaired retinal remodeling. Methods: Case report. Results: A 68-year-old man with a history of radiation-induced high-grade metastatic mediastinal leiomyosarcoma, on pazopanib 600 mg daily, presented with a superior retinal tear 2 months after initiating pazopanib. The patient was treated with pars plana vitrectomy and endolaser retinopexy without any immediate complications. One month postoperatively, the patient was found to have a new superior macula-sparing rhegmatogenous retinal detachment extending through the laser barricade nasally. A large proportion of the laser lesions in this area had notably remained chalk-white. The patient underwent pars plana vitrectomy with scleral buckling, and repeat endolaser retinopexy. Pazopanib therapy was stopped 1 week later in consultation with the oncology team and was reinitiated after the retina seemed stable under silicone oil for several weeks. The scars from the patient’s repeat endolaser retinopexy remained pale white at his clinic visit 2 months after the procedure, and at that time, his initial laser scars had only just begun to darken with pigment. Four and a half months after the initial vitrectomy and endolaser retinopexy, and three and a half months after his repeat vitrectomy and endolaser retinopexy, all the patient’s laser scars have developed increased pigment, and his retina remains completely flat under silicone oil tamponade. Conclusion: Pazopanib may have had an adverse effect on retinal wound healing after vitrectomy with endolaser retinopexy, leading to persistence of pale laser lesions many weeks after laser application. It is possible that this may have impaired the typical development of chorioretinal laser scar formation and led to subsequent retinal detachment.
关键词： pazopanib,retinal remodeling,scar formation,retinal detachment,retinopexy,retinal laser photocoagulation,wound healing
更新于2025-09-12 10:27:22
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Efficacy and safety of ranibizumab with or without panretinal laser photocoagulation versus laser photocoagulation alone in proliferative diabetic retinopathy – the PRIDE study
摘要： Purpose: Panretinal photocoagulation (PRP) is the current standard of care in proliferative diabetic retinopathy (PDR). However, treatment with anti-vascular endothelial growth factor agents might offer better patient outcomes with fewer side-effects. The PRIDE study aimed to assess the efficacy and safety of ranibizumab with or without PRP compared with PRP alone in patients with PDR. Methods: A total of 106 PDR patients without diabetic macular oedema were randomized to receive ranibizumab 0.5 mg monotherapy (n = 35), PRP (n = 35) or combined ranibizumab 0.5 mg/PRP (n = 36). The primary objective of this 12-month, multicentre, phase II study was to investigate the change in area of retinal neovascularization (NV). Complete regression of leakage and best-corrected visual acuity (BCVA) were key secondary end-points. Results: At Month 12, there was a statistically significant difference of ?2.83 mm2 in the least square mean change in NV area between the ranibizumab monotherapy and PRP group, favouring ranibizumab (95% CI [?5.45; ?0.21], p = 0.0344). At Month 3, 67%/0%/67% of the patients in the ranibizumab/PRP/combination groups, respectively, showed complete regression of leakage from NVs, while at Month 12, 28%/8%/18% showed complete regression of leakage from NVs. BCVA change was greater in the ranibizumab group compared with the PRP monotherapy group at Month 12 (+1.6 letters; 95% CI [?2.3; 5.5] versus ?3.9 letters; 95% CI [?7.8; ?0.1], p = 0.0495). Conclusions: Ranibizumab monotherapy is an alternative treatment option to laser treatment in patients with PDR. Ranibizumab showed stronger effects on NV leakage and area reduction while offering better visual acuity results than PRP alone.
关键词： ranibizumab,proliferative diabetic retinopathy,retinal neovascularization,panretinal laser photocoagulation,PRIDE study,anti-VEGF therapy
更新于2025-09-12 10:27:22