Objective To observe the therapeutic effect of radial optic neurotomy (RON) for ischemic central retinal vein occlusion (CRVO) with macular edema. Methods The clinical data of 6 patients with ischemic CRVO combined with macular edema who had been treated with vitrectomy and radial optic neurotomy were retrospectively analyzed. The pre- and post-operative visual acuity, results of fundus fluorescein angiography (FFA) and optic coherence tomography (OCT), including the macular thickness, fluorescein filling in retinal veins, retinal hemorrhages and papilloedema were analyzed and compared. Results In the 6 patients, the visual acuity increased in different degrees and retinal hemorrhages decreased evidently. Macular edema was alleviative in 5 patients, retinal vein dilatation meliorated in 4, and papilloedema disappeared in 2. Conclusion RON may alleviate macular edema in patients with ischemic CRVO, but the relation of the therapeutic effect and vitrectomy can not be eliminated. (Chin J Ocul Fundus Dis, 2005,21:3-5)
Objective To observe the changes of intraocular pressure (IOP) after intravitreous injection wih triamcinolone acetonide (TA) and their affected factors. Methods The clinical data of 125 patients (125eyes) who had undergone intravitreous injection with TA were retrospectively analyzed. The patients (52 males and 73 females) aged from 17 to 83 years with the average age of 56.5. There were 49 patient (39.2%) with diabetic retinopathy (DR), 56 (44.8%) with retinal vein occlusion (RVO), and 20 (16.0%) with exudative age-related macular degeneration (AMD). One day before the treatment, IOP was measured by Goldmann applanation tonometry, and the basic IOP was 7~31 mm Hg (1 mm Hg=0.133 kPa) and the average IOP was (14.69plusmn;3.72) mm Hg. The patients were divided into two groups according to the basic IOP:below 15 mm Hg group (n=64) and 15 mm Hg or above group (n=61). All of the patients underwent intravitreous injection with 4mg TA. IOP was measured 1 day, 3 days, 1 week, 2 weeks, and 1 month after the treatment in the same way, respectively, and later was measured once every 1 month. The follow-up period was 3~21 months with the mean of 5 months. The elevation of IOP would be defined as the pressure of 21mmHg or higher. The changes of IOP in patients before and after the treatment, and with different diseases and ages were analyzed. Results Thirty-six patients (28.8%) had elevation of IOP after the treatment, out of whom 97.2% had the elevation within 3 months after the injection and decreased to the basic level 7 months after the injection. In these patients, there were 11 (17.19%) in the below 15 mm Hg group and 25 (40.98%) in 15 mm Hg or above group, and the difference between the two groups was statistically significant (P＜0.01）. During the followup period, the mean maximum IOP was (20.09plusmn;7.58) mmHg, which was 5.43 mmHg higher than that before the treatment（P＜0.001）. The mean maximum IOP of 53 patients (42.4%) after the treatment was 5 mm Hg higher than that before the treatment. The mean maximum IOP during the followup period was （18.19plusmn;4.73）mmHg in DR group，（22.50plusmn;9.30）mmHg in RVO group, and（18.12plusmn;6.09）mmHg in AMD group. The occurrence of the elevation of IOP in RVO group was obviously higher than that in the other 2 groups (P＜0.01）. The result of regression analysis showed that age was correlative with the elevation of IOP after the treatment: more risks of occurrence of high IOP were found in younger patients (P=0.000). Conclusion Elevation of IOP after intravitreous injection with TA is common, which is correlative with the basic IOP, age, and pathogeny. After the intravitreous injection with TA, the elevation of IOP often occurs in patients with high basic IOP before treatment, younger age, and RVO. (Chin J Ocul Fundus Dis, 2007, 23: 115-117)
Objective To determine the effect of thiazolidinediones (TZDs) on early retinopathy in rats with experimental diabetes. Methods In 40 rats, diabetic models were set up in 36 by one-off intraperitoneal injection with streptozotocin (STZ), and other 4 were in the normal control group. Twenty-four diabetic rats with the disease-duration of more than 6 months underwent intravitreous injection (with rosiglitazone or pioglitazone in 10 rats, respectively), and the rest 4 rats werenprime;t injected with drugs as the diabetic positive control group. Immunohistochemical treptomycin-avidin-biotin-complex (SABC) method, in situ hybridization of retinal vascular endothelial growth factor (VEGF) mRNA, and TdT-dUTP terminal nick-end labelling (TUNEL) were performed on the ocular paraffin section to detect the cellular apoptosis. The difference of VEGF expression and cellular apoptosis between TZDs and control group was observed and analyzed. Results The results of immunohistochemical staining and hybridization in situ were negative in the normal control group. The positive expression rate of VEGF was lower in rosiglitazone and pioglitazone group than which in the diabetic positive control group, and there was no obvious differences of positive expression of VEGF mRNA and cellular apoptosis between the 2 groups. Conclusion TZDs (rosiglitazone and pioglitazone) may inhibit the positive expression of VEGF protein in retina of STZ-induced diabetic rats to some extent, but not affect the growth of VEGF in retina. (Chin J Ocul Fundus Dis, 2006, 22: 7-10)
ObjectiveTo detect the effect of adeno-associated-virus induced Kringles5 gene on retinal neovascularization in rats with retinopathy of prematurity (ROP), and to explore the new ways of treatment for ROP.MethodspSNAV-Kringle5-gfp carrier was constructed by subclone and adeno-associated-virus was packed to form rAAV-Kringle5-gfp. ROP model was set up under circumstances of high oxygen in 21 SD rats which were divided into experimental (21 eyes) and control group (21 eyes). Eighteen eyes from each group was used to making the histologic section of retina, and the other 3 eyes in each group was detected by polymerase chain reaction (PCR) and Western blotting. There were 5 rats in the normal control group. AAV-Kringle5-gfp with the dosage of 10 μl and titer of 2.5×1012vg/ml was injected into the eyes in experimental group, while rAAVlacZ with the same dosage and titer of 2.5×1011vg/ml was injected in to the eyes in control group. The expression of target gene in ocular tissues was observed under the fluoroscope. Twelve weeks later, the rats were executed, and the staining of Ⅷ factor related antigens in retinal vascular endothelial cells was performed and number of nucleolus of vascular endothelial cells were counted. ResultsThe plasmid of pSNAV-Kringle5-gfp was correct according to the sequence measurement; the expression of rAAV-Kringle5-gfp was found in vitreous cavity and on retina; the expression of target gene was found on the level of mRNA and protein; the number of nucleolus of vascular endothelial cells on the surface of retina was (19.954 2±3.825 7) in experimental group and (7.335 2±2.731 3) in the control group, which had significant difference between the two groups (P＜0.01）.ConclusionsAdeno-associated-virus induced Kringles5 gene can inhibit the occurrence of retinal neovascularization in patients with ROP.(Chin J Ocul Fundus Dis, 2005,21:288-291)
Objective:To evaluate the clinical effects of vitrectomy on total retinal detachment in patients with retinopathy of prematurity (ROP). Methods:The clinical data of 73 eyes of 56 patients with total retinal detachment in ROP (stage 5) who had undergone vitrectomy were retrospectively analyzed. The age o f the patients when underwent the surgery was 384 months old with the average o f (13.02plusmn;14.64) months. The gestation age ranged from 25 to 36 weeks with the average of (29.5plusmn;2.22) weeks; the birth weight ranged from 900 to 2500 g wit h th e average of (1400.19plusmn;300.05) g; the oxygeninhaling time ranged from 2 to 9 0 days with the average of (20.53plusmn;18.91) days. The surgery included open vitr ectom y, closed lens extraction, and vitrectomy. The anatomical outcomes of retinal re attachment were categorized as success: macular reattachment; partial success: macular detachment; and failure: total retinal detachment.Results:After the operation, the anatomical outcome was succeed in 10 eyes (13.69%), partially succeed in 20 eyes (27.39%), and failed in 43 eyes (58.9%). The visual acuity was hand moving in 9 eyes (12.33%), and the grating acuity was better than 0.004 in 6 e yes (8.21%) after the surgery.Conclusions:The procedures of vitrectomy for retinal detachment in ROP is difficult, and the prognosis of the operative therapy is poor. After t he operation, only a few patients get retinal reattachment, and few have certain extent recovery of the visual acuity.
ObjectiveTo seek the evidencebased medicine (EBM) evidences of curative effects of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsAll articles of intravitreous injection TA for macular edema published in English or Chinese were picked up from databases of MEDLINE and CNKI and then evaluated according to EBM standard. The data in accord with research standard were selected by using excluding and including criteria, and classified according to the appraisal standard of clinical therapeutic documents. ResultsIn the selected papers, none in gradeⅠevidence; 1 in gradeⅡevidence; 7 in grade Ⅲ evidence; 24 in grade Ⅳ evidence; and 19 in gradeⅤevidence. Forty-two papers reported that intravitreous injection with TA had significant effect for macular edema within 3 months, and the improvement of visual acuity was recorded in these papers. Regression of macular edema was recorded in 23 papers. Among 20 papers, side-effect was found in 93 eyes (31.41%) and the serious sideeffect in 4 eyes (1.35%).ConclusionsIntravitreous injection with TA has some curative effects for macular edema in short term, but the quality of current study has not been encouraging. There are no grade I document and lack of the study of validity in long term and essentiality and validity of retreatment. The special attention should be payed on the increasing persistency of efficacy and preventing the serious side-effects in the future investigation.(Chin J Ocul Fundus Dis, 2005,21:220-223)
Objective lt;brgt;To investigate the feasibility of labeling iris pigment epithelial（IPE）cells of rabbits with 5（and 6）carboxyfluorescein diacetate succinimidyl ester（CFSE）. lt;brgt; lt;brgt;Methods lt;brgt;Enzyme-assisted microdissection was used to isolate the cultured rabbitprime;s IPE cells.The third or forth subcultured IPE cells were incubated with 2.5，5，10，20，and 40 mu;mol/L of CFSE for 1，5，and10min respectively.The fluorescence intensity was detected by flow cytometry，and the leakage of CFSE and its dyeing were observed by fluorescence antibody labeling. lt;brgt;Results lt;brgt;Incubation with 20 mu;mol/L CFSE under 37℃for1minute was the most optimal condition for IPE cells labeling.The coloration of IPE cells stained by CFSE lasted 4 weeks.There was no leakage of dye from labeled rabbit IPE cells to non-labeled human IPE cells in mixed culture process. lt;brgt; lt;brgt;Conclusion lt;brgt;With the advantages of high rate of dyeing，long time of tracing，safety and convenience，CFSE can be used as a new method to label the rabbitprime;s IPE cells. lt;brgt; lt;brgt;(Chin J Ocul Fundus Dis, 2006, 22: 261-264)
Objective To evaluate the effect of vitrectomy on traumatic retinal detachment combined with choroidal damage. Methods The data of 1075 traumatic eyes which underwent vitrectomy from 1995 to 2005 were retrospectively analyzed. Forty-one patients (41eyes, 3.8%) with different kinds of choroidal injuries, including traumatic retinal detachment combined with serous choroidal detachment, hemorrhagic choroidal detachment (including traum atic separation of choroid and sclera) or subretinal hemorrhage, underwent closed vitrectomy. The operative prognosis in different groups were analyzed statisti cally. Results The retina reattached in 38 eyes （92.7％）, in cluding 10 with the final visual acuity gt; 0.1（24.4％）；the visual acuity improved postoperatively in 29 (70.7％)，including 14 in subretinal hemorrhage group （87.5％, 14/16），12 in serous choroidal detachment group（75.0%, 12/16）and 3 in hemorrhagic choroidal detachment（33.3%, 3/9） (chi;2＝8.394, P＝0.015); amaurosis was found in 6 eyes, all of which were with hemorrhagic choroidal deta chment preoperatively. In 17 eyes with ocular hypotension, a persistent silicone oil tamponade was needed in 8（47.1％）, in which 5 were in the hemorrhagic choroidal detachement group (55.6％, 5/9). Conclusions Appropriate vitrectomy is helpful for traumatic retinal detachment combined with choroidal damage, and the operative prognosis of the patients combined with subretinal hemorrhage is good. The operative prognosis of hemorrhagic choroidal detachment is worse than that of the serous choroidal detachment. However, it doesnprime;t mean that all the hemorrhagic choroidal detachment eyes need ocular enucleation. The prognosis of eyes with severe traumatic choroidal detachment was poor, and the eyes are with ocular hypotension which needs a long-term silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22:295-298)
Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ-Ⅳ idiopathic full-thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate，change of visual acuity，findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups (P＜0.05). (2) In anatomic success rate, the single vitrectomy group was significantly lower than the vitrectomy with APC treatment group（87.5%）or vitrectomy with both ILM peeling and APC as an adjuvant group(92.0%)(P＜0.05). (3) There was no significant difference in operative complication and improvement of distortion of vision. Conclusion Vitrectomy combined with APC as an adjuvant for the treatment of idiopathic macular hole is helpful to improve both the anatomic success rate and postoperative visual acuity. The usage of ILM peeling technique could improve the anatomic reattachment rate, but the vision prognosis of ILM peeling patients is not as good as the patients of APC as an adjuvant. (Chin J Ocul Fundus Dis, 2002, 18: 196-198)
Objective To evaluate the therapeutic effects of treatments of eye-retaining and enucleation for choroidal melanomas. Methods The clinical data of 44 patients (44 eyes) with choroidal melanomas after eye-retaining treatments and enucleation surgery were retrospectively analyzed. The metastasis, retention rate of eyeball after eye-retaining treatment, and visual acuity prognosis were observed and analyzed. In 44 eyes treated by eye-retaining therapy, transpupillary thermotherapy (TTT) was performed primaryly on 7 (15.9%), 106 Ru brachytherapy on 25 (56.8%), and local resection of tumor combined with 106 Ru brachytherapy on 12 (27.3%).The average follow-up period was 13.3 months. Results Forty-four patients had no melanoma metastasis during the follow-up period. In 39 patients (88.6%) who had their eyes retained successfully, the retention rate of eyeball was 100%, 92.9%, and 83.3% in 6, 14, and 24 eyes with small, middle, and large tumor, respectively. In the patients treated by eye-retaining therapy, the visual acuity was ge;0.3 in 11 (28.2%), ge;0.05-＜0.3 in 18 (46.2%), and ＜0.05 (25.6%) in 10 eyes. Conclusions 106 Ru brachytherapy and transpupillary thermotherapy are effective treatments for small and medium-sized choroidal melanomas; some selected cases with large choroidal melanomas was treated with local resection of tumor combined with106 Rubrachytherapy. However, longer followup will be necessary to assess if this treatment has a better comprehensive outcome, compared with enucleation surgery. (Chin J Ocul Fundus Dis, 2006, 22: 150-153)