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The prevalence of anxiety symptoms and disorders among ophthalmic disease patients. 眼病患者焦虑症状和障碍的患病率。
IF 2.5 Pub Date : 2022-01-01 DOI: 10.1177/25158414221090100
Zulvikar Syambani Ulhaq, Gita Vita Soraya, Nadia Artha Dewi, Lely Retno Wulandari

Background: Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients.

Methods: Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients.

Results: The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463-2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168-4.454, p = 0.016).

Conclusion: Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.

背景:进行性和不可逆转的视力丧失已被证明会使患者面临焦虑等心理健康问题的风险。然而,在不同的研究中,眼病患者中焦虑症状和疾病的患病率有所不同。因此,本研究旨在厘清眼病患者焦虑症状和障碍的估计患病率。方法:通过国际数据库、PubMed、Scopus和Web of Science收集眼病患者焦虑症状和障碍患病率的相关研究。采用随机效应模型确定眼病患者焦虑症状和障碍的总患病率。结果:纳入的95项研究显示,眼部疾病患者中有焦虑症状的患者占31.2%,有焦虑障碍的患者占19.0%。儿科患者的焦虑程度(58.6%)高于成人(29%)。焦虑症状在葡萄膜炎患者中最为普遍(53.5%),其次是干眼病(DED, 37.2%)、色素性视网膜炎(RP, 36.5%)、糖尿病性视网膜病变(DR, 31.3%)、青光眼(30.7%)、近视(24.7%)、年龄相关性黄斑变性(AMD, 21.6%)和白内障(21.2%)。焦虑障碍在甲状腺眼病中最常见(TED, 28.9%),其次是青光眼(22.2%)和DED(11.4%)。与健康对照组相比,焦虑症状的患病率增加了两倍(OR = 1.912, 95% CI 1.463-2.5, p p = 0.016)。结论:焦虑症状和障碍是眼病患者的常见问题。因此,对眼病患者的焦虑症状和障碍进行全面、适当的治疗是必要的。
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引用次数: 4
Combined photorefractive keratectomy and corneal collagen cross-linking for treatment of keratoconus: a 2-year follow-up study 联合光屈光性角膜切除术和角膜胶原交联治疗圆锥角膜:一项2年随访研究
IF 2.5 Pub Date : 2022-01-01 DOI: 10.1177/25158414221083362
G. De Rosa, S. Rossi, Carmine Santamaria, Rosa Boccia, L. de Rosa, Francesco Maria D’Alterio, F. Simonelli
Background: Corneal collagen cross-linking (CXL) is considered an effective procedure for slowing down or eliminating the progression of keratoconus. New techniques, in combination with CXL, have been proposed to stop the evolution of keratoconus and improve the visual function. Objective: To evaluate the effectiveness of combined photorefractive keratectomy (PRK) with mitomycin-C (MMC) application and CXL in the management of grade 1–2 keratoconus over a 2-year follow-up. Methods: Fifteen eyes underwent topography-guided PRK with 0.02% MMC application immediately followed by standard CXL. Results: Best corrected visual acuity improved from 0.15 ± 0.11 logMAR to 0.08 ± 0.09 logMAR at 24 months (p < 0.0001) in treated eyes. Mean steepest meridian keratometry reduced from 48.79 ± 3.22 D at baseline to 46.16 ± 3.11 D at 24 months (p < 0.0001). Mean flattest meridian keratometry reduced from 45.18 ± 2.17 D preoperatively to 44.35 ± 2.19 D at 24 months (p < 0.0001). Conclusion: Simultaneous topography-guided PRK with MMC 0.02% application and standard CXL is a safe, promising and effective procedure in the treatment of mild and moderate keratoconus.
背景:角膜胶原交联(CXL)被认为是减缓或消除圆锥角膜进展的有效方法。新的技术,结合CXL,已被提出,以阻止圆锥角膜的进化和改善视觉功能。目的:评价光屈光性角膜切除术(PRK)联合丝裂霉素- c (MMC)和CXL治疗1-2级圆锥角膜的疗效。方法:15只眼行地形引导PRK,应用0.02% MMC后立即行标准CXL。结果:治疗眼24月最佳矫正视力由0.15±0.11 logMAR改善至0.08±0.09 logMAR (p < 0.0001)。平均最陡子午角度数从基线时的48.79±3.22 D降至24个月时的46.16±3.11 D (p < 0.0001)。平均平直子午角度数由术前的45.18±2.17 D降至24个月时的44.35±2.19 D (p < 0.0001)。结论:地形引导PRK同时应用0.02% MMC和标准CXL治疗轻中度圆锥角膜是一种安全、有前景、有效的手术方法。
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引用次数: 2
A comprehensive review of intravitreal immunosuppressants and biologicals used in ophthalmology 眼科玻璃体内免疫抑制剂和生物制剂的综合综述
IF 2.5 Pub Date : 2022-01-01 DOI: 10.1177/25158414221097418
Nasiq Hasan, R. Chawla, Nawazish Shaikh, Sindhuja Kandasamy, S. Azad, M. Sundar
Systemic immunosuppressants and biologicals have been a valuable tool in the treatment of inflammatory diseases and malignancies. The safety profile of these drugs has been debatable, especially in localized systems, such as the eye. This has led to the search for fairly local approaches, such as intravitreal, subconjunctival, and topical route of administration. Immunosuppressants have been used as a second-line drug in patients intolerable to corticosteroids or those who develop multiple recurrences on weaning corticosteroids. Similarly, biologicals have also been used as the next line of therapy, when adequate control of inflammation could not be attained or immunosuppressants were contraindicated to patients. Intravitreal immunosuppressants, such as methotrexate and sirolimus, have been extensively studied in noninfectious posterior uveitis, whereas limited studies have established the efficacy of intravitreal biologicals, such as infliximab and adalimumab. Most of these drugs have shown good safety profile and tolerability in animal studies alone and have not been studied further in human subjects. However, most of the studies in literature are single-case reports or case series which limits the level of evidence. In this comprehensive review, we discuss the mechanism of action, pharmacodynamics, pharmacokinetics, indications, efficacy, and side effects of different intravitreal immunosuppressants and biologicals that have been studied in literature.
系统性免疫抑制剂和生物制剂已成为治疗炎症性疾病和恶性肿瘤的宝贵工具。这些药物的安全性一直存在争议,尤其是在眼部等局部系统中。这导致了寻找相当局部的方法,如玻璃体内、结膜下和局部给药途径。免疫抑制剂已被用作皮质类固醇不能耐受的患者或断奶后出现多发复发的患者的二线药物。同样,当无法充分控制炎症或患者禁用免疫抑制剂时,生物制剂也被用作下一种治疗方法。玻璃体内免疫抑制剂,如甲氨蝶呤和西罗莫司,已在非感染性后葡萄膜炎中进行了广泛研究,而有限的研究已确定玻璃体内生物制剂的疗效,如英夫利昔单抗和阿达木单抗。这些药物中的大多数在单独的动物研究中显示出良好的安全性和耐受性,尚未在人类受试者中进行进一步研究。然而,文献中的大多数研究都是单一的病例报告或病例系列,这限制了证据的水平。在这篇全面的综述中,我们讨论了文献中研究的不同玻璃体内免疫抑制剂和生物制品的作用机制、药效学、药代动力学、适应症、疗效和副作用。
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引用次数: 4
Comment on 'Assessment of corneal endothelial cell morphology and anterior segment parameters in COVID-19'. 对“COVID-19角膜内皮细胞形态学和前段参数的评估”的评论。
IF 2.5 Pub Date : 2022-01-01 DOI: 10.1177/25158414221138204
Nurettin Bayram
a result of various protuberances on the endothelium, such as dead endothelial cells or cellular debris
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引用次数: 0
Evaluation of the radial peripapillary capillary density in unilateral branch retinal vein occlusion and the unaffected fellow eyes 单侧视网膜分支静脉闭塞及正常眼桡骨乳头周围毛细血管密度的评价
IF 2.5 Pub Date : 2022-01-01 DOI: 10.1177/25158414221090092
C. U. Atılgan, Y. Goker, Gözde Hondur, P. Kosekahya, A. M. Koçer, M. Çıtırık
Background: Given that unilateral branch retinal vein occlusion (BRVO) and glaucoma share common systemic vascular risk factors, the fellow eyes of patients with BRVO may be at increased risk of glaucoma. Objectives: To analyze the radial peripapillary capillary density (RPCD) in eyes with unilateral BRVO and their unaffected fellow eyes using optical coherence tomography angiography (OCTA). Design: Cross-sectional, prospective study. Methods: The study included 120 eyes of 80 patients: 40 affected eyes of BRVO, 40 fellow eyes of BRVO, and 40 control eyes. The RPCD, retinal nerve fiber layer thickness (RNFLT) were analyzed using OCTA. Results: RPCDs in the whole image, peripapillary region, all the hemispheres, and quadrants were statistically lower in the affected eyes than in both the fellow and control eyes (p < 0.05 for all). RPCD values in the whole image and the peripapillary region were significantly lower in the fellow eyes than in the control eyes (p = 0.013, and p = 0.021, respectively). RNFLTs in the peripapillary region, inferior hemisphere and inferior quadrant were significantly lower in the affected eyes than in the control eyes (p < 0.05 for all). No significant differences were detected between the fellow eyes and the control eyes in term of RNFLT values in any regions (p > 0.05 for all). Conclusion: Lower RPCD values despite similar RNFLT values were observed in the fellow eyes of patients with unilateral BRVO compared with healthy controls. These results may indicate the shared vascular mechanisms and risk factors that account for the development of BRVO and glaucoma.
背景:鉴于单侧视网膜分支静脉闭塞(BRVO)和青光眼具有共同的全身血管危险因素,BRVO患者的同侧眼可能增加青光眼的风险。目的:应用光学相干断层扫描血管造影(OCTA)分析单侧BRVO眼和正常眼的径向乳头周围毛细血管密度(RPCD)。设计:横断面、前瞻性研究。方法:选取80例患者120只眼,其中BRVO患眼40只,BRVO伴眼40只,对照眼40只。OCTA分析rcd、视网膜神经纤维层厚度(RNFLT)。结果:患眼的全像、乳头周围区、所有半球和象限的RPCDs均低于对照组和对照组,差异均有统计学意义(p < 0.05)。结论:与健康对照相比,单侧BRVO患者的眼侧RPCD值较低,但RNFLT值相似。这些结果可能表明BRVO和青光眼发展的共同血管机制和危险因素。
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引用次数: 2
Use of biomaterials in corneal endothelial repair. 生物材料在角膜内皮修复中的应用。
IF 2.5 Pub Date : 2021-12-23 eCollection Date: 2021-01-01 DOI: 10.1177/25158414211058249
Noor Ahmed Hussain, Francisco C Figueiredo, Che J Connon

Human corneal endothelium (HCE) is a single layer of hexagonal cells that lines the posterior surface of the cornea. It forms the barrier that separates the aqueous humor from the rest of the corneal layers (stroma and epithelium layer). This layer plays a fundamental role in maintaining the hydration and transparency of the cornea, which in turn ensures a clear vision. In vivo, human corneal endothelial cells (HCECs) are generally believed to be nonproliferating. In many cases, due to their nonproliferative nature, any damage to these cells can lead to further issues with Descemet's membrane (DM), stroma and epithelium which may ultimately lead to hazy vision and blindness. Endothelial keratoplasties such as Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DEK) are the standard surgeries routinely used to restore vision following endothelial failure. Basically, these two similar surgical techniques involve the replacement of the diseased endothelial layer in the center of the cornea by a healthy layer taken from a donor cornea. Globally, eye banks are facing an increased demand to provide corneas that have suitable features for transplantation. Consequently, it can be stated that there is a significant shortage of corneal grafting tissue; for every 70 corneas required, only 1 is available. Nowadays, eye banks face long waiting lists due to shortage of donors, seriously aggravated when compared with previous years, due to the global COVID-19 pandemic. Thus, there is an urgent need to find alternative and more sustainable sources for treating endothelial diseases, such as utilizing bioengineering to use of biomaterials as a remedy. The current review focuses on the use of biomaterials to repair the corneal endothelium. A range of biomaterials have been considered based on their promising results and outstanding features, including previous studies and their key findings in the context of each biomaterial.

人角膜内皮(HCE)是排列在角膜后表面的单层六边形细胞。它形成了将房水与其他角膜层(间质层和上皮层)分开的屏障。这一层在维持角膜的水合作用和透明度方面起着至关重要的作用,从而确保清晰的视力。在体内,人类角膜内皮细胞(HCECs)通常被认为是不增殖的。在许多情况下,由于它们的非增殖性,对这些细胞的任何损伤都可能导致Descemet膜(DM)、间质和上皮的进一步问题,最终可能导致视力模糊和失明。内皮角膜移植术,如Descemet剥离自动内皮角膜移植术(DSAEK)和Descemet膜内皮角膜移植术(DEK)是内皮功能衰竭后恢复视力的常规标准手术。基本上,这两种类似的手术技术都是将角膜中心病变的内皮层替换为取自供体角膜的健康层。在全球范围内,眼库正面临着越来越多的需求,需要提供具有适合移植功能的角膜。因此,可以这样说,角膜移植组织明显短缺;每需要70个角膜,只有1个可用。如今,由于全球COVID-19大流行,眼库面临着捐献者短缺的漫长等待名单,与往年相比,这一情况严重恶化。因此,迫切需要寻找治疗内皮疾病的替代和更可持续的来源,例如利用生物工程将生物材料作为一种补救措施。现就生物材料在角膜内皮修复中的应用作一综述。一系列生物材料根据其有希望的结果和突出的特点,包括以前的研究及其在每种生物材料背景下的主要发现,被考虑。
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引用次数: 5
The role of multimodal imaging and vision function testing in ABCA4-related retinopathies and their relevance to future therapeutic interventions. 多模态成像和视觉功能测试在abca4相关视网膜病变中的作用及其与未来治疗干预的相关性
IF 2.5 Pub Date : 2021-12-19 eCollection Date: 2021-01-01 DOI: 10.1177/25158414211056384
Saoud Al-Khuzaei, Mital Shah, Charlotte R Foster, Jing Yu, Suzanne Broadgate, Stephanie Halford, Susan M Downes

The aim of this review article is to describe the specific features of Stargardt disease and ABCA4 retinopathies (ABCA4R) using multimodal imaging and functional testing and to highlight their relevance to potential therapeutic interventions. Standardised measures of tissue loss, tissue function and rate of change over time using formal structured deep phenotyping in Stargardt disease and ABCA4R are key in diagnosis, and prognosis as well as when selecting cohorts for therapeutic intervention. In addition, a meticulous documentation of natural history will be invaluable in the future to compare treated with untreated retinas. Despite the familiarity with the term Stargardt disease, this eponymous classification alone is unhelpful when evaluating ABCA4R, as the ABCA4 gene is associated with a number of phenotypes, and a range of severity. Multimodal imaging, psychophysical and electrophysiologic measurements are necessary in diagnosing and characterising these differing retinopathies. A wide range of retinal dystrophy phenotypes are seen in association with ABCA4 mutations. In this article, these will be referred to as ABCA4R. These different phenotypes and the existence of phenocopies present a significant challenge to the clinician. Careful phenotypic characterisation coupled with the genotype enables the clinician to provide an accurate diagnosis, associated inheritance pattern and information regarding prognosis and management. This is particularly relevant now for recruiting to therapeutic trials, and in the future when therapies become available. The importance of accurate genotype-phenotype correlation studies cannot be overemphasised. This approach together with segregation studies can be vital in the identification of causal mutations when variants in more than one gene are being considered as possible. In this article, we give an overview of the current imaging, psychophysical and electrophysiological investigations, as well as current therapeutic research trials for retinopathies associated with the ABCA4 gene.

这篇综述文章的目的是利用多模态成像和功能测试来描述Stargardt病和ABCA4视网膜病变(ABCA4R)的具体特征,并强调它们与潜在治疗干预措施的相关性。在Stargardt病和ABCA4R中使用正式的结构化深度表型对组织损失、组织功能和随时间变化的速率进行标准化测量是诊断、预后以及选择治疗干预队列的关键。此外,一份细致的自然历史文献在将来比较治疗和未治疗的视网膜时将是无价的。尽管我们熟悉Stargardt病这一术语,但在评估ABCA4R时,这种单独的同名分类是没有帮助的,因为ABCA4基因与许多表型和一系列严重程度相关。多模态成像,心理物理和电生理测量是诊断和表征这些不同视网膜病变所必需的。广泛的视网膜营养不良表型与ABCA4突变有关。在本文中,这些将被称为ABCA4R。这些不同的表型和表型的存在对临床医生提出了重大挑战。仔细的表型特征与基因型相结合,使临床医生能够提供准确的诊断、相关的遗传模式以及有关预后和管理的信息。这对于现在的治疗试验招募,以及将来有治疗方法可用时,都是特别重要的。准确的基因型-表型相关研究的重要性再怎么强调也不为过。当一个以上的基因变异被认为是可能的时候,这种方法和分离研究对于确定因果突变是至关重要的。在这篇文章中,我们概述了目前与ABCA4基因相关的视网膜病变的成像、心理物理和电生理研究,以及目前的治疗研究试验。
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引用次数: 4
Light and myopia: from epidemiological studies to neurobiological mechanisms. 光与近视:从流行病学研究到神经生物学机制。
IF 2.5 Pub Date : 2021-12-19 eCollection Date: 2021-01-01 DOI: 10.1177/25158414211059246
Arumugam R Muralidharan, Carla Lança, Sayantan Biswas, Veluchamy A Barathi, Low Wan Yu Shermaine, Saw Seang-Mei, Dan Milea, Raymond P Najjar

Myopia is far beyond its inconvenience and represents a true, highly prevalent, sight-threatening ocular condition, especially in Asia. Without adequate interventions, the current epidemic of myopia is projected to affect 50% of the world population by 2050, becoming the leading cause of irreversible blindness. Although blurred vision, the predominant symptom of myopia, can be improved by contact lenses, glasses or refractive surgery, corrected myopia, particularly high myopia, still carries the risk of secondary blinding complications such as glaucoma, myopic maculopathy and retinal detachment, prompting the need for prevention. Epidemiological studies have reported an association between outdoor time and myopia prevention in children. The protective effect of time spent outdoors could be due to the unique characteristics (intensity, spectral distribution, temporal pattern, etc.) of sunlight that are lacking in artificial lighting. Concomitantly, studies in animal models have highlighted the efficacy of light and its components in delaying or even stopping the development of myopia and endeavoured to elucidate possible mechanisms involved in this process. In this narrative review, we (1) summarize the current knowledge concerning light modulation of ocular growth and refractive error development based on studies in human and animal models, (2) summarize potential neurobiological mechanisms involved in the effects of light on ocular growth and emmetropization and (3) highlight a potential pathway for the translational development of noninvasive light-therapy strategies for myopia prevention in children.

近视不仅带来不便,而且是一种真实的、高度普遍的、威胁视力的眼部疾病,特别是在亚洲。如果不采取适当的干预措施,预计到2050年,目前流行的近视将影响世界50%的人口,成为不可逆转失明的主要原因。视力模糊是近视的主要症状,虽然可以通过隐形眼镜、眼镜或屈光手术改善,但矫正后的近视,特别是高度近视,仍然存在继发性致盲并发症的风险,如青光眼、近视黄斑病和视网膜脱离,因此需要预防。流行病学研究报告了户外时间与儿童近视预防之间的联系。户外时间的保护作用可能是由于人工照明所缺乏的阳光的独特特性(强度、光谱分布、时间模式等)。同时,动物模型的研究强调了光及其成分在延迟甚至阻止近视发展方面的功效,并努力阐明这一过程可能涉及的机制。在这篇叙述性的综述中,我们(1)基于人类和动物模型的研究,总结了目前关于光调节眼睛生长和屈光不正发展的知识;(2)总结了光对眼睛生长和近视化影响的潜在神经生物学机制;(3)强调了用于儿童近视预防的无创光治疗策略的转化发展的潜在途径。
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引用次数: 24
Brolucizumab for persistent macular fluid in neovascular age-related macular degeneration after prior anti-VEGF treatments. 先前抗vegf治疗后新生血管性老年性黄斑变性持续性黄斑液的Brolucizumab。
IF 2.5 Pub Date : 2021-12-13 eCollection Date: 2021-01-01 DOI: 10.1177/25158414211055964
Rehan M Hussain, Andrea Neal, Nicolas A Yannuzzi, Kevin H Patel, Siya Huo, Seenu M Hariprasad, Sumit P Bhatia
Background: Some patients with neovascular age-related macular degeneration (nAMD) have persistent intraretinal/subretinal fluid (IRF/SRF) despite being treated with anti-VEGF agents. There is limited data on efficacy of switching to intravitreal brolucizumab (IVBr) in these patients. Purpose: To determine anatomic and visual outcomes of eyes with nAMD treated with for persistent IRF/SRF. Methods: Retrospective series of eyes with nAMD treated initially with aflibercept (IVA, n = 48) and bevacizumab (IVBe, n = 10), then switched to IVBr for persistent IRF/SRF. Results: In the IVA-IVBr group, a mean of 42 days after one IVBr, mean logMAR changed from 0.50 to 0.49 (p = 0.73) and mean CSFT changed from 340 to 305 µm (p < 0.001); 31% of eyes had no fluid, 42% had persistent but reduced fluid, 25% had stable fluid, and 2% had increased fluid. For a subgroup of 25 eyes that completed a series of 3 IVBr, mean logMAR changed from 0.44 to 0.40 (p = 0.35) and mean CSFT changed from 325 to 277 µm (p = 0.001); 24% of eyes had no fluid at last follow-up, a mean of 54 days after last IVBr. In the IVBe-IVBr group, a mean of 44 days after one IVBr, mean logMAR changed from 0.46 to 0.40 (p = 0.114) and mean CSFT from 401 to 325 µm (p = 0.009); 30% of eyes had no fluid and 70% had persistent but reduced fluid. For a subgroup of four eyes that completed a series of three IVBr, mean logMAR changed from 0.33 to 0.35 (p = 0.391) and mean CSFT improved from 375 to 275 µm (p = 0.001); 50% of eyes had no fluid at last follow-up, a mean of 65 days after last IVBr. Conclusion: In nAMD eyes previously treated with IVA and IVBe, switching to IVBr significantly reduced persistent IRF/SRF but did not significantly affect visual outcomes.
背景:一些新生血管性年龄相关性黄斑变性(nAMD)患者尽管接受了抗vegf药物治疗,但仍存在持续的视网膜内/视网膜下积液(IRF/SRF)。在这些患者中,切换到玻璃体内brolucizumab (IVBr)的疗效数据有限。目的:探讨nAMD治疗持续性IRF/SRF的解剖和视力结果。方法:回顾性系列眼部nAMD患者,最初使用阿非利赛普(IVA, n = 48)和贝伐单抗(IVBe, n = 10)治疗,然后改用IVBr治疗持续性IRF/SRF。结果:IVA-IVBr组,IVBr后平均42天,平均logMAR从0.50变化到0.49 (p = 0.73),平均CSFT从340变化到305µm (p = 0.35),平均CSFT从325变化到277µm (p = 0.001);24%的眼睛在最后一次随访时无积液,平均在最后一次IVBr后54天。IVBe-IVBr组,IVBr 1次后平均44天,平均logMAR从0.46变为0.40 (p = 0.114),平均CSFT从401变为325µm (p = 0.009);30%的眼睛没有积液,70%的眼睛持续积液但积液减少。对于完成一系列三次IVBr的四眼亚组,平均logMAR从0.33变化到0.35 (p = 0.391),平均CSFT从375改善到275µm (p = 0.001);50%的患者在最后一次随访时无积液,平均为最后一次IVBr后65天。结论:在先前接受IVA和IVBe治疗的nAMD眼睛中,切换到IVBr可显着降低持续IRF/SRF,但对视力结果没有显着影响。
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引用次数: 8
Intravitreal bevacizumab prior to vitrectomy for proliferative diabetic retinopathy: a systematic review. 增殖性糖尿病视网膜病变玻璃体切除术前玻璃体内注射贝伐单抗:一项系统综述。
IF 2.5 Pub Date : 2021-12-06 eCollection Date: 2021-01-01 DOI: 10.1177/25158414211059256
Panagiotis Dervenis, Nikolaos Dervenis, David Steel, Teresa Sandinha, Paris Tranos, Panagiotis Vasilakis, Ioannis Liampas, Chrysoula Doxani, Elias Zintzaras

Background: Diabetic retinopathy is a leading cause of visual loss in the working population. Pars plana vitrectomy has become the mainstream treatment option for severe proliferative diabetic retinopathy (PDR) associated with significant vitreous haemorrhage and/or tractional retinal detachment. Despite the advances in surgical equipment, diabetic vitrectomy remains a challenging operation, requiring advanced microsurgical skills, especially in the presence of tractional retinal detachment. Preoperative intravitreal bevacizumab has been widely employed as an adjuvant to ease surgical difficulty and improve postoperative prognosis.Aims: This study aims to assess the effectiveness of preoperative intravitreal bevacizumab in reducing intraoperative complications and improving postoperative outcomes in patients undergoing vitrectomy for the complications of PDR.

Methods: A literature search was conducted using the PubMed, Cochrane, and ClinicalTrials.gov databases to identify all related studies published before 31/10/2020. Prespecified outcome measures were operation time, intraoperative iatrogenic retinal breaks, best-corrected visual acuity in the last follow-up visit, the presence of any postoperative vitreous haemorrhage and the need to re-operate. Evidence synthesis was performed using Fixed or Random Effects models, depending on the heterogeneity of the included studies. Heterogeneity was assessed using Q-statistic and I2. Additional meta-regression models, subgroup analyses and sensitivity analyses were performed as appropriate.

Results: Thirteen randomized control trials, with a total of 688 eyes were included in this review. Comparison of the intraoperative data showed that bevacizumab reduced operation time (p < 0.001), minimized iatrogenic retinal breaks (p < 0.001), provided better long-term visual acuity outcomes (p = 0.005), and prevented vitreous haemorrhage (p < 0.001) and the need for reoperation (p = 0.001 < 0.05). Findings were strongly corroborated by additional sensitivity and subgroup analyses.

Conclusion: Preoperative administration of bevacizumab is effective in reducing intraoperative complications and improving the postoperative prognosis of diabetic vitrectomy.PROSPERO registration number: CRD42021219280.

背景:糖尿病视网膜病变是工作人群视力丧失的主要原因。玻璃体切除已成为严重增殖性糖尿病视网膜病变(PDR)伴严重玻璃体出血和/或牵引性视网膜脱离的主流治疗选择。尽管手术设备的进步,糖尿病玻璃体切除术仍然是一个具有挑战性的手术,需要先进的显微外科技术,特别是在牵引性视网膜脱离的存在。术前玻璃体内贝伐单抗作为辅助治疗被广泛应用,以缓解手术难度,改善术后预后。目的:本研究旨在评估术前玻璃体内贝伐单抗在减少PDR并发症玻璃体切除术患者术中并发症和改善术后预后方面的有效性。方法:使用PubMed、Cochrane和ClinicalTrials.gov数据库进行文献检索,确定2020年10月31日之前发表的所有相关研究。预先规定的结果测量是手术时间,术中医源性视网膜断裂,最后一次随访的最佳矫正视力,术后玻璃体出血的存在和再次手术的需要。根据纳入研究的异质性,采用固定效应或随机效应模型进行证据综合。采用q统计量和I2评价异质性。适当时进行meta回归模型、亚组分析和敏感性分析。结果:本综述纳入13项随机对照试验,共688只眼。术中资料对比显示,贝伐单抗可缩短手术时间(p p = 0.005),预防玻璃体出血(p p = 0.001)。结论:术前给予贝伐单抗可有效减少糖尿病玻璃体切除术术中并发症,改善术后预后。普洛斯彼罗注册号:CRD42021219280。
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引用次数: 4
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Therapeutic Advances in Ophthalmology
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