Objective To investigate the method and effect of krypton laser photocoagulation for neovascularization in retinal vein occlusion . Methods Tweenty eight eyes of 27 patients with retinal vein occlusion with neovascularization were photocoagulated by krypton green and red laser.The fundus changes were observed by fundus fluorescein angiography after photocoagulation. Results The neov ascularization disappeared completely in 20 eyes and became smaller in 6 eyes,re mained no change in 2 eyes,and the visual acuity improved in 17 eyes (60.7%) after 6 monthes to 2.5 years of follow-up. Conclusion Krypton laser photocoagulation is obviously effective on regression of n eovascularization and prevenion of vitreous hemorrhage in retinal vein occlusion . (Chin J Ocul Fundus Dis, 2001,17:12-14)
Diabetic macular edema (DME) is a common ocular complication of diabetes patients. It mainly involve macular which is closely related with visual function, thus DME is one of the major reasons causing visual impairment or blindness for diabetes patients. How to reduce the visual damage of DME is always a big challenge in the ophthalmic practice. In the past three decades, there are tremendous developments in DME treatments, from laser photocoagulation, antiinflammation drugs to antivascular endothelial growth factor therapy. However, the mechanism of DME development is not yet completely clear; every existing treatment has its own advantages and weaknesses. Therefore DME treatment still challenges us to explore further to reduce the DME damages.
Objective To observe the short-term effect of changing the sequence of PRP and MLP on the pre-proliferative or proliferative diabetic retinopathy patients with clinical significant macular edema (CSEM). Methods Sixty-three consecutive pre-proliferative or proliferative diabetic retinopathy outpatients (103 eyes) with clinical significant macular edema were selected and divided into two groups: 54 eyes in patients of group A accepted MLP one month prior to PRP and 49 eyes in patients of group B accepted the photocoagulative therapies in a contrary sequence. All the patients were followed up for 3 to 13 months and visual acuity. Light sensitivity of 5deg;macular threshold, and FFA were performed pre- and post-photocoagution. Results The improvement of visual acuity was found to be better in group A than that of group B (Plt;0.01) 2 months after the therapy, since then, there was no significant defference (Pgt;0.05) in both groups. Three and 4 months after the treatment, there was no significant difference in change of light sensitivity of 5deg;macular threshold in both groups. The macular leakages of 59 eyes, 32 ingroup A and 27 in group B, were well controlled. Conclusion Among the pre-proliferative or proliferative diabetic retinopathy patients with CSEM, visual acuity of those who accept MLP prior to PRP more rapidly than those who accept contrary sequence of photocoagulation, but the changing of therapeutic sequence might have no dramatic influence on light sensilivity of 5deg;macular threshold. (Chin J Ocul Fundus Dis,2000,16:150-152)
ObjectiveTo observe the expression of inflammatory cytokines in diabetic rats received posterior sub-Tenon capsule injection of triamcinolone acetonide (TA) and pan-retinal photocoagulation. MethodsA total of 48 Brown Norway rats received intraperitoneal injection of streptozotocin to establish the diabetic model. Diabetic rats were randomly divided into experimental group (20 rats), control group (20 rats) and blank group (8 rats). 50 μl TA or saline was injected into the posterior sub-Tenon capsule immediately after the photocoagulation in the experimental group and the control group, respectively. The blank group received no treatment. The mRNA and protein expression level of retinal vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and tumor necrosis fator-α (TNF-α) were measured by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA) at 1, 3, 7 days after laser photocoagulation. ResultsThe mRNA and protein expression of VEGF, IL-6, TNF-α of the experimental group and control group were significantly higher than the blank group, the difference was statistically significant (P < 0.05). The mRNA and protein expression of VEGF, IL-6 and TNF-α of the experimental group were significantly lower than that of the control group. On day 1 after laser photocoagulation, the mRNA expression of VEGF was not statistically significant in the experimental group and control group (P > 0.05), the mRNA and protein expression of VEGF, IL-6, TNF-α of the two groups were statistically significant in the remaining observing time (P < 0.05). ConclusionPosterior sub-Tenon capsule injection of TA can effectively reduce retinal photocoagulation induced VEGF, IL-6, TNF-α expression.
Objective To make an evidence-based remedy for a patient with cerebral veins and sinuses thrombosis (CVST), who had an unsatisfactory response to routine treatment. Methods We searched the Cochrane Library (Issue 3, 2005), PubMed (1966 to 2005), CNKI (1979 to 2005) and VIP (1989 to 2005) to identify systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies about efficacy and safety of anticoagulants and thrombolysis therapy for CVST. Results We found 1 systematic review, 3 RCTs and 8 prospective cohort studies about anticoagulation therapy and 2 SRs and 1 CCT about thrombolysis therapy. Routine anticoagulation and thrombolysis for patients with CVST are not recommended due to insufficient evidence. Anticoagulation appeared to be safer and could prevent pulmonary embolism. According to the current evidence, the patient’s status and will, anticoagulants were given. His symptoms relieved and he had no subsequent hemorrhages or pulmonary embolism. Conclusion Patients with CVST should receive anticoagulation treatment with monitoring of de novo hemorrhages and the index of hemostasis and coagulation. Large-sample RCTs comparing the effect and safety of anticoagulant with placebo and RCTs comparing the effect and safety of anticoagulation therapy with that of endovascular thrombolysis therapy in high-risk patients are needed.
Objective To observe the functional and morphological changes of macular after panretinal photocoagulation（PRP）in the patients with diabetic retinopathy（DR）.Methods A total of 57 eyes of 34 patients with DR undergoing PRP were enrolled in this prospective and self-reflection study. Comparatively analyze the changes of the best visual acuity（BCVA）, optical coherence tomography (OCT) and multi-focal electroretinography (mfERG) before PRP,20 days, 3 months and more than 9 months after PRP. Statistical analyses were performed by wilcoxon, chisquare, Dunnett-t, LSD-t tests and spearman related analyses. The changes of macular function and foveal retinal thickness before and after PRP were comparatively analyzed.Results BCVA of all patients reduced at 9 months after PRP（P=0.022）.The amplitude density of mfERG P1 of ring 2 decreased at 20 days after PRP（P=0.039）,then recovered at 3 months and decreased again at 9 months（P=0.014）.The amplitude density of mfERG P1 of ring 3-5 decreased at 20 days,3 months and more than 9 months after PRP（20 days: ring 3: P=0.000,ring 4: P=0.001, ring 5: P=0.000；3 months: ring 3:P=0.000, ring 4: P=0.006, ring 5: P=0.001; more than 9 months: ring 3: P=0.000,ring 4: P=0.000, ring 5: P=0.000）. The amplitude density of mfERG P1 of ring 1 was significantly lower at 9 months after PRP（P=0.050）. The foveal retinal thickness increased at 20 days after PRP(P=0.007), then recovered at 3 months or later. Cystoid macular degeneration was found in 6 eyes(10.5%) at 20 days after PRP.Conclusions After the treatment of PRP, there were some extend reduction of the macular function, a transient increase on foveal retinal thickness. Combined mfERG and OCT can be a comprehensively and objectively assessment of macular function and morphology.
Objective To compare the therapeutic effects of 577 nm laser and 532 nm laser panretinal photocoagulation (PRP) in the treatment of non-proliferative diabetic retinopathy (NPDR). Methods This is a prospective controlled study. A total of 23 patients (41 eyes) with clinically diagnosed severe NPDR were randomly divided into two groups including 577 nm group (11 patients, 20 eyes) and the 532 nm group (12 patients, 21 eyes). 577 nm group and 532 nm group received 3 - 4 times PRP with single-point mode. The laser energy and the number of laser spots were compared, and the laser energy density was calculated. Before treatment and 1 day, 1, 3, 6 and 12 months after treatment, the changes of best corrected visual acuity (BCVA), average threshold sensitivity, a/b-wave amplitude of flash ERG (F-ERG) in the 30° - 60° visual field, and fundus fluorescein angiography (FFA) were compared between two groups. Results The response rate was 85.0% and 23.8%, respectively in the 577 nm and 532 nm group, the difference was statistically significant (χ2=15.43，P < 0.05).Compare to the pre-treatment measurement, the average threshold sensitivity, a/b wave amplitude of F-ERG and the 30° - 60°visual field were reduced at 1 day after treatment both in the 577 nm and 532 nm group, the difference were statistically significant (F=8.68, 7.57, 4.52; P < 0.05). The average threshold sensitivity (t=2.41, 3.48, 1.23), a/b wave amplitude (a wave: t=5.82, 4.45, 7.83；b wave: t=5.40, 3.23, 4.67) of F-ERG were different between 577 nm and 532 nm group at 3 , 6 and 12 months after treatment (P < 0.05). There was no retinal neovascularization and non-perfusion region in two groups at 6 months after treatment. The average laser power were (436.25±54.65) and (446.43±35.61) mW, number of laser spots were (1952.95±299.09) and (2119.05±302.69) spots, energy density were (7.60±1.30) and (7.60±3.00) mW×ms/μm2 in the 577 nm group and 532 nm group, respectively. There was no difference in average laser power (t=1.35), number of laser spots (t=2.85) and energy density (t=1.99) between two groups (P > 0.05). Conclusion Compared with the 532 nm laser, 577 nm laser treatment has better visual outcomes for NPDR patients.
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)
Objective To summarize the advancement of hereditary thrombophilia. Methods Relevant literatures about hereditary thrombophilia published recently domestic and abroad were reviewed and analyzed. Results The hereditary risk factors of venous thromboembolism were different among different races. In western population, the main risk factors were activated protein C resistance (APC-R) and mutation of factor V Leiden, methylene tetrahydrofolate reductase polymorphism (C677T) and prothrombin G20210A. While in Chinese population, the disorder of protein C system and hyperhomocysteinemia were the major genetic risk factor. The existence of multiple genetic risk factors increased the incidence of primary and recurrent venous thromboembolism. Conclusion Further study on the relations between the hereditary risk factors and thrombophilia will be very important for prediction and prevention of the venous thromboembolism.
The threshold micropulse laser is widely used in clinical practice as a safe, non-invasive laser for avariety of macular diseases. Compared with the conventional laser therapy, the subthreshold micropulse laser is selectively absorbed by the RPE and therefore it does not cause retinal damage. To explore the therapeutic mechanism and the safety, development of threshold micropulse laser in the treatment of various common macular diseases, and further clarify its indications and advantages, which are helpful for its wider clinical application.