| Part one Clinical Research To evaluate the relationship between the function and morphology of macular edema secondary to branch retinal vein occlusion by MAIA microperimetry and OCTObjective:To evaluate the correlation between visual function parameters and morphological parameters in BRVO.Method:Cross-sectional study.Patients with macular edema secondary to BRVO were enrolled from July 2016 to July 2018.All eyes were measured with the international standard Snellen E letter chart to measure the best corrected visual acuity(BCVA).And it was converted to the logarithm of the minimum angle of resolution(LogMAR)vision acuity when statistical analysis processing.Zeiss Cirrus HD-OCT 4000 was used to measure the CMT and CRV,and to identify the morphological features of the outer membrane(ELM),ellipsoidal zone(EZ),serous retinal detachment(SRD),and foveal bulge.The MAIA microperimetry was used to measure macular average threshold(AT),macular integrity index(MI),percentage of fixation point in the 1°radius range(PI),percentage of fixation point in the 2°radius range(P2),63%of the bivariate contour ellipse area(63%BCEA),and 95%of bivariate contour ellipse area(95%BCEA).Pearson correlation or Spearman correlation analysis was used to analyze the correlation among LogMAR BCVA,morphological parameters measured by OCT,and functional indicators measured by MAIA microperimetry.The correlation among age,duration of disease,the continuity of ELM,EZ,the existence of SRD,bulge and LogMAR BCVA,CMT,CRV and AT.LogMAR BCVA and AT,CMT,CRV related factors were analyzed by multiple linear regression analysis.The characteristics of functional change of each sector were measured by MAIA microperimetry.Results:Fifty-six patients with clinically diagnosed of BRVO were enrolled in the study,including 42 cases of supratemporal branch retinal vein occlusion and 14 cases of infratemporal branch retinal vein occlusion.There were 23 eyes in 23 males and 33 eyes in 33 females.The age was 56.6±12.8 years old.LogMAR BCVA was positively correlated with CMT(r=0.427,P=0.001),MI(r=0.276,P=0.040),63%BCEA(r=0.544,P<0.001),95%BCEA(r=0.544,P<0.001);and was negatively correlated with AT(r=-0.602,P<0.001),P1(r=-0.539,P<0.001),and P2(r=-0.484,P<0.001).CMT was negatively correlated with P1(r=-0.372,P=0.005)and P2(r=-0.345,P=0.009),and was positively correlated with 63%BCEA(r=0.346,P=0.009),95%BCEA(r=0.348.P=0.009).CRV was positively correlated with AT(r=0.349,P=0.008).AT was negatively correlated with MI(r=-0.641,P<0.001)、63%BCEA(r=-0.517,P<0.001),95%BCEA(r=-0.513,P<0.001),and was positively correlated with P1(r=0.477,P=0.000),P2(r=0.491,P=0.000).The different condition of continuity of ELM and EZ and the presence of SRD and bulge showed statistical difference of LogMAR BCVA,AT,CMT(P<0.05).LogMAR BCVA,AT,and CMT over 50 years old or under 50 years old did not show statistical difference(P>0.05).And the comparison of LogMAR BCVA and CMT divided by duration of disease above 2 months or below showed statistical difference(P<0.05).However,the comparison of AT,was not statistically significant(P>0.05).Multiple linear regression model showed that AT had linear correlation with LogMAR BCVA rather than CMT or CRV.Sector analysis results of microperimetry showed that the sensitivity of the retina above the supralateral retinal branch vein occlusion was worst,the center and the temporal side were second worst,the nasal side was third,the lower part was the most sensitive,while the infratemporal branch retinal vein occlusion was opposite,the sensitivity of the lower retina was the worst,the center and the temporal side were the second worst,the nasal side was third,the upper retina was the most sensitive.Conclusion:Microperimetry and OCT are complementary in the evaluation of ME secondary to BRVO.Microperimetry can analyze visual function comprehensively from both retinal sensitivity and fixation stability.It has great advantage in evaluation of macular disease and can be used as a good visual function evaluation index for ME secondary to BRVO.Part Two Clinical Research Clinical study of Qu Ji Tong Luo Formula combined with anti-VEGF in the treatment of branch retinal vein occlusionObjective:To evaluate the clinical efficacy of Qu Ji Tong Luo formula combined with anti-VEGF therapy in the treatment of branch retinal vein occlusion,and to provide scientific evidence for the clinical application of this Chinese medicine.Methods:Prospective,randomized,controlled clinical trials.From July 2016 to July 2018,60 patients with pattern of phlegm and blood stasis,syndrome of internal stagnation of fluid-dampness with retinal branch vein occlusion,and macular foveal thickness over 250μm diagnosed in Eye Hospital of China Academy of Chinese Medical Sciences.According to random number table method,subjects were randomly divided into control group and experimental group.In the control group,30 eyes of 30 patients were given intravitreal injection of Conbercept 0.5mg/0.05ml.The 1+PRN regimen was used,that is,1 injection loading was given first,then more injections were performed if needed,for 6 months.30 eyes of 30 patients in the experimental group were treated with oral Chinese herbal decoction combined with other therapy of control group for 3 months and observed for 6 months.The basic composition of traditional Chinese medicine was:peach kernel 10g,safflower 5g,unprocessed rehmannia root 20g,angelica 10g,endothelium corneum gigeriae galli 10g,prepared pinellia tuber 10g,dried tangerine peel 8g,poria 15g,notoginseng powder 3g,divaricate saposhnikovia 5g.Syndrome differentiation of modified treatment is considered when used.The examination was performed at baseline,1 week,1 month,and 3 months after treatment.It included visual acuity,slit lamp examination,color fundus photography,OCT,microperimetry.And fluorescein angiography was performed at baseline and 3 months after treatment.The number of injections was recorded at the 6th month after treatment.Results:LogMAR BCVA,CMT,AT,PI,P2,63%BCEA,and 95%BCEA were improved in the experimental group at 1 week and 1 month after surgery compared with baseline,and there was significant statistical difference(P<0.05).No improvement was observed about MI compared with baseline,and there was no statistical difference(P>0.05).LogMAR BCVA,CMT,MI,AT,P1,P2,63% BCEA and 95%BCEA were improved in the experimental group at 3 months after surgery compared with baseline.There was significant statistical difference(P<0.05).In the control group,LogMAR BCVA,CMT,AT,P1,P2,63%BCEA,and 95%BCEA were improved compared with baseline,and there was significant statistical difference(P<0.05).MI did not improve by therapy for no statistical difference(P>0.05).LogMAR BCVA,CMT,MI,AT,P1,63%BCEA and 95%BCEA were improved compared with baseline one month after operation,with significant statistical difference(P<0.05),P2 was no improvement compared with baseline for no statistical difference(P>0.05).LogMAR BCVA,CMT,AT and 63%BCEA were significantly improved compared with baseline.There were statistical differences(P<0.05).MI,P1,P2,95%BCEA did not improve by therapy for no statistical difference(P>0.05).There was no significant difference between the experimental group and the control group at 1 week after operation and the baseline(P>0.05).The difference between the experimental group and the control group in the first month after operation was compared with their baseline parameters.There was significant difference in CMT(P<0.05),but there was no significant difference between the other parameters(P>0.05).The difference between the parameters of the experimental group and the control group at 3 months was compared with the baseline.CMT and AT had statistical difference(P<0.05),but the other parameters were not statistically different(P>0.05).Conclusion:Both the Qu Ji Tong Luo formula combined with anti-VEGF drugs and anti-VEGF drugs singly can reduce the CMT of patients with branch retinal vein occlusion and improve the visual function of patients.The combination of Qu Ji Tong Luo formula with anti-VEGF drugs can reduce CMT of BRVO and improving visual function better than anti-VEGF drug singly. |
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