Grid Photocoagulation Research Articles

Intravitreal Lucentis (Ranibizumab) as A Treatment for Diffuse Diabetic Macular Edema

Introduction: Humanized anti-VEGF (Vascular endothelial growth factor) antibody fragment Lucentis (Ranibizumab) is prescribed to treat neovascular (wet) age-related macular degeneration, diabetic macular edema, diabetic retinopathy, and myopic choroidal neovascularization. It is also used to treat macular edema following retinal vein occlusion. Objective: This study was carried out to evaluate the anatomic effect and visual acuity response following intravitreal Lucentis (Ranibizumab). Methodology: In this investigation, diffuse diabetic macular edema was present in 30 eyes belonging to 30 patients with stable diabetes mellitus. Every eye had undergone argon laser photocoagulation, either Focal, Grid, or pan-retinal photocoagulation (PRP), for a minimum of three months. The patients with a mean age was 58.13±5.17 years were treated with two intravitreal injections of 0.5 mg of ranibizumab in 0.05 ml spaced four weeks apart. A skilled ophthalmologist assessed each patient's best-corrected visual acuity (BCVA), also assessed their central macular thickness (CMT) using optical coherence tomography, and assessed their diabetic retinopathy at both the baseline and follow-up sessions. The results: The results showed that the means of BCVA were significantly (P<0.01) decreased from baseline (1.189±0.077 logMAR) to 1 month (0.162±0.058 logMAR) and 3 months (1.109±0.049 logMAR) after injection. Also the results revealed that the mean of CMT were significantly (P<0.01) declined from the baseline (477.47±151.32 µm) to 1 month (438.27±115.68 µm) and 3 month (396.80±115.26 µm) after treatment. Conclusions: The study concluded that after three months of the second injection of Lucentis (ranibizumab) significantly reduced central macular thickness and improved visual acuity, then diffuse diabetic macular edema is significantly improved and treated using Lucentis (ranibizumab).

Laser Treatment Modalities for Diabetic Retinopathy

Diabetes is a chronic progressive metabolic disorder that is caused by the body's inability to regulate blood glucose levels. If uncontrolled, it can lead to various complications. Among its various complications, long-term diabetes leads to diabetic retinopathy (DR). It is a disease involving blood vessels and the destruction of retinal nerves. It is usually classified into two types: proliferativediabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR). It progresses and causes loss of vision. The leading cause of loss of vision is diabetic macular edema (DME). The argon laser is used as a modality in the management of PDR. There are various types of laser photocoagulation, such as peripheral retinal laser photocoagulation,focal macular laser photocoagulation, and grid photocoagulation. DR results in various adverse consequences such as vitreous hemorrhage, fibrosis, traction, detachment of the retina, and glaucoma. To assess DR, a detailedfundus examination with a slit lamp biomicroscopeneeds to be done. Seven-standard field stereoscopic-color fundus photography needs to be done for documentation and follow-up. Patients with diabetesmellitus (DM) type 1 have a greater risk of suffering fromDR. Another major complication of the condition is DME, which is characterized by an increase in the permeability of vessels and the thickening of the central part of the retina along with the accumulation of hard exudates on the macula. This article discussesvarious laser therapy modalities for the treatment of DR, their types, mechanisms, and aims. Clinical features of DR include abnormal dilatation of capillaries, and outpouchings in the form of microaneurysm from the capillary wallareone of the earliest and most dangerous changes; later, non-perfusion of the retina occurs, which is associated with cotton wool spots and blot hemorrhages. In patients suffering from PDR and maculopathy, peripheral retinal laser photocoagulation is used as a mode of intervention.

Therapeutic Effects of Combination Therapy and Photobiomodulation Therapy on Retinal Regeneration.

Introduction: Many systemic and ocular diseases cause macular edema (ME). Macular edema is seen in two primary forms; the first is diffuse thickening of the macula, and the other is a macula with a distinct petaloid (cloverleaf) appearance called cystoid macular edema. Macular edema has a known role in the reduction of visual equity, and many options have been proposed for the reversal of this condition. Methods: Articles on the effects of macular laser grid photocoagulation on diabetic macular edema (DME) or cystoid macular edema published between 2000 and 2022 were collected from PubMed, Google Scholar, and Web of Science. The following keywords were used for the search: "macular laser photocoagulation", "macular edema", "cystoid macular edema", "intravitreal pharmacotherapies", and "antivascular endothelial growth factor". Two hundred nineteen articles were found in google scholar and 165 articles in PubMed, and a total of 58 articles were included in the study after applying the exclusion criteria. Results: We investigated the effects of various lasers photocoagulation such as Focal and/or grid macular laser, subthreshold micropulse laser (SMPL), as well as intravitreal pharmacotherapies with triamcinolone acetonide, and fluocinolone, and extended released intraocular implants such as Ozurdex, Retisert, Iluvien, and anti-vascular endothelial growth factors such as bevacizumab (Avastin), Eyela, and Lucentis. Corticosteroids were more effective than lasers, although some researchers have found that lasers and combined lasers and corticosteroids are more effective. In addition, some studies have shown that the frequency and concentrations of intravitreal pharmacotherapies are effective in increasing visual outcomes. Conclusion: The results of the studies showed that the combined intravitreal corticosteroids are much more effective in improving visual acuity (VA) than a single corticosteroid, and the low concentration of the drug is safer. Still, corticosteroids have side effects such as increased intraocular pressure and glaucoma. Therefore, combining the medication with a laser is much more reasonable than each alone. Also, the subthreshold photocoagulation laser (670 nm) is better at reducing the central macular thickness (CMT) and improving VA than the micro pulse yellow laser and pan-retinal photocoagulation (PRP).

INCIDENCE AND UPDATES MANAGEMENT OF DIABETIC RETINOPATHY

One of the biggest causes of vision loss in the globe is diabetic retinopathy (DR), a consequence of diabetes. Despite significant attempts to lower the prevalence of vision impairment, DR continues to grow. There is damage to the vascular endothelial cells as the first pathophysiology of DRcells and a decrease in pericytes. As a result of the hypoxic reactions that follow, vascular endothelialvascular endothelial growth factor (VEGF) The most effective treatment available right nowControlling blood sugar levels is the key to preventing diabetic retinopathy and diabetic macular edema (DME). Superior in every way Laser therapy, anti-VEGF therapy, steroid therapy, and vitrectomy are all necessary treatments in these situations. Photocoagulation of the retinal pigment epithelium There is strong evidence that non-proliferative diabetic retinopathy (NPDR) is a viable treatment option.results that can be used to keep DR from progressing further. Furthermore, laser therapy has proven to be effective.For example, grid and subthreshold diode laser micropulse photocoagulation (SDM) for DME has been used.reported. In cases of vitreous hemorrhage or tractional retinal detachment in PDR patients, vitrectomy has been undertaken. There has also been significant interest in the ability of anti-VEGF medication to slow the progression of PDR from DME patients. Even with these therapies, many individuals with DR are still at risk of losing their eyesight and developing potentially dangerous side effects.. In the most advanced stages of DR, laser photocoagulation and vitrectomy are effective treatments for preventing severe vision loss. Both approaches, however, have their limitations. Evidence from preclinical and clinical studies shows that targeting renin-angiotensin system inhibition, vascular endothelial growth factor, and renin-angiotensin system blockade can reduce cardiovascular disease risk.the growth hormone, corticosteroids and protein kinase C.DR may be treated with these methodsMethodsThe study between January 2017 and November 2020 total number of patients 2968, Retrospective three year analysis.ResultsIncidence of referable retinopathy was independently associated with known duration of diabetes, age at diagnosis, and use of insulin treatment. For participants needing insulin treatment with a duration of diabetes of 10 years or more, cumulative incidence of referable retinopathy at one and three years was 9.61 and 30.99 per 1000 people, respectively.

Association of metformin treatment with enhanced effect of anti-VEGF agents in diabetic macular edema patients

To investigate the effect of metformin combined with anti-VEGF agents in patients with diabetic macular edema (DME). This study was a prospective, nonrandomized case-control study. Patients were included in with a diagnosis of DME who received anti-VEGF agents injection. Basic information, medical history, best-corrected visual acuity (BCVA), central macular thickness (CMT), the number of intravitreal injections, panretinal photocoagulation (PRP), and macular grid photocoagulation treatment during the 6-month follow-up, were recorded for each patient. A total of 50 DME patients were collected (24 patients with a history of oral metformin ≥ 6months and 26 patients who had not taken metformin). The BCVA and the CMT were significantly improved after anti-VEGF treatment in two groups (F1 = 19.35, F2 = 26.78; F1 = 65.45, F2 = 76.23; P < 0.05). The BCVA in the metformin group was better than that in non-metformin group at every point after treatment (F = 34.45, P < 0.05). The CMT in metformin group decreased much more than that in non-metformin group during the follow-up period (F = 87.05, P < 0.05). The injection numbers decreased in the metformin group compared with the non-metformin group (t = 5.14, P < 0.05). However, there was no difference in PRP and macular grid photocoagulation therapy between the two groups during the 6-month follow-up. Metformin can enhance the therapeutic effect of anti-VEGF agents on DME patients to improve their visual acuity, improve the structure of the macular area, and reduce the number of intravitreal injections 90.

Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy.

Diabetic retinopathy (DR) is a complication of diabetes and one of the leading causes of vision loss worldwide. Despite extensive efforts to reduce visual impairment, the prevalence of DR is still increasing. The initial pathophysiology of DR includes damage to vascular endothelial cells and loss of pericytes. Ensuing hypoxic responses trigger the expression of vascular endothelial growth factor (VEGF) and other pro-angiogenic factors. At present, the most effective treatment for DR and diabetic macular edema (DME) is the control of blood glucose levels. More advanced cases require laser, anti-VEGF therapy, steroid, and vitrectomy. Pan-retinal photocoagulation for non-proliferative diabetic retinopathy (NPDR) is well established and has demonstrated promising outcomes for preventing the progressive stage of DR. Furthermore, the efficacy of laser therapies such as grid and subthreshold diode laser micropulse photocoagulation (SDM) for DME has been reported. Vitrectomy has been performed for vitreous hemorrhage and tractional retinal detachment for patients with PDR. In addition, anti-VEGF treatment has been widely used for DME, and recently its potential to prevent the progression of PDR has been remarked. Even with these treatments, many patients with DR lose their vision and suffer from potential side effects. Thus, we need alternative treatments to address these limitations. In recent years, the relationship between DR, lipid metabolism, and inflammation has been featured. Research in diabetic animal models points to peroxisome proliferator-activated receptor alpha (PPARα) activation in cellular metabolism and inflammation by oral fenofibrate and/or pemafibrate as a promising target for DR. In this paper, we review the status of existing therapies, summarize PPARα activation therapies for DR, and discuss their potentials as promising DR treatments.

Curative effect of Triamcinolone acetonide combined with macular grid photocoagulation in the treatment of macular edema secondary to BRVO

Curative effect of Triamcinolone acetonide combined with macular grid photocoagulation in the treatment of macular edema secondary to BRVO

Combination of Ranibizumab with macular laser for macular edema secondary to branch retinal vein occlusion: one-year results from a randomized controlled double-blind trial

BackgroundIt is not clear whether macular laser combined with anti-vascular endothelial growth factor (VEGF) can reduce the number of anti-VEGF injections in the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Our study aimed to investigate the effects of intravitreal ranibizumab with or without macular laser for ME secondary to BRVO and its associated number of anti-VEGF injections.MethodsThis is a prospective, randomized, double-blind, monocentric trial.80 patients were enrolled and 64 patients fulfilled the study requirements. All patients received a minimum of 3 initial monthly ranibizumab injections, pro re nata (PRN) dosing thereafter VA and CRT stabilization criteria-driven PRN treatment. Laser was given 7 days after third ranibizumab injection in ranibizumab with laser group. The follow-up time of this study was 1 year. Best corrected visual acuity (BCVA) improvement, central retinal thickness (CRT) reduction and number of injections of patients were compared between two groups. T-test, non-parametric Wilcoxon test and chis-square tests were adopted for between-group comparisons.ResultsThirty patients received intravitreal ranibizumab 0.5 mg alone and 34 patients received intravitreal ranibizumab 0.5 mg with macular laser. At 52 week, BCVA increased significantly and CRT decreased significantly in both groups (P < 0.001). However, there was no significant difference in BCVA improvement with baseline BCVA adjusted (p = 0.5226), and in the CRT reduction (P = 0.4552) between two groups after 52 weeks. There was also no significant difference in the number of injections between the two groups. (P = 0.0756). There was also no significant difference between ischemic and non-ischemic groups in BCVA improvement, CRT reduction and number of injections (P > 0.05).ConclusionsOur study suggests that ranibizumab combined with macular laser is effective in the treatment of ME secondary to BRVO after 1 year of treatment with 3 + PRN regimen. However, combination of macular grid photocoagulation showed no beneficial anatomical or functional effect during follow-up period, nor did it reduce the number of ranibizumab injections, either in ischemic group or non-ischemic group. We suggest that there is no need to combine macular grid photocoagulation in the treatment of ME secondary to BRVO in the future.Trial registrationClinical Trials NCT03054766. https://register.clinicaltrials.gov.Prospectively registered.

Photocoagulation combined with ranibizumab for macular edema secondary to branch retinal vein occlusion

Objective To evaluate the clinical efficacy of macular grid photocoagulation combined with intravitreal ranibizumab injection in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). Methods The data of 50 eyes of 50 patients with macular edema secondary to BRVO from Oct.2013 to Dec.2017 were analyzed retrospectively. All cases were randomly divided into two groups, each group with 25 cases. All cases received intravitreal injection of ranibizumab. The combined group received standard macular grid photocoagulation at 1 week after injection. Results The difference in BCVA and central macular thickness (CMT) were not statistically significant between the two groups before treatment (P>0.05). BCVA was significantly improved and CMT was significantly decreased in both groups at 1, 2 and 6 months after treatment, the differences were statistically significant (P 0.05). Conclusion The single intravitreal injection of ranibizumab or combined with macular grid laser photocoagulation in the treatment of retinal macular edema secondary to BRVO are effective, and the combined effect is more durable. Key words: Macular edema, secondary; Branch, retinal, vein occlusion; Photocoagulation, macular, grid; Ranibizumab

Intravitreal bevacizumab injection versus intravitreal bevacizumab injection followed by macular grid laser photocoagulation for diabetic macular edema

Background: Diabetic macular edema is the commonest cause of visual impairment in diabetic patients. The aim of the study is to evaluate the effectiveness of repeated intravitreal bevacizumab injections alone versus injection with sequential macular grid laser photocoagulation in patients with diabetic macular edema. Methods: This study included 128 eyes of 64 patients with bilateral diabetic macular edema, randomly assigned into two groups. First group was treated with monthly intravitreal bevacizumab injections (IVB group). Second group was treated with 3 monthly IVB injections, followed by macular grid photocoagulation (MGP) 4 weeks later (combined group). All patients received a complete ophthalmic examination including measurement of best corrected visual acuity (BCVA) and measurement of central macular thickness (CMT) by optical coherence tomography at baseline and 3 weeks after each injection. Results: At the end of the follow-up period there was a statistically significant difference between the mean BCVA and the CMT compared to baseline in both groups. In the IVB group at the end of study, the mean BCVA was 0.46±0.11 LogMAR compared to 0.79±0.16 LogMAR preoperatively, and the mean CMT was 248.49±13.40µm compared to 497.25±27.97µm preoperatively. In the combined group the mean BCVA was 0.41±0.12 LogMAR compared to 0.89±0.12 LogMAR preoperatively, and the mean CMT was 239.47±13.53µm compared to 510.86±37.64µm preoperatively. The mean number of injections was significantly lower in combined group. Conclusion: Intravitreal injection of bevacizumab is effective in controlling DME. Performing MGP 4 weeks after the third injection decreased the number of IVB injections needed during the study duration.

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.

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). 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 2weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38weeks. 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. 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 38weeks, 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 496.2μm ± 138.4μm and 538.9μm ± 156.9μm in BEV (P < 0.1697). At 38weeks, CRT decreased in both groups significantly, 98.2μm in the BEV + GRID (P = 0.02) and 141.7μm 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. 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.

Laser Treatment in Central Retinal Vein Occlusion and Macular Edema

Central retinal vein occlusion can result in severe visual acuity loss that is a common retinal vascular disorder. There are two distinct laser treatments: Grid and scatter pan-retinal photocoagulation. Grid laser aims to reduce macular edema and improve visual acuity. The aim of scattering pan-retinal photocoagulation to reduce VEGF burden by ablating peripheral ischemic retina and prevent the development of neovascularization in the retina, iris, and angle or to provide regression if developed. Laser photocoagulation is currently performed in combination with intravitreal anti-VEGF and intravitreal steroid treatments, but not alone in retinal vein occlusion.

Observation on the efficacy of combinded treatment for diabetic macular edema

Objective To observe the clinical efficacy of macular grid photocoagulation combined with or without intravitreal injection of Ranibizumab for diabetic macular edema (DME). Methods The data of 120 eyes of 120 patients with DME were analyzed retrospectively, they were randomly divided into two groups. The control group, 60 eyes received standard macular grid photocoagulation. The combined therapy group, 60 eyes received standard macular grid photocoagulation 2 weeks after intravitreal Ranibizumab injection. The visual acuity, central macular thickness (CMT) and photocoagulation energy before and 1, 3, 6 months after treatment were compared between the two groups. Results The difference in BCVA and CMT before treatment were not statistically significant between the two groups (P>0.05). The difference of BCVA and CMT in the two groups were statistically significant between before and after treatment (P<0.05). The BCVA of the combined therapy group were better than that of the control group at 1, 3, 6 months after treatment (t=7.059, 8.821, 6.826, P<0.05). The CMT of the combined therapy group were thinner than that of the control group at 1, 3, 6 months after treatment (t=8.154, 6.421, 5.689, P<0.05). The photocoagulant energy in the control group was(97.95±6.75) mW. The photocoagulation energy in the combined treatment group was (84.25±9.89) mW. Conclusion The intravitreal Ranibizumab injection combined with macular grid photocoagulation can improve the vision and reduce macular edema in DME patients greatly. Key words: Macular edema, diabetic; Ranibizumab, intravitreal injection; Photocoagulation, macular, grid

Conventional and Pattern Laser Applications in Diabetic Retinopathy and Diabetic Macular Edema

Diabetes mellitus leads to two major complications, diabetic retinopathy (DRP) and diabetic macular edema (DME), resulting in loss of vision. Diabetes mellitus is the most common cause of loss of vision when all age groups are taken into account. However, this complication can be prevented or delayed with various treatments, especially strict blood glucose regulation. Laser, anti-VEGF, and corticosteroids are used in the treatment of DME. Laser therapy is applied as a focal / grid or pan-retinal photocoagulation. Nowadays, different lasers are presented to use in the treatment in DRP and DME. Each has different advantages and disadvantages. This article discusses the characteristics of lasers used in the treatment of DRP and DME.

Treatment before macular grid in patients of diabetic macular edema.

AIM:The aim of this study is to compare the efficacy of intravitreal bevacizumab and posterior subtenons triamcinolone acetate in the management of diffuse diabetic macular edema (DME) and to evaluate their efficacy as an adjunct to modified grid laser in management of DME.DESIGN:This was a prospective, randomized clinical trial of 30 patients.MATERIALS AND METHODS:A total of 30 patients attending the medical ophthalmology clinic at a tertiary care hospital were included in the study. These 30 patients were divided into two groups. Group I (15 eyes) received intravitreal bevacizumab followed by modified grid photocoagulation 2 weeks after injection. Group II (15 eyes) received posterior subtenons triamcinolone followed by modified grid photocoagulation 2 weeks after injection. Each patient in our study was followed up at 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after the initial injection to record the central macular thickness (CMT) and best-corrected visual acuity (BCVA).RESULTS:Both the combination therapies have efficacy to reduce the CMT (P = 0.001). The percentage fall in CMT was greater in bevacizumab + laser group, and there was a significant difference in the CMT values at the end of the study in the bevacizumab group (P = 0.013). The mean BCVA improved in both the groups and this difference was statistically significant compared to the baseline (P = 0.005). However, there was no statistically significant difference in BCVA between the two groups at the end of the study.CONCLUSION:Both intravitreal bevacizumab and posterior subtenons triamcinolone given as an adjuvant therapy along with modified grid laser are equally efficacious in the reduction of the CMT; however, the percentage fall in the CMT was greater in bevacizumab + laser group, and there was a significant difference in the fall in CMT at all the visits as compared to a plateau in the fall of CMT in posterior subtenons triamcinolone group.

Observation on the clinical efficacy of combined therapy for the treatment of diabetic macular edema

Objective To observe the clinical efficacy of intravitreal Ranibizumab combined with macular grid photocoagulation for treatment of diabetic macular edema (DME). Methods Sixty eyes of 60 patients with DME in the First Affiliated Hospital of Zhengzhou University from November 2013 to October 2014.They were randomly divided into 2 groups: the combined therapy group of 30 eyes and the control group of 30 eyes.The patients in combined therapy group received intravitreal Ranibizumab injection, and then combined with standard macular grid photocoagulation one week later. The patients in the control group received intravitreal Ranibizumab only.The visual acuity was examined with standard chart.The vision results converted into logarithmic of the minimum angle resolution (logMAR) to record. The changes of the logMAR of best corrected visual acuity (BCVA) and central macular thickness (CMT) before and 1, 3, 6 months after the treatment were compared. The average BCVA of the combined therapy group before treatment was 0.75±0.32 and the average BCVA of control group was 0.74±0.29.There was no statistically significant difference (t=0.20, P=0.83) in BCVA between the two groups. The average CMT is (486.87±92.44)μm in the combined therapy group and(487.13±86.519)μm in the control group before treatment.There was no statistically significant difference (t=1.247, P=0.089) in the CMT of two groups. Results At 1, 3, 6 months after the treatment, the BCVA of patients in control group were(0.41±4.10), (0.40±0.85)and(0.36±9.85)and the CMT were (273.53±103.36)μm, (275.21±92.14)μm and (274.65±93.21)μm, respectively. Howerer, in combined therapy group, the BCVA were (0.44±1.60), (0.43±1.73)and(0.44±2.36)and the CMT were (273.53±103.36)μm, (275.21±92.14)μm and (274.65±93.21)μm respectively. There were statistically significant differences (t=2.16, P=0.04; t=2.34, P=0.02; t=4.25, P=0.00)in the BCVA and in the CMT (t=2.114, P=0.021; t=2.352, P=0.015; t=2.534, P=0.008)at 1, 3, 6 months after the treatment between the two groups.The BCVA in both two groups were significantly improved compared with that of preoperative (P<0.05). The CMT decreased rapidly after the treatment(P<0.05). During the follow-up, the BCVA presented declining trend and the CMT was on the rise slowly in the control group. The BCVA and CMT in combined therapy group remained stable. Conclusion Intravitreal Ranibizumab injection combined with macular grid photocoagulation and simple Ranibizumab intravitreal injection can improve the vision and reduce macular edema in DME patients and the therapeutic efficacy of the combined group is more stable than the control group. Key words: Macular edema, diabetic; Ranibizumab, intravitreal injection; Grid photocoagulation, macular

Comparison of therapeutic effect of micro-pulse laser and conventional laser on diabetic macular edema

Objective To compare the therapeutic effect of micro-pulse laser, single-spot laser and pattern scan laser for diabetic macular edema(DME). Methods Total of 120 eyes of 60 patients who were confirmed as preproliferative diabetic retinopathy or IV phase proliferative diabetic retinopathy complicated with clinically significant macular edema were included. These patients were randomized divided into the micro-pulse group with 40 eyes of 20 patients, the single-spot laser group with 40 eyes of 20 patients and the pattern scan laser group with 40 eyes of 20 patients.The patients in micro-pulse group underwent micro-pulse laser therapy in macular region , the single-spot laser group underwent macular laser grid photocoagulation therapy by single-spot laser, the pattern scan laser group underwent macular laser grid photocoagulation therapy by pattern scan laser.The BCVA, central macular thickness(CMT) and mean sensitivity(MS) of all patients were examined before and after the treatment. The changes in BCVA, CMT and MS at 6 months after treatment were observed and compared among the groups. Results At 6 months after the treatment, the BCVA of micro-pulse group increased more significantly compared to that before treatment(P 0.05). At 6 months after the treatment, the CMT of micro-pulse group, single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment(P 0.05). At 6 months after the treatment, the MS of micro-pulse group increased significantly compared to that before treatment(P<0.05), the MS of single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment(P<0.05), the MS of the three groups showed statistical difference (P<0.05). Conclusion Micro-pulse laser, single-spot laser and pattern scan laser therapies on DME can effectively reduce CMT and alleviate macular edema, micro-pulse laser therapy on DME also increase BCVA and MS, and improve visual function.Single-spot laser and pattern scan laser therapies can not improve visual function. Key words: Macular edema, diabetic; Micro-pulse laser; Laser coagulation; Effect, therapeutic

Comparison of anti-vascular endothelial growth factors, laser treatments and a combination of the both for treatment of central retinal vein occlusion.

To compare changes in visual acuity and macular edema in patients with central retinal vein occlusion (CRVO) treated with intravitreal injections of bevacizumab, macular grid photocoagulation combined with pan retinal photocoagulation (PRP), or both (bevacizumab+grid+PRP). Our study is a retrospective cohort clinical study that examined patients that suffered from ischemic CRVO with macular edema. Study inclusion criteria were ischemic CRVO with macula edema and the availability of complete medical records for at least 12mo after treatment. Excluded were patients with diabetes or any other retinal disease. We reviewed the medical records of patients treated in one ophthalmology department-comparing changes in visual acuity and macular edema in patients treated with intravitreal injections of bevacizumab vs those that were treated with macular grid photocoagulation and PRP or both. The main outcome measures were the differences in best corrected visual acuity (BCVA) and in macular thickness, as assessed by optical coherence tomography, between the enrollment and the final follow up visits. Sixty-five patients met inclusion criteria. There were no statistically significant differences among the three groups in the mean changes in macular thickness as measured by ocular coherence tomography (131.5±41.2, 108.6±29.2, and 121.1±121.1, P=0.110), or in visual acuity (0.128±0.077, 0.088±0.057, and 0.095±0.065), for intravitreal injections, macular grid photocoagulation+PRP and a combination of the treatments, respectively, P=0.111. The proportions of patients with macular edema after treatment were: 26.1%, 28.6%, and 14.3%, respectively, P=0.499. Similar benefit was observed for intravitreal injections, laser photocoagulation, or a combined regimen in the treatment of CRVO. A non-statistically significant trend for reduction in macular edema was observed following combined treatment.

Visual Improvement in Retinal Vein Occlusion Patient Who Had Intravitreal Bevacizumab with and without Laser Photocoagulation

Background: Intravitreal bevacizumab (IVB) appears to be an effective and safe drug for reducing macular edema and improving visual acuity secondary to RVO. Grid photocoagulation to macular edema caused by BRVO significantly improved long-term visual prognosis. In CRVO, reduced the angiographic evidence of macular edema, but did not lead to improvement in the vision of treated eyes. Methods: an observational, retrospective study from medical record of patients RVO underwent IVB and combined treatment at Cicendo National Eye Center conducted between January and December 2012. A total of 49 eyes from 49 patients met the inclusion criteria. Data was compiled on demographic characteristics, pre and postoperative visual acuities. The main outcome was proportion of visual gain in 1 month after therapy. Result: All patients (49 eyes) completed the 1 months follow-up with 17 patients BRVO who had treatment IVB and 11 patients with combined treatment. And 14 patients CRVO who had treatment IVB and 7 patients had combined treatment. The proportion of BRVO and CRVO eyes have the same visual improvement in IVB and combined treatment groups (BRVO 58.8% vs 72.7%, p=0.120 and CRVO 57.1% vs 57.1%, p=1.000). Conclusion: There was no significant difference in the proportion of visual improvement between IVB and combined treatment groups in BRVO and CRVO at one months follow up. Keywords: branch retinal vein occlusion, central retinal vein occlusion, intravitreal bevacizumab, laser photocoagulation

Comparison of efficacy of different methods for diabetic macular edema

Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with macular grid photocoagulation for diabetic macular edema (DME). Methods Totally 60 eyes of 60 patients with DME were randomly divided into three groups with 20 cases in each group. Patients in group A received intravitreal ranibizumab injection every 4 weeks for 3 months and macular grid photocoagulation was performed 1 week later. Patients in group B received intravitreal injection of ranibizumab with same dose and same frequency without macular grid photocoagulation. Patients in group C received intravitreal injection of ranibizumab only once. At 1, 3 and 6 months follow-up after the first injection, the changes of best corrected visual acuity (BCVA) and center macular thickness (CMT) between 3 groups were compared. Results In group A, the BCVA and CMT after injection were satisfactory and steady during follow-up (all P 0.05). The CMT had no statistically significant difference between pre-operation and 6 months after the treatment (P>0.05). Conclusion Successive intravitreal injection of ranibizumab combined with macular grid photocoagulation can effectively improve visual acuity and decrease central macula thickness for patients with DME. But the stability at postoperative 6 months of the combined treatment group is better than successive intravitreal injection therapy group. The successive intravitreal injection method with or without macular grid photocoagulation is better than monoinjection therapy. Key words: Diabetic retinopathy; Macular edema; Ranibizumab; Grid photocoagulation