Comparison of photodynamic therapy with two different parameters combined with subconjunctival injection of bevacizumab for corneal neovascularization.

BACKGROUND: To the best of our knowledge, no studies have been performed to determine the optimal parameters of photodynamic therapy (PDT) combined with subconjunctival injection of bevacizumab for corneal neovascularization. This study aimed to compare the effect of photodynamic therapy with two different sets of parameters combined with subconjunctival injection of bevacizumab for corneal neovascularization. METHODS: Patients with stable corneal neovascularization (CNV) unresponsive to conventional treatment (topical steroid) were included in this study. Patients were divided into two groups, receiving PDT with two different sets of parameters (group 1 receiving fluence of 50 J/cm2 at 15 min after intravenous injection of verteporfin with, group 2 receiving fluence of 150 J/cm2 at 60 min after intravenous injection of verteporfin with). Subconjunctival injection of bevacizumab was performed immediately after PDT. All patients were followed for 6 months. Best-corrected visual acuity and intraocular pressure were evaluated, and slit-lamp biomicroscopy as well as digital photography were performed. Average diameter and cumulative length of corneal neovascular were measured to evaluate the corneal neovascularization. RESULTS: Seventeen patients (20 eyes) were included in this study. At the last visit, the vision was improved in 12 eyes (60 %), steady in 4 eyes (20 %) and worsen in 4 eyes (20 %). The intraocular pressure (IOP) of all patients remained in normal range. A significant decrease in corneal neovascularization was showed in all the eyes after treatment. At 6 months after the combined treatment, the average diameter and cumulative length of vessels significantly decreased to 0.041 ± 0.023 mm (P < 0.05) and 18.78 ± 17.73 mm (P < 0.05), respectively, compared with the pretreatment data (0.062 ± 0.015 mm, 31.48 ± 18.21 mm). The reduction was more remarkable in group 2 compared to group 1.In group 1, the average diameter was 0.062 ± 0.013mm before and 0.056 ± 0.017mm after, the cumulative length of vessels was 38.66 ± 22.55mm before and 31.21 ± 17.30 after. In group 2, the date were 0.061 ± 0.016mm before and 0.029 ± 0.020mm after, 25.60 ± 8.95 mm before and 8.61 ± 8.26 mm. The reported complications included epithelial defect in four eyes, small white filaments in two eyes and corneal epithelial erosion in two eyes. CONCLUSION: The PDT combined with subconjunctival injection of bevacizumab was effective for the chronic corneal neovascularization. A more promising treatment outcome was observed when PDT was performed at 60 min after intravenous injection of verteporfin with fluence of 150 J/cm2. No serious complications or systemic events were observed throughout the follow-up period.

Retinal blood vessel segmentation based on Densely Connected U-Net.

The segmentation of blood vessels from retinal images is an important and challenging task in medical analysis and diagnosis. This paper proposes a new architecture of the U-Net network for retinal blood vessel segmentation. Adding dense block to U-Net network makes each layer's input come from the all previous layer's output which improves the segmentation accuracy of small blood vessels. The effectiveness of the proposed method has been evaluated on two public datasets (DRIVE and CHASE_DB1). The obtained results (DRIVE： Acc = 0.9559， AUC = 0.9793， CHASE_DB1： Acc = 0.9488， AUC = 0.9785) demonstrate the better performance of the proposed method compared to the state-of-the-art methods. Also, the results show that our method achieves better results for the segmentation of small blood vessels and can be helpful to evaluate related ophthalmic diseases.

Long-term effects of pattern scan laser pan-retinal photocoagulation on diabetic retinopathy in Chinese patients: a retrospective study.

AIM: To evaluate the long-term effects of pattern scan laser (PASCAL) pan-retinal photocoagulation (PRP) on diabetic retinopathy (DR) in Chinese patients. METHODS: In this retrospective study, we evaluated clinical data of 29 patients (53 eyes) with severe non-proliferative DR (SNPDR) or proliferative DR (PDR) who received PRP and follow-up at our hospital from 2008 to 2013. Sixteen patients (29 eyes) received PASCAL PRP and 13 patients (24 eyes) received 100-ms conventional laser PRP. RESULTS: After long-term follow-up (mean, min-max days: 719.8, 290-1666 for PASCAL PRP vs 743.5, 240-1348 for conventional PRP, P=0.569), patients receiving PASCAL PRP required fewer photocoagulation sessions than the conventional PRP group (2.6±1.0 vs 3.9±0.9, P<0.01). Best corrected visual acuity (BCVA) was reduced slightly in PASCAL PRP group while reduced significantly in conventional PRP group. At last visit, 24 eyes in the PASCAL group (88.9%) and 21 eyes in the conventional group (91.7%) were improved or stable. Two eyes in PASCAL PRP group (7.4%) and 3 eyes in the conventional PRP group (12.5%) developed vitreous hemorrhage or vitreous fibrovascular proliferation. CONCLUSION: PASCAL PRP is as effective and may be more conducive to maintaining visual acuity with less treatment sessions for DR treatment compared to conventional laser PRP.

Microvascular changes after conbercept therapy in central retinal vein occlusion analyzed by optical coherence tomography angiography.

AIM: To investigate microvascular changes in eyes with central retinal vein occlusion (CRVO) complicated by macular edema before and after intravitreal conbercept injection and evaluate correlations between these changes and best-corrected visual acuity (BCVA) and retinal thickness. METHODS: Twenty-eight eyes of 28 patients with macular edema caused by CRVO were included in this retrospective study. All patients received a single intravitreal conbercept injection to treat macular edema. BCVA and the results of optical coherence tomography angiography (OCTA) automatic measurements of the vessel density in the superficial (SCP) and deep retinal capillary plexus (DCP), the foveal avascular zone (FAZ) area, the FAZ perimeter (PERIM), the vessel density within a 300-µm wide ring surrounding the FAZ (FD-300), the acircularity index (AI), the choriocapillaris flow area, and retinal thickness were recorded before and at one month after treatment and compared with the results observed in age- and sex-matched healthy subjects. RESULTS: The vessel density in the SCP and DCP, the FD-300, and the flow area of the choriocapillaris were all significantly lower in CRVO eyes than in healthy eyes, while the AI and retinal thickness were significantly higher (all P<0.05). After treatment, retinal thickness was significantly decreased, and the mean BCVA had markedly improved from 20/167 to 20/65 (P=0.0092). The flow area of the choriocapillaris was also significantly improved, which may result from the reduction of shadowing effect caused by the attenuation of macular edema. However, there were no significant changes in SCP and DCP vessel density after treatment. The flow area of the choriocapillaris at baseline was negatively correlated with retinal thickness. CONCLUSION: OCTA enables the non-invasive, layer-specific and quantitative assessment of microvascular changes both before and after treatment, and can therefore be used as a valuable imaging tool for the evaluation of the follow-up in CRVO patients.

Correlations between the optic nerve head morphology and ocular biometrics in highly myopic eyes.

AIM: To analyze peripapillary atrophy ß/γ zone (PPA-ß/γ) and the optic disc ovality index, and to assess their associations with the axial length (AL), refractive error, best corrected visual acuity (BCVA), choroidal thickness (CT), and age in highly myopic eyes. METHODS: This was a retrospective observational case series. The study included 667 patients consecutively examined for highly myopic eyes [spherical equivalent ≤-6.0 diopters (D) and AL≥26 mm] with or without myopic retinopathy. Each patient went through a comprehensive ophthalmological examination that included spectral domain optical coherence tomography (SD-OCT) of the macula, A-mode ultrasonography, and a cycloplegic refraction test. The ovality index and PPA-ß/γ area were measured from optic disc photographs. RESULTS: A significant association was seen between PPA-ß/γ area and the ovality index (P=0.000, r=-0.232). The PPA-ß/γ area increased significantly with a longer AL, older age, worse BCVA, higher refractive error, and thinner choroid (P<0.01). The oval disc was significantly correlated with a longer AL, older age, worse BCVA, higher refractive error, larger PPA-ß/γ area, and thinner choroid (P<0.01). CONCLUSION: The PPA-ß/γ zone and ovality index in highly myopic eyes show distinct associations with the AL, refractive error, BCVA, age, and CT.

ELECTRICAL INJURY INDUCED BILATERAL PERIPAPILLARY MERIDIONAL RETINA-CHOROIDAL ATROPHY: A Case Report.

PURPOSE: To illustrate the clinical findings in a patient who experienced an electrical shock injury. METHODS: Observational case report. A 54-year-old man who experienced an electrical shock injury was followed up with fundus photography, fluorescein angiography, and indocyanine green angiography. Visual acuity, electroretinography, and visual field were also performed. The visual acuity of the right eye was 20/25 and the left eye was 20/20. Bilateral meridional atrophy areas were found around the optic nerve in fundus color images. Axial symmetrical meridional atrophies around the optic disk in both eyes were found in the patient's fundus fluorescein angiography and indocyanine green angiography images. RESULTS: Atrophy of bilateral retina and choroid can be found on fundus autofluorescence, fundus fluorescein angiography, and indocyanine green angiography in this electrical current-injured case, which looks like meridional direction from superior temporal to inferior nasal through optic disk. CONCLUSION: We report a rare case of bilateral peripapillary meridional retina-choroidal atrophy after electrical injury. Because of the variable timing and spectrum of ocular findings, patients experiencing electrical injury without profound vision loss should undergo long observation.

[Clinical study of photodynamic therapy with visudyne for polypoidal choroidal vasculopathy].

OBJECTIVE: To study the clinical effect of photodynamic therapy (PDT) with Visudyne for polypoidal choroidal vasculopathy (PCV). METHODS: Ten patients (10 eyes) with PCV who were diagnosed by fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optic coherence tomography (OCT) were treated by PDT with Visudyne. Eight cases (8 eyes) were male, the other two cases (2 eyes) were female. Their ages ranged from 50 to 77 years, mean (59.5 +/- 9.70) years. The best corrected visual activity (BCVA) before PDT was 0.1 - 0.5. The changes of BCVA, fundus photography, FFA and ICGA before and after PDT were compared. Follow-up time varied from 6 months to 36 months, mean 24 months. RESULTS: 1 month after PDT the BCVA was found to be unchanged in 4 eyes, increased in 1 line in 3 eyes, increased in 2 lines in 2 eyes, decreased in 3 lines in 1 eye. FFA and/or ICGA showed no leakage in 4 eyes, leakage reduced in 3 eyes, slight leakage in 2 eyes. At the last follow-up, the BCVA was found to be unchanged in 4 eyes, increased in 1 line in 2 eyes, increased in 2 lines in 2 eyes, increased in 3 lines in 1 eye which received 3 times PDT, decreased in 2 lines in 1 eye. FFA/ICGA showed no leakage in 7 eyes, slight leakage in 2 eyes. No systemic or local adverse effect was found during or after PDT, except 1 eye with extensive subretinal hemorrhage suffered vitreous hemorrhage one month after PDT. CONCLUSIONS: Photodynamic therapy with Visudyne may stop or reduce the macular leakage, facilitate the absorption of hemorrhage, exudates and edema, stabilize or increase the patients' visual activities. It could be a choice for the treatment of PCV. Certainly these tendencies need to be confirmed in a multi-center randomized controlled investigation with longer follow-up time.

[Clinical trial of verteporfin photodynamic therapy in Chinese age-related macular degeneration with subfoveal predominant choroidal neovascularization patients].

OBJECTIVE: To determine the safety and efficacy of verteporfin (visudyne) photodynamic therapy in age-related macular degeneration patients with subfoveal predominant choroidal neovascularization in China. METHODS: Multicenter, open-label, non-controlled clinical study. The included patients are diagnosed AMD patients with predominant classic CNV. The included patients received verteporfin intravenously followed by 689 nm laser light administration 15 minutes after the infusion start. The patients were be followed up for 24 weeks (+/-12 days) after initial verteporfin PDT treatment. Clinical follow-up was done at the end of week 12 (+/-12 days) and week 24 (+/-12 days) after the initial treatment. Additional treatment was given after 12 weeks from initial treatment if leakage from CNV was observed on fundus fluorescein angiogram. The visual acuity with ETDRS visual chart and the retinal lesion changes were documented and compared with baseline. The adverse events both in the process of treatment and in the follow-up were recorded throughout the entire study period. RESULTS: Thirty-one patients (31 eyes) were included and completed the trial with verteporfin PDT treatment. During the 24 weeks of the trial, 38.7% of the treated eyes had a vision gain more than 5 letters, 83.9% of the treated eyes had less than 15 letters vision loss. At week 12 after the initial treatment, 12.9% of the treated eyes had no leakage; 61.3% of the treated eyes had leakages, but limited to the former lesion, 25.8% of the treated eyes had increased leakage. The results at week 24 after the initial treatment were similar to those at week 12. At week 24 after the initial treatment, there were only slight enlargements in the lesion size, area of retinal lesion, the lesion surrounding area, and greatest linear dimension (GLD) of the lesion, but no statistical significant difference was found between baseline and week 12 after initial treatment (P = 0.65, 0.31, 0.12, respectively). No obvious progress of the fibrosis was detected in most of the PDT treated eyes. Eleven cases of adverse events (AE) occurred in our trial and the incidence was 34.4%. Among the 11 patients with reported adverse event, 7 (21.9%) had mild adverse event; 3 (9.4%) had moderate adverse events; 1 (3.1%) had a serious adverse event. During the study period, no abnormal changes were found in most of the laboratory tests including serum and urine biochemistry, hematology and Electrocardiogram. CONCLUSIONS: The results of this trial showed positive efficacy of PDT with verteporfin in the treatment of predominantly subfoveal CNV secondary to AMD by reducing the risk of vision loss. The incidence of serious adverse events was only 3.1%. It is highly safe to use PDT with verteporfin in Chinese AMD patients with subfoveal predominant classical CNV.

[Effect of endocyclophotocoagulation on survival of corneal grafts].

OBJECTIVE: To observe the effect of semiconductor (diode) laser endocyclic-photocoagulation (ECP) on the survival of corneal grafts for patients with uncontrolled refractory glaucoma secondary to penetrating keratoplasty (PKP). METHODS: Thirty-four eyes of 34 patients with refractory glaucoma were prospectively assigned to diode laser ECP in 12 eyes, and diode laser ECP with anterior vitrectomy in 22 eyes in Zhongshan Ophthalmic Center from March 2000 to April 2004 as ECP group. Twenty-six eyes of 26 patients were underwent trans-scleral cyclophotocoagulation (TCP) as TCP group. The preoperative and postoperative follow-up parameters evaluated included visual acuity (VA), intraocular pressure (IOP), corneal graft clearance, endothelial cell density (ECD), anterior chamber inflammation, ciliary processes and chamber angle (viewed under ultrasonic biomicroscope, UBM), and the postoperative complications were recorded as well. RESULTS: In ECP group, a mean of (2.7 +/- 1.3) glaucoma medications was used with mean preoperative IOP value of (40.1 +/- 9.6) mm Hg preoperatively. IOP was decreased (below 21 mm Hg) in 13 eyes (38.2%) 3 months postoperatively. Six months after ECP, decreased IOP (below 21 mm Hg) was obtained in 23 eyes (67.7%). In TCP group, a mean of (2.3 +/- 1.5) glaucoma medications were administrated with mean preoperative IOP value of (41.4 +/- 10.4) mm Hg preoperatively. IOP was decreased (below 21 mm Hg) in 10 eyes (38.5%) 3 months postoperatively. Six months after TCP, decreased IOP (below 21 mm Hg) was obtained in 8 eyes (30.8%). The difference of IOP reduction between these two groups showed no statistical significance 3 months postoperatively (chi(2) = 0.0003, P = 0.986), but it was statistically significant after 6 months (chi(2) = 8.024, P = 0.005). In ECP group, 25 eyes had clear corneal grafts preoperatively, with mean ECD of (1353 +/- 293) cells/mm(2). Postoperative mean ECD was (1013 +/- 170) cells/mm(2). In TCP group, 20 eyes had clear corneal grafts preoperatively, with mean ECD of (1221 +/- 191) cells/mm(2). Postoperative mean ECD was (847 +/- 136) cells/mm(2). The difference of ECD between ECP and TCP group was statistically significant (t = -0.009, P = 0.033). Reactive no-specific inflammation in anterior chamber occurred in 9 eyes (26.5%) in ECP group and 21 eyes (80.8%) in TCP group, which showed statistical significance (chi(2) = 17.376, P = 0.001). CONCLUSIONS: ECP proved more efficacious than TCP in controlling IOP in patients with post-penetrating keratoplasty glaucoma in long-term observation. Compared with TCP, ECP shows less corneal graft endothelial cell loss, and comparatively mild post-ECP uveitis, which improves the survival of corneal grafts greatly.

[The inhibition effect of photodynamic on human Tenon capsule fibroblast cells].

OBJECTIVE: To investigate the inhibition of photodynamic effect on human Tenon capsule fibroblast cells in vitro. METHODS: The human Tenon capsule fibroblast cells were divided into nine groups named as group A to I, each group had four wells. Group A to G, each group was added photosensitizer benzoporphyrin derivative monoacid ring A (BPD) with end concentration of 2.50 x 10(3) g/L, 1.25 x 10(3) g/L, 0.62 x 10(3) g/L, 0.31 x 10(3) g/L, 0.16 x 10(3) g/L, 0.08 x 10(3) g/L, 0.04 x 10(3) g/L respectively. Then the culture cells were irradiated by 689 nm diode laser with dosage of 2.4 J/cm(2) after BPD treatment for 15 minutes. Group H was treated with Mitomycin C (MMC) at concentration of 0.2 g/L. Group I was control without any treatment. All the cells were kept cultured for another 24 hours and then MTT colorimetric assay was applied to measure the relative inhibitory rate of photodynamic effect on the cells. RESULTS: There is statistical significance between group A to H and group I with the method of one way analysis of variance. When compared to group I, the relative inhibitory rates of group A to G are 93.3%, 91.0%, 90.3%, 87.1%, 66.0%, 41.6%, 12.5% respectively, and the inhibitory rate of group H (MMC) is 93.0%. CONCLUSION: Photodynamic effect can inhibit the proliferation of human Tenon capsule fibroblast cells in vitro. The inhibitory rate appears to be dependent on the concentration of the photo sensitizer.