Objective To evaluate the effects of vitrectomy with internal limiting membrane (ILM) peeling on epiretinal membrane and visual acuity of rhegmatogenous retinal detachment (RRD) with severe proliferative vitreoretinopathy (PVR). Methods Sixty-two patients with RRD and PVR (C3 - D2) were enrolled in this study. The patients were divided into two groups: 30 patients in group A had undergone conventional vitrectomy; 32 patients in group B had undergone vitrectomy and ILM peeling. All patients had been tamponaded by silicone oil after the operation. The logarithm of minimal angle of resolution (logMAR) visual acuity in group A and B before the operation were 1.47±0.38 and 1.44±0.33 respectively, the difference between two groups was not statistically significant (F=0.089，P=0.766). The followup period was 9-12 months. The silicone oil was removed three months after the operation. LogMAR visual acuity, ocular fundus, and optical coherence tomography had been followed up. Results Epimacular membrane formation was found in seven eyes (23.3%) in group A, but none in group B, the difference was significant (χ2＝8.42, P＝0.004). The logMAR visual acuity increased significantly both in group A (0.70±0.22) and B (0.57±0.17) at the last visit (t=16.881, 17.887; P=0.000). The logMAR visual acuity in group B was better than that in group A (t=2.497, P=0.015), the difference of vision improvement was not significant between those two groups (F=2.084, P＝0.153). Conclusions Vitrectomy with ILM peeling can significantly inhibit the epimacular membrane formation and improve the visual acuity in eyes with RRD and severe PVR.
Objective To explore the influencing factors of visual prognosis of macular edema secondary to branch retinal vein occlusion (BRVO-ME) after treatment with ranibizumab, and construct and verify the nomogram model. MethodsA retrospective study. A total of 130 patients with BRVO-ME diagnosed by ophthalmology examination in the Department of Ophthalmology, Liuzhou Red Cross Hospital from January 2019 to December 2021 were selected in this study. All patients received intravitreal injection of ranibizumab. According to the random number table method, the patients were divided into the training set and the test set with a ratio of 3:1, which were 98 patients (98 eyes) and 32 patients (32 eyes), respectively. According to the difference of logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) at 6 months after treatment and logMAR BCVA before treatment, 98 patients (98 eyes) in the training set were divided into good prognosis group (difference ≤－0.3) and poor prognosis group (difference ＞－0.3), which were 58 patients (58 eyes) and 40 patients (40 eyes), respectively. The clinical data of patients in the two groups were analyzed, univariate and multivariate logistic regression analysis were carried out for the different indicators, and the visualization regression analysis results were obtained by using R software. The consistency index (C-index), convolutional neural network (CNN), calibration curve and receiver operating characteristic (ROC) curve were used to verify the accuracy of the nomogram model. ResultsUnivariate analysis showed that age, disease course, outer membrane (ELM) integrity, elliptical zone (EZ) integrity, BCVA, center macular thickness (CMT), outer hyperreflective retinal foci (HRF), inner retina HRF, and the blood flow density of retinal deep capillary plexus (DCP) were risk factors affecting the visual prognosis after treatment with ranibizumab in BRVO-ME patients (P＜0.05). Multivariate logistic regression analysis showed that course of disease, ELM integrity, BCVA and outer HRF were independent risk factors for visual prognosis after ranibizumab treatment for BRVO-ME patients (P＜0.05). The ROC area under the curve of the training set and the test set were 0.846[95% confidence interval (CI) 0.789-0.887) and 0.852 (95%CI 0.794 -0.873)], respectively; C-index were 0.836 (95%CI 0.793-0.865) and 0.845 (95%CI 0.780-0.872), respectively. CNN showed that the error rate gradually stabilized after 300 cycles, with good model accuracy and strong prediction ability. ConclusionsCourse of disease, ELM integrity, BCVA and outer HRF were independent risk factors of visual prognosis after ranibizumab treatment in BRVO-ME patients. The nomogram model based on risk factors has good differentiation and accuracy.
Serum anti-retinal autoantibodies (ARA) are a group of autoantibodies that bind to retinal auto-antigens with significant biological importance in pathological processes such as retinal degeneration, inflammatory microenvironment formation, and tissue destruction. In recent years, the expression of serum anti-retinal antibodies has been found to be upregulated in patients with various blinding retinal diseases such as age-related macular degeneration, autoimmune retinopathy, and retinitis pigmentosa, closely correlated with the progression of diseases. However, current researches on ARA are incomplete, lacking animal experiments and large randomized controlled clinical trials. As a result, the exact mechanism of ARA is not well understood. Although several studies have demonstrated that serum ARA has an important diagnostic value in hereditary, autoimmune, and degenerative retinal diseases, there still lacks recognized laboratory tests and laboratory indicators with high specificity and sensitivity. Clinical symptoms should be considered when making definitive diagnosis of the diseases. Therefore, clarifying the mechanisms of ARA in retinal dystrophies provides new ideas in early diagnosis and treatments of retinal diseases, which is clinically and scientifically important for the maintenance of visual functions.
ObjectiveTo observe the therapeutic effect of segmental scleral buckling and vitrectomy with/without lensectomy on the retinopathy of prematurity (ROP) stage 4a, 4b and 5. MethodsOne hundred and thirty-four ROP infants (181 eyes) diagnosed as stage 4a, 4b and 5, and performed with segmental scleral buckling or vitreous with/without lensectomy were retrospectively analyzed. The operated 4a-, 4b- and 5- stage eyes were 40, 51 and 90 eyes. The operational method depended on the location and severity of fibrovascular membrane. Of 181 eyes, segmental scleral buckling was referred for 37 eyes which include 23 eyes with 4a stage and 14 eyes with 4b stage; vitrectomy was referred for 50 eyes which include 14 eyes with 4a stage, 29 eyes with 4b stage and 7 eyes with 5 stage; vitrectomy with lensectomy was referred for 94 eyes which include 3 eyes with 4a stage, 8 eyes with 4b stage and 83 eyes with 5 stage. The effect was classified as success, improved and failure. Failure includes lost eye. Follow-up for 4a, 4b and 5 stage patients are 34, 31 and 29 months respectively. ResultsSegmental scleral buckling was referred for 37 eyes, success in 23 eyes (62.16%), improved in 11 eyes (29.73%), failure in 3 eyes (8.11%). Vitrectomy was referred for 50 eyes, and success in 20 eyes (40.00%), improved in 22 eyes (44.00%), and failure in 8 eyes (16.00%). In the total of 94 eyes underwent vitrectomy with lensectomy, 20 eyes was success (21.28%), improved in 17 eyes (18.08%), failure in 57 eyes (60.64%). In 40 stage 4a eyes, 33 successes (82.50%), 6 improved (15.00%) and 1 failure (2.50%). In 51 stage 4b eyes, 11 successes (21.57%), 30 improved (58.82%) and 10 failures (19.61%). For 90 stage 5 eyes, 14 successes (17.50%), 19 improved (23.75%) and 57 failures (71.25%). The therapeutic effect of segmental scleral buckling for stage 4a was better than that for stage 5 (χ2=6.707,P=0.035). The difference of therapeutic effect of vitrectomy for different stage was significant (χ2=21.010,P=0.000); stage 4a was the best; stage 4b was the second, stage 5 was the worst. The therapeutic effect of vitrectomy with lensectomy for stage 5 was worse than that for stage 4a and 4b (χ2=16.066,P=0.003). ConclusionThe surgery patterns of ROP was determined based on the disease severity, the surgery effects of stage 4a and 4b were better than stage 5, which had nothing to do with the surgical procedures.
Objective To investigate the relationship among central retinal vein occlusion (CRVO), major systemic diseases, ocular local diseases and related risk factors in Chinese population. Methods Seventeen-six patients with CRVO diagnosed by fundus fluorescein angiography (FFA) without any medical treatment were in CRVO group. Another 76 patients without CRVO or any vascular diseases of ocular fundus were in the control group who were matched with the ones in CRVO group to a one-to-one partnership according to the age and gender. The 2 groups were subdivided into le;45 years old (25 patients, 32.9%) and gt;45 years old (51 patients, 67.1%) subgroups according to the age, and 2 ischemia and non-ischema subgroups according to the results of FFA, respectively. The blood lipid, blood pressure, and fasting blood glucose were measured. The systematic diseases, ocular local diseases and the related risk factors were statistically analyzed and compared. Results The incidence of hypertension and hyperlipemia in CRVO group were significantly higher than that in the control group (Plt;0.001,P=0.001). There was no significant difference of cardiovascular diseases, cerebrovascular diseases, open-angle glaucoma, and smoking and drinking between the two groups(Pgt;0.05). In le;45 years old subgroups, there was no significant difference of each examination target between CRVO and control group(Pgt;0.05). In ischemia subgroups, except for the hypertension and hyperlipemia, the incidence of diabetes mellitus was obviously higher in CRVO group than that in the control group (hyperlipidemia:P=0.031; diabetes mellitus:P=0.024; diabetes mellitus: Plt;0.001). Conclusion Hypertension and hyperlipidemia are the systematic factors in Chinese population with occurrence of CRVO. In addition, diabetes mellitus is associated with ischemic CRVO. Timely diagnosis and treatment of the systematic diseases is important to the prevention and treatment for CRVO. (Chin J Ocul Fundus Dis, 2007, 23:159-162)
Objective To verify the effect of Evans blue dye on determining the retina blood vessel leakage． Methods Male Sprague-Dawley rats were used in this study． The VEGF induced retinal blood vessel leakage was checked with Evans blue dye． Then the bloodretina barrier breakdown of 1 week diabetic animals was quantified with Evans blue．The dye was extracted from retina by formamide and the extraction was checked with spect rophotometer． Evans blue leakage was normalized against wet or dry retina weight． Results The retinal Evans blue content of eyes treated with VEGF was remarkably higher than that of the controls (n=17 ,Plt;0．0001)． And the eyes of 1 week diabetic duration animals had more Evans blue dye than that of the normal controls (Plt;0．05)． Conclusion Evans blue dye is a sensitive tracer in quantitatively diagnosing the blood retina barrier breakdown． (Chin J Ocul Fundus Dis, 2001,17:221-223)
Two-hundred and forty-five eyes of 240 cases of branch retinal vein occlusion (BRVO) were analysed to determine the risk factors influencing the development of retinal neovascularization (NV).There were 208 eyes with major BRVO, 37 eyes with macular BRVO, 79 eyes with major BRVO developed NV, and the incidence of NV in this series was 37.9%.The incidence of vitreous hemorrhage in these eyes was 15.9%(39 eyes). The risk factors influencing the development of retinal NV in BRVO seem as follows: (]) the extent of retinal capillary nonperfusion area, (2)inefficiency of arterial infusion, (3) the extent of venous block at the arteriovenous crossing, (4) the duration of follow-up since onset of BRVO, and (5) the lack of collateral formation, Because BRVO has a long natural history, it is recommended that the patients should be followed-up for a long time If the vessels at peripheral retina closed, fluorescein angiography should be performed without hesitation and if the nonperfusion area is greater than 20-30 disc area, one should follow the patient carefully.As soon as the new vessels appear, laser photocoagulation should be applied without delay. （Chin J Ocul Fundus Dis,1994,10:67-70）
Objective To investigate the correlation factors of macular pucker after vitrectomy, and compare the surgical effect between secondary and idiopathic epiretinal macular membrane.Methods A study of 26 consecutive patients (26 eyes), in which 18 were diagnosed as secondary epiretinal macular membranes and 8 as idiopathic epiretinal macular membranes, underwent par plana vitrectomy, vitreous cortex separation, and peeling off of the epiretinal macular membrane. The follow-up period was within 3~12 months. Preoperative and postoperative examination included visual acuity, fundus photography, and optical coherence tomography in some patients.Results Among the 18 patients with secondary epiretinal macular membranes, 9 (50.0%) were related to vitreous surgery. There was statistical difference between cryoretinopexy to giant retinal tear and endolaser （χ2=12.24，P＜0.05). Eleven patients (61.1%) with secondary epiretinal macular membranes were related to vitreous hemorrhage before or after surgery. We found all macular puckers removed in post-operative examination. The metamorphopsia disappears after 3 months in 8 patients (30.8%), and the situation was better in 18 (69.2%). The visual acuity of the patients with idiopathic epiretinal macular membranes improved 3 lines averagely after operation, and the best-corrected visual acuity was 0.8. The patients with secondary epiretinal macular membranes improved 1.33 lines averagely after vitreous and retinal surgery, and the best-corrected visual acuity was 0.6. Conclusion Cryoretinopexy to giant retinal tear and vitreous hemorrhage before or after surgery are the risk factors of secondary epiretinal macular membranes. Idiopathic epiretinal macular membrane has a better surgical effect than secondary one. (Chin J Ocul Fundus Dis，2003，19：90-92)
Objective To investigate the relationship between expression of retinal intercellular adhesion molecule-1 (ICAM-1) and blood-retinal barrier (BRB) rupture and therapeutic effect of intravitreous injection with triamcinolone acetonide (TA) on blood-retinal barrier rupture in rats with diabetes mellitus (DM). Methods Diabetic model of Wistar rats was induced and were divided into normal control group, DM-4-month group and DM-6-month group. Each group was subdivided into immunohistochemcial staining and BRB measurement groups. BRB measurement group was further divided into non-TA treatment group, 1-week-TA treatment group, and 2-week-TA treatment group. The rats were intravitreously injected with 5 mu;l TA. The digested retinal preparation was stained by immunohistochemcial method to observe the expression of retinal ICAM-1 and morphological changes. The mean optic density (A) value of endothelial cells was measured by image-analyzing software to quantify the expression of ICAM-1. BRB changes were measured by content test of retinal Evans blue (EB). Results In the immunohistochemcial staining groups, there was no significant positive expression of ICAM-1 in retinal capillary in control group. Compared with the control, there was significant positive expression of ICAM-1 in DM-4-month group (P＜0.001) with some morphological changes such as irregular width of capillary caliber, and there was enhanced positive expression of ICAM-1 in DM-6-month group (P＜0.001) with aggravated morphological changes and even acellular capillary. In the BRB measurement groups, there was no significant difference of EB content(P＞0.05) among control groups. The EB content in two DM groups significantly increased compared with that in the controls (Plt;0.001), and higher in DM-6-month group than that in DM-4-month group (Plt;0.01). In TA treatment groups, the EB content in all the DM groups significantly decreased (Plt;0.001) but with no significant difference among the groups(P＞0.05). EB content in DM-4-month group after 2-week treatment almost reached to normal value (P＞0.05) while was higher in the rest of TA treatment groups than that in the control group (Plt;0.05). Rectilinear correlation between A value of endothelial cells and the retinal EB content(r=－0.959)was found. Conclusion There is a positive relation between the expression of ICAM-1 and BRB rupture in retina of DM rats, and intravitreous injection with TA can effectively alleviate BRB rupture. (Chin J Ocul Fundus Dis, 2006, 22: 24-27)
Objective To investigate the possible damaging effect of infrasound on ultrastructure and permeability of rats′blood-retinal barrier (BRB). Methods Twenty mature male rats, averagely divided into 5 groups according to the exposure duration, were exposed to infrasound at a 16 Hz frequency and 130 dB sound pressure level in a pressure chamber for 2 hours per day. After exposed for 0, 1 day, 7, 14, and 21 days respectively, ultrastructural changes of rats′ BRB were observed through injection of lanthanum (La) nitrate solution, which was used as a tracer to demonstrate the breakdown of the BRB.Results With prolonging the duration of infrasound exposure, BRB structure lesion, chondriosome tumefaction, endoplasmic reticulum expandedness, membrane disc damage, retinal pigment epithelial cells distortion and putrescence, karyotheca expandedness, and La leakage on each level of retina aggravated gradually.Conclusion Infrasound may cause the breakdown of BRB, and the lesions aggravated with prolonged infrasound exposure time. (Chin J Ocul Fundus Dis，2003，19：46-48)