Intravitreal anti-VEGF injection have been widely used in retinal vascular diseases and achieved good efficacy. Early pregnancy is an important period for fetal organ formation and vascular development. Studies have proved that VEGF plays an important role in maintaining the fetal and placental vascular system, and its loss or decline will affect embryonic development and lead to abortion. The use of intravitreal anti-VEGF during pregnancy is controversial, which may cause systemic side effects to the mother and fetus. This paper summarizes the literature of 23 cases on the use of anti-VEGF during pregnancy. Three cases reported loss of pregnancy with concomitant exposure to intravitreal bevacizumab, which suggested that we should be careful about the use of anti-VEGF during pregnancy and explain the possibility of ocular and systemic side effects to patients in detail. When deciding whether to use anti-VEGF, we should consider the relationship between exposure time and the critical period of vascular development and the systemic exposure of different drugs. Currently, there is a lack of large sample size studies on the use of anti-VEGF in pregnancy, and its safety needs to be further observed.
Objective To analysis the effect of lens opacity on the measurement of retinal vessel oxygen saturation. Methods This was a cross sectional study. Forty four eyes of 44 patients with different degrees of lens opacity were enrolled. There were 23 males and 21 females. The patients aged from 48 to 84 years, with the mean age of (71.8±10.3) years. The mean best corrected visual acuity was 0.65±0.22. The mean intraocular pressure was (14.2±4.3) mmHg (1 mmHg=0.133 kPa). The mean equivalent spherical degree was (−0.05±2.10) D. The opitical quality analysis system was applied to measure intraocular objective scattering index (OSI) caused by lens opacity. According to the OSI, the opacity of lens was divided into four groups. Patients with OSI value ＜1.0 was grouped to level 1, which indicated that the lens were basically transparent; patients with OSI value between 1.0 and 3.0 was grouped to level 2, which indicated early cataract; patients with OSI value between 3.0 and 7.0 was grouped to level 3, which indicated progressive cataract; patients with OSI value ＞7.0 was grouped to level 4, which indicated the mature stage of cataract. The retinal oximeter Oxymap T1 was used to capture the fundus images under different wavelengths. Pearson correlation analysis was used to analyze the correlation between retinal oxygen saturation and age, intraocular pressure, equivalent spherical degree and OSI. One way ANOVA was used to analyze the difference of retinal oxygen saturation among groups. Results The mean retinal arterial oxygen saturation, venous oxygen saturation and arteriovenous difference was (90.70±6.46)%, (47.34±13.51)%, (43.36±10.09)%, respectively. The correlations of retinal arterial oxygen saturation, venous oxygen saturation and arteriovenous difference with age, intraocular pressure, equivalent spherical degree was not statistically significant (all P＞0.05). The retinal arterial oxygen saturation and venous oxygen saturation was negatively correlated with OSI (r=−0.462,−0.500; P=0.002, 0.001), the arteriovenous difference and OSI was positively correlated (r=0.373, P=0.013). According to lens opacity, there were 11 eyes in level 1, 9 eyes in level 2, 14 eyes in level 3, 10 eyes in level 4. There were significant differences of retinal artery and venous oxygen saturation among different lens opacity levels (F=5.340, 4.710; P=0.003, 0.007); meanwhile, the arteriovenous difference was not significantly different (F=2.048, P=0.123). The retinal arterial oxygen saturation and venous oxygen saturation was significantly lower in the level 4 lens opacity group than any other three groups (all P＜0.05), but there was no statistically significant difference among level 1 to level 3 lens opacity group. Conclusion The effect of lens opacity of level 1 to level 3 is limited on the measurement of retinal oxygen saturation, but level 4 lens opacity will cause decrease of retinal artery and venous oxygen saturation.
Objective To compared the changes of macular microvascular architecture in early stage familial exudative vitreoretinopathy (FEVR) patients with inner retinal layer (IRL) persistence and without IRL persistence. MethodsA retrospective clinical study. From 2017 to 2022, 94 patients with stage 1 FEVR with or without IRL residue and 45 age- and sex-matched healthy volunteers with 45 eyes (normal control group) who were confirmed by ophthalmology examination in Hangzhou Hospital of Optometry Affiliated to Wenzhou Medical University and Zhejiang Provincial People's Hospital were included in the study. According to whether there was IRL residue, the patients were divided into IRL group and non-IRL group, with 22 patients (22 eyes) and 72 patients (72 eyes), respectively. Best corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were performed in all eyes. Superficial vessel density (SCP) and deep vessel density (DCP) of whole image, fovea and parafovea, the area and perimeter of fovea avascular area (FAZ), A-circularity index (AI, perimeter/standard circle perimeter with equal area) and vessel density around the 300 μm width of the FAZ (FD), central macular thickness (CMT) on macular 3 mm × 3 mm scan on OCTA were measured. ResultsSCP and DCP of whole image (F=10.774, 4.583) and parafovea (F=10.433, 3.912), CMT (F=171.940) in IRL group and non-IRL group on macular 3 mm × 3 mm scan on OCTA were significantly lower than that in normal persons (P＜0.05). There were significant differences among three groups of the area of FAZ (F=4.315), AI (F=3.413), FD-300 (F=13.592) (P＜0.05). BCVA were worst in IRL group (P＜0.05). ConclusionsBlood flow density decreased in macular area of FEVR patients. CMT is significantly thicker than normal population. The FAZ area of the foveal IRL residual eyes is small and irregular, with worse BCVA and lower macular blood density.
Retinopathy of prematurity (ROP) is a major cause of vision loss and blindness among premature infants. Timely screening, diagnosis, and intervention can effectively prevent the deterioration of ROP. However, there are several challenges in ROP diagnosis globally, including high subjectivity, low screening efficiency, regional disparities in screening coverage, and severe shortage of pediatric ophthalmologists. The application of artificial intelligence (AI) as an assistive tool for diagnosis or an automated method for ROP diagnosis can improve the efficiency and objectivity of ROP diagnosis, expand screening coverage, and enable automated screening and quantified diagnostic results. In the global environment that emphasizes the development and application of medical imaging AI, developing more accurate diagnostic networks, exploring more effective AI-assisted diagnosis methods, and enhancing the interpretability of AI-assisted diagnosis, can accelerate the improvement of AI policies of ROP and the implementation of AI products, promoting the development of ROP diagnosis and treatment.
ObjectiveTo observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.MethodsA retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males (5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.ResultsIn ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ2=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).ConclusionsInverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.
Objective To investigate the correlation between the vitreomacular adhesion (VMA) and exudative age-related macular degeneration (AMD). Methods A literature research was performed in PubMed, EMbase, Cochrane Library, CNKI and Wanfang database from January 2000 to December 2016. Case-control studies on the relationship between VMA or posterior vitreous detachment and exudative AMD were included in this analysis. Literature screening and data extraction were performed according to inclusion and exclusion criteria. The qualities of the literatures were evaluated according to the Newcastle-Ottawa Scale (NOS). Seven literatures were selected into meta-analysis. The NOS score was 9 points in 1 article, 8 scores in 4 articles, 7 points in 2 articles. A total of 947 eyes with exudative AMD, 638 eyes with dry AMD, and 618 eyes with controls were included. The correlation between exudative AMD and VMA were analyzed using the software Review manager 5.3. Results The prevalence of VMA in exudative AMD eyes was higher than that in controls [odds ratio (OR)=2.14, 95% confidence interval (CI)=1.19 - 3.84, P=0.010] and dry AMD eyes (OR=2.24, 95%CI=1.24 - 4.03, P=0.007). There was no difference in PVD prevalence among exudative AMD eyes, dry AMD eyes (OR=0.44, 95%CI=0.16 - 1.20, P=0.110) and controls (OR=0.70, 95%CI=0.41 - 1.18, P=0.180). Conclusion There is correlation between VMA and exudative AMD.
ObjectiveTo study a deep learning-based dual-modality fundus camera which was used to study retinal blood oxygen saturation and vascular morphology changes in eyes with branch retinal vein occlusion (BRVO). MethodsA prospective study. From May to October 2020, 31 patients (31 eyes) of BRVO (BRVO group) and 20 healthy volunteers (20 eyes) with matched gender and age (control group) were included in the study. Among 31 patients (31 eyes) in BRVO group, 20 patients (20 eyes) received one intravitreal injection of anti-vascular endothelial growth factor drugs before, and 11 patients (11 eyes) did not receive any treatment. They were divided into treatment group and untreated group accordingly. Retinal images were collected with a dual-modality fundus camera; arterial and vein segments were segmented in the macular region of interest (MROI) using deep learning; the optical density ratio was used to calculate retinal blood oxygen saturation (SO2) on the affected and non-involved sides of the eyes in the control group and patients in the BRVO group, and calculated the diameter, curvature, fractal dimension and density of arteriovenous in MROI. Quantitative data were compared between groups using one-way analysis of variance. ResultsThere was a statistically significant difference in arterial SO2 (SO2-A) in the MROI between the affected eyes, the fellow eyes in the BRVO group and the control group (F=4.925, P<0.001), but there was no difference in the venous SO2 (SO2-V) (F=0.607, P=0.178). Compared with the control group, the SO2-A in the MROI of the affected side and the non-involved side of the untreated group was increased, and the difference was statistically significant (F=4.925, P=0.012); there was no significant difference in SO2-V (F=0.607, P=0.550). There was no significant difference in SO2-A and SO2-V in the MROI between the affected side, the non-involved side in the treatment group and the control group (F=0.159, 1.701; P=0.854, 0.197). There was no significant difference in SO2-A and SO2-V in MROI between the affected side of the treatment group, the untreated group and the control group (F=2.553, 0.265; P=0.088, 0.546). The ophthalmic artery diameter, arterial curvature, arterial fractal dimension, vein fractal dimension, arterial density, and vein density were compared in the untreated group, the treatment group, and the control group, and the differences were statistically significant (F=3.527, 3.322, 7.251, 26.128, 4.782, 5.612; P=0.047, 0.044, 0.002, <0.001, 0.013, 0.006); there was no significant difference in vein diameter and vein curvature (F=2.132, 1.199; P=0.143, 0.321). ConclusionArterial SO2 in BRVO patients is higher than that in healthy eyes, it decreases after anti-anti-vascular endothelial growth factor drugs treatment, SO2-V is unchanged.
ObjectiveTo observe and analyze the correlations between aqueous humor cytokine concentrations and disorganization of retinal inner layers (DRIL), as well as postoperative visual acuity, in patients with idiopathic epiretinal membrane (iERM). MethodsA prospective clinical study. From November 2022 to October 2024, 40 eyes of 40 patients diagnosed with iERM at Ophthalmology Center of Zhejiang Provincial People's Hospital (Affiliated People's Hospital) underwent cataract surgery alone or combined with pars plana vitrectomy (iERM group) were enrolled; 19 eyes of 19 patients undergoing cataract surgery alone during the same period served as the control group. All eyes underwent best-corrected visual acuity (BCVA) testing and swept-source optical coherence tomography (SS-OCT). BCVA was assessed using a logarithmic visual acuity chart and converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Central macular thickness (CMT) was measured using SS-OCT. The iERM group was further subdivided into DRIL-positive and DRIL-negative subgroups (21 eyes and 19 eyes, respectively), based on the presence or absence of DRIL. Aqueous humor samples were collected preoperatively from eyes in both the iERM and control groups. Concentrations of transforming growth factor (TGF)-β1, TGF-β2, TGF-β3, platelet-derived growth factor (PDGF)-AB, hepatocyte growth factor, fibroblast growth factor, vascular endothelial growth factor-A (VEGF-A), placental growth factor (PLGF), glial cell line-derived neurotrophic factor (GDNF), intercellular adhesion molecule-1 (ICAM-1), angiopoietin (Ang)-1, Ang-2, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured. Follow-up examinations using the same equipment and methods were performed at 1 month postoperatively. Aqueous cytokine levels were compared between the iERM group, control group, DRIL-positive subgroup, and DRIL-negative subgroup. Correlations between aqueous cytokine levels in the iERM group and BCVA or CMT were also analyzed. Intergroup comparisons utilized the Mann-Whitney U test; correlations between variables were assessed using Spearman's rank correlation analysis. ResultsCompared to the control group, the iERM group exhibited significantly higher aqueous concentrations of TGF-β1, TGF-β3, PDGF-AB, PLGF, GDNF, ICAM-1, Ang-1, and TNF-α (P＜0.05). Compared to the DRIL-negative subgroup, the DRIL-positive subgroup showed significantly elevated aqueous concentrations of TGF-β3, PDGF-AB, PLGF, GDNF, ICAM-1, Ang-1, Ang-2, TNF-α, and IL-6 (P＜0.05). Significant differences were observed in logMAR BCVA (P=0.028) and CMT (P＜0.001) within the iERM group between preoperative and 1-month postoperative measurements. LogMAR BCVA differed significantly between the DRIL-positive and DRIL-negative subgroups (P=0.048). Correlation analysis revealed that baseline aqueous levels of VEGF-A and IL-6 in eyes with DRIL were positively correlated with postoperative BCVA (r=0.324, 0.452; P=0.042, 0.003). No significant correlation was found between CMT and any cytokine (P＞0.05). ConclusionsAqueous humor cytokines are closely associated with DRIL in iERM patients. IL-6 and VEGF-A may serve as potential predictive biomarkers for early postoperative visual recovery.
ObjectiveTo observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic.MethodsA prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12% C3F8 was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.ResultsThe foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20; P＜0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.ConclusionsPars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.
Objective To establish a risk prediction model of diabetic retinopathy (DR) for type 2 diabetic patients (T2DM). Methods A total of 315 T2DM patients (600 eyes) were enrolled in the study. There were 132 males (264 eyes) and 183 females (366 eyes). The mean age was (67.28±12.17) years and the mean diabetes duration was (10.86±7.81) years. The subjects were randomly assigned to model group and check group, each had 252 patients (504 eyes) and 63 patients (126 eyes) respectively. Some basic information including gender, age, education degree and diabetes duration were collected. The probable risk factors of DR including height, weight, blood pressure, fasting glucose, glycosylated hemoglobin (HbA1c), blood urea, serum creatinine, uric acid, triglyceride, total cholesterol, high-density lipoprotein, low density lipoprotein cholesterol and urinary protein. The fundus photograph and the axial length were measured. Multivariate logistic regression was used to analyze the correlative factors of DR and establish the regression equation (risk model). Receiver operating characteristic (ROC) curves were used to determine the cut-off point for the score. The maximum Youden Index was used to determine the threshold of the equation. The check group was used to check the feasibility of the predictive model. Results Among 504 eyes in the model group, 170 eyes were DR and 334 eyes were not. Among 126 eyes in the check group, 45 eyes were DR and 81 eyes were not. Multivariate logistic regression analysis revealed that axial length [β=–0.196, odds ratio (OR)=0.822,P＜0.001], age (β=-0.079,OR=0.924,P＜0.001), diabetes duration (β=0.048,OR=1.049,P=0.001), HbA1c (β=0.184,OR=1.202,P=0.020), urinary protein (β=1.298,OR=3.661,P＜0.001) were correlated with DR significantly and the simplified calculation of the score of DR were as follows:P=7.018–0.196X1–0.079X2+0.048X3+0.148X4+1.298X5 (X1= axial length, X2=age, X3=diabetes duration, X4=glycosylated hemoglobin, X5= urinary protein). The area under the ROC curve for the score DR was 0.800 and the cut-off point of the score was -1.485. The elements of the check group were substituted into the equation to calculate the scores and the scores were compared with the diagnostic threshold to ensure the patients in high-risk of DR. The result of the score showed 84% sensitivity and 59% specificity. ROC curve for the score to predict DR was 0.756. Conclusion Axial length, age, diabetes duration, HbA1c and urinary protein have significant correlation with DR. The sensitivity and specificity of the risk model to predict DR are 84.0% and 59.0% respectively. The area under the ROC curve was 0.756.