No significant changes in serum levels of VEGF were found from 3 to 30 days following a single intravitreal ranibizumab injection. Although certain influences existed 24-h post-injection, effect(s) of a single intravitreal ranibizumab injection on the homeostasis of the cardiovascular system during such a brief period is unknown.

Background: The aim of this work was to compare the efficacy of intravitreal dexamethasone implant (Ozurdex) and intravitreal ranibizumab (Lucentis) in the treatment of macular edema (ME) caused by retinal vein occlusion (RVO). Methods: Thirty-two ME cases treated with Ozurdex and 32 ME cases treated with ranibizumab were enrolled, with 26 central (C)RVO and 6 branch (B)RVO subjects in each group. We compared the results of best-corrected visual acuity (BCVA), central retinal thickness, number of injections, and intraocular pressure (IOP) at 1, 2, 3, and 6 months after injection. Results: BCVA in both groups at each follow-up were significantly increased compared to baseline with no statistical difference between the groups. Ozurdex and ranibizumab successfully reduced CMT at each follow-up. Both CRVO and BRVO patients had significant between-group differences in the mean number of injections. Among the CRVO patients, IOP in the Ozurdex group was significantly increased compared to baseline and the ranibizumab group at 1, 2, and 3 months postinjection. Conclusions: Intravitreal injection of Ozurdex and ranibizumab can effectively control ME secondary to RVO and increase a patient's BCVA. The advantages of Ozurdex are fewer injections and longer efficacy, while the advantages of ranibizumab include fewer side effects.

Background: It 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. Methods: This 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. Results: Thirty 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).

Aims. To compare the relationship between the nonperfusion area (NPA) on ultra-widefield fluorescein angiography (UWFFA) and the nonflow area (NFA) on optical coherence tomographic angiography (OCTA) in retinal vein occlusion (RVO). Methods. Cross-sectional study. 46 eyes of 46 RVO patients who underwent UWFFA and OCTA. NPA and ischemic index (ISI) were quantified on UWWFA. NFA, vessel density (VD) of the superficial capillary plexus (SCP), the deep capillary plexus (DCP), and the size foveal avascular zone (FAZ) on 3 ∗ 3 mm OCTA were measured. The association of the NPA and ISI on UWWFA and the parameters on OCTA were analyzed. Spearman correlation was used for statistical testing. Results. The NPA and ISI on UWFFA were significantly correlated with the NFA on OCTA in RVO, and r values were 0.688 ( p < 0.01 ) and 0.680 ( p < 0.01 ), respectively. VD in the SCP of the temporal quadrant was negatively correlated with NPA and ISI, and r values were −0.346 ( p < 0.05 ) and −0.337 ( p < 0.05 ), respectively. VD in the DCP of the temporal quadrant was negatively correlated with the NPA, and the r value was −0.246 ( p < 0.05 ). No significant correlation was found between the NPA and ISI on UWFFA and VD of other quadrants in the SCP or DCP and the FAZ area on OCTA. Conclusion. NPA in the peripheral retina was correlated with NFA in macula. NFA detected by OCTA could be an indicator of the ischemic status in RVO.

Aims. To quantify the capillary density of the optic nerve head in healthy control eyes and different stages of diabetic retinopathy (DR) eyes and identify the parameters to detect eyes with or without DR using optical coherence tomographic angiography (OCTA). Methods. In this cross-sectional study, 211 eyes of 121 participants with type 2 diabetes with different stages of DR or without DR and 73 eyes of 38 healthy age-matched controls were imaged by OCTA. Radial peripapillary capillary (RPC) plexus density and retinal nerve fiber layer (RNFL) thickness were examined. The mixed model binary logistic regression model was used to identify the parameters to detect eyes with or without DR. The area under the receiver operating characteristic (ROC) curve was calculated. Results. RPC density decreased significantly in diabetic patients without DR compared with the healthy controls, and it was negatively correlated with the severity of DR (P<0.01). RPC density was a significant parameter to distinguish diabetic eyes with or without DR (P<0.01). The area under the ROC curve was 0.743. Conclusions. Quantification of RPC density by OCTA provides evidence of microvascular changes in the optic nerve in diabetic patients. RPC density can serve as a possible biomarker in detecting eyes with DR. Larger cohort studies need to support this statement.

Background There is no consensus on the optimal initial treatment for polypoidal choroidal vasculopathy (PCV). Our study aimed to report the efficacy of repeated injections of intravitreal ranibizumab with or without photodynamic therapy for the treatment of PCV and to determine the possible factors predictive of visual outcomes. Methods The results of the initial treatment of 40 patients with PCV with 3 monthly injections of ranibizumab were retrospectively reviewed. We compared the results in terms of the best corrected visual acuity (BCVA), the central retinal thickness (CRT), the number of injections, the regression rates of polyps and the rates of the reduction of subretinal fluid. Results At the 3-month follow-up, the mean BCVA was significantly increased by 7.3 ± 12.4 letters compared to baseline ( p < 0.01). At the 12-month follow-up, the mean BCVA was increased by 3.4 ± 15.4 letters compared to baseline, and there was no significant difference ( p > 0.05). The mean CRT at the 12-month follow-up was 593.58 ± 243.64 μm, with an average decrease of 101.55 ± 256.07 μm compared to baseline ( p < 0.01). Fifteen eyes (18.8%) showed the complete regression of polyps, and 22 eyes (27.5%) showed a reduction in polyps. The baseline VA, the reduction in subretinal fluids and the greatest lesion diameter were significant independent factors that were predictive of improved VA at the final follow-up. Conclusions Three monthly injections of ranibizumab as an initial treatment could significantly improve VA in PCV patients in the short term. At 12 months postinjection, ranibizumab treatment could stabilize VA in most PCV patients. The baseline VA, the reduction in subretinal fluids and the greatest lesion diameter were predictive factors for the relative improvement of VA at the final follow-up.

Background At present, intraocular injection of anti-VEGF (vascular endothelial growth factor) drugs has replaced traditional laser therapy as the first-line treatment for DME (diabetic macular edema). However, ranibizumab, a commonly used anti-VEGF drug, is expensive and requires multiple intraocular injections. It places a heavy economic burden on patients with DME. Micropulse laser is safer than conventional laser and can reduce edema. Combined treatment with anti-VEGF may reduce the number of intraocular injections. This study will compare the efficacy of micropulse laser combined with ranibizumab treatment to ranibizumab monotherapy in the treatment of DME, providing a new regimen for future DME treatment. Methods This study is a prospective randomized double-blind controlled clinical trial (RCT) in patients with DME. After 1-year follow-up, visual acuity and macular edema regression will be compared between micropulse laser combined with ranibizumab group and ranibizumab monotherapy group to determine whether the efficacy of micropulse laser combined with ranibizumab treatment was not lower than that of ranibizumab monotherapy in the treatment of DME. Visual acuity measured by the ETDRS chart is the primary outcome measure. The secondary outcome measures are CMT (central macular thickness) measured by OCT (optical coherence tomography) and the number of injections of two groups. Changes in visual acuity and CMT of the two groups will be compared at 12-month follow-up. Before patients are recruited, we provide them with informed consent, in which we explain to them the purpose and process of the study. Discussion Micropulse laser combined with anti-VEGF drugs in the treatment of DME can reduce the number of intravitreal anti-VEGF injections, not only relieve the pain of the patients, but also ease the economic and psychological burden of patients, bringing great benefits. However, there is no treatment consensus for the parameters and specific methods of micropulse laser treatment for DME. There is a lack of clinical research data reference of micropulse laser combined with anti-VEGF therapy in clinical practice. This study intends to provide a new direction for clinical DME treatment and also provide a realistic consideration for the application of micropulse laser in DME treatment. Trial registration ClinicalTrials.gov NCT03690947. Registered on 1 October 2018.

PurposeA systematic review and meta-analysis was conducted to investigate changes in retinal and choroidal microvasculature in patients with multiple sclerosis (MS) using optical coherence tomography angiography (OCTA).MethodsPubMed and Google Scholar were searched for studies that compared retinal and choroidal microvasculature between MS and healthy controls (HC) with OCTA. MS patients were divided into 2 groups: MS with (MSON) or without optic neuritis (MSNON).ResultsTotally, 13 studies including 996 MS eyes and 847 HC eyes were included. Compared with the HC, the vessel density of the whole superficial vascular complex (SVC) was reduced by 2.27% and 4.30% in the MSNON and MSON groups, respectively. The peripapillary vessel density was 2.28% lower and 4.96% lower in the MSNON and MSON groups, respectively, than in the HC. Furthermore, the MSON group had significant lower vessel density of the SVC (mean difference [MD] = −2.17%, P &lt; 0.01) and lower peripapillary vessel density (MD = −2.02%, P = 0.02) than the MSNON group. No significant difference was found in the deep vascular complex or choriocapillaris densities among MSNON, MSON or HC groups (P &gt; 0.05). Meta-regression analyses suggested that illness duration and the Expanded Disability Status Scale scores of MS patients were possible sources of heterogeneity (P &lt; 0.05).ConclusionThe retinal SVC and peripapillary vessel density decreased significantly in MS eyes, especially in eyes with optic neuritis. Retinal microvasculature is a potential biomarker of disease progression in MS.