The concept of treatment of central serous chorioretinopathy (CSC) has evolved dramatically with the understanding of its pathogenesis recently. Initial clinical studies found that CSC is a selflimiting disease, therefore advocated observation or conservative treatment was recommended. Further study by fundus fluorescein angiography indicated that CSC results from barrier dysfunction of retinal pigment epithelium (RPE), which leads to serous RPE and (or) neural retinal detachment; so laser photocoagulation to close RPE leakage points by its thermal effects became a strategy to treat CSC. Recent study by indocyanine green angiography revealed that increased choroidal vascular permeability can induce high hydrostatic pressure and focal RPE detachment, resulting in mechanical breakage of RPE barrier. This is likely the major pathological basis of CSC now. Photodynamic therapy (PDT) can embolize of choroidal capillary network, thereby preventing choroidal leakage caused by increased capillary permeability, and thus cure the CSC. However the search for the pathogenesis and better treatment of CSC is far from over. Further investigation about pathogenesis and improvement of diagnosis and treatment is an urgent need for clinic work, but also major issues challenging the wisdom of an ophthalmologist. We need to work together to promote more and better clinical and basic research of CSC.
Multicenter randomized controlled studies can recruit more subjects in a relatively short period of time, avoiding the bias of single research institution studies, resulting in reliable conclusions and providing strong guidance to clinical practice. They are the most scientific and most reliable methods to evaluate clinical researches. However, there are few multicenter clinical trials in China as Chinese doctors are often trapped in difficulties in clinical research, including imperfect research system, lack of experience, capital investment deficient, the tension in the doctor-patient relationship and so on. Although the above problems are related to medical system architecture of our country in a certain extent, compared with the overseas, we also have our own advantages, such as resource of our patients, doctors, and diseases type. Pay attention to discovering of new type of diseases, looking for genetics discipline, and exploring new medical technology is an important task of clinical research. We have plenty of high level ophthalmology centers at present, which provide favorable conditions for launching multi-center clinical trial studies. We have good reasons to believe that, if we can effectively exploit the resources in our hands, carefully observe and discover clinical problems, there will be more convincing clinical results present in the world after bring up hypothesis boldly while prove it conscientiously and carefully.
The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.
The etiology of intraocular inflammatory disease and its diagnosis is complicated. Currently available and newly emerging systemic and ocular examinations are of important to determine etiology of intraocular inflammatory disorders. But there also exists multiple misunderstanding, and the strategy of their application is not well defined, or even exaggerated. Unprincipled or randomly selection of auxiliary examination would not help for etiology determination, but bring unnecessary pain and economic burden to patients. Establishment of diagnosis thinking of intraocular inflammatory disease is helpful to standardize the diagnosis process of the disease, improve the diagnostic efficiency, and relief patients from the pain and financial burden that caused by too many useless examinations.
Objective To observe the relationship between endothelial constitutive nitric oxide synthase (ecNOS) genetic polymorphism and diabetic retinopathy（DR）of non insulindependent diabetes mellitus (NIDDM) patients of the Han nationality.Methods A total of 166 patients who clinical diagnosed with NIDDM as case group, 85 cases of patients (cataract or fracture) and healthy subjects without diabetes, hypertension and kidney disease,over 40 years old of age and without consanguinity between each other were selected as normal control group. Case group were divided into non-DR (NDR) group, nonproliferative-DR (BDR) group and proliferativeDR (PDR) group according to the result of fundus fluorescein angiography. Case group and normal control group subjects all were Han nationality. DNA was extracted from peripheral venous blood; the fourth 27 base pairs (bp) repeat polymorphism of ecNOS gene by was measured by polymerase chain reaction (PCR). Results The 27 bp repeat sequences within the ecNOS gene present in the Han nationality,allele b repeat 5 times, alleles a repeat 4 times. PCR results showed that there are 2 alleles and 3 genotypes in normal control, NDR, BDR and PDR group. The frequency of genotype bb、ab、aa were 80%, 16.5%, 3.5% in normal subjects; 77.2％, 13.9%, 8.9％ in NDR group; 80.5％, 17.1%,2.4％ in BDR group;78.3％, 13%, 8.7％ in PDR group,respectively. The allele frequency (chi;2 =1.841) and gene frequency (chi;2=3.847) were not statistically significant (P＞0.5) in normal control,NDR,BDR and PDR group. Logistic regression analysis showed that there is no relation between DR and ecNOS duplicated gene polymorphism. Conclusions There is 27 bp repeated polymorphism in 4th intron of ecNOS gene, which may not be associated with the DR of NIDDM in the Han nationality.
Objective To detect the variation rule of different cellular components, extracellular matrix, matrix-metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases（TIMPs）in proliferative membranes in proliferative vitreoretinopathy (PVR) with different courses of disease, and to investigate the remodeling mechanism of PVR. Methods Sixteen surgically excised specimens of proliferative membranes from patients with rhegmatogenous retinal detachment combined with PVR with the course of disease of 2 months to 8 years were selected. The different cellular component of retinal pigment epithelial (RPE) cells and glial cells, component of extracellular matrix including fibronectin, laminin，and collagen types Ⅰ to Ⅳ, and matrix metalloproteinases (MMP2, MMP9) and TIMP1 in proliferative membrane were labeled by immunohistochemical method. The variati on of those labeled components in proliferative membrane in PVR duration and the correlation between these components and the course of PVR were analyzed. Results As the duration of PVR increased,the expression of RPE cells, fibronectin and MMP2 decreased (Plt;0.05）,while glial cells,collagen type Ⅰ and Ⅲ increased (Plt;0.05）.The positive staining of laminin and collagen type Ⅱ and Ⅳ were found, but the association with PVR duration was not detected. A negative correlation between PVR duration and RPE cells, MMP2, and fibronectin respectively and a positive correlation between PVR duration and glial cells, collagen Ⅰand Ⅲ respectively were detected. MMP2 positively related with variation of fibronect in. Positive staining of MMP9 and TIMP1 was recorded but did not change with the variation of the disease course. Conclusion During the formation and development of proliferative membrane in PVR, RPE cells, glial cells, fibronectin, collagen type Ⅰand Ⅲ and MMP2 take part in the remodeling of proliferative membrane. (Chin J Ocul Fungdus Dis, 2006, 22:308-312)
ObjectiveTo evaluate the potential risk factors with incidence and degree of retinopathy of prematurity (ROP) in infants with very low birth weight.MethodsThe clinical data of 130 premature infants with birth weight ≤1500 g recorded in Peking University People′s Hospital from July 2002 to April 2004 were retrospectively analyzed.ResultsThere were 60 infants in ROP group and 70 infants in control group. The mean birth weight and gestational age was (1256.3±196.8) g and (29.583 3±1.543 6) weeks in ROP group, and (1337.8±146) g and (31.217 4±2.430 6) weeks in control group, respectively. In 39 ecdemic infants, 32 were found with ROP (82.1%, 1 with mild and 31 with severe ROP) while in 91 local infants, 28 were found with ROP (30.8%, 15 with mild and 13 with severe ROP). The time of the first examination in infants with mild ROP was (36.062 5±2.909 0) weeks, which was significantly earlier than (59.477 3±33.604 0) weeks in the ones with severe ROP. The time of the first examination and surgery was earlier in non vitrectomy group than in nonvitrectomy group.ConclusionLow birth weight is the high risk factor in ROP. Incidence of ROP is higher in ecdemic infants. The severity of ROP correlates with time of first examination, and the way of surgery is relative to time of the first examination and surgery.(Chin J Ocul Fundus Dis,2005,21:275-277)
ObjectiveTo seek the evidencebased medicine (EBM) evidences of curative effects of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsAll articles of intravitreous injection TA for macular edema published in English or Chinese were picked up from databases of MEDLINE and CNKI and then evaluated according to EBM standard. The data in accord with research standard were selected by using excluding and including criteria, and classified according to the appraisal standard of clinical therapeutic documents. ResultsIn the selected papers, none in gradeⅠevidence; 1 in gradeⅡevidence; 7 in grade Ⅲ evidence; 24 in grade Ⅳ evidence; and 19 in gradeⅤevidence. Forty-two papers reported that intravitreous injection with TA had significant effect for macular edema within 3 months, and the improvement of visual acuity was recorded in these papers. Regression of macular edema was recorded in 23 papers. Among 20 papers, side-effect was found in 93 eyes (31.41%) and the serious sideeffect in 4 eyes (1.35%).ConclusionsIntravitreous injection with TA has some curative effects for macular edema in short term, but the quality of current study has not been encouraging. There are no grade I document and lack of the study of validity in long term and essentiality and validity of retreatment. The special attention should be payed on the increasing persistency of efficacy and preventing the serious side-effects in the future investigation.(Chin J Ocul Fundus Dis, 2005,21:220-223)