Objective To observe the relationship between the suturing patterns to close the scleral incision and postoperative intraocular pressure (IOP) in 23G minimally invasive vitrectomy. Methods Eighty eyes of 80 patients with vitreoretinal diseases, who were treated with primary 23G minimally invasive vitrectomy, were enrolled in this prospective clinical study. Patients with poor closed scleral incision which need suturing were excluded from this study. The corrected visual acuity ranged from hand movement to 0.2. The IOP ranged from 7.9 to 19.8 mm Hg (1 mm Hg=0.133 kPa), with the mean of (13.9plusmn;1.8) mm Hg. The eyes were randomly divided into three groups: group A (20 eyes), suturing all three scleral puncture after vitrectomy; group B (20 eyes), suturing only two upper scleral puncture, but not the lower infusion puncture after vitrectomy; group C (40 eyes), no suturing for all 3 scleral puncture after vitrectomy. All patients underwent 23G vitrectomy only. The corrected visual acuity and IOP were observed after surgery. Results The corrected visual acuity were 0.1 -0.3, 0.2- 0.5, 0.3 -0.8 in one, seven and 14 days after surgery, respectively. No one in group A, B experienced hypotony in one, three, seven and 14 days after surgery. Thirteen (32.5%), five (12.5 %), two eyes (5.0%) in group C experienced hypotony in one, three and seven days after surgery. Seven eyes (17.5%) experienced severe hypotony (＜5 mm Hg) in 14 day after surgery in group C. The difference was statistically significant compared the incidence of hypotony in group C with group A, B respectively at different time points after surgery (chi;2= 16.82,P=0.007). The difference was statistically significant compared the incidence of hypotony in group C at different time points after surgery (chi;2=11.64,P=0.003). The difference was no significant compared the IOP between group A and B at different time points after surgery (F=1.618,P=0.205). Compared the IOP of group C to group A and B, the difference was statistically significant in one and three days after vitrectomy (F=9.351,P=0.000); but not statistically significant in seven and 14 days after vitrectomy(F=0.460,P=0.633). Conclusions Whether or not suturing the scleral punctures is closely related to postoperative hypotony in 23G vitrectomy. Suturing only the two upper scleral punctures can reduce the occurrence of postoperative hypotony.
ObjectiveTo observe the effects of bulbar subconjunctival and periocular injection of dexamethasonone on blood glucose levels of type 1 diabetic mellitus (T1DM)rats. Methods80 healthy adult male Sprague-Dawley rats were randomly divided into GroupⅠ(n=40) and GroupⅡ(n=40). GroupⅠrats received intraperitoneal (IP) injection of streptozotocin to induce T1DM model, while GroupⅡrats received IP injection of citrate buffer solution and was the control group.GroupⅠrats and GroupⅡrats were further divided into four subgroups:A (n=10), a (n=10), B (n=10), and b (n=10). Subgroup-A rats received bulbar subconjunctival injection of dexamethasone, subgroup-a rats received bulbar subconjunctival injection of saline, subgroup-B rats received periocular injection of dexamethasone, subgroup-b rats received periocular injection of saline. After the injection, rats were fasted but could drink water. Tail vein blood samples were collected and the blood glucose level was measured by glucose monitor. ResultsAfter modeling, the blood glucose level of GroupⅠand GroupⅡrats was(9.31±1.79) mmol/L and (5.72±0.80) mmol/L respectively, the difference was statistically significant (P < 0.05). The blood glucose level of GroupⅠrats reached the peak in 3h after injection. In 6-24 h after injection, the blood glucose level of GroupⅠA rats was obviously increased than that of the blood glucose level of Group Ia rats and the difference was statistically significant (P < 0.05). In 3-24 hours after injection, the blood glucose level of GroupⅠB rats was obviously increased than that of the blood glucose level of GroupⅠb rats and the difference was statistically significant (P < 0.05). Comparing the blood glucose level during different injection time between GroupⅠA rats and GroupⅠB rats, between GroupⅠa rats and GroupⅠb rats, the difference was not statistically significant (P > 0.05). In 3-24 hours after injection, the blood glucose level of GroupⅡA rats was obviously increased than that of the blood glucose level of GroupⅡa rats and the difference was statistically significant (P < 0.05); the blood glucose level of GroupⅡB rats was obviously increased than that of the blood glucose level of GroupⅡb rats and the difference was statistically significant (P < 0.05). Comparing the blood glucose level during different injection time between GroupⅡA rats and GroupⅡB rats, between GroupⅡa rats and GroupⅡb rats, the difference was not statistically significant (P > 0.05). ConclusionBulbar subconjunctival injection and periocular injection of dexamethasone could both increase the blood glucose of TIDM rats, but these two injection methods had no differences on the blood glucose level.
Anti-VEGF therapies have been widely used in the treatment of age-related macular degeneration, diabetic macular edema, retinal vein occlusion with macular edema and other retinal diseases. It have achieved remarkable treatment effect with relatively high safety, but there are still reports of adverse reactions in cardio-cerebral vessels and eyes. There are many methods to measure retinal blood flow. Although the principles of these methods are different, the results are different, and there is no uniform standard, it has been observed that anti-VEGF drugs may cause some changes in retinal vessel diameter, arterial blood flow velocity and blood flow parameters. Especially after multiple injections, the effect may be more obvious.
ObjectiveTo observe the changes in physical properties of silicone oil after intraocular tamponade. MethodsThe silicone oil was removed from 99 patients (99 eyes) of primary retinal detachment with 23G vitreous cutter system. The upper silicone oil was collected after put the vitrectomy samples at room temperature for 3 days. According to the time of intraocular tamponade, the silicone oil samples were divide into six groups including group A (1 month, 12 samples), group B (2 months, 15 samples), group C (3 months, 25 samples), group D (6 months, 22 samples), group E (1-2 years, 13 samples) and group F (above 2 years, 12 sample). Fresh unused silicone oil was set as blank control group. Then the emulsion particles, kinematic viscosity, surface tension, density, transmittance and refractive index were measured. ResultsThe difference between group A-F and the control was statistical significant (P<0.05) in emulsion particles (F=89.337), kinematic viscosity (F=10.660), surface tension (F=11.810), density (F=13.497), transmittance of wavelengths (F=455.496, 566.105, 525.102, 767.573, 622.961, 601.539), but not statistical significant at refractive index (F=2.936, P>0.05). The number of silicone oil emulsion particles has no statistical difference between group A and the control (P>0.05), but was significantly different between group B-F (P<0.05). The kinematic viscosity of silicone oil has no statistical difference between group A, B and the control (P>0.05), but was significantly different between group C-F (P<0.05). The surface tension of silicone oil has no statistical difference between group A-D and the control (P>0.05), but is significantly different between group E and F (P<0.05). The density of silicone oil has no statistical difference between group A-D and the control (P>0.05), but was significantly different between group E and F (P<0.05). The transmittance of silicone oil has statistical difference between group A-F and the control(P<0.05). The refractive index of silicone oil has no statistical difference between all the groups and the controls significantly (P>0.05). ConclusionsThe physical properties of silicone oil will change during the intraocular tamponade. The emulsion particles number will increase and the transmittance will decrease after 2 months, the kinematic viscosity of silicone oil will decrease significantly after 3 months, and the density and surface tension will change significantly after 1 year of tamponade.
ObjectiveTo evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus.MethodsThis is a prospective uncontrolled case study. The data of 140 consecutive primary 23G vitrectomy patients (145 eyes) were enrolled in this study. There were 56 males (59 eyes) and 84 females (86 eyes), with the mean age of (56.34±9.98) years and axial length of (23.99±2.57) mm. There were 139 phakic eye and 6 aphakic eyes. All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus. To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex, the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries. Pearson correlation analysis was used to analyze the relationship between age, anteroposterior axis of eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex.ResultsSurgical related complications included retinal tears close to the scleral incision sites (3/145 eyes, 2.1%) and lens injury (3/121 eyes, 2.5%). No other surgical complications occurred, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Based on CT images, the average scleral distance from limbus to the plane passing through the lens posterior apex, anteroposterior axis of eyeball and lens thickness was (6.72±0.81), (24.39±0.97), (4.22±0.47) mm, respectively. The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation (r=0.328 9, P=0.000 6).ConclusionPrimary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe.
Objective To observe the short-term intraocular pressure after 25G+ pars plana vitrectomy (PPV) and analyze the possible influencing factors in rhegmatogenous retinal detachment (RRD) and proliferative diabetic retinopathy (PDR) eyes. Methods This is a retrospective case-control study. A total of 160 patients (163 eyes) of RRD and PDR who underwent 25G+ PPV were enrolled in this study. There were 88 males (89 eyes) and 72 females (74 eyes), with the mean age of (50.37±13.24) years. There were 90 patients (92 eyes) with RRD (the RRD group) and 70 patients (74 eyes) with PDR (the PDR group). Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were performed on all the patients. The BCVA was ranged from hand motion to 0.6. The average IOP was (12.61±4.91) mmHg (1 mmHg=0.133 kPa). There were significant differences in crystalline state (χ2=9.285, P=0.009), IOP (χ2=58.45, P=0.000), history of PPV (χ2=4.915, P=0.027) and hypertension (χ2=24.018, P=0.000), but no significant difference in sex (χ2=0.314, P=0.635) and age (χ2=5.682, P=0.056) between the two groups. A non-contact tonometer has been used to measure IOP on postoperative day 1 and 3. The postoperative IOP distribution has been divided into five groups: severe ocular hypotension (≤5 mmHg), mild ocular hypotension (6 - 9 mmHg), normal (10 - 21 mmHg), mild ocular hypertension (22 - 29 mmHg), severe ocular hypertension (≥30 mmHg). Logistic regression analysis has been used to analyze the risk and protective factors. Results On the first day after surgery, there were 21 eyes (12.9%) in mild ocular hypotension, 96 eyes (58.9%) in normal, 22 eyes (13.4%) in mild ocular hypertension and 24 eyes (14.7%) in severe ocular hypertension. On the first day after surgery, there were 18 eyes (11.0%) in mild ocular hypotension, 117 eyes (71.7%) in normal, 23 eyes (14.1%) in mild ocular hypertension and 5 eyes (3.1%) in severe ocular hypertension. There was no significant difference of IOP distribution between the two groups (Z=−1.235, −1.642; P=0.217, 0.101). The results of logistic regression analysis showed that silicone tamponade was a risk factor for ocular hypertension in PDR eyes on the first day after surgery [odds ratio (OR)=15.400, 95% confidence interval (CI) 3.670 - 64.590; P＜0.001], while intraocular lens was the risk factor for ocular hypotension in PDR eyes on third day after surgery (OR=19.000, 95%CI 1.450 - 248.2; P=0.025). As for RRD eyes, the ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=3.755, 95%CI 1.088 - 12.955; P=0.036). For all eyes, silicone tamponade (OR=0.236, 95%CI 0.070 - 0.797), air tamponade (OR=0.214, 95%CI 0.050 - 0.911) and inert gas tamponade (OR=0.092, 95%CI 0.010 - 0.877) were protective factors for ocular hypotension on the first day after surgery (P=0.020, 0.037, 0.038); silicone tamponade was protective factor for ocular hypotension on the third day after surgery (OR=0.249, 95% CI 0.066 - 0.94, P=0.040); while aphakic eyes was the risk factor for ocular hypotension on third day after surgery (OR=7.765, 95% CI 1.377 - 43.794, P=0.020). The ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=4.034, 95% CI 1.475 - 11.033, P=0.007). Conclusions The abnormal IOP is common after 25G+ PPV with a rate from 28.3% to 31.1%. Silicone tamponade, air tamponade and inert gases tamponade are protective factors for postoperative ocular hypotension, aphakic eye is risk factor for postoperative ocular hypotension. Ocular hypotension before surgery and silicone oil tamponade are risk factors for postoperative ocular hypertension.
Background Tongxinluo capsule is a new drug for cardio- cerebral vascular diseases on the national essential drug list of China, and the second-class award of National Science and Technology Development of China, 2001. Objective This review aims to assess the effect (harms and benefits) of Tongxinluo capsule for unstable angina. Search strategy electronic searchs The Cochrane Heart Review Group specialised trials register,The Cochrane Controlled Trials Register, published in the latest issue of the Cochrane Library, MEDLINE, EMBASE, CBM, Chinese Cochrane Centre Controlled Trials Register, Current Controlled Trials (www. controlled-trials. com), The National Research Register Handsearchs We will search 83 journals of Chinese traditional medicine. Inclusion riteria We will include randomised controlled trials of Tonxinluo capsule versus placebo or other current phamarcotherapy or other Chinese medicinal herbs in the participants with unstable angina pectoris. Studies will report mortality (sudden death from acute myocardial infarction), severity of angina pectoris, frequency of acute attack angina, ECG improvement, rate of dosage reducing or taking frequency of nitroglycerine and symptom improvement, etc. Data analysis Data will be included in a meta-analysis if they are available, of sufficient quality and sufficiently similar.
Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR). Methods A prospective clinical studies. Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No. 306 Hospital of PLA during January 2014 and December 2015 were included in this study. Among them, 21 eyes of NPDR and 20 eyes of PDR; 13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group). All eyes underwent best corrected visual acuity (BCVA), fundus color photography, fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations. The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field). The BCVA of DR eyes was 0.81±0.28; the VFI and MD values were (89.8±8.4)% and −7.5±3.85 dB, respectively. The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27, the VFI were (90.86±7.86)% and (87.46±9.41)%, the MD values were −6.86±3.43 and 8.87±4.48 dB. PRP was performed on eyes using 577 nm krypton laser. The changes of VFI, MD and BCVA were observed at 1, 3, and 6 months after treatment. Results Compared with before treatment, the VFI of DR eyes decreased by 12.0%, 12.3% and 14.8% (t=7.423, 4.549, 4.79; P＜0.001); the MD values were increased by −4.55, −4.75, 6.07 dB (t=−8.221, −5.313, −5.383; P＜0.001) at 1, 3 and 6 months after treatment, the differences were statistically significant. There was no difference on VFI (t=1.090, −0.486; P＞0.05) and MD value (t=−0.560, −0.337; P＞0.05) at different time points after treatment. Compared with before treatment, the BCVA was significantly decreased in DR eyes at 1 month after treatment, the difference was statistically significant (t=2.871, P＜0.05). Before and after treatment, the BCVA of the DME group was lower than that of the non-DME group, the difference were statistically significant (t=4.560, 2.848, 3.608, 5.694; P＜0.001); but there was no differences on the VFI (t=1.209, 0.449, 0.922, 0.271; P＞0.05) and MD values (t=1.582, 0.776, 0.927, 1.098; P＞0.05) between the two groups. Conclusion The range of 30° visual field loss is about 12%-14.8% after 577 nm krypton laser PRP for DR. VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.
ObjectiveTo observe the effects of repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs on vitreous macular interface (VMI) in patients with exudative age-related macular degeneration (AMD).MethodsRetrospective study. Thirty-four exudative AMD patients who treated with intravitreal anti-VEGF drugs were included in this study. There were 26 males and 8 females. The age ranged from 50 to 80 years, with the average of (62.8±8.35) years. The eyes with at least 6 treatments during the 1-year follow-up were taken as the study eyes, and the eyes with no anti-VEGF drug treatment were the control eyes. Optical coherence tomography (OCT) examination was used to observe the VMI status of both eyes before treatment. Vitreous macular adhesion (VMA), macular epiretinal membrane (MEM), and complete vitreous detachment (C-PVD) were defined as abnormalities in VMI. The VMA was classified as focal (≤1500 μm) and broad (＞1500 μm) depending on the diameter of the vitreous and macular adhesions on the OCT images. Before treatment, there were 12 eyes with abnormal VMI in study eyes, including 8 eyes with broad VMA, 3 eyes with focal VMA, and 1 eye with MEM; 12 eyes with abnormal VMI in control eyes: broad VMA in 7 eyes, focal VMA in 2 eyes, C-PVD in 2 eyes, and MEM in 1 eye. The average follow-up time after treatment was 16.4 months. During the follow-up period, OCT was performed monthly in a follow-up mode. Comparing the changes on VMI between before and after treatment in both eyes of patients, respectively. The chi-square test was used to compare the difference on VMI. Because the number of samples was ＜40, Fisher's exact test was used for the analysis.ResultsAt the final follow-up, 12 eyes with abnormal VMI in the study eyes, including 5 eyes with broad VMA, 2 eyes with focal VMA, 3 eyes with C-PVD, and 2 eyes with MEM. There were 6 eyes altered comparing with baseline. In the control eyes, there were 13 eyes with abnormal VMI, including 5 eyes with broad VMA, 7 eyes with C-PVD, and 1 eye with MEM. A total of 6 eyes changed on VMI comparing with baseline. At the final follow-up, there was no significant difference on VMI changes between the study eyes and its corresponding control eyes (P=0.053). In all eyes, a total of 4 eyes changed from focal VMA to C-PVD at the final follow-up, accounting for 80.0% of the total focal VMA; 3 eyes changed from broad VMA to C-PVD, accounting for 21.4% of the total broad VMA.ConclusionsRepeated anti-VEGF treatment has little effect on VMI. Regardless of anti-VEGF therapy, eyes with focal VMA appears to be more prone to C-PVD than the broad one.
ObjectiveTo observe the influence of down-regulation of HtrA1 expression by small interfering RNA on light-injured human retinal pigment epithelium (RPE) cells. MethodsCultured human RPE cells(8th-12th generations)were exposed to the blue light at the intensity of (2000±500) Lux for 6 hours to establish the light injured model. Light injured cells were divided into HtrA1 siRNA group, negative control group and blank control group. HtrA1 siRNA group and negative control group were transfected with HtrA1 siRNA and control siRNA respectively. The proliferation of cells was assayed by CCK-8 method. Transwell test was used to detect the invasion ability of these three groups. Flow cytometry was used to detect the cell cycle and apoptosis. The expression of HtrA1 and vascular endothelial growth factor (VEGF)-A was detected by real time-polymerase chain reaction and Western blot respectively. ResultsThe mRNA and protein level of HtrA1 in the light injured cells increased significantly compared to that in normal RPE cells (t=17.62, 15.09; P<0.05). Compared with negative control group and blank control group, the knockdown of HtrA1 in HtrA1 siRNA group was associated with reduced cellular proliferation (t=6.37, 4.52), migration (t=9.56, 12.13), apoptosis (t=23.37, 29.08) and decreased mRNA (t=17.36, 11.32, 7.29, 4.05) and protein levels (t=12.02, 15.28, 4.98, 6.24) of HtrA1 and VEGF-A. Cells of HtrA1 siRNA group mainly remained in G0/G1 phase, the difference was statistically significant (t=6.24, 4.93; P<0.05). ConclusionKnockdown of HtrA1 gene may reduce the proliferation, migration capability and apoptosis of light-injured RPE cells, and decrease the expression of VEGF-A.