Objective To investigate the effects of Hep-A and Hep-B on vascular endothelial growth factor (VEGF)-induced breakdown of blood-retinal barrier. Methods The mice were subcutaneously injected vehicle, Hep-A or Hep-B 10 mg/kg twice a day for 5 days. Then, 1 μl of 10-6mol/L VEGF were intravitreous injected. After 6 hours, 13.7×104Bq/g3H-mannital were injected intraperitoneally. The mice were sacrificed and the retinas, lungs, kidneys were removed and examined for radioactivity. The result were analyzed using SPSS software to calculate and compare retina/lung and etina/kidney leakage ratio among groups of different treatment. Result The retina/lung and retina/kidney leakage ratio were 0.38±0.04 and 0.21±0.03 respectively in normal mice; increased significantly to 1.05±0.11 and 0.46±0.04 respectively in model mice, both Plt;0.01 compared to those in normal mice; decreased to 0.59±0.06 and 0.32±0.03 respectively in mice treated with Hep-A, both Plt;0.01 compared to those in model mice; decreased 0.54±0.04 and 0.35±0.03 in mice treated with Hep-B,both Plt;0.01 compared to those in model mice. Conclusion Hep-A and Hep-B can significantly reduce VEGF-induced breakdown of blood-retinal barrier in mice. Chin J Ocul Fundus Dis，2004，20：352-354)
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients. It mainly includes focal DME and diffuse DME, while DME of clinical significance needs timely intervention treatment. Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME. Currently, the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation. Among them, anti-VEGF injection is becoming the first-line therapeutic, and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients. During the diagnosis and treatment of DME, attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME. With the appearance of heterogeneity in the efficacy of anti-VEGF drugs, it remains to be further studied how to choose alternative therapeutics and when to replace them.
Objective The present study focus on the macular branch retinal vein occlusion (MBRVO) with and without laser treatment,and evaluate prospectively whether laser treatment is useful in improving the visual acuity and reducing the macular edema. At the same time to learn the difference of macular light sensitivity before and after laser treatment.Methods Forty-five eyes of forty-five patients with MBRVO and macular edema were randomized to laser treatment and no laser treatment. Follow up examinations were performed every 3 months. We compared the difference of visual improvement, resolution of macular edema between the two groups. The central 30°visual field of 20 patients with MBRVO were examined at pretreatment and 3 months after laser treatment. A comparison of light sensitivity at fovea ，central 10°and 11~30°eccentricity were done between before and after laser treatment. Results Comparison of visual improvement and resolution of macular edema showed a statistical difference between laser treatment and no laser treatment. The mean reduction of macular light sensitivity at the fovea and 11~30°3 months after the treatment has no statistical difference between before and after treatment (Pgt;0.05). But the mean light sensitivity at central 10°eccentricity were significantly decreased 3 months after photocoagulation (Plt;0.05).Conclusion The laser treatment might promote or accelerate visual acuity recovery and reduce the macular edema. There is no significant difference about the efficiency on macular function after laser treatment.(Chin J Ocul Fundus Dis，2003，19：201-268)
The prevalence of diabetes mellitus in adults of China has reached 12.8%. Diabetic retinopathy (DR) accounts for approximately 1/4-1/3 of the diabetic population. Several millions of people are estimated suffering the advanced stage of DR, including severe non-proliferative DR (NPDR), proliferative DR (PDR) and diabetic macular edema (DME), which seriously threat to the patients’ vision. On the basis of systematic prevention and control of diabetes and its complications, prevention of the moderate and high-risk NPDR from progressing to the advanced stage is the final efforts to avoid diabetic blindness. The implementation of the DR severity scale is helpful to assess the severity, risk factors for its progression, treatment efficacy and prognosis. In the eyes with vision-threatening DR, early application of biotherapy of anti-vascular endothelial growth factor can improve DR with regression of retinal neovascularization, but whether it is possible to induce capillary re-canalization in the non-perfusion area needs more investigation. Laser photocoagulation remains the mainstay treatment for non-center-involved DME and PDR.
Objective To expolre the factors which affect the size of diabetic,macular fobeal avascss scular zone(FAZ). Methods Making ten years of duration of diabetes a limit,79 nonproliferative and early proliferative diabetic patients were divided into 2 groups.Diabetic retinopathy severity level was diveided into 4 stages,and the macular edema was subdivided into focal、diffuse and cystoid according to fluorescein leakage of foveomacular region.All patients were measured FAZ with Heidelberg scanning laser fluoresceion angiography system and then compaired the size of FAZ of patients with different duration of diabetes、diabetic retinopathy severity level and macular edema status.The results were performed analysis of variance and t test. ResultsThe study shown the size of FAZ was not directly related to the duration of diabetes(t=1.3854,Pgt;0.1);There were significant differences about the size of FAZ of patients with different diabetic retinopathy severity level(F=7.6251,P＜0.01)and macular edema status(F=5.4369,P＜0.01)． Conclusion The size of FAZ was significantly increased in diabetic patients.It was enlarged with the development of diabetic retinopathy severity level,but it was not related to duration of diabetes. (Chin J Ocul Fundus Dis,2000,16:155-156)
Diabetic macular edema is the leading cause of central vision loss and even blindness in diabetic retinopathy. Compared to FFA, OCT can obtain the high-resolution 3D image quickly, easily to reflect the details of the tissue and realize the quantitative measurement. As a novel technology, OCT angiography (OCTA) can display microvascular structure from different layers of retina and choroid, having its advantage of quantifying the vessel density and the lesion area. By detecting fundus morphology, quantifying and quantitating the retinal vessels and vessel density, the combination of OCT and OCTA could play a guiding role in diagnosis, classification, treatment and prognosis of diabetic macular edema.
ObjectiveTo observe the changes of macular microvascular structure in eyes with macular edema secondary to branch retinal vein occlusion (BRVO-ME) after intravitreal injection of conbercept and analyze its relationship with visual function and central retinal thickness (CRT).MethodsA prospective clinical study. From July 2018 to June 2019, 21 eyes of 21 patients with unilateral temporal BRVO-ME diagnosed in the Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 14 eyes of 14 males and 7 eyes of 7 females; the average age was 58.0±8.3 years. There were 13 eyes and 8 eyes with occlusion of the superior temporal and inferior temporal branches of the retinal vein, respectively. The affected area was defined as the side of the venous obstruction. All the affected eyes underwent best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) examination. The BCVA was tested using the international standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistical analysis. All the eyes were treated with intravitreal injection of conbercept once a month for 3 months, and then treated as needed. A 3 mm × 3 mm scan centered on fovea was obtained and the vascular density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), fovea avascular zone (FAZ) area, perimeter of FAZ (PERIM), acircularity index (AI), foveal vascular density in a 300 μm wide region around FAZ (FD-300) and central retinal thickness (CRT) were measured. The follow-up time after treatment was 6 months. The vascular density and FAZ parameters were compared before and after treatment by paired t test. The correlations of BCVA, CRT and vascular density, FAZ area and the other parameters at 6 months after treatment were analyzed by linear regression analysis. ResultsBefore treatment, the logMAR BCVA of the eyes was 0.506±0.159, and the CRT was 375.4±81.3 μm; 6 months after treatment, the logMAR BCVA of the eyes was 0.294±0.097, and the CRT was 266.3±46.7 μm. There was a statistically significant difference of logMAR BCVA and CRT between the eyes before and after treatment (t=8.503, 9.843; P＜0.05). There was no statistically significant difference in the overall vascular density of SCP and DCP before and 6 months after treatment (t=－0.091, －0.320; P＞0.05). The foveal vascular density decreased, and the difference was statistically significant (t=8.801, 3.936; P＜0.05). The vascular density of DCP of the affected area increased, and the difference was statistically significant (t=－2.198, P＜0.05). Compared with those before treatment, the FAZ area and PERIM of the affected eyes had an increasing trend, while AI and FD-300 had a decreasing trend, and the differences were statistically significant (t=－18.071, －12.835, 2.555, 8.610; P＜0.05). The linear regression analysis showed that BCVA and FAZ area 6 months after treatment have significant correlation (t=2.532, P=0.024). ConclusionCRT decreased and BCVA increased after intravitreal injection of conbercept in BRVO-ME eyes. After treatment, the foveal vascular density of SCP and DCP decreased while the vascular density of DCP of the affected area increased. The FAZ increased and the PERIM and AI decreased during follow-up. The BCVA was significantly correlated with the FAZ area 6 months after treatment.
ObjectiveTo observe the therapeutic effect of intravitreous injection with triamcinolone acetonide (TA) on diffused diabetic macular edema.MethodsIntravitreous injection with TA was performed on 21 patients with diabetic macular edema who had undergone ocular-fundus examination, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT). The followup duration was 1 month, 3, and 6 months. The visual acuity, intraocular pressure, and retinal thickness at the macular area before and after the treatment, examined by ETDRS eye chart, noncontact tonometer, and OCT respectively, were observed and compared.ResultsOne month, 3, and 6 months after the injection, the mean extent of improvement of visual acuity was 7.5, 9.1 (including 2-line improvement in 10 eyes which occupied 48%), and 5.1 letters respectively; while the decrease of retinal thickness at macula was 143 μm (decrease of 33%), 184 μm (decrease of 42%), and 151 μm (decrease of 35%) respectively.ConclusionsIntravitreous injection with TA is effective for diffused diabetic macular edema in a short term (about 3 months).(Chin J Ocul Fundus Dis, 2005,21:217-219)
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 observe the changes of macular blood flow density in patients of macular telangiectasis type 1 (Mac-Tel type 1) with macular edema before and after the treatment of anti-VEGF.MethodsA retrospective clinical study. From January 2016 to December 2017, 14 Mac-Tel type 1 patients (14 eyes) diagnosed in Nanjing Medical University Eye Hospital were included in the study. There were 6 males (6 eyes) and 8 females (8 eyes), with the mean age of 35.3±9.3 years. All patients underwent BCVA and OCT angiography examinations. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. All the patients were received anti-VEGF injection treatment once a month for 3 consecutive months. The OCTA scanning region in the macular area was 3 mm × 3 mm. Macular blood flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the vessel density within a 300 μm width ring surrounding the foveal avascular area (FD-300) and central macular thickness (CMT) were measured in all eyes. Paired samples t-test and Pearson correlation analysis were used in this study.ResultsAt the baseline, logMAR BCVA was 0.69±0.07, CMT was 468.43±26.59 μm, SCP blood flow density was (50.99±1.19)%, DCP blood flow density was (43.79±1.44)%, FD-300 was (50.73±1.16)%. Compared with the baseline, there were significant differences between logMAR BCVA, CMT, DCP blood flow density and FD-300 in 1 week, 1 month, 3 months after treatment and 2 months after cessation of treatment (logMAR BCVA: t=6.77, 13.30, 16.99, 9.51; P=0.00, 0.01, 0.00, 0.01. CMT: t=6.99, 15.88, 26.10, 6.50; P=0.00, 0.01, 0.01, 0.00. DCP: t=6.75, 8.61, 15.12, 7.63; P=0.00, 0.01, 0.01, 0.00. FD-300: t=11.86, 13.08, 14.36, 4.41; P=0.00, 0.01, 0.01, 0.03). There was no significant difference in blood flow density of SCP between baseline and 2 months after cessation of treatment (t=1.36, P=0.19), but there was significant difference at the other time points after treatment (t=5.50, 6.84, 6.27; P=0.00, 0.01, 0.01). The Pearson's correlation analysis showed that there was a significant positive correlation between FD-300 and CMT (r2=0.54, P=0.04).ConclusionsThere is no significant change in the SCP blood flow density in the patients of Mac-Tel type 1 with macular edema, while the DCP blood flow density decreased and FD-300 increased. After anti-VEGF treatment, DCP blood flow density increased and FD-300 decreased. FD-300 is positively correlated with CMT.