ObjectiveTo compare the outcomes of 23G and 25G plus (25G+) vitrectomy in treatment of proliferative diabetic retinopathy (PDR). MethodsThis is a prospective randomized study. Fifty-seven PDR patients (75 eyes) with symptoms requiring vitrectomy were randomly divided into 23G vitrectomy group (30 patients, 39 eyes) and 25G+ vitrectomy group (27 patients, 36 eyes). Visual acuity, intraocular pressures, ophthalmoscopy, B-scan ultrasound was examined before surgery. The follow-up period was 10.0 (23G group) and 8.5 months (25G+ group) respectively. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications and postoperative ocular conditions were analyzed. ResultsThe mean surgical times were (53.35±7.42) minutes and (49.16±5.17) minutes in 23G and 25G+ group respectively, and the difference was significant (t=4.37, P < 0.05). Iatrogenic injuries occurred in 11 eyes (28.21%) and 5 (13.89%) eyes in 23G and 25G+ group respectively, and the difference was significant (χ2=4.93, P < 0.05). The postoperative visual acuity of 23G and 25G+ group were improved compared to before surgery (χ2=16.81, 18.29; P < 0.05). At last follow-up, there was 25 eyes and 24 eyes with visual acuity≥0.05 in 23G and 25G+ groups respectively, and the difference was not significant (χ2=0.13, P > 0.05). Hypotony was detected in 7 and 3 eyes at the third postoperative day in 23G and 25G+ group respectively, and the difference was significant (χ2=5.67, P < 0.05). Conclusion25G+ vitrectomy is a safe and effective treatment for PDR with shorter surgery time and fewer surgical complications.
ObjectiveTo evaluate the efficacy and safety of intravitreal ranibizumab (IVR) for the treatment of retinopathy of prematurity(ROP). MethodsA total of 57 eyes of 29 premature infants with diagnosis of high-risk pre-threshold, threshold ROP, or aggressive posterior ROP were reviewed and analyzed in the study. The lesions of 18 eyes were located in zoneⅠ, 39 eyes were located in zoneⅡ. All infants in the study received IVR (10 mg/ml, 0.025 ml) as the initial treatment within 24 hours after diagnosis. Follow-up examinations were performed after treatment, every week at the first month, every 2 weeks at the second and third month, every month afterward, until vascularization of zoneⅢwas observed. Follow-up ranged from 16 weeks to 52 weeks, and the average follow-up time was (28.1±11.7) weeks. If the infants didn't respond positively to the treatment or the disease recurred, the additional treatments were applied. 36 eyes (63.2%) received a single injection, whereas 21 eyes (36.8%) received additional treatments. The follow-up examinations included the development of retinal vessels, the ocular or systemic adverse events. ResultsAmong the eyes, the development of peripheral retinal vessels could be observed in 36 eyes (63.2%) which received a single injection; clinical improvement in 11 eye (19.3%) which received repeat injection; stable disease in 10 eyes (17.5%) which received laser therapy. Among the eyes, 18 eyes (31.6%) recurred, including ggressive posterior ROP (14 eyes), threshold ROP (2 eyes) and high-risk pre-threshold ROP (2 eyes). The mean time of recurrence was (5.7±2.1) weeks (range 2.0-8.0 weeks). Three eyes (5.3%) of high-risk pre-threshold, threshold ROP lacked a positive response to the treatment. The lesions were controlled after additional laser given in these eyes. No serious ocular or systemic adverse events associated with the drug or the injection was observed during the follow-up period. ConclusionIVR is safe and effective for most ROP infants. In cases of recurrence or no response, conventional laser treatment or an additional IVR injection were needed.
Ultra-wide-field fluorescein angiography (UWFA) can obtain very wide retinal images (up to 200°), and is a very helpful tool to detect peripheral retinal lesions which cannot be found by other imaging methods. Analyzing the characteristics of the UWFA images may improve our understanding, treatment outcomes and management strategies of ocular fundus diseases. However this technology is still in its premature stage, there is still a lot of work to be done to improve its clinical application and study the characteristics and clinical meanings of these peripheral retinal lesions.
ObjectiveTo observe the clinical efficiency of intravitreal Conbercept on exudative age-related macular degeneration (eAMD). MethodsThis is an open and prospective study without control trial. Twenty eyes from 20 patients (19 males and 1 female) with eAMD diagnosed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were enrolled in this study. Before the injection, best-corrected visual acuity (BCVA) of early treatment of diabetic retinopathy study (ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, fundus fluorescein angiograph (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were examined. The initial average letters of ETDRS acuity were 41.20±22.61, range from 8 to 80. The initial average central retina thickness (CRT) was (345.25±131.96) μm, range from 152 to 770 μm.All affected eyes were treated with intravitreal conbercept 0.05 ml (10 mg/ml). The patients were followed up for 6 to 9 months, with the mean time of (7.35±0.99) months.The BCVA, CRT after treatment were compared with baseline using paired t-test. ResultsDuring the 1, 3, 6, 12 months after treatment and the latest follow up, the mean BCVA were all improved with statistically significant difference (t=5.85, 7.09, 7.44, 7.25; P < 0.05). At 1 month ater treatment, the mean BCVA was obviously improved in 6 eyes (30%), improved in 8 eyes (40%), stable in 6 eyes (30%). At latest follow up, the mean BCVA was obviously improved in 6 eyes (30%), improved in 9 eyes (45%), stable in 5 eyes (25%). During the 1, 3, 6, 12 months after treatment and the latest follow up, the mean CRT were all decreased with statistically significant difference (t=3.34, 3.78, 3.47, 3.44; P < 0.05). At latest follow up, the leakage in macula lutea disappeared in 6 eyes (30%), decreased in 11 eyes (55%) and increased in 3 eyes (15%). No adverse events such as secondary retinal detachment or endoophthalmitis were found during the follow-up duration. ConclusionIntravitreal conbercept is a safe and effective approach for eAMD, may improve visual acuity, exudation and macular edema.
ObjectiveTo observe the changes of eotaxin-1(CCL11), eotaxin-2(CCL24)and eotaxin-3(CCL26)in ranibizumab treated light-injured human retinal pigment epithelium (RPE) cells ARPE-19 and investigate the effects of vascular endothelial growth factor (VEGF) antagonist to the expressions of eotaxins. MethodsCultured human RPE cells(8th-12th generations)were divided into light-injured group, ranibizumab treated group and normal control group. Cells of the three groups were exposed to the blue light at the intensity of(600±100) Lux for 12 h to establish the light injured model, while cell culture dishes of the normal control group were wrapped with double-layer foil. The cells of ranibizumab treated group were treated with VEGF-A antagonist(ranibizumab)at the final concentration of 0.125 mg/ml for 24 hours directly after the illumination. The mRNA and protein of VEGF-A, eotaxin-1, eotaxin-2, eotaxin-3, NF-κB were determined by Real time-PCR, enzyme-linked immunosorbent assay, Western blot, immunohistochemical staining at 0, 3, 6, 12, 24 hours after light damage. ResultsThe mRNA and protein level of VEGF-A, eotaxin-1, eotaxin-2, eotaxin-3, NF-κB in the light-injuried group increased significantly compared to that in normal control group (P < 0.05). After treating with ranibizumab, the expression of eotaxin-1, eotaxin-2, eotaxin-3, NF-κB were significantly suppressed (P < 0.05). ConclusionThe suppression of over-expression of VEGF in human RPE may down-regulate the expression of eotaxins, via the suppression of NF-κB.
ObjectiveTo study changes in choroidal thickness(CT) with intravitreal injections of ranibizumab treatment. MethodsThis is a prospective, uncontrolled, open-label study. A total of 31 eyes of 31 patients diagnosed with wet age-related macular degeneration (AMD) and 33 eyes of 33 patients diagnosed with choroidal neovascularization (CNV) secondary to pathological myopia (PM) were included in the study. All affected eyes were treated with intravitreal ranibizumab 0.05 ml (10 mg/ml) and followed up monthly until 6 months. Enhanced depth imaging on Cirrus spectral-domain optical coherence tomography was used to measure the CT. The initial CT was compared with the data at 1, 3 and 6 month after treatment, and the correlation between of the decrease of CT at the 6 month and the number of injection times was analyzed. ResultsIn AMD group, the average CT respectively decreased by (9.68±11.02), (12.58±11.04), (13.84±11.67)μm at 1, 3 and 6 month, and the differences were significant(t=4.89, 6.34, 6.60;P < 0.001). In PM group, the average CT respectively decreased by (2.06±10.92), (3.64±8.78), (3.27±7.20)μm at 1, 3 and 6 month. The difference at 1 month was not significant (t=1.08, P=0.287). While after 3 months and 6 months, the differences were significant(t=2.38, 2.61;P=0.024, 0.014). The injection times were not correlated with the CT decreases at 6 month in both groups(r=0.04, 0.30;P=0.815, 0.099). ConclusionIntravitreal injections of ranibizumab can induce choroidal thickness reduction for wet age-related macular degeneration and choroidal neovascularization secondary to pathologic myopia.
ObjectiveTo observe the influence of down-regulation of HtrA1 expression by small interfering RNA on light-injured human retinal pigment epithelium (RPE) cells. MethodsCultured human RPE cells(8th-12th generations)were exposed to the blue light at the intensity of (2000±500) Lux for 6 hours to establish the light injured model. Light injured cells were divided into HtrA1 siRNA group, negative control group and blank control group. HtrA1 siRNA group and negative control group were transfected with HtrA1 siRNA and control siRNA respectively. The proliferation of cells was assayed by CCK-8 method. Transwell test was used to detect the invasion ability of these three groups. Flow cytometry was used to detect the cell cycle and apoptosis. The expression of HtrA1 and vascular endothelial growth factor (VEGF)-A was detected by real time-polymerase chain reaction and Western blot respectively. ResultsThe mRNA and protein level of HtrA1 in the light injured cells increased significantly compared to that in normal RPE cells (t=17.62, 15.09; P<0.05). Compared with negative control group and blank control group, the knockdown of HtrA1 in HtrA1 siRNA group was associated with reduced cellular proliferation (t=6.37, 4.52), migration (t=9.56, 12.13), apoptosis (t=23.37, 29.08) and decreased mRNA (t=17.36, 11.32, 7.29, 4.05) and protein levels (t=12.02, 15.28, 4.98, 6.24) of HtrA1 and VEGF-A. Cells of HtrA1 siRNA group mainly remained in G0/G1 phase, the difference was statistically significant (t=6.24, 4.93; P<0.05). ConclusionKnockdown of HtrA1 gene may reduce the proliferation, migration capability and apoptosis of light-injured RPE cells, and decrease the expression of VEGF-A.
ObjectiveTo observe the characteristics of optical coherence tomography (OCT) angiography (OCTA) in retinal vein occlusion (RVO). MethodsProspective and observational study. Clinical examination of 81 consecutive patients (86 eyes) diagnosed with RVO were included in the study, in which the branch retinal vein occlusion in 47 eyes, central retinal vein occlusion in 39 eyes. Forty-five patients were male and 36 patients were female. Aged from 28 to 76 years old, the mean age was (55.36±10.01) years old. Comprehensive optical and imaging examination were performed, including fundus photography, fundus fluorescein angiography (FFA), spectral domain OCT, en face OCT and OCTA. The retinal blood flow imaging scan mode and the optic disc blood flow imaging scan mode were performed, the scanning region in the macular area were 3 mm×3 mm, 6 mm×6 mm, 8 mm×8 mm respectively, around the optic disc were 3 mm×3 mm and 4.5 mm×4.5 mm. Each region scans 2 times. The characteristics of foveal avascular zone change, macular edema, non-perfusion and optical disc edema in OCTA and their corresponding FFA and en face OCT were observed. ResultsBy OCTA, 67 eyes (77.9%) for foveal avascular zone change, 23 eyes (26.7%) for macular edema, 40 eyes (46.5%) for non-perfusion, and 33 eyes (38.4%) for optical disc edema can be detected. The foveal avascular zone change can be indentified as the tranformation, destruction and even vanish of the arch in superfacial layer of retinal macular area, acompanied with the dilatation and thickening of capillary vessels, the occlusion and expanding of capillary vessels arounded the foveal avascular zone in the deep layer of macular area. Those performances were more clear than FFA. The main expression of macular edema was low signal and was not as clear as en face OCT. The tortuosity and expansion of retinal vessels, density decreasing and even occlusion or abnormal traffic branch of capillary vessels can be observed in non-perfusion. These observations were similar to FFA. However, pieces of highly signal identical with non-perfusion area can be detected in chroid capillary. The representation of optical disc edema was the brush-like expanding of capillary vessels aroud optical disc. ConclusionsOCTA can help for observing the abnormal changing of capillary vessels in foveal avascular zone and macular edema, non-perfusion and optical disc edema. Foveal avascular zone change showed occlusion and expanding of capillary vessels around the foveal avascular zone in the deep layer of macular area. Macular edema showed the weak signal. Non-perfusion showed tortuosity and expansion of retinal vessels, density decreasing and even occlusion or abnormal traffic branch of capillary vessels. Optical disc edema showed brush-like expanding of capillary vessels around optical disc.
Objective To observe the angiographic features of patients with retinal vein occlusion (RVO) by ultra-wide-field fluorescein angiography (UWFA) and compare with the conventional 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Fifty-eight eyes of 56 RVO patients were included. There were 25 males (26 eyes) and 31 females (32 eyes). The age ranged from 25 to 69 years, with a mean age of (48.12±18.56) years. The course of disease was from 2 days to 25 months, with a mean course of (12.78±11.35) months. Thirty eyes were diagnosed with central RVO (51.72%), 26 eyes were diagnosed with branch RVO (44.83%) and 2 eyes were diagnosed with hemicentral RVO (3.45%). Retinal laser photocoagulation was performed in 11 eyes (18.97%). All patients received examinations of UWFA (British Optomap 200Tx imaging system) and optical coherence tomography (OCT). Using the protocol for obtaining 7SF images as described in the Early Treatment Diabetic Retinopathy Study, 7 circular regions with a range of 30 degrees were combined as the 7SF template to determine the observation area. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. The visualized retinal area, retinal non-perfusion area, retinal neovascularization area, and laser spot area of UWFA and 7SF were quantified by a retinal specialist. In addition, the OCT images of the affected eye were observed and analyzed to confirm the existence of macular edema. Correlation analysis was done between retinal non-perfusion, retinal neovascularization and macular edema detected by UWFA. Results The results of UWFA and 7SF examination were the same. Compared with 7SF, UWFA showed 3.53 times more retinal visual area, 3.31 times more non-perfusion area, 1.94 times more neovascularization area, and 3.59 times more laser spots (t=72.13, 4.69, 1.76, 5.78;P=0.000, 0.005, 0.102, 0.000). Lesions of 11 eyes (18.97%) were found outside the range of 7SF images. By UWFA, non-perfusion area correlated with neovascularization and macular edema (χ2=12.13, 4.82;P=0.000, 0.028;C=0.42, 0.28). Non-perfusion area anterior to the equator have significantly correlations with macular edema (χ2=6.32,P=0.012,C=0.31), but non-perfusion posterior to the globe equator have no relevance with macular edema (χ2=2.88,P=0.090, C=0.22). Conclusions UWFA can detect more peripheral retinal lesions than 7SF images. By UWFA, non-perfusion area has correlation with neovascularization and macular edema.
Objective To observe the ocular fundus features and consistency of classification of diabetic retinopathy (DR) by ultra-wide-field fluorescein angiography (UWFA) and the simulated early treatment diabetic retinopathy study (ETDRS) 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Ninety-six eyes of 55 DR patients were included. The ages ranged from 25 to 73 years, with a mean age of (41.34±15.07) years. UWFA examination (British Optos 200Tx imaging system) using the protocol for obtaining 7SF images as described in the ETDRS, 7 circular regions with a range of 30 degrees are spliced as 7SF templates to determine the observation range. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. And the visualized area of the retina, retinal non-perfusion (NP) area, retinal neovascularization (NV) area, and pan-retinal photocoagulation (PRP) area of UWFA and 7SF were quantified by a retinal specialist. Results UWFA imaging and 7SF imaging have a high degree of consistency in judging DR classification (kappa=0.851,P=0.000). The retinal visual area, NP area, NV area and PRP area of the UWFA imaging were 3.16, 3.38, 2.22 and 3.15 times more comparing with the simulated 7SF imaging (t=213.430, 45.013, 22.644, 142.665;P=0.000, 0.000, 0.003, 0.000). The lesions of 8 eyes were found outside the range of simulated 7SF imaging, including peripheral NP in 5 eyes, NV areas in 3 eyes, respectively. Conclusion UWFA imaging and simulated 7SF imaging are consistent to judge DR classification, but UWFA can find more peripheral retinal lesions.