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)
ObjectiveTo seek the evidencebased medicine (EBM) evidences of curative effects of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsAll articles of intravitreous injection TA for macular edema published in English or Chinese were picked up from databases of MEDLINE and CNKI and then evaluated according to EBM standard. The data in accord with research standard were selected by using excluding and including criteria, and classified according to the appraisal standard of clinical therapeutic documents. ResultsIn the selected papers, none in gradeⅠevidence; 1 in gradeⅡevidence; 7 in grade Ⅲ evidence; 24 in grade Ⅳ evidence; and 19 in gradeⅤevidence. Forty-two papers reported that intravitreous injection with TA had significant effect for macular edema within 3 months, and the improvement of visual acuity was recorded in these papers. Regression of macular edema was recorded in 23 papers. Among 20 papers, side-effect was found in 93 eyes (31.41%) and the serious sideeffect in 4 eyes (1.35%).ConclusionsIntravitreous injection with TA has some curative effects for macular edema in short term, but the quality of current study has not been encouraging. There are no grade I document and lack of the study of validity in long term and essentiality and validity of retreatment. The special attention should be payed on the increasing persistency of efficacy and preventing the serious side-effects in the future investigation.(Chin J Ocul Fundus Dis, 2005,21:220-223)
Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ-Ⅳ idiopathic full-thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate，change of visual acuity，findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups (P＜0.05). (2) In anatomic success rate, the single vitrectomy group was significantly lower than the vitrectomy with APC treatment group（87.5%）or vitrectomy with both ILM peeling and APC as an adjuvant group(92.0%)(P＜0.05). (3) There was no significant difference in operative complication and improvement of distortion of vision. Conclusion Vitrectomy combined with APC as an adjuvant for the treatment of idiopathic macular hole is helpful to improve both the anatomic success rate and postoperative visual acuity. The usage of ILM peeling technique could improve the anatomic reattachment rate, but the vision prognosis of ILM peeling patients is not as good as the patients of APC as an adjuvant. (Chin J Ocul Fundus Dis, 2002, 18: 196-198)