Objective To investigate the relationship of choroidal thickness and visual acuity after successful repair of rhegmatogenous retinal detachment (RRD) in eyes without high myopia. Methods Fifty-three eyes of 53 patients with RRD and without highly myopic eyes after anatomically successful surgical repair were enrolled in this study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. Spectral domain-optical coherence tomography (OCT) was used to assess the postoperative foveal structure, central foveal thicknesses (CFT) and choroidal thickness. The correlation between the postoperative BCVA and abnormality of the fovea, CFT and choroidal thickness was evaluated. According to the postoperative thickness of the choroid, the patients were divided into le;150.00 mu;m group and ＞150.00 mu;m group; the improvement of postoperative BCVA in the two groups was analyzed. The state of inside and outside section (IS/OS) and the external limiting membrane (ELM) was divided into reconstructed and un-reconstructed categories. The postoperative BCVA, CFT and choroidal thickness of two types were comparatively analyzed. Results At the last time of follow up, the mean BCVA was 0.52plusmn;0.47. The results of spectral domain OCT showed that the mean CFT was (207.45plusmn;63.63) and mean choroidal thickness was (175.46plusmn;62.68) mu;m. The postoperative BCVA correlated positively with IS/OS junction and choroidal thickness (r=4.92, 4.63; P＜0.05), but was insignificantly associated with ELM junction, whether subretinal fluids were present or not, whether epiretinal membrane was affected or not, whether there was macular edema or not and CFT (r=0.24, 1.20, 0.30, 0.03, 0.14; P＞0.05). Two weeks to three months after surgery, the improvement of BCVA in ＞150.00 mu;m group was significantly higher than that in le;150.00 mu;m group (t=-2.318, P＜0.05). Compared the reconstructed with un-reconstructed IS/OS eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.253, 2.396; P＜0.05). The difference of mean CFT was not statistically significant (t=1.454，P＞0.05). Compared the reconstructed with un-reconstructed ELM eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.940, 3.563;P＜0.05). The difference of mean CFT was not statistically significant (t=1.117, P＞0.05). Conclusion The choroidal thickness has a significant correlation with visual acuity after successful repair of RRD in eyes without high myopia.
Objective To observe the efficacy of vitrectomy for vitreous hemorrhage in patients with polypoidal choroidal vasculopathy (PCV). Methods Fourteen patients (14 eyes) of PCV with vitreous hemorrhage diagnosed by routine ophthalmologic examination, A and/or B mode ultrasound, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were enrolled in this study. The patients included eight males (eight eyes) and six females (six eyes), with the mean age of (58.7plusmn;6.0) years. All patients received vitrectomy with silicone oil and C3F8 gas tamponade. There were eight eyes received photodynamic therapy (PDT) after surgery. The retinal reattachment, visual acuity, pathological lesion degree and complications were comparatively analyzed. Results Among 14 eyes, six eyes (42.9%) recovered, seven eyes (50.0%) improved, and one eye (7.1%) aggravated. Ten eyes achieved retinal reattachment after surgery, while four eyes developed retinal detachment after the first surgery. The retina remained attached in these three eyes after silicon oil tamponade, C3F8 gas tamponade and scleral buckling, respectively; but one eye maintained silicon oil without special treatment. Thirteen eyes (92.9%) achieved retinal reattachment finally. Five eyes of them occurred hyphema one to seven days after surgery, but hyphema was absorbed and intraocular pressure was stable after douche of anterior chamber and pharmacotherapy. The vision improved with more than two lines in one eyes, improved with one to two lines in one eye, unchanged in 10 eyes, and decreased in two eyes. Of eight eyes who underwent PDT, abnormal vessels regressed in five eyes, abnormal vessels remained in three eyes. Conclusions Vitrectomy can remove cloudy refracting media for PCV with vitreous hemorrhage. The combined treatment of vitrectomy and PDT can improve or stabilize visual function,is an effective therapy for the PCV with vitreous hemorrhage.
Objective To observe the effect of Chinese Herbal Preparation -Mingjing Granule on the recruitment and adhesion of bonemarrow derived cells (BMCs) to choroidal neovascu1arization (CNV) in mice induced by laser photocoagulation. Methods A total of 75 C57BL/6 mice were divided into treatment group (30 mice), control group (30 mice) and normal control group (15 mice). CNV was induced by krypton laser in the mice of treatment group and control group. BMCs from GFPtransgenic mice were injected through tail vein to those mice 0.5 -1.0 hours after laser surgery. On day one after laser surgery, the mice of treatment group were gavaged with 0.3 ml Mingjing Granule solution every day［30 g/(kg?d)］, while the control group mice were gavaged with distilled water. The mice of normal group fed with normal cereals. 7, 14, 28 days after treatment, choroidal flatmount were prepared to measure the CNV severity and BMCs recruitment. The choroidal histopathological change was observed by optical microscope. CXCR4 level in peripheral blood was measured by enzymelinked immuno sorbent assay (ELISA). Stromal cell derived factor1alpha; (SDF-1alpha;), vascular cell adhesion molecule-1 (VCAM-1), inter-cellular adhesion molecule 1 (ICAM-1) were detected by immunofluorescent staining. Results Choroidal flatmount showed that CNV developed in treatment group and control group, but not in normal group. On day seven and 14, CNV lesions in the treatment group showed less incorporation of BMCs and smaller CNV in size compared with the control group (t=10, 9; P=0.007, 0.024), histologic sections also showed less severe lesions in the treatment group. CXCR4 level in peripheral blood in the treatment group was less than that in the control group and normal control group on day seven and day 14（t=8.107, 2.747;P＜0.05). The expression of SDF-1alpha;, ICAM-1 and VCAM-1 in the treatment group was lower compared with the control group. Conclusions Mingjing Granule could inhibit the recruitment and adhesion of BMCs in peripheral blood to CNV at the early stage. The mechanism may be related with the action of Mingjing Granule in lowing chemokines levels in peripheral blood and expression of adhesion molecules around CNV.
Objective To observe ophthalmoscopic image characteristics of central serous chorioretinopathy (CSC). Methods Twenty-one eyes of the 18 patients diagnosed with CSC were enrolled in this study．The patients included 12 males (14 eyes) and six females (seven eyes)．The patients ages ranged from 26 to 47 years，with a mean age of (39.1plusmn;5.4) years. There were nine patients (11 eyes) with acute CSC, seven patients (seven eyes) with chronic CSC, and two patients (three eyes) with recurrent CSC. All the patients were examined using color fundus photography including infrared (IR), auto-fluorescence (AF), near infrared ray-auto-fluorescence (NIR-AF), fluorescein angiography (FA) and indocyanine green angiography (ICGA) photography. The ophthalmoscopic image characteristics of CSC were comparared. Results The circular serous retinal detachments of 21 eyes were depicted in color images of the ocular fundus, which in the IR showed the hypo-fluorescence. Ten eyes displayed mottled hyper-fluorescent spots associated with serous retinal detachments corresponding to the leakage points. The serous retinal detachments of 15 eyes in the AF images showed hypo-fluorescence, six eyes showed hyper-fluorescence. Fourteen eyes presented with hypo-or hyper-fluorescent spots corresponding to the leakage points, seven eyes presented without abnormal fluorescence corresponding to the leakage points. In addition, three eyes with acute CSC showed many scattered hyper-fluorescent spots, which showed hypo-fluorescence in the ICGA. The serous retinal detachment of 15 eyes exhibited hypo-fluorescence in the NIR-AF images, six eyes showed hyper-fluorescence. Fourteen eyes presented with hypo- or hyper-fluorescent spots corresponding to the leakage points, seven eyes presented without abnormal fluorescence corresponding to the leakage points. Twenty-one eyes in FA identified the leakage. Eight eyes showed regional choroidal delayed filling, 13 eyes exhibited regional choriocapillary dilatation during 1-5 minutes after injection of ICGA. During 1-5 minutes after injection of ICGA, six eyes showed more lesions than FA, three eyes showed obvious patchy hypo-fluorescence whereas the FA were normal. Conclusions CSC has its own characteristic fundus images in the IR, FA and NIR-A. FA is still the photographic method of choice, but ICGA can reveal lesions of the choroid in CSC. IR, FA and NIR-AF are not as good as FA and ICGA for detecting of leakage points.
Objective To observe the location of peripapillary choroidal watershed zones relative to the optic disc in the different types of glaucoma. Methods A total of 98 patients (98 eyes) with glaucoma (glaucoma group) were enrolled in this study. The eyes included 34 eyes with primary open-angle glaucoma (POAG group), 33 eyes with normal tension glaucoma (NTG group) and 31 eyes with chronic angle closure glaucoma (CACG group). Thirty-seven fellow eyes of 37 patients with monocular blunt trauma were selected in this study as control group. The differences of age (t=1.197), sex (chi;2=3.548), average diopter (t=-1.644) between glaucoma group and control group were not statistically significant (P＞0.05). The differences of age (F=2.645), sex (F=1.984), average diopter (F=2.621), and visual fields mean defect (MD) (F=0.899) between different types of glaucoma were also not statistically significan(P＞0.05).Simultaneous indocyanine green angiography (ICGA) and fundus fluorescein angiography (FFA) were performed on all subjects. The watershed zones were classified into three types according to its location relative to the optic disc: in type Ⅰ, the watershed zone did not include the optic disc or could not be observed; in type Ⅱ, the watershed zone partially included the optic disc; in type Ⅲ, the watershed zone completely included the optic disc. The location of watershed zones relative to the optic disc in the different types of glaucoma was comparatively analyzed. The relationship between watershed zones, type and age, and MD were also analyzed by Pearson analysis method. Results The constituent ratio of type Ⅱ and Ⅲ watershed zones were 81.6% and 56.8% in glaucoma group and control group, respectively; with a statistically significant difference (chi;2=8.756,P＜0.003). The constituent ratios of type Ⅱ and Ⅲ watershed zones were 82.4%, 90.9%, 71.1% in POAG, NTG and CACG group, respectively. No significant differences were found between POAG and NTG group (chi;2=1.039), POAG and CACG group (chi;2=1.039, 1.166;P＞0.05). But there was significant difference between NTG and CACG group (chi;2=4.107,P＜0.05). Significant differences were found between POAG and control group, NTG and control group (chi;2=5.352, 10.141;P＜0.05). No significant difference was found between CACG and control group (chi;2=1.444,P＞0.05). There was no correlation between age and watershed zone type (r=0.114,P＞0.05). The watershed zones type of glaucoma group positively correlated with MD (r=0.354,P=0.000). Conclusion The peripapillary choroidal watershed zones in glaucoma patients include the optic disc more than in healthy eyes.
Objective To analyze and reveal the domestic and abroad studies on polypoidal choroidal vasculopathy (PCV) by bibliometric. Methods Foreign articles were searched from American Institute of Scientific Information online database of web of science (WOS) database, Chinese articles were searched from China National Knowledge Infrastructure (CNKI) database. The age distribution, national and regional, funding agency and citation of the PCV literatures published before December 31 2012 were analyzed by software Bibexcel and SPSS 17.0. Results Totally 696 literatures were analyzed, including 440 foreign literatures and 256 Chinese literatures. The numbers of foreign literatures were gradually increased since 2000, significantly after 2007, reached the maximum at 2011. The literatures were mainly in English, the number of the literatures of China ranked 4th of all countries. The National Natural Science Foundation of China ranked No.5 of funding agency. Citations gradually increased since 2000, increased significantly after 2008; there were 30 highfrequency subjects, and hot topics were clustered into 5 categories: treatment of PCV, genetics studies of PCV, detection, diagnosis and epidemiology of PCV, relationships between PCV and macular degeneration, related cytokine of PCV. Chinese literatures increased since 2000, significantly after 2006, and reached the maximum at 2010; there were 15 literatures supported by National Natural Science Foundation of China; Citation of Chinese literatures gradually increased since 2001, and reached the maximum at 2012. There were 30 highfrequency subjects, and hot topics were clustered into 5 categories: genetics and cytokine studies of PCV, detection and diagnosis of PCV, treatment of PCV, PCV and macular diseases, PCV and vitreous hemorrhage. Conclusions Literatures of PCV were gradually increased since 2000, abroad and domestic literatures of PCV reached maximum at 2011 and 2010 respectively. The abroad research of PCV focuses on 5 categories: treatment of PCV, genetics studies of PCV, detection, diagnosis and epidemiology of PCV, relationships between PCV and macular degeneration, related cytokine of PCV. The domestic research focuses on genetics and cytokine studies of PCV, detection and diagnosis of PCV, treatment of PCV, PCV and macular diseases, PCV and vitreous hemorrhage.
Objective To investigate the effect of photodynamic therapy (PDT) combined with intravitreal bevacizumab on wet age-related macular degeneration (AMD). Methods In this retrospective study, 34 eyes (28 cases) diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab, including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography; On optical coherence tomography (OCT), 23 eyes showed intraretinal fluid (IRF) and 11 eyes presented subretinal fluid (SRF). After signing informed consent, all patients underwent initial standard PDT followed by intravitreal bevacizumab (1.25 mg) within succeeding 3 to 7 days. Best corrected visual acuity (BCVA) and OCT with routine eye examinations were evaluated monthly. Additional bevacizumab (1.25 mg) was injected intravitreally if new or increasing fluid appreciated on OCT, or BCVA lowered more than 5 letters even with stabilized fluid. Injection was discontinued if no fluid was showed on OCT (quot;dry macularquot;), or BCVA was stabilized even with fluid after two consecutive injections. BCVA and central retinal thickness (CRT) were analyzed and compared between baseline and 6 month follow-up. The correlation between parameters such as baseline BCVA, greatest linear dimension (GLD), type of CNV, SRF or IRF and posttreatment BCVA will be analyzed. The injection number of bevacizumab and complications were recorded. Results Compared to baseline, BCVA improved (9.4plusmn;10.2) letters and reach 44.9plusmn;21.3 letters (t=5.438，P＜0.01) and CRT decreased (184.6plusmn;214.6) mu;m (t=4.810，P＜0.01) at 6 month visit. The average of injection number was 1.9plusmn;0.9 (including initial injection of combination therapy). With multiple lineal regression analysis, only baseline BCVA correlated to posttreatment BCVA at 6 month visit (r=0.802.P＜0.01). The type of CNV, GLD, SRF or IRF on OCT and CRT at baseline were not associated to post-treatment BCVA (r=0.053, -0.183, 0.139 and 0.053, respectively.P＞0.05). BCVA of eyes with SRF (14.7 letters) increased more than eyes with IRF (6.9 letters) on OCT (t=-2.207，P=0.035). The change of BCVA after treatment (t=-0.076), change of CRT (t=-1.028) and number of injections (Z=-1.505) were not different between classic CNV and minimally classic CNV (P＞0.05). The change of CRT (t=-0.020) and number of injections (Z=-0.237) did not present difference between SRF and IRF (P＞0.05). The change of BCVA (t=1.159) and number of injections (Z=-1.194) were not correlated to whether residual fluid or not at 6 month visit (P＞0.05). No severe complications were noticed during follow-up.Conclusion For wet AMD patients, PDT combined intravitreal bevacizumab could improve visual acuity, reduce retinal thickness and control CNV progress in a short-term.
Ovjective To observe the surgically excised specimens from eyes with hemorrhagic age-related macular degeneration (AMD). Methods Thirty-six surgically excised specimens were captured from 36 patients with hemorrhagic AMD, 26 specimens were diagnosed as occult choroidal neovascular membrane (CNVM), 10 specimens were diagnosed as polypoidal choroidal vasculopathy (PCV). All specimens were routinely processed by hematoxylin and eosin, periodic acidSchiffprime;s stain and Masson stainings. At the maximum horizontal and vertical slice of the specimens, the category and amount of the cells in the specimen were recorded, as well as the relationship between the specimens and the surrounding tissue. Results The 36 specimens are categorized as neovascular membrane dominant (19/36), collagen fiber dominant (6/36), blood clot dominant (8/36) and degenerated thickened Bruch`s membrane dominant (3/36). Eighteen occult CNVM specimens and 1 PCV specimen are categorized as neovascular membrane dominant; all 6 collagen fiber dominant specimens are occult CNVM; 1 occult CNVM and 7 PCV specimens are categorized as blood clot dominant; and 1 occult CNVM and 2 PCV specimens are categorized as degenerated thickened Bruch`s membrane dominant. The occult CNVM categorized as neovascular membrane dominant present as small blood vessel with single endothelium cell attached; the PCV specimen categorized as neovascular dominant presents as big blood vessel with thick vessel wall under the Bruch`s membrane, retinal pigment epithelium and choroidal melanocyte are both observed in the PCV specimens. Conclusion The components of the specimens captured from eyes with hemorrhagic AMD are diversified.
Objective To investigate the clinical characteristics of patients with polypoidal choroidal vasculopathy (PCV) from Central China . Methods This was a retrospective study, and 403 eyes of 362 patients diagnosed as PCV by ocular fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were enrolled. The general clinical data, fundus manifestation and ocular fundus examinations were statistically analyzed. Results Three hundred and sixty-two cases included 249 males (68.8%) and 113 females (31.2%). Age ranged from 45 to 91 years old, and mean age was (64.81plusmn;9.31) years old. Bilateral lesions were observed in 41 patients (11.3%) and unilateral lesions were observed in 321 patients (88.7%)． In these 403 eyes, typical orangered lesions were observed in 162 eyes (40.2%); yellowishwhite exudate could be found in 185 eyes (45.9%); 268 eyes (66.5%) showed variable degrees of subretinal hemorrhage. Drusen was found in 23 eyes (5.7%), pigment proliferation in 20 eyes (5.0%) and fiber vascular scar in 96 eyes (23.8%). The lesions of 386 eyes (95.8%) located in macular region, 53 eyes (13.2%) in peripapillary area. Lesions presented multifoci in 67 eyes (16.6%). Three hundred and four eyes (75.4%) presented typical polypoidal lesions and 152 eyes (37.7%) with abnormal branching choroidal networks. Hemorrhagic retinal pigment epithelial detachments (PED) were found in 200 eyes (49.6%) and serous PED in 96 eyes (23.8%), both existed in 25 eyes（6.2%）. OCT showed 56 eyes (13.9%) presented cystoid dark chamber between the neurosensory retina and 109 eyes (27.0%) with double-layer sign formed by the separation of retinal pigment epithelium and Bruchprime;s membrane (27.0%). Two hundred and seventy-four eyes (68.0%) were found with conelike elevation beneath the RPE layer and 151 eyes (37.6%) with neurosensory detachment. Conclusions In Central China, the majority of PCV patients were male, unilateral. Most PCV lesions were located in the macula. Subretinal hemorrhage, polypoidal lesions and abnormal choroidal vascular networks were common in the PCV patients. Hemorrhagic PED presented a higher ratio than serous PED.
Objective To compare the clinic therapeutic effect of intravitreal ranibizumab injection versus photodynamic therapy (PDT) combined with intravitreal ranibizumab injection for idiopathic choroidal neovascularizatio (ICNV), and to investigate the clinical effect and safety of treatment. Methods A randomized controlled clinical prospective study was performed for 27 patients (27 eyes) diagnosed as ICNV. Fourteen patients were assigned to receive PDT and intravitreal ranibizumab injection (combination roup.n=14); the control group was treated with only intravitreal ranibizumab injection (single group, n=13).The combination group was treated with an intravitreal injection of ranibizumab (0.5 mg/0.05 ml) 1 week after PDT. The bestcorrected visual acuity (BCVA) (logMAR), examination of the ocular fundus, fluorescence fundus angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were performed respectively at 1, 2, 3, 6 and 12 months after treatment. If choroidal neovascularization (CNV) was only partially regressed or the leakage went on during follow-up, those patients were re-injected with ranibizumab. Results After 12 months, the average vision is 0.22plusmn;0.11 in single group, and 0.21plusmn;0.12 in combination group, and the differences were not significant (t=0.187, P=0.853). In single group FFA and ICGA showed completely closed CNV in 10 eyes (77.92%), and almost closed CNV in 3 eyes (23.08%) with obvious reduction of fluorescence leakage. In combination group FFA and ICGA showed completely closed CNV in 12 eyes (85.71%), and almost closed CNV in 2 eyes (14.29%) with obvious reduction of fluorescence leakage; OCT showed the subretinal fluid absorption and reduction of CNV. The average macular retinal thickness (MRT) in single groups is （167.96plusmn;10.69） m, and in combination groups is （171.64plusmn;11.30）m. In single and combination groups MRT decreased significantly at the final follow-up, but no significant differences in both groups (t=-0.887.P=0.389). The average number of intravitreal injection was （1.5plusmn;0.7） in combination group and （2.4plusmn;1.0） in single group (t=2.821，P=0.009). There were no ocular or systemic adverse events observed except for one patient with subconjunctival hemorrhage in the single group.Conclusions Intravitreal ranibizumab injection and PDT combined with intravitreal bevacizumab injection are both effective and safe for the patients with ICNV. The combined therapy can induce CNV regression, fundus hemorrhage and exudation absorption more effectively, and have less recurred CNV and side effects.