The intervention therapy targeting vascular endothelial growth factor (VEGF) has become a specific and effective method for the treatment of diabetic retinopathy (DR). However, some patients did not respond or responded poorly to anti-VEGF therapy, and its effects of eliminating edema and improving vision appear to be unstable in the same patient. Hypoxia-inducible factor-1α (HIF-1α), an important upstream transcriptional regulator of VEGF, is an oxygen concentration-sensitive protein expressed in tissues under hypoxia. It can simultaneously target many downstream target genes except VEGF, such as placental growth factor and angiopoietin-like protein 4, to cause blood-retinal barrier damage and neovascularization, and thus participate in various pathological changes of DR to promote the occurrence and development of DR. Therefore, direct intervention of HIF-1α or targeting one or more downstream target genes regulated by HIF-1α to treat DR may have better efficacy. In the future, the development of effective and safe HIF inhibitors or anti-VEGF with HIF-1α other target gene inhibitors may have broader clinical application prospects.
Diabetic retinopathy (DR) is one of the most common causes of visual impairment and blindness in diabetic patients. It is particularly important to set up simpler, safer, non-invasive and highly effective methods for diagnosis as well as monitoring DR. A variety of new fundus imaging techniques show great advantages in early diagnosis, treatment and monitoring of DR in recent years. The main characteristics of wide-field scanning laser imaging system is achieving a large range of retinal image in a single photograph and without mydriasis. It provides several options for color images, FFA and FAF, which satisfy to detect the retina, choroid and vascular structure. Multi spectral fundus imaging system is suitable for DR screening, because it is able to recognize the typical characteristics of DR, such as microaneurysms, hemorrhage and exudation, and is non-invasive and convenient. OCT angiography is a quantitative examination that provides foveal avascular zone area, macular blood flow density, which provides strong evidence for DR diagnosis. The improvement of these new techniques will help us to build up a personalized evaluation system of DR.
Objective To learn the prevalence and risk factors of diabetic retinopathy (DR) of provincial civil servants (more than 40 years old) in Guangdong, China. Methods Total of 3844 Guangdong provincial civil servants over 40 years old were enrolled in this study. All participants diagnosed with diabetes underwent a complete ophthalmologic examination, including stereoscopic fundus photography and optical coherence tomography. Photographs were graded in a masked manner to assess the presence and severity of DR and diabetic macular edema (DME). Results Of 3844 civil servants, DM was confirmed in 155 patients, the prevalence was 4.03%. Of 155 DM patients, DR was in 11 patients, the DR prevalence was 7.10%. There were statistically differences on the fasting blood glucose (FBG), total cholesterol, low density lipoprotein and whether or not to use insulin between DR group and non DR group (t=3.158, 2.200, 2.050;chi;2=5.128; P＜0.05). High-FBG values, high blood lipids, INS applications had accelerated the occurrence and development of DR. The high FBG and the insulin using were the independent risk factors of DR. Conclusions DR prevalence is 7.10% in Guangdong provincial civil servants more than 40 years old. The high FBG and the insulin using are the independent risk factors of DR.
Objective To observe the expression of programed death-1 (PD-1) and its ligands including PD-L1 and PD-L in peripheral blood mono-nuclear cells (PBMCs) of patients with diabetic retinopathy (DR) patients. Methods Forty patients with DR (DR group) and 20 healthy controls (control group) were included in this study. There were 20 patients with non-proliferative DR (NPDR) and 20 patients with proliferative DR (PDR). Peripheral Blood samples were obtained from two groups. Real time polymerase chain reaction (RT-PCR) was used to analyze PD-1, PD-L1, and PD-L2 mRNA expression in PBMCs. The clinical data was analyzed in DR group and controls, also in PDR group and NPDR group. Results The results of RT-PCR showed that the expression of PD-1 and PD-L1 mRNA in DR group were significantly lower than those in the control group (t=-2.060, -2.562; P=0.043, 0.013). There was no significant difference in PD-L2 mRNA expression between DR and control group (t=-0.857，P=0.395). Compared with the NPDR group, the lower expression level of PD-1 mRNA and higher expression level of PD-L1 and PD-L2 mRNA in PDR group were observed, but the differences were not statistically significant (t=-1.335, 0.987, 0.131; P=0.190, 0.334, 0.897). Conclusion PD-1 and PD-L1 mRNA expression in PBMCs of DR patients is decreased compared with controls, but there are no differences in PD-L2 mRNA expression in them.
ObjectiveTo investigate the risk factors for neovascular glaucoma (NVG) after vitrectomy in proliferative diabetic retinopathy (PDR) patients. MethodsThree hundred and one patients (301 eyes) with PDR who underwent vitrectomy between January 2008 and December 2013 in our hospital were retrospectively evaluated. Risk factors for NVG after vitrectomy were identified by multivariate Logistic regression analysis. ResultsTwelve of 301 patients (4.0%) developed postoperative NVG in 2 to 18 months after vitrectomy. The incidence of postoperative NVG peaked in 2 to 6 months after vitrectomy (7 eyes, 58.3%). Logistic regression analysis showed that postoperative retinal detachment was a significant risk factor for postoperative NVG in eyes with PDR (P < 0.001). Eyes with postoperative retinal detachment were more likely to develop NVG after vitrectomy than those without postoperative retinal detachment (OR=17.826). Gender, age, duration of diabetes, preoperative serum creatinine levels, glycated hemoglobin levels, preoperative intraocular pressure, preoperative lens status, combined phacoemulsification surgery and tamponade were not associated with postoperative NVG (P > 0.05). ConclusionPostoperative retinal detachment is a major risk factor for NVG after vitrectomy in PDR.