Objective To observe the therapeutic effect of radial optic neurotomy (RON) for ischemic central retinal vein occlusion (CRVO) with macular edema. Methods The clinical data of 6 patients with ischemic CRVO combined with macular edema who had been treated with vitrectomy and radial optic neurotomy were retrospectively analyzed. The pre- and post-operative visual acuity, results of fundus fluorescein angiography (FFA) and optic coherence tomography (OCT), including the macular thickness, fluorescein filling in retinal veins, retinal hemorrhages and papilloedema were analyzed and compared. Results In the 6 patients, the visual acuity increased in different degrees and retinal hemorrhages decreased evidently. Macular edema was alleviative in 5 patients, retinal vein dilatation meliorated in 4, and papilloedema disappeared in 2. Conclusion RON may alleviate macular edema in patients with ischemic CRVO, but the relation of the therapeutic effect and vitrectomy can not be eliminated. (Chin J Ocul Fundus Dis, 2005,21:3-5)
Objective:To evaluate the clinical effects of vitrectomy on total retinal detachment in patients with retinopathy of prematurity (ROP). Methods:The clinical data of 73 eyes of 56 patients with total retinal detachment in ROP (stage 5) who had undergone vitrectomy were retrospectively analyzed. The age o f the patients when underwent the surgery was 384 months old with the average o f (13.02plusmn;14.64) months. The gestation age ranged from 25 to 36 weeks with the average of (29.5plusmn;2.22) weeks; the birth weight ranged from 900 to 2500 g wit h th e average of (1400.19plusmn;300.05) g; the oxygeninhaling time ranged from 2 to 9 0 days with the average of (20.53plusmn;18.91) days. The surgery included open vitr ectom y, closed lens extraction, and vitrectomy. The anatomical outcomes of retinal re attachment were categorized as success: macular reattachment; partial success: macular detachment; and failure: total retinal detachment.Results:After the operation, the anatomical outcome was succeed in 10 eyes (13.69%), partially succeed in 20 eyes (27.39%), and failed in 43 eyes (58.9%). The visual acuity was hand moving in 9 eyes (12.33%), and the grating acuity was better than 0.004 in 6 e yes (8.21%) after the surgery.Conclusions:The procedures of vitrectomy for retinal detachment in ROP is difficult, and the prognosis of the operative therapy is poor. After t he operation, only a few patients get retinal reattachment, and few have certain extent recovery of the visual acuity.
Objective To observe the changes of intraocular pressure (IOP) after intravitreous injection wih triamcinolone acetonide (TA) and their affected factors. Methods The clinical data of 125 patients (125eyes) who had undergone intravitreous injection with TA were retrospectively analyzed. The patients (52 males and 73 females) aged from 17 to 83 years with the average age of 56.5. There were 49 patient (39.2%) with diabetic retinopathy (DR), 56 (44.8%) with retinal vein occlusion (RVO), and 20 (16.0%) with exudative age-related macular degeneration (AMD). One day before the treatment, IOP was measured by Goldmann applanation tonometry, and the basic IOP was 7~31 mm Hg (1 mm Hg=0.133 kPa) and the average IOP was (14.69plusmn;3.72) mm Hg. The patients were divided into two groups according to the basic IOP:below 15 mm Hg group (n=64) and 15 mm Hg or above group (n=61). All of the patients underwent intravitreous injection with 4mg TA. IOP was measured 1 day, 3 days, 1 week, 2 weeks, and 1 month after the treatment in the same way, respectively, and later was measured once every 1 month. The follow-up period was 3~21 months with the mean of 5 months. The elevation of IOP would be defined as the pressure of 21mmHg or higher. The changes of IOP in patients before and after the treatment, and with different diseases and ages were analyzed. Results Thirty-six patients (28.8%) had elevation of IOP after the treatment, out of whom 97.2% had the elevation within 3 months after the injection and decreased to the basic level 7 months after the injection. In these patients, there were 11 (17.19%) in the below 15 mm Hg group and 25 (40.98%) in 15 mm Hg or above group, and the difference between the two groups was statistically significant (P＜0.01）. During the followup period, the mean maximum IOP was (20.09plusmn;7.58) mmHg, which was 5.43 mmHg higher than that before the treatment（P＜0.001）. The mean maximum IOP of 53 patients (42.4%) after the treatment was 5 mm Hg higher than that before the treatment. The mean maximum IOP during the followup period was （18.19plusmn;4.73）mmHg in DR group，（22.50plusmn;9.30）mmHg in RVO group, and（18.12plusmn;6.09）mmHg in AMD group. The occurrence of the elevation of IOP in RVO group was obviously higher than that in the other 2 groups (P＜0.01）. The result of regression analysis showed that age was correlative with the elevation of IOP after the treatment: more risks of occurrence of high IOP were found in younger patients (P=0.000). Conclusion Elevation of IOP after intravitreous injection with TA is common, which is correlative with the basic IOP, age, and pathogeny. After the intravitreous injection with TA, the elevation of IOP often occurs in patients with high basic IOP before treatment, younger age, and RVO. (Chin J Ocul Fundus Dis, 2007, 23: 115-117)
Objective To determine the effect of thiazolidinediones (TZDs) on early retinopathy in rats with experimental diabetes. Methods In 40 rats, diabetic models were set up in 36 by one-off intraperitoneal injection with streptozotocin (STZ), and other 4 were in the normal control group. Twenty-four diabetic rats with the disease-duration of more than 6 months underwent intravitreous injection (with rosiglitazone or pioglitazone in 10 rats, respectively), and the rest 4 rats werenprime;t injected with drugs as the diabetic positive control group. Immunohistochemical treptomycin-avidin-biotin-complex (SABC) method, in situ hybridization of retinal vascular endothelial growth factor (VEGF) mRNA, and TdT-dUTP terminal nick-end labelling (TUNEL) were performed on the ocular paraffin section to detect the cellular apoptosis. The difference of VEGF expression and cellular apoptosis between TZDs and control group was observed and analyzed. Results The results of immunohistochemical staining and hybridization in situ were negative in the normal control group. The positive expression rate of VEGF was lower in rosiglitazone and pioglitazone group than which in the diabetic positive control group, and there was no obvious differences of positive expression of VEGF mRNA and cellular apoptosis between the 2 groups. Conclusion TZDs (rosiglitazone and pioglitazone) may inhibit the positive expression of VEGF protein in retina of STZ-induced diabetic rats to some extent, but not affect the growth of VEGF in retina. (Chin J Ocul Fundus Dis, 2006, 22: 7-10)
ObjectiveTo detect the effect of adeno-associated-virus induced Kringles5 gene on retinal neovascularization in rats with retinopathy of prematurity (ROP), and to explore the new ways of treatment for ROP.MethodspSNAV-Kringle5-gfp carrier was constructed by subclone and adeno-associated-virus was packed to form rAAV-Kringle5-gfp. ROP model was set up under circumstances of high oxygen in 21 SD rats which were divided into experimental (21 eyes) and control group (21 eyes). Eighteen eyes from each group was used to making the histologic section of retina, and the other 3 eyes in each group was detected by polymerase chain reaction (PCR) and Western blotting. There were 5 rats in the normal control group. AAV-Kringle5-gfp with the dosage of 10 μl and titer of 2.5×1012vg/ml was injected into the eyes in experimental group, while rAAVlacZ with the same dosage and titer of 2.5×1011vg/ml was injected in to the eyes in control group. The expression of target gene in ocular tissues was observed under the fluoroscope. Twelve weeks later, the rats were executed, and the staining of Ⅷ factor related antigens in retinal vascular endothelial cells was performed and number of nucleolus of vascular endothelial cells were counted. ResultsThe plasmid of pSNAV-Kringle5-gfp was correct according to the sequence measurement; the expression of rAAV-Kringle5-gfp was found in vitreous cavity and on retina; the expression of target gene was found on the level of mRNA and protein; the number of nucleolus of vascular endothelial cells on the surface of retina was (19.954 2±3.825 7) in experimental group and (7.335 2±2.731 3) in the control group, which had significant difference between the two groups (P＜0.01）.ConclusionsAdeno-associated-virus induced Kringles5 gene can inhibit the occurrence of retinal neovascularization in patients with ROP.(Chin J Ocul Fundus Dis, 2005,21:288-291)
Objective To observe the efficacy of vitreoretinal surgery on proliferative diabetic retinopathy (PDR) in patients with type 1 and type 2 diabetes mellitus (DM). Methods Retrospectively analyzed the clinical data of 451 patients with DM (71 with type 1 and 380 with type 2) who underwent PDR from June 1999 to October 2003. The follow-up period was at least 14 months with the average of 29 months. The pre-and post-operative visual acuity, progression and regression of iris neovascular (INV), neovascular glaucoma (NVG), and the reattached and being attached rate of retina were observed and compared between the two groups. The effect of different types of DM on vitreoretinal surgery for PDR were observed. Results The preoperative data showed that the number of type 1 DM patients with severe PDR was more than the type 2 DM patients: the rate of grade VI PDR, the visual acuity lower than 0.1, INV and NVG were all higher that which in type 1 DM patients. The increased ratio of postoperative visual acuity was 64.8% (46/71) in type 1 DM patients and 72.4% (275/380) in type 2 DM patients (P=0.196). There were 75.0% patients with PDR combined with rubeosis iridis in type 1 DM group and 60.0% in type 2 DM group (P＝0.678);the rate of new rubeosis iridis after surgery was 6.3% in type 1 DM group and 5.6% in type 2 DM group (P＝0.822). The intraocular pressure of NVG eyes were all controlled effectively in both type 1 and type 2 DM groups, and INV did not regressed only in one case in type 1 DM group. In the patients with preoperative retinal detachment at the grade VI of PDR, the rate of retinal reattachment after on off operation was 87.2% in type 1 DM group and 89.8% in type 2 DM (P＝0.611); the rate of retina being-attachment after one-off surgery were 90.1% in type 1 DM group and 93.4% in type 2 DM group, respectively (P＝0.323). Conclusion There was no obvious difference of surgical efficacy on the two types of DM in patients with PDR. (Chin J Ocul Fundus Dis,2007,23:248-251)
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)
Objective To investigate the bloodretinal barrier（BRB）function of porcine retinal pigment epithelial（RPE）cells cultured in vitro. Methods Primary porcine RPE cells were cultured，and the third generation were inoculated in a microporous filter with the filter membrane of polyvinylpyrrolidone（PVP）-free polycarbonate membrane.After 1，2，3 and 4 weeks of culture，the surface of filter membrane was observed by light microscope，and after 2 weeks of culture，the section of filter membrane was observed by light microscope and transmission electron microscope.Transepithelial electrical resistance（TER）was detected and the permeability was measured with fluorescein sodium（FS）and horseradish peroxidase（HRP）. Results Primary porcine RPE cells were cultured successfully.RPE cells converged1week after inoculation; 2 and 3 weeks after inoculation，the density of RPE cells did not changed obviously; 4 weeks after inoculation，the density of RPE cells decreased.The characteristics of polarized growth of monolayer were found in RPE cells on the surface of filter membrane; 2 weeks after inoculation，the TER of RPE cells was（97.44plusmn;11.36）Omega;/cm2 which maintained till the 3rd week after inocubation.After incubated for 30 minutes，only 0.27% of FS and 0.17% HRP reached the inferior filter membrane，and the permeability rate of SF with low molecular weight was higher than which of HRP with high molecular weight. Conclusions The filter with PVPfree polycarbonate membrane may be used to set up the model of RPE cells with polarized growth of monolayer and investigate the barrier function of RPE cells. (Chin J Ocul Fundus Dis, 2006, 22: 188-191)
Objective To investigate the mutations of the gene in Chinese patients with X linked juvenile retinoschisis (XLRS), and to provide the genetic diagnosis and consultation of heredity for the patients and their families. Methods Genomic DNA was isolated from leukocytes of 29 male patients with XLRS, 38 female carriers and 100 normal controls (the patients and the carriers were from 12 families). All 6 exons of XLRS1 gene were amplified by polhism (SSCP) assay. The positions and types of XLRS1 gene mutations were determined by direct sequencing. Results Eleven different XLRS1 mutations were identified in these 12 families, including one frameshift mutation due to base loss of the first exon: c.22delT（L9CfsX20）, one nonsense mutation due to base loss of the first exon (Trp163X), one splice donor site mutation(c.52+2 Trarr;C; IVS1+2T to C), and eight missense mutation due to base replacement（Ser73Pro, Arg102Gln, Asp145His, Arg156Gly, Arg200Cys, Arg209His, Arg213Gln, and Cys223Arg). No gene mutation was detected in the control group. Four new mutations included frmaeshift mutation（L9CfsX20）and mutations of Asp145His, Arg156Gly, and Trp163X at the fifth exon. A newly discovered non-disease-related polymorphism (NSP) was the c.576C to T (Pro192Pro) change at the sixth exon. Conclusion Eleven different XLRS1 mutations were detected, which is the cause of XLRS in Chinese people. The detection of gene mutations may provide the guidance of genetic diagnosis and the consultation of family heredity for the patients and their families. (Chin J Ocul Fundus Dis, 2006, 22: 77-81)
Objective To evaluate the therapeutic effects of treatments of eye-retaining and enucleation for choroidal melanomas. Methods The clinical data of 44 patients (44 eyes) with choroidal melanomas after eye-retaining treatments and enucleation surgery were retrospectively analyzed. The metastasis, retention rate of eyeball after eye-retaining treatment, and visual acuity prognosis were observed and analyzed. In 44 eyes treated by eye-retaining therapy, transpupillary thermotherapy (TTT) was performed primaryly on 7 (15.9%), 106 Ru brachytherapy on 25 (56.8%), and local resection of tumor combined with 106 Ru brachytherapy on 12 (27.3%).The average follow-up period was 13.3 months. Results Forty-four patients had no melanoma metastasis during the follow-up period. In 39 patients (88.6%) who had their eyes retained successfully, the retention rate of eyeball was 100%, 92.9%, and 83.3% in 6, 14, and 24 eyes with small, middle, and large tumor, respectively. In the patients treated by eye-retaining therapy, the visual acuity was ge;0.3 in 11 (28.2%), ge;0.05-＜0.3 in 18 (46.2%), and ＜0.05 (25.6%) in 10 eyes. Conclusions 106 Ru brachytherapy and transpupillary thermotherapy are effective treatments for small and medium-sized choroidal melanomas; some selected cases with large choroidal melanomas was treated with local resection of tumor combined with106 Rubrachytherapy. However, longer followup will be necessary to assess if this treatment has a better comprehensive outcome, compared with enucleation surgery. (Chin J Ocul Fundus Dis, 2006, 22: 150-153)