| Long-term observation of anti-VEGF and early-laser combined therapy in branch retinal vein occlusionObjectiveTo observe the long-term efficacy and safety of anti-VEGF combined with early-laser therapy in BRVO patientsMethodsThis retrospective study included a total of 30 eyes from 30 patients who were diagnosed with branch retinal vein occlusion in the Department of Ophthalmology,Qilu Hospital of Shandong University from May 2015 to March 2018.The average age was 54.7 ± 11.15 years old and the average follow-up time was 44(32,57.5)months.Using 1+PRN intravitreal injection of anti-VEGF drugs(Ranibizumab or Conbercept)combined with early-laser treatment,the patient received retinal laser photocoagulation therapy was performed 2 weeks after the first intravitreal injection of anti-VEGF drugs.The retinal laser photocoagulation sites are the area of retinal hemorrhage and the drainage area of diseased veins outside of the upper and lower vascular arches of the macular area,and the retinal hemorrhage area and the diseased venous drainage area outside the 2 times the diameter of the optic disc on the temporal side of the macular area When the patient has decreased vision or recurrent macular edema,he can be treated with vitreous anti-VEGF injection or retinal laser photocoagulation again.Observing and recording the BCVA,CRT,the number of anti-VEGF injections,laser therapy times,and any adverse events between the baseline period to the last follow-up.Results1.This retrospective study included a total of 30 eyes from 30 patients whose average age was 54.7±11.15 years old and the average follow-up time was 44(32,57.5)months.2.The baseline BCVA and the last follow-up BCVA were 52.13±14.70 and 66.87±13.01 letters respectively.The last follow-up BCVA was significantly higher than the baseline period(p=0.000,p<0.05),with an average increase of 14.73±11.38 letters;the baseline CRT and the last follow-up CRT was 525.90±129.17μm and 232.43±24.13μm respectively.The CRT at the last follow-up was significantly lower than the baseline period(p=0.000,p<0.05),with an average decrease of 293.47± 138.79μm.The baseline IOP and the last follow-up IOP were 17.27±1.80mmHg and 16.40±1.92 mmHg respectively.There is no significant difference between the baseline IOP and the last follow-up IOP(p=0.079,p>0.05).The patients received 2.37±1.16 times anti-VEGF injections and 1(1,2)times laser treatment.Age is correlated with BCVA at baseline(r=-0.484,p=0.007,p<0.05)and last follow-up(r=-0.561,p=0.001,p<0.05),the younger the age at onset,the better the visual acuity.The BCVA at the last follow-up is correlated with CRT at baseline(r=-0.564,p=0.018,p<0.05),The BCVA at the last follow-up is correlated with BCVA at baseline(r=0.669,p=0.000,p<0.05).The BCVA at baseline is correlated with CRT at baseline(r=-0.696,p=0.000,p<0.05),the more severe the macular edema at baseline,the worse the baseline visual acuity.There is no correlation between the last follow-up BCVA and the last follow-up CRT(r=0.116,p=0.543,p>0.05).3.According to the baseline visual acuity,they were divided into 2 groups.Group A had baseline visual acuity ≤50 letters,and group B had baseline visual acuity>50 letters.The baseline BCVA of group A and group B were 40.33±9.26 and 63.93±7.96 letters,respectively.The BCVA at the last follow-up was 61.33±13.99 and 72.40±9.46 letters,respectively.The visual acuity of group A and B were significantly improved after treatment(group A:p=0.000,p<0.05,group B:p=0.003,p<0.05),and the visual acuity of group B at the last follow-up was significantly higher than that of group A(p=0.017,p<0.05);The BCVA of group A and group B increased by 21.00±10.10 and 8.47±9.06 letters respectively.The visual acuity improvement in group A was significantly greater than that in group B(p=0.001,p<0.05).The CRT of group A and group B decreased by 381.00±113.27μm and 205.93± 103.21μm,respectively.There was no significant difference in CRT between the two groups at the last follow-up(p=0.108,p>0.05).The anti-VEGF times of the group A and B were 2.60±1.35 times and 2.13±0.92 times,respectively,there was no significant difference in the times of anti-VEGF between the two groups(p=0.394,p>0.05).The laser therapy times of the group A and B were 2(1,3)and 1(1,1)times respectively,there was a statistical difference in the number of lasers between the two groups(p=0.013,p<0.05).The number of lasers in group B was less than that in group A.Conclusion1+PRN anti-VEGF injection combined with early-laser treatment can significantly improve the vision and decrease the macular edema of patients with BRVO.Subjects with worse baseline vision generally experience greater visual gains after treatment compared with their counterparts with better vision.There is a positive correlation between subjects with better baseline visual acuity and vision preservation in the last fallow-up.Patients with poor baseline vision generally experience more laser therapy times compared with their counterparts with better vision.FFA features and arteriovenous crossing analysis of branch retinal vein occlusionObjectiveTo observe the FFA performance and the characteristics of retinal vascular arteriovenous crossing in BRVO patientsMethodsThis retrospective study included a total of 53 eyes from 53 patients who were diagnosed with BRVO using fundus fluorescein angiography(FFA)in the Department of Ophthalmology,Qilu Hospital of Shandong University from May 2015 to August 2020,including 30 males and 23 females whose average age was 58.88±11.21 years.Observing the following 3 points through FFA combined with fundus photography:First,observing the characteristics of FFA,the main observation indicators are optic disc edema,tube wall staining,macroaneurysm,microaneurysm,collateral circulation,and retinal non-perfusion areas.Second,observing the obstructed position of the affected eyes and the way of arteriovenous crossing at the obstructed place.The adjacent retinal artery runs over the affected vein is the arterial overcrossing,the affected retinal vein runs over the adjacent artery is the venous overcrossing.According to the occlusion of the branch retinal vein,it is divided into the following 5 categories,A is the obstruction located at the large branch vein at the level of the optic disc.B is the obstruction located in the large branch vein away from the optic disc.C is the obstruction located in the macula branch vein.D,E and F is the obstruction located at the periphery without involving the macula.Third,observing the number of arteriovenous crossings and crossing methods of retinal vessels which draining the macular area of the affected eyes and the follow-eyes.Results1.This retrospective study included a total of 53 eyes from 53 patients whose average age was 58.88±11.21 years.2.No patient had optic disc edema,23 patients had tube wall staining,2 patients had large tube aneurysms,5 patients had microtubule aneurysms,and 10 patients had established collateral circulation;20 patients were ischemic BRVO.3.Analysis of the location characteristics of arteriovenous crossing at the affected eyes:There were 4 patients with obstruction at site A,including 2 patients with blockage at site A had arterial crossover,and 2 patients could not distinguish the way of arteriovenous crossing.28 patients with obstruction at site B,including 18 patients with blockage at site B had arterial crossover,1 patient was venous crossing and 9 patients could not distinguish the way of arteriovenous crossing;There were 20 patients with blockage at site C,17 patients with blockage located at site C had arterial crossing,1 patient was venous crossing and 2 patients could not distinguish the way of crossing.one patient had blockage located at site E which was arterial crossing.4.Among the 31 patients who could identify superior temporal and inferior temporal arteriovenous crossing at the same time,the number of superior temporal and inferior temporal arteriovenous crossing in the affect eyes was 5(3,6)and 4(3,5),respectively.The number of superior temporal and inferior temporal arteriovenous crossing in the follow eyes was 4(2,5)and 4(3,5),respectively.There was no statistical difference in the number and the pattern of arteriovenous crossings above the temporal and inferior temporal in the affected eyes as well as the follow-eyes(p>0.05).There was no statistical difference in the number and the pattern of arteriovenous crossings between the affected eyes and the follow-eyes in the superior temporal as well as the inferior temporal(p>0.05).ConclusionsThere was no significant difference in the number and the pattern of arteriovenous crossings above the temporal and inferior temporal in the affected eyes as well as the follow-eyes.There was no significant difference in the number and the pattern of arteriovenous crossings between the affected eyes and the follow-eyes in the superior temporal as well as the inferior temporal. |
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