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 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 choroidal changes of diabetic macular edema (DME) with serous macular detachment (SMD) in non-proliferative diabetic retinopathy (NPDR) patients by optical coherence tomography (OCT).Methods Nine NPDR patients including DME with SMD in one eye (SMD group) and only DME in the other eye (DME group) were enrolled. These 18 eyes were also divided into PRP group (six eyes, received panretinal photocoagulation before) and non-PRP group (12 eyes). Spectral domain EDI (enhance depth imaging) OCT and fundus photograph were performed in all the eyes. The subfoveal choroidal thickness was measured. The choroidal simulation area acquired by horizontal EDI-OCT scan through the center of the fovea was calculated by Image Plus Pro 6.0 software. The difference between DME and SMD group was compared and analyzed with matched t- test; the difference between PRP and non-PRP group was compared and analyzed with F test.Results In SMD group, spindle-like or domelike low signal of detachment areas with intact external limiting membrane were found in the retinal detachment region, and the inner and outer segments (IS/OS) were separated from the retinal pigment epithelium (RPE) Bruch membrane. Both subfoveal choroidal thickness and choroidal simulation area in SMD group were significant greater than those in DME group (t=2.306, 2.306;P＜0.05). Choroidal simulation area in PRP group was larger than that in nonPRP group (F=5.227,P＜0.05). But there was no significant difference of subfoveal choroidal thickness between PRP and non-PRP group (F=3.276,P＞0.05). Conclusion EDI-OCT detects spindlelike or domelike low signal areas in detachment region of SMD with DME in NPDR patients.
Objective To observe the clinical characteristics of diabetic neovascularization on the disc (DNVD).Methods The clinical data of 526 patients (1052 eyes) who were diagnosed as diabetes in Department of intern medicine, as diabetic retinopathy by ophthalmoscope and fundus fluorescein angiograph (FFA) was retrospectively reviewed. All patients were carried out with best corrected visual acuity（BCVA）, slitlamp microscope,ophthalmoscope and FFA after mydriasis. In which, who has neovascularization on the optic disc with ophthalmoscopy and FFA examination were included in this study.The relationship between the occurrence and development of DNVD and phase of DR, disease duration, the level of blood glucose and panretinal photocoagulation were analyzed. Results DNVD was found in167/1052eyes (15.87%). There were 91 eyes (54.49%) with BCVA＜0.1, 58 eyes (34.73%) with BCVA＜0.4 but ge;0.1，and 18 eyes(19.78%) with BCVAge;0.4. Retinal neovascularization was located in the surface of disc surface or within 1PD from the optic disc；Those vessels filled early and rapidly, and with local b fluorescence due to fluorescence leakage at middle and late stage of FFA examination.All 167 DNVD eyes are proliferative diabetic retinopathy (PDR) with 43 eyes (25.75%) in stage IV,52 eyes (31.14%) in stage V and 72 eyes (43.11%) in stage VI.Of those DNVD eyes,there were 5 eyes (2.99%) with course of diabetes ＜3 years,12 eyes (7.19%) s＜5 years but ge;3 years, 21 eyes (12.57%)＜10 butge;5 years, 56 eyes (33.53%)＜15 but ge;10 years and 73 eyes (43.71%) ge;15 years. There were 15 eyes (8.98%) with fasting blood glucose (FBG)＜7.0 mmol/L,26 eyes (15.57%) with FBG＜9.0 but ge;7.0 mmol/L,50 eyes (29.94%) with FBG＜12.0 but ge;9.0 mmol/L and 76 eyes (45.51%) with FBG ge;12.0 mmol/L;there were 28 eyes (16.77%) with 2 hour postprandial blood glucose（2hPBG）＜10.0 mmol/L, 35 eyes (20.96%) with 2hPBG＜12.0 but ge;10.0 mmol/L,42 eyes (25.15%) with 2hPBG ＜16.0 butge;12.0 mmol/L and 62 eyes (50.30%) with 2hPBG ge;16.0 mmol/L. The occurrence of DNVD and duration of diabetes, FBG and 2hPBG were all positively correlated (r=0.991,0.984,0.960, P=0.001, 0.016, 0.040) by the Person correlation analysis. 15 eyes (5.84%) of DNVD happened in 257 eyes who treated with PRP in severe nonproliferative diabetic retinopathy (NPDR),152 eyes (19.12%) DNVD happened in 795 eyes who untreated with PRP in severe NPDR，the differences were statistically significant (chi;2=25.659,P＜0.01) between them.Conclusion DNVD happened commonly in DR, the occurrence of DNVD is intensive related with diabetic retinopathy stage,duration of diabetes,FBG and PBG.
Objective To evaluate the visual prognostic factors in vitreoretinal surgery for diabetic tractional retinal detachment (DTRD). Methods 102 eyes of 86 consecutive patients with DTRD underwent vitreoretinal surgery were analyzed retrospectively. All cases diagnosed via indirect ophthalmoscope and B ultrasonic scan after mydriasis. Followup duration varied from 12 to 56 months (mean: 23 months). Best corrected visual acuity (BCVA) and anatomic success were observed postoperatively. The patients were divided into visual acuity improved group and didn't improved group. Ttest, Chisquare test and Multivariate Logistic regression analysis were performed to predict the prognosis of visual acuity. Results After primary vitreoretinal surgery, 87 eyes (85.3%) were anatomically reattached, 15 eyes (14.71%) needed reoperation because of the recurrence of retinal detachment (RD). Postoperative BCVA improved and better than 0.05 in 49 eyes (48.04%), reduced or increased but less than 0.05 in 53 eyes (51.96%). Comparing natural factors between these two groups, only combined cataract surgery and optic nerve atrophy were significant different (chi;2=5.266,9.274;P=0.022,0.002). Among post-operative complications only the RD recurrence was significant different (chi;2=12.059，P=0.000). Multivariate Logistic regression revealed recurrence of RD and optic nerve atrophy were two independent risk factors in the final BCVA (P=0.003,0.041;OR=33.518、4.079). Preoperative PRP was identified as the only protecting variable in the final BCVA(P=0.034，OR=0.270).Conclusion This study revealed recurrence of RD and optic nerve atrophy were two independent risk factors in final BCVA of DTRD patients.
ObjectiveTo observe the expression of inflammatory cytokines in diabetic rats received posterior sub-Tenon capsule injection of triamcinolone acetonide (TA) and pan-retinal photocoagulation. MethodsA total of 48 Brown Norway rats received intraperitoneal injection of streptozotocin to establish the diabetic model. Diabetic rats were randomly divided into experimental group (20 rats), control group (20 rats) and blank group (8 rats). 50 μl TA or saline was injected into the posterior sub-Tenon capsule immediately after the photocoagulation in the experimental group and the control group, respectively. The blank group received no treatment. The mRNA and protein expression level of retinal vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and tumor necrosis fator-α (TNF-α) were measured by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA) at 1, 3, 7 days after laser photocoagulation. ResultsThe mRNA and protein expression of VEGF, IL-6, TNF-α of the experimental group and control group were significantly higher than the blank group, the difference was statistically significant (P < 0.05). The mRNA and protein expression of VEGF, IL-6 and TNF-α of the experimental group were significantly lower than that of the control group. On day 1 after laser photocoagulation, the mRNA expression of VEGF was not statistically significant in the experimental group and control group (P > 0.05), the mRNA and protein expression of VEGF, IL-6, TNF-α of the two groups were statistically significant in the remaining observing time (P < 0.05). ConclusionPosterior sub-Tenon capsule injection of TA can effectively reduce retinal photocoagulation induced VEGF, IL-6, TNF-α expression.
ObjectiveTo observe the effect and complications of vitrectomy combined with intraocular silicon oil or C3F8 filling for proliferative diabetic retinopathy (PDR). MethodsEighty-six consecutive patients (101 eyes) with PDR-related vitreous hemorrhage who underwent primary standard three-port vitrectomy and intraocular tamponade of silicone oil or C3F8 were included in this retrospective study. They were divided into silicone oil group and C3F8 groups. There was no statistically significant difference between these two groups of patients for gender, age, duration of diabetes, fasting glucose, history of hypertension, diabetic kidney disease history, history of cardiac and vascular diseases, body mass index and smoking history. There was statistically significant difference between these two groups of patients for visual acuity (Z=-2.604, P=0.009). There was no statistically significant difference between these two groups of patients for intraocular pressure before surgery (Z=0.064, P=0.949). The mean follow-up was (20.3±16.4) months with a range from 1 to 47 months. The patients were followed up for visual acuity, intraocular pressure, neovascular glaucoma (NVG), the incidence of retinal detachment, recurrent vitreous hemorrhage, and repeated operation for complications. ResultsVisual acuity (t=-3.932, -8.326; P=0.000, 0.000) and intraocular pressure (t=-3.159, -2.703; P=0.006, 0.009) were changed significantly after surgery for both groups. Between these two groups after surgery, there were significant differences of visual acuity (Z=-1.879, P=0.040), intraocular pressure (Z=-3.593, P=0.000), and complications (revision operation, retinal detachment, recurrent vitreous hemorrhage and NVG) (t=-2.777, -2.102, -2.308, -2.013; P < 0.05). ConclusionIntraocular silicone oil tamponade can reduce the postoperative complications of PDR, especially for severe retinal neovascularization, exudation associated with retinal edema.
ObjectiveTo observe the efficacy of phacoemulsification with intravitreal triamcinolone injection (IVTA) in diabetic patients with severe cataract and diabetic macular edema (DME). MethodsTwenty-one patients (25 eyes) with severe cataract and DME were enrolled in this retrospective study. Fifteen eyes underwent standard phacoemulsification and intraocular lens implantation with 4 mg IVTA at completion of surgery. Ten eyes underwent standard phacoemulsification and intraocular lens implantation. All the patients were followed up for best corrected visual acuity (BCVA), optical coherence tomography(OCT) and ophthalmological examination.Changes in logarithm of he minimal angel of resolution (logMAR) BCVA and central macular thickness (CMT) were evaluated preoperatively and 1 month, 3 months and 6 months postoperatively by repeated measures ANOVA. Correlations between logMAR BCVA and CMT preoperatively and postoperatively were analyzed by Pearson correlation analysis. Postoperative 6 months logMAR BCVA and affecting factors were evaluated by multivariate linear regression analysis. ResultsBoth groups showed significant improvements of logMAR BCVA after surgery (F=4.855, 6.235; P=0.037, 0.020). There were no statistical differences of logMAR BCVA improvement at different time points postoperatively (F=0.007, 0.006, 0.023; P=0.973, 0.938, 0.882). The CMT reductions in IVTA group at month 1 and month 3 postoperatively were statistically significant than the reductions in group without IVTA(F=10.449, 7.374; P=0.012, 0.026), and there was no statistical difference of CMT reduction at month 6 postoperatively between two groups(F=2.173; P=0.114). Correlation Coefficients between CMT and BCVA were not statistically significant preoperatively and 6 months postoperatively(r=0.279, 0.172; P=0.295, 0.574). Analysis of multiple linear regression showed that external limiting membrane status and duration of diabetes are factors affecting the visual recovery (β=0.577, -0.411; P=0.025, 0.030). ConclusionsPhacoemulsification with concurrent IVTA for treatment of patients with severe cataract and DME is effective in reducing edema. But IVTA does not further improve logMAR BCVA postoperatively.
ObjectiveTo assess and classify the features of fundus autofluorescence (FAF) with optical coherence tomography (OCT) in clinically significant diabetic macular edema according to the criteria reported by ETDRS. Methods Eighty-four eyes of 47 diabetic patients with untreated clinically significant macular edema (CSME) diagnosed by OCT/FAF examination were enrolled in this study. The mean BCVA was 0.38±0.26, CRT was (360.23±139.40) μm and volume was (9.59±1.97) mm3. According to the FAF patterns, the CSME patients were divided into normal group (30 eyes), single-spot group (20 eyes), and multiple-spot group (22 eyes). There were 44, 18 and 22 eyes with diffuse edema, cystoid edema and serous retinal detachment, respectively. The correlation of visual acuity with central retinal thickness and total volume of macular was analyzed between different groups. ResultsIn the normal group and the single-spot group, the prevalence of the diffuse type was highest in the OCT (83.3%, 60.0%). In the multiple-spot group, the prevalence of the SRD type was highest in the OCT (50.0%). In the three FAF pattern groups, the BCVA were 0.47±0.26, 0.43±0.30, 0.28±0.19; the CRT were (272.41±48.62), (402.84±134.89), (505.67±135.20) μm; the total volume was (8.67±1.03), (8.94±1.63), (10.79±2.20) mm3. The BCVA were 0.43±0.25, 0.45±0.30, 0.22±0.14; the CRT were (272.41±48.62), (402.84±134.89), (505.67±135.20) μm; the total volume was (8.58±0.95)、(9.22±1.33)、(12.03±2.01) mm3 in eyes with diffuse edema, cystoid edema and serous retinal detachment, respectively(r=-0.31, -0.34; P > 0.05). Correlation analysis showed CRT positively correlated to volume (r=0.85, P < 0.05), BCVA negatively correlated to CRT and volume(r=-0.31, -0.34; P > 0.05). ConclusionThere are more diffuse edema eyes in normal group and single-spot group, while serous retinal detachmen in multiple-spot group. FAF correlates better with visual acuity than OCT patterns.
Objective To observe the corneal nerve fibres damage in different stage of diabetic retinopathy (DR) with type 2 diabetes. Methods A cross-sectional study. One hundred and twenty eyes of 120 patients with type 2 diabetes served as diabetes group. According to International Clinical Diabetic Retinopathy Disease Severity Scales (2002), diabetes patients were classified into 4 subgroups: patients without diabetic retinopathy (NDR), patients with mild or moderate non-proliferative diabetic retinopathy (mNPDR), patients with severe non-proliferative diabetic retinopathy (sNPDR) and patients with proliferative diabetic retinopathy (PDR), each subgroup has 30 eyes of 30 patients. Another 30 eyes of 30 healthy participants served as control group. All eyes were scanned with HRT3 in vivo corneal confocal microscopy. Images of sub-basal nerve plexus were quantified including nerve fiber length (NFL), nerve fiber density (NFD), nerve fiber branch density (NFB), and nerve tortuosity (NT). The correlations of corneal nerve fiber with age, duration of diabetes and glycated hemoglobin (HbA1c) were analyzed using Spearman correlation analysis. Results NFL, NFD and NFB were found to be significantly lower in diabetic patients (F=147.315, 142.586, 65.898;P=0.000, 0.000, 0.000), NT was significantly greater in diabetic patients (F=39.431,P=0.000), when compared to control group. In diabetic patients, NFL, NFD and NFB were gradually reduced with DR severity, NT was gradually increased with DR severity. While the difference of NFL, NFD, NFB, NT was not statistically significant between sNPDR and PDR subgroups (P＞0.05), but was statistically significant between other subgroups (P＜0.05). Spearman correlation analysis results showed that age (r=－0.071, －0.080, 0.001, 0.100;P=0.391, 0.328, 0.991, 0.224) and HbA1c (r=－0.109, －0.115, －0.126, 0.025;P=0.238, 0.211, 0.169, 0.781) had no correlation with NFL, NFD, NFB, NT. Duration of diabetes was negatively correlated with the NFL, NFD (r=－0.212, －0.264;P= 0.020, 0.004), positive correlated with NT (r=0.261,P=0.004), and had no correlation with NFB (r=－0.119,P=0.194). Conclusions Corneal nerve fiber loss and nerve tortuosity increased were found in patients with type 2 diabetes, and even without diabetic retinopathy. The progress of corneal neuropathy was correlated with the severity of DR, but it was not change significantly between sNPDR and PDR.