Objective To observe the expression of vascular endothelial growth factor (VEGF) in aqueous humor and vitreous body in eyes with proliferative vitreo-retinal diseases, and to investigate the role of VEGF plays in the pathoge nesis of proliferative vitreo-retinal diseases. Methods The concentration of VEGF in aqueous humor and vitreous body in eyes with proliferative vitreoretinopathy (PVR), retinal vein occlusion (RVO), proliferative diabetic retinopathy (PDR), and neovascular glaucoma (NVG) were measured by double antibodies sandwich enzyme-linked immunosorbent assay (ELISA). Results The concentration of VEGF in aqueous humor and vitreous body in eyes with PVR, RVO, PDR and NVG were obviously higher than that in the control group (Plt;0.05), respectively. Among all of the diseases, the concentration of VEGF in aqueous humor and vitreous body decreased orderly in NVG, PDR, RVO and PVR (Plt;0.05). The concentration of VEGF in vitreous body in eyes with PVR, RVO, PDR and in the control group were much higher than that in aqueous humor in corresponding groups (Plt;0.05). There was a negative correlation between the disease history and content of VEGF in aqueous humor and vitreous body in patients with PVR (r=－0.819, －0.823；Plt;0.05). The disease history positi vely correlated with the concentration of VEGF in aqueous humor and vitreous body in patients with RVO (r=0.913, 0.929；Plt;0.05), and the time of vitreous hemorrhage positively correlated with the concentration of VEGF in aqueous humor and vitreous body in patients with PDR (r=0.905, 0.920；Plt;0.05). Conclusion The concentration of VEGF in aqueous humor and vitreous body in patients with proliferative vitreo-retinal diseases significantly increases, and VEGF may play an important role in the pathoge nesis of proliferative vitreo-retinal diseases. (Chin J Ocul Fundus Dis, 2006, 22: 313-316)
Objective To observe the the inhibitory effect of recombined adenovirus mediated delivery of p21 (rAd-p21) on oxygen-induced retinal neovascularization in mice. Methods A total of 56 C57BL/6 mice at the age of seven days were divided into control group, phosphate buffer solution (PBS) group, rAd-p21 group and rAdno purpose gene control (rAd-NC) group, 14 mice in each group. The retinal neovascularization of PBS, rAd-p21and rAd-NC group were induced by oxygen, and received an intravitreal injection 1 mu;l PBS, rAd-p21 and rAd-NC at postnatal day 11, respectively.The rats of control group were not intervened. At postnatal day 17,RNV was determined by retinal flat mounts and retinal section; non-perfusion areas of retina were analyzed by Image-Pro plus 6.0 software; reverse transcription-polymerase chain reaction (RT-PCR) and Western blot was used to measure the mRNA and protein expression of p21 and CDK2. Results Compared with PBS and rAdNC groups, the retinal nonperfusion areas, neovascularization and the numbers of endothelial cell nuclei breaking through the internal limiting membrane in rAd-p21 group were reduced significantly. Nonperfusion areas of retina in rAd-p21 group was less than that in PBS and rAd-NC groups, the difference among these three groups was significantly (F=101.634，P＜0.05). Compared with the other three groups, the level of p21 mRNA and protein in rAd-p21 group increased significantly (F=839.664, 509.817;P＜0.05); the level of CDK2 mRNA and protein in rAd-p21 group decreased significantly (F=301.858, 592.882;P＜0.05). Conclusion rAd-p21can inhibit oxygen-induced retinal neovascularization, up-regulated p21 expression and down-regulated CDK2 expression may be the mechanism.
Objective To observe the inhibitory effect of recombined adenovirus of p21 (rAd-p21) on the proliferation of Rhesus retinal vascular endothelial cell line (RF/6A). Methods RF/6A cells were cultured in vitro which divided into phosphate buffered solution (PBS) group, rAd-p21 transfection group and negative control (NC) group. Plasmid vectors were transfected into RF/6A cells. The expression of p21 mRNA and protein in RF/6A cells were measured by RT-PCR and Western blot respectively. The cell cycle distribution was analyzed by flow cytometry. Endothelial-cell tube formation assay was performed in Matrigel.Results The expression of p21 mRNA and protein in rAd-p21 transfection group were higher than that in PBS and negative control group. The cell cycle distribution showed that the proportion of G0/G1 cells in rAd-p21 transfection group ［(67.45plusmn;11.61) %］ was apparently higher than that in the negative control group ［(41.55plusmn;8.99)%］ and PBS group ［(40.76plusmn;6.66) %］ (F=21.284, P=0.000). The number of endothelialcell tubes in the rAd-p21 transfection group (3.86plusmn;1.21) was apparently less than that in the negative control group (7.62plusmn;2.69) and PBS group (8.25plusmn;3.19) (F=7.138，P=0.004). Conclusions The p21 mRNA and protein can stably express in RF/6A cells after rAd-p21 transfection. RAd-p21 can inhibit the proliferation of RF/6A cells.
Objective To evaluate the efficacy of perioperative management for vitrectomy of patients with severe systemic disease. Methods The clinical data of 21 patients (22 eyes) with severe systemic disease who underwent vitrectomy were retrospectively analyzed. There were 11 patients (12 eyes) with proliferative diabetic retinopathy, 9 patients (9 eyes) with rhegmatogenous retinal detachment, and 1 patient (1 eye) with intraocular lens dislocation. The preoperative visual acuity ranged from hand movement to 0.6. There were 4 patients (5 eyes) with renal insufficiency undergoing renal dialysis, 7 patients (7 eyes) with myocardial infarction or coronary artery stenosis received cardiac bypass surgery or coronary stent implantation, 2 patients (2 eyes) with severe arrhythmia received cardiac pacemaker implantation or radiofrequency catheter ablation, 5 patients (5 eyes) with cerebral infarction, 2 patients (2 eyes) with hemophilia, and 1 patient (1 eye) with aplastic anemia. For patients with cardiac bypass surgery or coronary stent implantation, anticoagulants were switch to low molecular heparin at 7 days before vitrectomy. For patients undergoing renal dialysis, 0.4 ml low molecular heparin was used during renal dialysis at one day before vitrectomy, protamine and heparin were administered after vitrectomy. Prothrombin complex was infused from 1 day before surgery to 5 days after surgery for Hemophilia B patients.6 patients (6 eyes) underwent phacoemulsification, and 1 patient (1 eye) underwent ciliary sulcus fixed intraocular lens implantation. 14 patients (14 eyes) underwent silicone oil tamponade,5 patients (6 eyes) underwent C3F8 tamponade.Results The postoperative visual acuity ranged from light perception to 1.0. The vision increased in 18 patients (19 eyes), unchanged in 2 patients (2 eyes), and decreased in 1 patient (1 eye). The retina attached in all eyes postoperatively. The postoperative complications mainly included mild anterior chamber bleeding in 4 patients (4 eyes), severe anterior chamber bleeding in 1 patient (1 eye), mild retinal hemorrhage in 2 patients (2 eyes), optic disc bleeding in 2 patients (3 eyes), temporary elevation of intraocular pressure in 1 patient (1 eye), and neovascular glaucoma in 1 patient (1 eye). Serum creatinine increased in 1 patient and hypertension in 1 patient within 1 week postoperatively. Conclusions Severe systemic disease is not an absolute contraindication for vitrectomy. Vitrectomy can be successfully performed with better outcomes under the proper perioperative management of systemic disease.
ObjectiveTo observe the effect and complications of vitrectomy combined with intraocular silicon oil or C3F8 filling for proliferative diabetic retinopathy (PDR). MethodsEighty-six consecutive patients (101 eyes) with PDR-related vitreous hemorrhage who underwent primary standard three-port vitrectomy and intraocular tamponade of silicone oil or C3F8 were included in this retrospective study. They were divided into silicone oil group and C3F8 groups. There was no statistically significant difference between these two groups of patients for gender, age, duration of diabetes, fasting glucose, history of hypertension, diabetic kidney disease history, history of cardiac and vascular diseases, body mass index and smoking history. There was statistically significant difference between these two groups of patients for visual acuity (Z=-2.604, P=0.009). There was no statistically significant difference between these two groups of patients for intraocular pressure before surgery (Z=0.064, P=0.949). The mean follow-up was (20.3±16.4) months with a range from 1 to 47 months. The patients were followed up for visual acuity, intraocular pressure, neovascular glaucoma (NVG), the incidence of retinal detachment, recurrent vitreous hemorrhage, and repeated operation for complications. ResultsVisual acuity (t=-3.932, -8.326; P=0.000, 0.000) and intraocular pressure (t=-3.159, -2.703; P=0.006, 0.009) were changed significantly after surgery for both groups. Between these two groups after surgery, there were significant differences of visual acuity (Z=-1.879, P=0.040), intraocular pressure (Z=-3.593, P=0.000), and complications (revision operation, retinal detachment, recurrent vitreous hemorrhage and NVG) (t=-2.777, -2.102, -2.308, -2.013; P < 0.05). ConclusionIntraocular silicone oil tamponade can reduce the postoperative complications of PDR, especially for severe retinal neovascularization, exudation associated with retinal edema.
ObjectiveTo analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.
ObjectiveTo observe the value of optical coherence tomography (OCTA) in distinguishing ischemic and non-ischemic branch retinal vein occlusion (BRVO). MethodsA prospective clinical observational study. From January 2020 to January 2021, 44 eyes of 44 patients with BRVO diagnosed in Tianjin Medical University Eye Hospital were included in the study. Among them, there were 24 eyes of 24 males and 20 eyes of 20 females. The macular edema subsided after three consecutive anti-vascular endothelial growth factor (VEGF) drug treatments. All the affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fluorescein fundus angiography (UWFFA), and OCTA examination. According to the results of UWFFA, the affected eyes were divided into ischemic group and non-ischemic group, with 22 eyes in 22 patients. The macular area of the affected eye with an OCTA instrument were scaned in the range of 3 mm×3 mm to measure the blood flow density (SVD, DVD), foveal blood flow density (SFVD, DFVD), parafoveal blood flow density (SPFVD, DPFVD), affected hemilateral blood flow density (SHVD, DHVD) and affected quadrant blood flow density (SQVD, DQVD) of the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina, foveal retinal thickness (CRT), fovea avascular zone (FAZ) area, perimeter of FAZ (PERIM), out-of-roundness index (AI), and blood flow density within 300 μm width of FAZ (FD-300). The two-sample independent t test was used to compare the parameters between the ischemic group and the non-ischemic group. Receiver operating characteristic (ROC) curve analysis was used to measure the area under the curve (AUC) of blood flow density to predict ischemic BRVO, determine the critical value for predicting ischemic BRVO and the corresponding sensitivity and specificity, with AUC＞0.9 as the prediction performance was good. ResultsThe differences of BCVA (t=1.544), intraocular pressure (t=－0.404), SFVD (t=0.444), DFVD (t=－0.812), CRT (t=1.082), FAZ area (t=－0.785), PERIM (t=－0.685), AI (t=1.047) of the eyes in the ischemic group and non-ischemic group were not statistically significant (P＞0.05). The differences of age (t=2.194), SVD (t=－3.796), SPFVD (t=－4.181), SHVD (t=－4.700), SQVD (t=－3.594), DVD (t=－2.324), DPFVD (t=－2.476), DHVD (t=－2.118), DQVD (t=－6.529) and FD-300 (t=－5.116) of the eyes in the ischemic group and non-ischemic group area were statistically significant (P＜0.05). ROC curve analysis results showed that DQVD predicted the AUC of ischemic BRVO the largest (0.917), the best cut-off value was 33.75%, and the sensitivity and specificity were 90.9% and 81.8%, respectively. ConclusionOCTA can quantitatively assess the microvascular structure of SCP and DCP in the macular area of BRVO eyes, and contribute to distinguish ischemic and non-ischemic BRVO.