There are many topics in clinical studies of diabetic retinopathy (DR). The current hot topics include the relationship between DR and systemic diseases, major factors for initiation and progression of DR, early DR screening strategies, DR prevention strategies and how to improve the therapeutic effects of DR. However, due to the complexity of DR pathogenesis, multiple risk factors, long cycle of DR prevention and control, it is difficult to exclude all the confounding factors in the DR clinical research. From the long-term perspective, delaying the occurrence and progression of DR and establishing an efficient and practical prevention and control system is the focus of the future DR research in China.
Refractory macular hole (MH) has lower surgical anatomical closure rate and poor recovery of visual acuity due to its clinical characteristics. Refractory macular hole includes unclosed MH, reopening MH, large MH, high myopic MH, traumatic MH and secondary MH. Some modified surgeries were employed to improve the surgical results. Inverted internal limiting membrane flap, autologous transplantation of the internal limiting membrane, laser photocoagulation, extended internal limiting membrane peeling, arcuate retinotomy, lens capsular flap transplantation and mesenchymal stem cell transplantation can improve the prognosis partially. Loosening MH traction, providing a scaffold for Müller cell proliferation and promoting photoreceptor reconstruction will be the key points in future.
ObjectiveTo analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.
ObjectiveTo predict as well as bioinformatically analyze the target genes of has-miR-451. MethodsmiRBase, miRanda, TargetScan and PicTar were used to predict the target genes of hsa-miRNA-451. The functions of the target genes were demonstrated by Gene Ontology and pathway enrichment analysis. P < 0.05 was set as statistically significant. Results18 target spots of hsa-miRNA-451 were predicted by 3 databases or prediction software at least. The functions of the target genes were enriched in proliferation and development of epithelial cells and regulation of kinase activity (P < 0.05). Pathway analysis showed that transforming growth factor-beta signaling pathway, mitogen-activated protein kinase signaling pathway, epidermal growth factor signaling pathway, Wnt signaling pathway and mammalian target of rapamycin signaling pathway were significantly enriched (P < 0.05). Conclusionhsa-miRNA-451 might be involved in various signaling pathways related to proliferation and development of epithelial cells.
ObjectiveTo observe the expression of hot shock protein 47 (HSP47) in pre-retinal membrane of proliferative vitreoretinopathy (PVR) and the influence of transforming growth factor-β2 (TGF-β2) on the expression of HSP47 in retinal pigment epithelial (RPE) cell. MethodsPre-retinal membranes were collected and observed by hematoxylin-eosin, Masson and immunohistochemical staining. Cultured ARPE-19 cells were treated with TGF-β2 at serial concentration (0, 1, 5, 10 ng/ml) and time (0, 12, 24, 48 hours), respectively. And then the mRNA and protein expressions of HSP47 and Col-Ⅰ were measured by fluorescence quantitative reverse transcription polymerase chain reaction and Western blot at the same time. ResultsA lot of epithelial cells with pigmental particles were observed in pre-retinal membranes of PVR, much accumulated collagen protein was observed in the specimens, and HSP47 positive expression was bserved in cytoplasm and stroma of most of the epithelioid cells. Compared with 0 ng/ml group, the expressions of HSP47 mRNA in ARPE-19 were up-regulated by 1.32, 2.35, 1.85 fold, significant differences were observed in all groups (F=27.21, P<0.05); the expressions of protein were up-regulated by 2.33, 2.89, 2.60 fold, significant differences were observed in all groups (F=39.78, P<0.05). The expressions of Col-Ⅰ mRNA were up-regulated by 1.29, 1.52, 2.11 fold, significant differences were observed in all groups (F=23.45, P<0.05); the expressions of protein were up-regulated by 1.18, 1.49, 2.11 fold and significant differences were observed in all groups (F=29.10, P<0.05). Compared with 0 hour group, the expressions of HSP47 mRNA were up-regulated by 1.56, 1.84, 2.86 fold in ARPE-19 cells stimulated by 5 ng/ml TGF-β2 for 12, 24 and 48 hours, and the differences were all significant (F=31.56, P<0.05); the expressions of protein were up-regulated by 2.08, 2.37, 2.80 fold, and the differences were all significant (F=49.18, P<0.05). The expressions of Col-Ⅰ mRNA were up-regulated by 1.57, 1.86, 2.78 fold and the differences were all significant (F=54.43, P<0.05), the expressions of protein were up-regulated by 1.38, 1.59, 2.16 fold and the differences were all significant (F=42.52, P<0.05). ConclusionTGF-β2 may play a role in the pathologic process of PVR by promoting the expression of HSP47 and then increasing the synthesis and accumulation of Col-Ⅰ.
Monocyte chemoattractant protein-1(MCP-1) is a cytokine which belongs to the CC chemokine family. Retinal pigment epithelium (RPE) cells, photoreceptors and microglial cells in the retina can secrete MCP-1. Physiological level of MCP-1 is important for preserving morphology of RPE and glial cells, as well as retinal function and gross morphology. MCP-1 is likely released from Müller glia and the RPE cells when retina under stress, and attracts microglia/macrophages to the sites of retinal damage, activates the microglia to ingest cell debris. MCP-1 has been found upregulated in the intraocular fluid of retina in patients and animal models with retinal detachment, posterior uveitis and age-related macular degeneration. The expression of MCP-1 may be response to retinal inflammation. Therefore, it is tempting to speculate that pharmacological targeting of MCP-1 may be a safe and viable strategy in treatment of retinal disease.
ObjectiveTo observe the influence of human umbilical cord mesenchymal stem cells (hUCMSC) transplantation into vitreous cavity of diabetic rats on the retinal morphology, and the expression of glial fibrillary acidic protein (GFAP) and rhodopsin (RHO). Methods78 male Sprague-Dawley rats were used. 70 rats were injected with streptozotocin by tail vein injection at a dose of 40 mg/kg to establish the diabetes mellitus model, and another 8 rats were injected with 0.1 mol/L pH 4.0 citric acid buffer at the same dose as the normal control group. After 6 weeks of modeling, 10 rats were taken as the control group of diabetic model. hUCMSC suspension was injected into the right eye vitreous cavity of the remaining 60 rats, and the same volume of Dulbecco's modified Eagle/F12 medium was injected into the left vitreous cavity as control eyes. 1, 2 and 4 weeks after transplantation, follow-up experiments were performed. The experimental eyes were labeled as U1, U2, and U4 groups, while the control eyes were recorded as D1, D2, D4, and each group consisted of 20 eyes. After paraffin section and hematoxylin-eosin staining, the structure of the retina was observed by optical microscopy and the thickness of the outer nuclear layer and the inner nuclear layer (INL) were measured. The distribution and migration of hUCMSC in rat retina were observed by frozen section-tissue immunofluorescence assay. The mRNA and protein expression of GFAP and RHO in the retina were detected by real-time quantitative polymerase chain reaction (PCR) and Western blot assays. ResultsThe results of optical microscope observation showed the normal structure of retina in normal control group. The retinal nerve fiber layer (NFL) was thinned and the number of retinal ganglion cells (RGC) in the control group of diabetic rats was decreased. The decreased number and disorder arrangement of RGC were observed as well in U1, D1 rats. The RGC number of U2, U4, D2, D4 rats was gradually decreased. Compared with D4 group, the thickness of INL in U4 group was significantly increased (P < 0.05). Tissue immunofluorescence assay showed that hUCMSC were distributed along the inner limiting membrane in the retina of the U1 group, while the number of hUCMSC in the U2 group was gradually decreased, mainly in the NFL and ganglion cell layers. Real-time PCR and Western blot data indicated that the relative expression of GFAP mRNA and protein in the diabetic retina was significantly increased, and the relative expression of RHO mRNA and protein decreased gradually in the diabetic model group and the D1, D2, D4 groups. Compared with D2 and D4 groups, the mRNA and protein expression of GFAP in U2 and U4 groups were decreased, and the relative expression of RHO mRNA and protein were all increased (P < 0.01). ConclusionhUCMSC could migrate and integrate into the retina, after the transplantation into the vitreous cavity of diabetic rats, which reduced the expression of GFAP, but enhanced the expression of RHO.
Objective To evaluate the effect of 27G pars plana vitrectomy (PPV) and 25G PPV on idiopathic epiretinal membrane (IMEM). Methods Thirty-eight eyes of 38 patients with IMEM were enrolled into this retrospective and comparative study. Eighteen eyes were treated with 27G PPV (group A), 20 eyes underwent 25G PPV (group B) voluntarily. The best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp microscope, indirect ophthalmoscopy, fundus color photograph, ocular coherence tomography (OCT) and counting of corneal endothelial cells (CEC) were examined before the surgery. BCVA results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. There was no statistically significant difference between two groups in terms of BCVA, IOP, foveal macular thickness (FMT), the counting of CEC and CEC hexagon rate before the surgery (t=1.627, 0.860, 0.293, 1.238, 0.697;P＞0.05). All operations were performed by the same doctor. Operation time for vitrectomy and peeling membrane was recorded. BCVA, IOP, OCT, FMT, counting of CEC and the improvement of metamorphopsia were observed on 1, 7 days and 1, 3 months after PPV. Results The mean operation time for vitrectomy in group A and B were (6.7±2.8), (10.5±3.3) min, respectively. The mean operation time for vitrectomy in group A was significantly longer than that in group B (t=3.084,P＜0.05). The mean operation time for peeling membrane in group A and B were (10.2±5.2), (11.0±5.9) min, respectively. There was no statistically significant difference between two groups in terms of the time for peeling membrane (t=1.970,P=0.187). On 1, 7 days and 1, 3 months after PPV, the difference of BCVA (t=1.463, 0.683, 0.961, 1.226;P=0.833, 0.509, 0.699, 0.744) and IOP (t=1.314, 1.262, 0.699, 1.116;P=0.763, 0.721, 0.534, 0.712) between two groups were not statistically significant. On 1 day after PPV, there were 2 eyes and 5 eyes with ＜9 mmHg (1 mmHg=0.133 kPa) IOP in group A and B. On 7 days and 1, 3 months after PPV, the difference of FMT between two groups were not statistically significant (t=1.257, 1.368, 1.437;P=0.735, 0.745, 0.869). On 3 months after PPV, the difference of CEC between two groups were statistically significant (t=2.276,P＜0.05); the difference of hexagon rate between two groups were not statistically significant (t=1.473,P=0.889). Conclusion The efficacy of 27G PPV for IMEM appears similar to 25G PPV. But 27G PPV has a shorter operating time for vitrectomy, a more stable IOP and a minimal damage to CEC.
Objective To observe the optic disc perfusion in anterior ischemic optic neuropathy (AION) patients. Methods Forty eyes of 40 AION patients and 30 eyes of 30 normal subjects were included. The stage of the diseases was defined based on the course of the disease, including acute stage (less than 3 weeks) and recovery stage (more than 3 months). Optic disc blood flow area, outer vascular density and blood flow index were measured by optical coherence tomography angiography in all the subjects. Optic disc perfusion was observed in acute and recovery stage of disease. Results The optic disc blood flow area, outer vascular density and blood flow index were decreased of AION eyes in acute stage compared with the normal subjects, the difference was statistically significant (P < 0.05); while the optic disc blood flow area, outer vascular density and blood flow index of AION eyes in the recovery stage showed no significant difference compared with normal subjects (P > 0.05). ConclusionDisc perfusion is reduced in AION at the acute stage, but recovered at the recovery stage.
Idiopathic parafoveal telangiectasis (IPT) is a retinal vascular disease which is characterized by foveal and parafoveal telangiectasia. The main clinical manifestations are retinal telangiectasis, reduced retinal transparency, retinal venular dilatation, yellow exudation, retinal pigment epithelial lesions, retinal hemorrhage, macular atrophy, macular hole or lamellar hole, subretinal neovascularization and retinal detachment. According to the clinical characteristics and features of fluorescein angiography, IPT can be divided into 3 types and 6 subtypes. Laser photocoagulation, photodynamic therapy, and intravitreal injection of glucocorticoid or anti-vascular endothelial growth factor drugs, can reduce the macular edema and neovascularization. However, due to the unclear etiology of IPT, the existing treatment measures are not specific for its etiology. We need to work hard to understand further the clinical features and pathogenesis of IPT and search the targeted treatments based on its pathogenesis mechanism.