Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
Objective To summarize the available clinical evidence on the treatment of non-proliferative diabetic retinopathy (NPDR). Methods Based on the basic methods and principles of evidence-based medicine, we searched and evaluated the NPDR-related evidence from the Cochrane Library(Issue 3,2007), PubMed (1966 to June 2007) and CBM(1979 to June 2007) Results We finally identified 1 systematic review and 20 randomized controlled trials. Clinical evidence showed that critical glycemic control and blood pressure control were essential in the treatment of NPDR, which might delay the progression of retinopathy. The effectiveness of other therapeutic measures needed to be further investigated. Conclusion NPDR is the early stage of diabetic retinopathy (DR). Relevant systematic reviews and high-quality randomized controlled trials have confirmed the effectiveness of critical control of blood glucose and blood pressure for NPDR. The effectiveness of other therapeutic measures needs to be confirmed by systematic reviews of high quality and rigorously designed randomized, multi-center and large-scale trials.
目的:观察波及黄斑区的孔源性视网膜离术后各时期黄斑区相干光断层扫描图像特征及孔源性视网膜脱离患者眼轴长度与手术后视网膜下液吸收的关系,分析其与视力恢复过程的相关性。方法:对 53例(53眼)波及黄斑区的孔源性视网膜脱离经巩膜外加压术后视网膜复位的患者分别于术后1周、1月、3月、6月进行相干光断层扫描检查,观察黄斑区形态变化及黄斑区视网膜下液残留情况,并将检查结果与患者病程、眼轴长度以及手术后视力恢复情况等临床资料进行了对比分析。 结果:术后1周,所有病例均残留程度不等的视网膜下液,随着时间的延长,积液不断吸收。与之相对应,患者视力逐渐提高。术后3月,黄斑区视网膜下积液全部吸收累计33例, 其中眼轴长度大于26 mm患者视网膜下液吸收速度较慢,差异有统计学意义(P＜0.05)。术后6月,43例患者黄斑区视网膜下积液全部吸收,仍有 7例神经上皮浅脱离,3例局限性神经上皮脱离。术后6月时患者最佳矫正视力lt;0.05者7眼,005~03者17眼,≥0.3者29眼。结论:光学相断层扫描能从微观角度清晰地显示视网膜复位后黄斑区形态结构的变化。巩膜外加压术后视网膜复位的患者黄斑区仍残留少量的视网膜下积液,视网膜下积液的逐步吸收能较好地解释术后视力的恢复过程。眼轴长度大于26mm患者视网膜下液吸收速度较慢。
Objective To investigate the relationship between diabetic retinopathy (DR) and coronary atherosclerosis (CAS) in type 2 diabetes patients and other risk factors of DR. Methods A total of 118 patients of type 2 diabetes with DR (DR group), 120 patients of type 2 diabetes without DR matched in age and sex (non-DR group), and 86 normal controls (control group) were enrolled in this study. The body mass index (BMI), blood pressure (BP), fasting blood-glucose (FPG), glycosylated haemoglobin (HbA1C), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), creatinine, estimate glomerular filtration rate (eGFR) and urinary albumin excretion rate(UAER) in all the subjects were measured. Meanwhile, the incidence of CAS in the three groups was detected by 64slice multidetector computed tomography angiography (MDCTA). Assume concurrent DR as dependent variable, clinical indicators and laboratory parameters as independent variable, the risk factors were determined by Logistic regression analysis. In addition, CAS as dependent variable, DR as fixed factor, analysis of covariance was used to investigate the relationship between CAS and DR. Results The incidence of CAS in DR group was higher than that in nonDR group and control group, the differences were statistically significant (chi;2=26.9,35.5;P＜0.05). The results of Logistic regression analysis showed that systolic BP, BMI, CAS, myocardial infarction and UAER were key risk factors for DR ［odds ratio (OR)=1.02, 0.89, 4.50, 3.89, 1.34;P＜0.05］. There was a negative relationship between BMI and DR. The results of analysis of covariance showed that there was significant correlation between CAS and DR (OR=5.31, 95% confidence interval=2.62-10.60; P＜0.05). Conclusion CAS is independently associated with DR in type 2 diabetes patients. In addition, the other risk factors for DR include systolic BP, BMI, myocardial infarction and UAER.
Objective To compare the clinical results of yellow micro-pulse laser and traditional laser grid (MLG) photocoagulation for diabetic macular edema (DME). Methods Seventy-eight patients (106 eyes) with DME diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in this study. The patients were divided into micro-pulse group (39 patients, 51 eyes) and MLG group (39 patients, 55 eyes). The patients of micropulse group underwent 577 nm yellow micro-pulse laser therapy, while the patients of MLG group underwent continuous wavelength laser photocoagulation with a 561 nm yellow green laser. All the patients were examined documenting corrected visual acuity, macular retinal thickness (CMT) and mean sensitivity within macular 10 deg; examination before and after treatment. Six months after treatment was considered as the judgment time for the therapeutic effects. The mean corrected visual acuity, CMT and MS were comparatively analyzed. Results Six months after treatment, the mean corrected visual acuity of micropulse group and MLG group were 0.45plusmn;0.20 and 0.42plusmn;0.20, which increased significantly compared to those before treatment (t=3.404,2.316; P＜0.05). The difference of mean corrected visual acuity between before and after treatment of micro-pulse group and MLG group were 0.08plusmn;0.02 and 0.06plusmn;0.03, the difference was statistically significant between two groups (t=0.532, P＞0.05). The mean CMT of micropulse group and MLG group were (323.94plusmn;68.30) and (355.85plusmn;115.88) mu;m, which decreased significantly compared to those before treatment (t=4.028, 2.039; P＜0.05). The difference of mean CMT between before and after treatment of micro-pulse group and MLG group were (55.12plusmn;13.68) and (22.25plusmn;10.92) mu;m. The difference was not statistically significant between two groups (t=1.891,P＞0.05). The mean MS of micro-pulse group and MLG group were (6.63plusmn;2.65) and (4.53plusmn;1.81) dB. The mean MS of micro-pulse group increased significantly compared to that before treatment(t=3.335,P＜0.05). The mean MS of MLG group decreased significantly compared to that before treatment (t=3.589,P＜0.05). The difference of mean MS between before and after treatment of micro-pulse group and MLG group were (1.10plusmn;0.33) and (-0.91plusmn;0.25) dB.The difference was statistically significant between groups (t=4.872，P＜0.05). Conclusions In the treatment of DME, yellow micro-pulse laser therapy and MLG can improve visual acuity, and reduce CMT. In addition, yellow micro-pulse laser therapy can improve the MS, but MLG reduces MS.
The pathogenesis of diabetic retinopathy is complicated. The vast network of multiple factors including unifying mechanism, inflammatory reaction, neuron degeneration and metabolic memory of glucose, and the four established pathogenic molecular pathways are hotspots of mechanism research for diabetic retinopathy. Nevertheless, these researches may be only one corner of the ldquo;icebergrdquo; of DR mechanism, and we still face enormous challenges in DR mechanism research. Collaboration with multiple disciplines to study the relationship between DR and diabetes and other systemic diseases, search novel therapy targets may increase the result in an unexpected windfall for DR basic research.
Objective To observe the subfoveal choroidal thickness (SFCT) in eyes of patients with diabetic macular edema (DME). Methods Twenty patients (32 eyes) with DME were enrolled in this crosssectional observational study. The patients included 12 males and eight females, with a mean age of (47.3plusmn;10.2) years. All the patients were examined documenting best corrected visual acuity (BCVA), spectraldomain optical coherence tomography (OCT) and ophthalmological examination. According to OCT DME morphology, samples are divided into diffuse macular edema, cystoid macular edema, serous retinal detachment and hard exudate groups. The SFCT was measured by a Cirrus HD-OCT with enhanced depth imaging (EDI) and was compared with the average SFCT (286.84plusmn;28.80) mu;m of same age group. Correlation between SFCT and age, diopter, diabetic duration, fasting blood glucose, BCVA and central retinal thickness were analyzed by Pearson Analysis. SFCT of different DME types were analyzed by ANOVA Analysis. Results The mean SFCT of 32 eyes was (223.81plusmn;43.74) mu;m (ranging from 120.50 to 361.50 mu;m), which was lower by 63.03 mu;m (95% confidence interval, -78.80 to -47.26 mu;m, P＜0.01) from normal SFCT. SFCT was independent of age (r=0.124), diopter (r=0.277), diabetic duration (r=0.286), fasting blood glucose (r=0.408), BCVA (r=0.087), and central retinal thickness (r=0.036). There was no significant difference of SFCT between different DME types (F=0.042，P＞0.05). Conclusion SFCT is thinner in eyes with DME as compared to normal eyes of the same age.
Objective To observe the oxidative damage of mtDNA, apoptosis and expression of adhesion molecules in retinal capillary cells of diabetic rat with different disease courses. Methods One hundred Sprague-Dawley rats were randomly divided into the control group and the experimental group. The rats of experimental group were induced with streptozotocin (STZ) injection creating a diabetic model. Then they were divided into DR1m, DR2m DR3m group according to disease courses. The rats of control group were divided into NR1m, NR2m, NR3m group. Rat retinal capillaries were prepared, and then the contents of undamaged mtDNA were examined by Southern blot combined with Fpg. The expression of cyclooxygenase (COX)-1 encoded by mtDNA and transcription factors A (mtTFA) mRNA were detected by real-time quantitative polymerase chain reaction (RT-PCR). Apoptosis and expression of intercellular adhesion molecule-1 (ICAM-1) were detected by terminal dUT nick endlabeling (TUNEL) immuno-fluorescence and immunohistochemistry respectively. Results The contents of undamaged mtDNA in rats of DR1m, DR2m, DR3m were less than those of NR1m、NR2m、NR3m. The contents of undamaged mtDNA in diabetic rats decreased with the increase of disease courses. In addition, the mRNA levels of COX-1 and mtTFA were downregulated in diabetic rats. The positive cells of TUNEL and ICAM-1TUNEL and ICAM-1 in diabetic rats increased with the increase of disease courses. Conclusion With the increase of disease courses, mtDNA damage and apoptotic cells are increased, while the expression of mRNA encoded by mtDNA and ICAM-1 decreased in retinal capillary cells in diabetic rats.
Objective To investigate the relationship of macular microstructure and visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage. Methods Fifty-three patients (53 eyes) with diabetic vitreous hemorrhage who underwent microinvasive vitrectomy were enrolled in this retrospective study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. The central foveal thicknesses (CFT) were measured after surgery by spectral domainoptical coherence tomography (SD-OCT). The median follow-up time was (12.81plusmn;8.22) months, ranging from six to 36 months. According to the results of SD-OCT at last follow-up time, macular edema (ME), epiretinal membrane (ERM), interrupted inside and outside section (IS/OS) and interrupted external limiting membrane (ELM) were macular abnormalities were observed. The preoperative and postoperative BCVA of different macular abnormalities were comparatively analyzed. The correlation between BCVA and macular microstructure were analyzed. Results The CFT was ranged from 103.00 mu;m to 498.00 mu;m,with the mean of（251.12plusmn;90.23） mu;m. Macular abnormalities were observed in 37 eyes (69.8%), and normal macula in 16 eyes (30.2%). Among 37 eyes with macular abnormalities, there were 20 eyes (37.7%) with ME, 12 eyes (22.6%) with ERM, 33 eyes (62.3%) with interrupted IS/OS, and 20 eyes (37.7%) with interrupted ELM. The BCVA of ME eyes decreased significantly than that in nonME eyes （t=-2.09，P＜0.05). The difference of BCVA in ERM and nonERM eyes was not statistically significant (t=-1.10,P＞0.05). The BCVA of interrupted IS/OS eyes decreased significantly more than that in continuous IS/OS eyes （t=-4.33,P＜0.05). The BCVA of interrupted ELM eyes decreased significantly more than that in continuous ELM eyes (t=-2.58, P＜0.05). The postoperative BCVA correlated positively with integrity of the IS/OS junction, CFT, and whether ME or not (r=7.65, 8.21, 4.99; P＜0.05), but insignificantly associated with integrity of the ELM and whether ERM or not (r=0.01, 0.82; P＞0.05). Conclusion The final visual acuity of patients with diabetic vitreous hemorrhage after micro-invasive vitrectomy is related to the CFT，the status of IS/OS junction, whether ME or not, but not related to integrity of the ELM or whether ERM or not.
Objective To observe the effect of resveratrol on retinal vasculopathy in diabetic rats. Methods Forty-five Sprague-Dawley male rats were randomly divided into the resveratrol group, treatment control group and the normal control group, 15 rats in each group. Diabetic rat models were induced with streptozotocin injection in resveratrol group and treatment control group. The same volume of sterile saline solution was injected into the rats of the normal control group. The rats of resveratrol group and treatment control group were feed with highfat diet. The rats of resveratrol group received oral gavage of resveratrol (75 mg/kg) twice a day for four months. The same volume of sterile saline solution was given by gavage in rats of treatment control group twice a day for four months. 2 ml femoral vein blood and 50 mu;l aqueous fluid of anterior chamber of the eye from rats of three groups were collected to detect fasting blood glucose, aqueous fluid glucose, cholesterol and triglyceride. The retinal vascular permeability was test by labeling with evans blue. Whole retina was isolated to detect the pericyte number. Total protein was extracted from retina to test the level of vascular endothelial growth factor (VEGF). Results The fasting blood glucose, aqueous fluid glucose, cholesterol and triglyceride in treatment control group were higher than those in normal control group, also higher than those in resveratrol group except cholesterol. The differences among the three groups were statistically significant (F=152.809, 65.230, 3.861, 15.059; P＜0.05). The retinal vascular permeability in treatment control group was higher than that in normal control group, while it in resveratrol group was lower than that in treatment control group. The differences among the three groups was statistically significant (F=11.626,P＜0.05). The pericyte number in treatment control group decreased as compared to normal control group, while it in resveratrol group increased as compared to treatment control group. The differences among the three groups was statistically significant (F=43.284, P＜0.05). The VEGF expression in treatment control group increased as compared to normal control group, while it in resveratrol group decreased as compared to treatment control group. The differences among the three groups was statistically significant (F=14.017, P＜0.05). Conclusion Resveratrol can improve abnormal retinal vasculopathy structure and function, down-regulated level of fasting blood glucose, aqueous fluid glucose, triglyceride and VEGF may be the mechanism.