Epigenetic modifications such as DNA methylation, histone post-translational modifications, non-coding RNA are reversible, heritable alterations which are induced by environmental stimuli. Major risk factors of diabetes and diabetic complications including hyperglycemia, oxidative stress and advanced glycation end products, can lead to abnormal epigenetic modifications in retinal vascular endothelial cells and retinal pigment epithelium cells. Epigenetic mechanisms are involved in the pathogenesis of macular edema and neovascularization of diabetic retinopathy (DR), as well as diabetic metabolic memory. The heritable nature of epigenetic marks also playsakey role in familial diabetes mellitus. Further elucidation of epigenetic mechanisms in DR can open the way for the discovery of novel therapeutic targets to prevent DR progression.
Purpose To investigate the effects of intervention with Tanakan on anterior ocular segment in diabetic retinopathy (DR) after retinal photocoagulation． Methods Prospective random controlled study was performed on 72 patients (72 eyes) with ultrasound biomicroscopy (UBM),by obtaining and quantitatively analyzing the changes of anterior ocular segment including anterior chamber, anterior chamber angle, ciliary body and choroids before and the 3rd day and the 7th day after retinal photocoagulation. Results Three days after photocoagulation, significant elev ated IOP and narrowed chamber angle were observed in control group and 4 eyes (1 1.11%) in Tanakan group (Plt;0.01)． Choroidal detachment in 32 eyes (88.89%) in control group and in 2 eyes (5.56%) in Tanakan group and the severity of ciliochoroidal detachment in tanakan group was significantly lower than that in control group． Conclusion Tanakan is effective to prevent the complications of anterior segment, such as ciliochoroidal detachment, elevation of IOP, narrowing of chamber angle occurring early after retinal photocoagulation and reduce the severity of ciliochoroidal detachment． (Chin J Ocul Fundus Dis, 2001,17:187-189)
Age-related macular degeneration is one of the major causes of blindness in the elderly. As an important pathway of cell metabolism, autophagy maintains intracellular homeostasis through the degradation and recycle of damaged organelles and macromolecules. Understanding its mechanism may promote discoveries to delay aging process, reduce the incidence of age-related diseases. In mammals, silent information regulator protein 6 (SIRT6) plays its deacetylase and ribonucleotransferase activity in multiple signaling pathways, including inhibition of cellular senescence, tumorigenesis, metabolic diseases, regulating cellular lifespan. It has a significant impact on the structure and function of tissues and organs. SIRT6 regulates intracellular autophagy mainly through the insulin-like growth factor-protein kinase B-mammalian target of rapamycin, reducing the accumulation of toxic metabolites and cellular senescence. The function of SIRT6 in age-related macular degeneration need to be combined with the genetic background, pathogenesis, clinical manifestations and other aspects of the disease, and it is expected to be further studied in subsequent studies.
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients. It mainly includes focal DME and diffuse DME, while DME of clinical significance needs timely intervention treatment. Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME. Currently, the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation. Among them, anti-VEGF injection is becoming the first-line therapeutic, and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients. During the diagnosis and treatment of DME, attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME. With the appearance of heterogeneity in the efficacy of anti-VEGF drugs, it remains to be further studied how to choose alternative therapeutics and when to replace them.
Objective To investigate the early influences of laser photocoagulation on macular retinal thickness in diabetic retinopathy(DR). Methods Optic coherence tomography examination was performed in 30 eyes with DR(phase Ⅲ~Ⅳ) before, and on the 3rd day and the 7th day after photocoagulation respectively. The thickness of neuroretina and pigment epithelium were measured in the areas of fovea macula and 750 μm from fovea macula. Results Three days after photocoagulation, significant thickening of neuroretina was observed in the fovea macula, which is positively related with age, fasting blood sugar and duration of DR. There was no significant changes in the thickness of pigment epithelium in macula and in the thickness of neuroretina 750 μm from fovea macula. Conclusion Significant thickening of neuroretina in fovea macula in DR early after photocoagulation reveals progressed macular edema induced by photocoagulation which is positively related with age, fasting blood sugar and duration of DR. (Chin J Ocul Fundus Dis, 2002, 18: 31-33)
The mechanisms behind diabetic retinopathy (DR) can be ascribed primarily to retinal microvascular abnormalities, excessive inflammatory response and neurodegeneration. Circular RNA (circRNA) is a type of endogenous non-coding RNA with a special circular structure, which is mainly composed of precursor RNA after shearing and processing. It is widely present in the retina and participates in the occurrence and development of various fundus diseases. CircRNAs express in an abnormal way in retina, serving as “the sponge” for miRNA so as to play roles in dysfunction of retinal vascular, inflammatory response and neurodegeneration in the development of DR. Further studies for circRNAs in DR will illustrate pathophysiology of DR more deeply, shedding light on circRNAs becoming novel biomarkers and molecular targets for diagnosis and treatment, thus achieving the goal of early diagnosis and precise therapy of DR.
Objective To investigate the early influences of laser photocoagulation on retinal function in diabetic retinopathy(DR)． Methods The multifocal electroretinograms (MERG) of 30 eyes with DR (phase Ⅲ～Ⅳ) were tested with visual evoked response image system IV b efore,and the 3rd day and the 7th day after laser photocoagulation． Results Three days after photocoagulation, the latency of N1 prolonged in the central macula 5deg; area and superionasal quadrant．Th e response densities of N1,P1 and N2 markedly reduced, and most significant changes occurred in the central macula 5deg; area and then in the central 10deg;area． There were also differences in the changes of the amplitude of N1 and P1 in diff erent quadrants ．The changes of visual acuity were positively related to the de crease of amplitudes of N1,P1 and N2 in the macula． Conclusion The reduction of response densities in MERG reveals functional damage in diabetic retina occurring early after photocoagulation．The functional damage in macula induced indirectly by photocoagulation may explain the reduction of visual acuity after panretinal photocoagulation in some degree． (Chin J Ocul Fundus Dis, 2001,17:181-183)
ObjectiveTo compare the consistency of artificial analysis and artificial intelligence analysis in the identification of fundus lesions in diabetic patients.MethodsA retrospective study. From May 2018 to May 2019, 1053 consecutive diabetic patients (2106 eyes) of the endocrinology department of the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 888 patients were males and 165 were females. They were 20-70 years old, with an average age of 53 years old. All patients were performed fundus imaging on diabetic Inspection by useing Japanese Kowa non-mydriatic fundus cameras. The artificial intelligence analysis of Shanggong's ophthalmology cloud network screening platform automatically detected diabetic retinopathy (DR) such as exudation, bleeding, and microaneurysms, and automatically classifies the image detection results according to the DR international staging standard. Manual analysis was performed by two attending physicians and reviewed by the chief physician to ensure the accuracy of manual analysis. When differences appeared between the analysis results of the two analysis methods, the manual analysis results shall be used as the standard. Consistency rate were calculated and compared. Consistency rate = (number of eyes with the same diagnosis result/total number of effective eyes collected) × 100%. Kappa consistency test was performed on the results of manual analysis and artificial intelligence analysis, 0.0≤κ＜0.2 was a very poor degree of consistency, 0.2≤κ＜0.4 meant poor consistency, 0.4≤κ＜0.6 meant medium consistency, and 0.6≤κ＜1.0 meant good consistency.ResultsAmong the 2106 eyes, 64 eyes were excluded that cannot be identified by artificial intelligence due to serious illness, 2042 eyes were finally included in the analysis. The results of artificial analysis and artificial intelligence analysis were completely consistent with 1835 eyes, accounting for 89.86%. There were differences in analysis of 207 eyes, accounting for 10.14%. The main differences between the two are as follows: (1) Artificial intelligence analysis points Bleeding, oozing, and manual analysis of 96 eyes (96/2042, 4.70%); (2) Artificial intelligence analysis of drusen, and manual analysis of 71 eyes (71/2042, 3.48%); (3) Artificial intelligence analyzes normal or vitreous degeneration, while manual analysis of punctate exudation or hemorrhage or microaneurysms in 40 eyes (40/2042, 1.95%). The diagnostic rates for non-DR were 23.2% and 20.2%, respectively. The diagnostic rates for non-DR were 76.8% and 79.8%, respectively. The accuracy of artificial intelligence interpretation is 87.8%. The results of the Kappa consistency test showed that the diagnostic results of manual analysis and artificial intelligence analysis were moderately consistent (κ=0.576, P＜0.01).ConclusionsManual analysis and artificial intelligence analysis showed moderate consistency in the diagnosis of fundus lesions in diabetic patients. The accuracy of artificial intelligence interpretation is 87.8%.
Objective To determine the affected factors of intraorbital hemodynamic results in diabetic retinopathy (DR) and the risk factors related to the occurrence of DR. Methods Posterior ciliary artery (PCA), central retinal artery (CRA), central retinal vein (CRV), and vortex vein (VV) of 68 patients with DR were measured by color Doppler flow image (CDFI). Thirty-one hemodynamic parameters, including systolic velocity, diastolic velocity, mean velocity, resistive index, pulsatility index and accelerative velocity of ophthalmic artery (OA), and other variates (blood pressure, blood sugar, gender, age, duration of the disease, and so on) were collected and clustered in a principal components analys is following a forward, stepwise logistic regression on these components. Results Nine principal components were extracted from 37 original variates, reflecting the velocity of OA, velocity of PCA, resistance of OA, velocity of CRA,resistance of CRA, resistance of PCA, time-related factor, venous drainage factor and gender factor, respectively. In the result of logistic regression, resistance of OA, velocity of CRA, resistance of PCA, time-related factor, and venous drainage factor were the risk factors related to DR. Conclusion The first risk factor affecting DR is time, and intraorbital hemodynamic abnormity influencing the development of diabetic retinopathy may be the increase of resistance of OA, decrease of velocity of CRA, decrease of resistance of PCA, and increase of venous drainage. (Chin J Ocul Fundus Dis，2004，20：98-100)
To evaluate the tberapeutlc effect of diode laser photocoagulation trearment on eases of diabetic retinopathy with certain degree of refractive media opacity. METHODS: Diode laser photocoagulation treatment were given to 36 selected cases (40 eyes )of diabetic retinopathy who can not be treated with argon laser because of refractive media opacity, Before and after treatment,visual acuity and fundus were examined and fundus fluorescein angiography and retinal color photographp were taken. The follow-up period was 8~14 months (with an average of 11 months) RESULT:Visual acuity were improved or maintained in 29 eyes(about 73%)of the 34 eyes of proliferative diabetic retinopathy ,retinal new vessels partly or entirely regressed in 25 eyes(about 74%). CONCLUTION ;Tbe effect of diode laser treatment on patients with diabetic retinopatby with certain degree of lens/vitreous opacity is relatively safisfactory. （Chin J Ocul Fundus Dis,1996,12:111- 113）