Objective To investigate the method and the effects of the surgical treatment of massive subretinal hemorrhage and vitreous hemorrhage associated with age-related macular degeneration. Methods A retrospective study of 14 consecutive patients underwent a complete pars plana vitrectomy. Retinotomy was carried out for removing subretinal hemorrhage by using balanced salt solution. Complete air-fluid exchange and gas or silicone oil tamponade were performed in all patients. The follow-up period was within 3～7 months. Results Atrophy of eyeball in 2 eyes (14.3%) postoperatively. Improvement of corrected final visual acuity and anatomical retinal reattachment were achieved in 12 (85.7%) of the 14 eyes postoperatively. Seven days after operation, muddy-sand-hemorrhage in anterior chamber occurred in 4(28.6%)of the eyes and paracenteses of anterior chamber were performed for these eyes. Conclusion Surgical intervention should be applied in the eyes with the massive subretinal hemorrhage associated with age-related macular degeneration in order to avoid the affected eyes becoming atrophic due to the subsequent complication of vitreous hemorrhage, anterior chamber muddy sand hemorrhage,ghost cell-glaucoma or retinal detachment. (Chin J Ocul Fundus Dis,2000,16:217-219)
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 lt;brgt;To evaluate the efficacy of arteriovenous sheathotomy on treatment of branch retinal vein occlusion (BRVO). lt;brgt; lt;brgt;Methods lt;brgt;Six consecutive patients (6 eyes) with BRVO underwent par plana vitrectomy, po lt;brgt;sterios vitreous cortex separation, arteriovenous sheathotomy for BRVO. The foll lt;brgt;owup period was within 3～12 months. Postoperative examinations included color fundus photography, fundus fluorescein angiography(FFA), optical coherence tomography(OCT) and multifocal electroretinography (mERG). lt;brgt; lt;brgt;Results lt;brgt;Increasing downstream blood flow in proximal past of compressed venule was promptly observed during the procedures of incision of the advential sheath of blood vessel, and separating and elevating the ateriole from the venule in all the operations in this series. Visual acuities improved postoperatively in 5 patients, and the best corrected visual acuity was 1.5. The examination of FFA showed obvious absorption of retinal hemorrhage, and leakage of dye was reduced, while large areas of capillary closure in retinas distal to the sheathotomy site were found 3 months after operation in 3 patients. OCT revealed disappearance or lightening of macular edema. mERG showed that the response amplitude of retina including the macular area was obviously higher after the operation. There was recurrent vitreous hemorrhage necessitating further surgery in one patient. lt;brgt; lt;brgt;Conclusion lt;brgt;The operation of arteriovenous sheathotomy for the treatment of BRVO is much beneficial to improve patient′s visual acuity, downstream blood flow and macular affections, although the improvement of retinal reperfusion of the retina is not obvious. lt;brgt; lt;brgt;(Chin J Ocul Fundus Dis,2002,18:6-9)
Diabetic retinopathy (DR) is a common ocular complication in diabetic patients, which is chronic and progressive and seriously impairs visual acuity. The rapid occurrence and progress of cataract in diabetic patients is also one of the important reasons for visual impairment in DR patients. Compared with non-diabetic patients, diabetic patients have higher risk of complications after cataract surgery. Studies have shown that anti-vascular endothelial growth factor (VEGF) therapy after cataract surgery can prevent the aggravation of diabetic macular edema in DR patients. However, due to the lack of systematic review of the clinical effect of anti-VEGF drugs in DR patients undergoing cataract surgery, the use of anti-VEGF drugs is relatively conservative in clinic. It is believed that with the deepening of research and the progress of clinical trials, the wide application of anti-VEGF drugs in clinical practice is expected to provide more accurate and effective treatment for DR patients in the future.
Objective To construct specifically expressed vascular endothelial growth factor (VEGF)165 gene in retina. Methods Rho promoter, specifically expressed in retina, was amplified by polymerase chain reaction (PCR) from the genomic DNA of a BLAB/C rat, then it was cut with restriction enzymes and cloned into the plasmid pcDNA3.1+-VEGF165 to form recombinant plasmid pcDNA3.1+-rho-VEGF165. The correct recombinant plasmid pcDNA3.1+-rho-VEGF165 was identified by restriction enzymes and PCR, and was transferred by jetPEI into cultured human navel vein endothelial cells and human retinal pigment epithelial (RPE) cells. The expression of VEGF protein in human navel vein endothelial and RPE cells was detected by immunocytochemical staining and protraction of the growth curve of the cells. Results In human RPE cells, the expression of VEGF protein was more in recombinant plasmidpcDNA3.1+-rho-VEGF165 than that in plasmidpcDNA3.1+-rho-VEGF165 ; in human navel vein endothelial cells, no obvious difference of the expression of VEGF protein between recombinant plasmid pcDNA3.1+-rho-VEGF165 and plasmid pcDNA3.1+-rho-VEGF165 was found. Conclusions The construction of pcDNA3.1+-rho-VEGF165 carrier may provide the basic material for the study of the nosogenesis of VEGF in retinal neovascularization, and establish the foundation to set up the model of transgenic mice with VEGF specific expressing in retina. (Chin J Ocul Fundus Dis, 2005,21:106-108)
Objective To investigate the protective effect of blocking the signal path of p38 mitogen activated protein kinase on blood retinal barrier (BRB) and retinal ganglion cells (RGC) in early diabetic rats.Methods A total of 60 Wistar rats were divided into the control and diabetes group, with 30 rats in each group. Diabetes was induced in rats in diabetes group by peritoneal injection of streptozotocin (STZ);the plasma glucose level of ＞16.7 mmol/L indicated that the diabetes model was set up successfully.The rats in the control group underwent peritoneal injection of equivalent sodium citrate solution. IgG leakage method was used to measure the damage of BRB function and vascular leakage. The expression and localization of caspase-3 and vascular endothelial growth factor (VEGF) in retina of diabetic rats were examined by immunohistochemistry analyses.Two weeks after the establishment of the diabtes model, the rats in diabtes group underwent intravitreal injection with SB203580, a p38 inhibitor;six weeks after the injection, the expression of caspase-3 and VEGF was detected, and the number of apoptosis RGC was counted via immunofluorescence technique.Results In the contral group, IgG staining located in the blood vessels with little leakage; while the IgG leakage was much more obvious in the diabetes group eight weeks after the establishment of the model. Six weeks after intravitreal injection with SB203580, the leakage decreased in diabtes rats. The results of semiquantitative analysis and fluorescence immunohistochemistry showed that compared with the results in diabetes rats 8 weeks after intravitreal injection (2.9 times much more than that in the control group), the fluorescence expression of VEGF decreased in diabetes rats six weeks after intravitreal injection (1.8 times much more than that in the control group).The apoptisis RGC number in rats 6 weeks after intravitreal injection of SB203580 was much less than that in rats without intravitreal injection (t＝5.731, Plt;0.01). Conclusions SB203580 can alleviate the disruption of BRB and apoptosis of RGC in early diabetes rats, which suggests that p38 MAPK pathways appear to be directly involved in the pathogenesis of early diabetic retinopathy.