Objective To determine the expression of the growth factors and the receptors related to angiogenesis in the intraocular tissues incarcerating in the sclerotomy sites. Methods Ten specimens from prolapsing intraocular tissues in sclerotomy sites during vitrectomy were obtained and serially sectioned in cryostate and were stained with a group of polyclonal antibodies against vascular endothelial growth factor(VEGF), basic fibroblast growth factor (bFGF), platelet-derived growth factor-A(PDGF-A) and transforming growth factor-β1(TGF-β1) as well as their receptors by using a streptavidin peroxidase system. Results The tissues prolapsed from the sclerotomy sites were identified as retina(3 cases), vitreous tissues(3 cases), degenerated red blood cell components(2 cases), ciliary body(one case) and fibrous tissue(one case). All specimens expressed VEGF and bFGF as well as their receptors. PDGF-A, TGF-β1 and their receptors expressed in the most of specimens. The positive cells included retinal cells, ciliary non-pigmented epithelial cells and pigmented epithelial cells, fibrous cells and the cells in vitreous. Conclusions The intraocular tissues incarcerated in the sclerotomy entries express the growth factors and receptors related to angiogenesis. This might be one of the potential factors of developing anterior proliferative vitreoretinopathy. (Chin J Ocul Fundus Dis, 2002, 18: 34-37)
Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.
Abstract: Objective To explore the protection of pulmonary function by shortening the thoracic opening time inesophagectomy of esophageal carcinoma. Methods A retrospective review of the postoperative pulmonary function of 54 patients with upper esophageal cancer undergoing esophagectomy with triple incisions in Tongji Hospital from January 2007 to April 2010 was conducted. The patients were divided into two groups. Twentyeight patients including 25 males and 3 females aged at 58.9±8.2 years were in in the classic procedure group, accepting classical esophagectomy with triple incision approach. Among them, there were 26 patients with squamous carcinoma and 2 with adenocarcinoma. Twentysix patients including 22 males and 4 females aged at 54.7±9.4 years were in the improved procedure group, accepting improved esophagectomy with triple incision approach. Among them, 25 patients had squamous carcinoma and 1 had adenocarcinoma. We analyzed the difference of the thoracic opening time, onelung ventilation time during the operation, arterial oxygen pressure (PaO2), arterial carbon dioxide differential pressure(PaCO2), pulse oximeter saturation (SpO2), postoperative mechanical ventilation time, intensive care unit (ICU) stay time, postoperative oxygen support days, postoperative inhospital days, and the incidence of pulmonary infection and respiratory failure between the two groups. Results There was a statistical difference between the two groups in thoracic opening time (4.7±1.2 hours versus 2.6±0.8 hours, t=7.51, Plt;0.05) and onelung ventilation time (3.7±15 hours versus 23±0.8 hours, t=4.23, Plt;0.05). The PaO2 and SpO2 on the 1st day and the 3rd day after operation were significantly lower than those before operation in both the classic procedure group (on the 1st day after [CM(159mm]operation, PaO2: F=516.03, Plt;0.05; SpO2: F=129.63, Plt;0.05; on the 3rdday after operation, PaO2: F=213.99, Plt;005; SpO2: F=61.84, Plt;0.05) and the improved procedure group (on the 1st day after operation, PaO2: F=423.56, Plt;0.05; SpO2: F=184.24, Plt;0.05; on the 3st day after operation, PaO2: F=136.78, Plt;0.05). On the 1st day after operation, PaO2 and SpO2 in the improved procedure group were significantly higher than those in the classic procedure group (F=36.20, Plt;0.05; F=93.42, Plt;0.05), while PaCO2 in the improved procedure group was significantly lower than that in the classic procedure group (F=155.49, Plt;0.05). On the 3rd day after operation, PaO2 in the improved procedure group was significantly higher than that in the classic procedure group (F=29.23, Plt;0.05). The postoperative mechanical ventilation time and ICU stay time in the improved procedure group were significantly shorter than those in the classic procedure group (t=3.81, P=0.00; t=4.65, Plt;0.05). Conclusion Improved esophagectomy of carcinoma with triple incision approach can significantly shorten the thoracic opening time and onelung ventilation time during operation, which plays a good role in protecting pulmonary function and lowering the incidence of pulmonary complications.
The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi, posterior scleral staphyloma and macular atrophy. At present, minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD, as it can promote MH closure, and significantly improve the outcome of MHRD. However if this method can improve the postoperative visual function is still controversial. The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane. It can stimulate Müller cell gliosis more effectively, and promote tissue filling in the MH which results in MH closure. It can also promote retinal reattachment and reduce the likelihood of retinal re-detachment. This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future. The inserted internal limiting membrane flap technique is relatively easy to perform, induces stable flaps by simple procedures, and can be an essential complement procedure of the inverted internal limiting membrane flap technique. In order to reduce the recurrence rate in the future, it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.
Objective To summarize research progress of postoperative complications of transilluminated powered phlebectomy in treatment of varicose veins. Method The clinical and scientific research about the treatment of varicose veins with transilluminated powered phlebectomy in recent years were searched and the progress of the postoperative complications were reviewed. Results With the evolution of surgical techniques and the accumulation of experience, a variety of translucent resection of the postoperative complications such as the cellulitis, wound abscess, hematoma, residual vein, nerve damage reduced. Conclusions From current development trend, incidence of complications after transilluminated powered phlebectomy might continue to decline. It has a potential to become a mainstream surgical technique for varicose veins in future.
Objective To observe the etiological factors and variation of effects of nontraumatic severe vitreous hemorrhage. Methods A total of 1107 patients (1202 eyes) with nontraumatic severe vitreous hemorrhage who underwent vitrectomy from January 2005 to December 2011 were enrolled in this study. The patients were divided into A group (444 eyes of 415 patients were operated between January 2005 and December 2008) and group B (758 eyes of 692 patients between January 2009 and December 2011) according to admission date. The etiological factors and variations were recorded and retrospectively analyzed. Results Of all 444 eyes in group A, 156 eyes were due to retinal vein occlusion (RVO), 117 eyes associated with proliferative diabetic retinopathy (PDR), 61 eyes with retinal hole／retinal detachment (RH／RD), 42 eyes with Eales disease, 20 eyes with exudative agerelated macular degeneration (EAMD). These diagnoses accounting for 89.19% of the total eyes, were found to be the common causes in patients with severe vitreous hemorrhage, with RVO as the most common cause. Similarly in group B, severe vitreous hemorrhage was found in 347 eyes with proliferative diabetic retinopathy (PDR), 135 eyes with retinal hole／retinal detachment (RH／RD), 133 eyes with retinal vein occlusion (RVO), 25 eyes with Eales disease, 22 eyes with exudative age-related macular degeneration (EAMD), accounting for 87.87% of the total eyes. PDR was the most common cause instead of RVO to vitreous hemorrhage in this group. The number of vitreous hemorrhages increased year by year. Conclusions PDR, RH／RD, RVO, Eales disease and EAMD are the common causes of nontraumatic severe vitreous hemorrhage. There is a trend toward an increasing proportion of PDR among the causes of vitreous hemorrhage.
Diabetic macular edema (DME) is the most common retinopathy that seriously threatens the visual function of diabetic patients, and it represents a major cause of blindness especially among people in working age. Ocular VEGF inhibitors are most often used as a first line therapy for DME, and have revolutionary significance in improving visual outcomes. However, there remain 30%-50% patients who fail to respond to anti-VEGF treatment, and the need for frequent injections brings a substantial treatment burden to patients and society. Novel therapeutic strategies include improving efficacy and duration of anti-VEGF drugs, targeting inflammation, the plasma kallikrein–kinin system, the angiopoietin-Tie2 system, neurodegeneration and other alternative pathways, as well as using subthreshold and targeted laser therapy. It is still challenging in the individualized management of DME to identify non-responders to anti-VEGF drugs and to establish a standardized regimen for the switch from anti-VEGF therapy to anti-inflammatory or other alternative treatment. Further research and development of new therapies, as well as preventive and screening strategies, are needed to reduce the impact of diabetic retinopathy and DME on public health.
Objective To investigate the relationship between glomerular filtration rate (GFR) and diabetic retinopathy (DR) and macular thickness in patients with type 2 diabetes mellitus (T2DM). Methods A total of 161 T2DM inpatients were enrolled in this study. There were 95 males (95 eyes) and 66 females (66 eyes), with an average age of (62.2±11.0) years. The average duration of diabetes was (14.8±7.9) years. The patients were grouped according to the degree of DR. Among them, 91 patients were no DR, 24 patients were mild non-proliferative DR (NPDR), 24 patients were moderate NPDR, 13 patients were severe NPDR and 9 eyes were proliferative DR (PDR). Severe NPDR and PDR were combine into severe DR group for statistical analysis. All patients underwent direct ophthalmoscope, fundus colorized photography, spectral domain optical coherence tomography (SD-OCT), fasting blood-glucose, glycated hemoglobin and renal function examinations. GFR was evaluated by99 mTcDTPA. DR degree was evaluated by direct ophthalmoscope and fundus colorized photography. Central subfield (CSF), central macular volume and mean retinal thickness (MRT) were measure by SD-OCT. The correlation between GFR and DR staging and macular retinal thickness were analyzed by Spearman correlation analysis and Pearson correlation analysis. Logistic regression analysis was used to analyze the correlation between GFR and presence of DR. Results GFR was gradually decreased in patients with no DR, mild NPDR, moderate NPDR and severe DR (F=12.32,P＜0.001). Pearson correlation analysis demonstrated that GFR was negatively correlated to CSF (r=−0.202,P=0.010); but no correlation with MRT (r=−0.087,P=0.272). Spearman correlation analysis demonstrated that GFR was negatively correlated to DR staging (r=−0.325,P＜0.001). The difference of DR prevalence rate in normal, slight abnormal renal function and renal insufficiency patients was significant (χ2=12.32,P=0.002). Logistic regression analysis demonstrated that lower levels of GFR was significantly associated with presence of DR (95% confidence interval=1.71–4.32, odds ratio=2.72,P＜0.001). Conclusion In T2DM patients, GFR is negatively correlated to DR staging and CSF. Lower GFR is independent risk factors for DR.
Objective To detect the prognosis of visual acuity, operation timing and medical management of peri-operation in patients who had undergone pars plana vitrectomy for uveitis associated with tractive retinal detachment. Methods The clinical data of 15 eyes (13 patients) with tractive retinal detachment associated with uveitis who had undergone pars plana vitrectomy from our Department were retrospectively analyzed. The patients, 6 males and 7 females, aged from 19.0 to 70.0 years, with the average of 42.8 years. The duration of the disease history was 3-15 years with the average of 7 years. In the 15 affected eyes, the visual acuity was le;hand moving before the eye in 7 eyes, 0.01-0.1 in 7, and 0.2 in 1. Vitreous opacity, proliferative vitreoretinopathy, and tractive retinal detachment were found in all of the affected eyes. All the patients had been treated with oral and topical steroid. In addition, 3 of them received oral azathioprine meanwhile. Eye drops of 1% prednisolone acetate, 1% atropine, and tropicamide were used. The inactive duration of inflammation of uveitis was 0.5-4.5 months with the average of 2.0 months. After the inflammation became inactive, pars plana vitrectomy with membrane peeling, intraocular photocoagulati,filling with C3F8 or silicon oil were performed, including 7 eyes underwent lens excision. Glucocorticoid was given to the patients orally before the operation, and systemic and ocular medication of glucocorticoid were given continuously after the operation, in whom 3 were treated with oral azathioprine meanwhile. The postoperative follow-up duration ranged from 3 to 146 months with the average of 26 months. Results No recrudescence of uveitis, inflammation of ocular anterior segment, or vitreous inflammation was fund in the 15 eyes. The retina reattached successfully and the visual acuity improvement in 13 eyes (86.7%), inluding 2 eyes achieved the visual acuity increased from 0.2 to 0.8 and 0.03 to 0.6, 1 eye had unchanged visual acuity (6.7%)，and 1 eye decreased from hand moving to light perception (6.7%). In the follow-up duration, 4 eyes had cataract formation and underwent cataract extraction and intraocular lens (IOL) implantation, and the visual acuity improved after the operation. Iris neovascularization and secondary hyphema were found in 1 eye. Organization membrane on the surface of rtina and tractive retinal detachment recurred in another eye. Conclusion Pars plana vitrectomy is effective on uveitis associated with tractive retinal detachment. Operation timing and perioperational reasonable glucocorticoid application are essential for surgery success. (Chin J Ocul Fundus Dis, 2007, 23: 108-111)