The therapeutic effect of anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) was determined by a number of factors. Comprehensive thorough analysis of clinical features, imaging results and treatment response can predict the potential efficacy and possible vision recovery for the patient, and also can optimize the treatment regime to make a personalized therapy plan. Precise medicine with data from genomics, proteomics and metabolomics study will provide more objective and accurate biology basis for individual precise treatment. The future research should focus on comprehensive assessment of factors affecting the efficacy of anti-VEGF therapy, to achieve individualized precise diagnosis and treatment, to improve the therapeutic outcome of nAMD.
In the expert consensus published by the Pediatrics in 2013, it was first proposed that anti-VEGF drugs can be considered for retinopathy of prematurity (ROP) with stage 3, zone Ⅰ with plus disease. However, there are many problems worth the attention of ophthalmologists, including the advantages and disadvantages of anti-VEGF therapy compared with traditional laser therapy, systemic and ocular complications after anti-VEGF therapy, and what indicators are the end points of anti-VEGF therapy. Combined with this consensus and numerous research findings, we recommend that the first treatment for anti-VEGF or laser therapy should be considered from disease control effects. For the threshold and pre-threshold lesions, the effect of anti-VEGF therapy for zoneⅡ lesions is better than that for zone Ⅰ lesions and the single-time effective rate is high. So, it is suggested that anti-VEGF therapy should be preferred for the first treatment. The choice of repeat treatment should be considered from the final retinal structure and functional prognosis. Laser therapy is advisable for the abnormal vascular regression slower and abnormalities in the posterior pole. It can reduce the number of reexaminations and prolong the interval between re-examinations. However, the premature use of laser has an inevitable effect on peripheral vision field. Excluding the above problems, supplemental therapy can still choose anti-VEGF therapy again. Most of the children with twice anti-VEGF therapy are sufficient to control the disease. Anti-VEGF therapy should be terminated when there are signs such as plus regression, threshold or pre-threshold lesions controlled without recurrence, peripheral vascularization, etc.
PURPOSE: To produce monoclonal antibodies directed against tumor-associated antigens expressed of retinoblastoma-derived tissue culture cell line SO-RBS0. METHODS:Hybridization was performed and the specificity of the antibody was tested by immunofluorescent and immunohistochemical methods. RESULTS:Two hybridomas secreted specific monoclonal antibody against retinoblastoma cells were produced ,and the isotype of the monoclonal antibody was IgG2a CONCLUION:The monoclonal antibodies were specific and highly active against retinoblastoma cells and might be used as immunoconjugate.
Objective To observe the efficiency and safety of a single intravi treal injection of Bevacizumab (Avastin) in patients with diabetic macular edema. Methods Prospective, open label study of 18 eyes of 18 patients with diabetic macular edema which was diagnosed by examination of regular inspection, fundus fluorescein angiography(FFA) and optic coherence tomography(OCT). The patients without general or partial surgery contraindications, aged from 34-75 years with a mean age of 54plusmn;11 years. The best corrected visual acuity of logMAR was 1.023plusmn;0.45 and the retinal thickness of macular foveal was 486 mu;m before the treatment. The eyes have intravitreal injection with Bevacizumab at dose 1.5 mg (0. 06 ml). After the treatment, the follow-up period ranging from 12 to 20 weeks (m e an 16plusmn;4 weeks). The changes of visual acuity, intraocular pressure, OCT and FFA before and after the treatment were observed and analyzed. Results All 18 patients had a mean logMAR BCVA of 1.023plusmn;0.45 at baseline and at the follow-up weeks 1, 4, 12, the mean logMAR BCVA was significantly improved as 0.864plusmn;0.48 （P=0.001）, 0.739plusmn;0.51 (P=0.003), 0.792plusmn;0.50 (P=0.015) respectively, and the differences are statistically significant compared with before. Sixteen eyes (88.9%) had a improved or stable visual acuity, the BCVA increased 2 lines (0.2 logMAR vision) or better in 10 eyes (55.6%) and decreased in 2 eyes at 12 weeks after injection. OCT demonstrated that retinal thickness of macular foveal decreased from 486 mu;m to 413 mu;m at 4 weeks, decreased to 383mu;m at 12 weeks（P=0.002， P=0.001）, and the differences are statistically significant compared with before. There are remarkable resolution of central retinal edema in 13 eyes (72.2%) at 12 weeks after the injection. No local or systemic adverse events were observed in any patients. Conclusions The preliminary result in our observati on showed that int ravitreal injection of Bevacizumab therapy was well tolerated with a significant improvement in BCVA and decrease in macular edema for patients with diabetic macular edema. A randomly controlled multicenter clinical trial is necessary. (Chin J Ocul Fundus Dis,2008,24:172-175)
Neuromyelitis optica spectrum disorder (NMOSD) is a kind of demyelinating disease of central nervous system which mainly affect optic nerve and spinal cord. Because of its serious blindness and disability, how to effectively prevent relapse has become the focus of ophthalmologists. With the deep understanding of the pathogenesis and the progress of scientific and technological means, more and more monoclonal antibodies(mAb) continue to enter clinical trials. B cell surface antigen CD20 blocker, rituximab, has become a first-line drug for the treatment of NMOSD. CD19 blocker, inebilizumab, can reduce the recurrence and disability of NMOSD patients. The addition of interleukin 6 receptor blocker, satralizumab, and complement C5 inhibitor, eculizumab, reduce the recurrence. Some mAbs such as natalizumab and alemtuzumab may not be effective for the treatment of NMOSD. The expansion of mAb treatment indications and the launch of new drugs still require more clinical trials which are large-scale and international cooperation. At the same time, its potential adverse events and cost issues cannot be ignored.
Objective To evaluate the therapeutic effect of intravitreal injection with bevacizumab (Avastin) (IVB)combined with extra panretinal photocoagulation (E-PRP) for highrisk proliferative diabetic retinopathy (PDR).Methods A total of 57 eyes of 53 patients with highrisk PDR underwent intravitreal injection combined with E-PRP. The examinations of vision acuity, intraocular pressure, iris fluorescein angiography (IFA),fundus photos and fundus fluorescein angiography (FFA) were performed on all of the patients before and 1,2,3,and 6 months after the treatment; the results of the examinations before and after the treatment were compared and analyzed.The average follow up was 6 months.Results The mean visual acuity was (0.143plusmn;0.072) before the treatment and (0.218plusmn;0.128) 7 days after the tretment; the difference was significant (t=-7.940, Plt;0.05). The mean visual acuity 1,3,and 6 months after E-PRP (0.228plusmn;0.138, 0.223plusmn;0.125,0.220plusmn;0.134, respectively) differed much from that before IVB (Plt;0.05), but not so much from that after IVB (Pgt;0.05).The mean intraocular pressure of 21 eyes which had the neovascularization of pupil margin and iris surface before and 7 days after IVB was (26.632plusmn;2.629) and (19.316plusmn;3.092) mm Hg(1 mm Hg=0.133 kPa), respectively; the difference was significant (t=12.838, Plt;0.05) . The mean intraocular pressure 1,3,and 6 months after E-PRP was (16.947plusmn;2.345),(16.474plusmn;1.611), and (16.421plusmn;4.702) mm Hg, respectively, which differed much from that before and after IVB (Plt;0.05). Neovascularization on the disc and the retinae of 57 eyes were subsided partly, and a significant reduction or disappeared of the area of retinal neovascularization and the blood vessel leakage were observed 7 days after IVB. The neovascularization of pupil margin and iris surface of 21 eyes disappeared, and the IFA leakage decreased. The results of FFA 2 months after E-PRP showed that the one-off efficiency of E-PRP was 68.4%;12 eyes (21.1%) needed an additional laser, in which 6 eyes (10.5%) underwent vitreous surgery. Conclusion IVB combined with E-PRP as a treatment for highrisk PDR may improve the regression of retinal neovascularization and the reduction of vascular permeability,and prevent or reduce the complications and improve the therapeutic effect.
Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study. Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female. The average age was (51.25±12.24) years and the course was 5–17 days. All patients were given best corrected visual acuity (BCVA), intraocular pressure, slit lamp with preset lens, fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination. The patients were divided into conbercept and laser group (group Ⅰ), laser group (group Ⅱ) and conbercept group (group Ⅲ), with 30 eyes in each group. The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072, 0.286;P=0.930, 0.752). Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg), and macular grid pattern photocoagulation 3 days later. Group Ⅱ patients were given macular grid pattern photocoagulation. Times of injection between group Ⅰ and Ⅲ, laser energy between group Ⅰ and Ⅱ, changes of BCVA and CMT among 3 groups at 1 week, 1 month, 3 months and 6 months after treatment were compared. Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20±0.41) and (2.23±1.04) times respectively, and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections. The difference of injection times between two groups was significant (P＜0.001). Patients in group Ⅱ had received photocoagulation (1.43±0.63) times, 9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation. The average laser energy was (96.05±2.34) μV in group Ⅰ and (117.41±6.85) μV in group Ⅱ, the difference was statistical significant (P=0.003). BCVA improved in all three groups at last follow-up. However, the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607, –4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=–0.802,P=0.429). The mean CMT reduced in all three groups after treating for 1 week and 1 month, comparing that before treatment (t=–11.855, –10.620, –10.254;P＜0.001). There was no statistical difference of CMT between group Ⅰand Ⅲ at each follow up (t=0.404, 1.723, –1.819, –1.755;P=0.689, 0.096, 0.079, 0.900). CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=–4.621, –3.230;P＜0.001, 0.003). The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month, but the difference was not statistically significant (t=1.995,P=0.056). All patients had no treatment-related complications, such as endophthalmitis, rubeosis iridis and retinal detachment. Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO. Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.