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Retinal vascular bed area(RVBA)is the total area of retinal vasculature segmented by ultra-widefield fluorescein angiography(UWFA)images, and is an objective absolute value in square millimeter. RVBA is mainly affected by the diameter and length of retinal vessels, and whether RVBA increases or decreases depends on the “competition” between ischemia and angiogenesis, indicating subtle changes in retinal vascular morphology. As a new indicator for the study of retinal vascular diseases, RVBA may have higher stability and accuracy than the ischemia index(ISI)and non-perfusion area(NPA). RVBA is currently mainly used to evaluate the progression and prognosis of diabetic retinopathy(DR). It was found that retinal total RVBA in DR eyes was greater than the normal eyes and it decreased in DR eyes after anti-vascular endothelial growth factor(VEGF)treatment. These findings provide favorable support for the study of microvascular lesions in DR. In this article, the application of RVBA in DR was reviewed to provide a reference for the clinical study of RVBA in other retinal vascular diseases such as retinal vein occlusion(RVO).
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Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.
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AIM: To evaluate the repeatability and reproducibility of thickness profile measurement of intra-retinal layers determined by an automated algorithm applied to OCT images from Cirrus optical coherence tomography (OCT) instrument.METHODS: In this prospective cross-sectional study,retinal thickness images at 6mm×6mm around fovea were obtained from 86 eyes of 43 normal subjects with Cirrus HD-OCT instrument.The retinal images from patients were analysis by Cirrus automated algorithm GCA software,including ganglion cell layer and inner plexiform layer(GCIPL).During this study,operator A would make 2 times measurements to all patients,after that operator B would make another 2 times measurements by Repeat scan model.All the data,including GCL average thickness,min thickness,12 clock average thickness,2 clock average thickness,4 clock average thickness,6 clock average thickness,8 clock average thickness and 10 clock average thickness were measured by SPSS 15.0 software.Standard deviation (SD),coefficient of variation (CV) and interclass correlation coefficient (ICC) were calculated from the results of three-times tests by different examiner to evaluate the repeatability and from the results of two different examiners to assess the reproducibility.Written informed consent was obtained from each subject prior to any medical procedure.RESULTS: The average GCIPL thickness of OD was 85.12±3.95μm;the minimum average GCIPL thickness was 83.21±4.41μm;the standard deviation of OD in clock map was from 3.79μm to 4.84μm;CV(95%CI) was between 0.26 and 0.93;ICC was from 0.939 to 0.989.The average GCL+IPL thickness of OS was 84.65±8.73μm;the minimum average GCPL thickness was 81±13.08μm;the standard deviation of OS in clock map was from 8.24μm to 10.56μm;CV(95%CI) was between 0.92 and 4.94;ICC was from 0.264 to 0.968.CONCLUSION: Cirrus HD-OCT GCA software with automated algorithm can offer accurate and repeatable thickness profile of OCT retinal image.GCA is a useful and reliable approach to the measurement of intra-retinal layer thickness,which may improve the diagnosis and monitoring of retinal diseases.
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AIM: To observe the clinical efficacy and safety of vincamine sustained release capsules on non- arteritic anterior ischemic optic neuropathy ( NAION) . · METHODS: Patients who were diagnosed with monocular onset NAION in acute stage from January to September 2015 were divided into two groups. Routine treatment such as steroid pulse therapy and neurotrophic treatment were given to all the patients. Vincamine was added to the treatment group patients with 30mg twice a day for 3mo. The best corrected visual acuity ( BCVA), mean deviation ( MD) of visual field, retinal nerve fiber layer ( RNFL ) , ganglion cell complex ( GCC ) , pattern visual evoked potential ( PVEP ) and OCT results were analyzed before and after the treatment. ·RESULTS:Totally 42 eyes of 42 patients were enrolled in our study. There were 27 patients in the treatment group, aged from 33 to 79 years old, the average value was 55. 55± 11. 83 years old. The control group has 15 patients, aged from 40 to 70 years old, the average value was 55. 71 ± 10. 06 years old. There were no statistical differences between the two groups in the baseline. After 3mo of the treatment, MD value of the two groups were lower compared with the baseline, the difference was statistically significant in the treatment and control group respectively (t= 2. 342, 2. 692; P = 0. 027, 0. 041). The difference of PVEP amplitude and potential of the two groups before and after the treatment were not statistically significant. The thickness of retinal nerve fiber layer and the ganglion cell complex were all lower than the baseline, and the difference was statistically significant (P<0. 001). The treatment of the two groups were both effective, the treatment group has better treatment effect than the control group. Adverse events related to the treatment of vincamine had not been found. ·CONCLUSION:Vincamine is helpful in the treatment of non-arteritic anterior ischemic optic neuropathy.
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The progress of modality therapy has improved both survival rate and quality of life of retinoblastoma(RB) patients.However,some problems are still left and unsolved.Parts of the RB relapse after they are treated for the first time.Even more remarkable,the related individuals to the RB patients run a risk of RB.Gene diagnosis and treatment are emerging and appear to solve these problems.Some researches in developed countries and Hong Kong have successfully made progress in gene diagnosis of RB.However,the detection rate of Rb1 gene mutation is very low.Researches documented for many years that gene diagnosis for RB is extremely complex,so we should go further to achieve a goal of gene diagnosis.Gene diagnosis of RB is still an initiation in China.We should strengthen relevant study and spread this technique.
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Background Oxygen-induced retinal neovascularization is the main pathological basis for many retinal vascular diseases.Research showed that light exposure at night can suppress retinal neovascularization in oxygen-induced retinopathy(OIR),but there were few reports discussing its effect on ROP.Objective This study aimed to observe the effect of light exposure at night on retinal neovascularization in an OIR mouse model.Methods Sixty-four newborn C57 BL/6J mice were randomly divided into four groups,with 16 mice for each group.OIR models were established by rearing the newborn C57BL/6J mice with their mothers in a(75±2)％ oxygen environment from postnatal day 7(P7)to Pl2,and then transferred to room air.In the OIR model group,the environmental illumination level was the same as the normal control group,and the model mice were exposed to 100 lx light at night in the OIR+ light exposure group.In the simple light exposure group,normal mice were reared in room air and were exposed to light at night from P12 to P17.All the mice were sacrificed on P17,and retinal flat mounts were prepared to assess the oxygen-induced changes of retinal vessels using the adenosine diphosphatase(ADPase)histochemical technique.The amount of proliferative neovascularization was quantified by counting the number of endotheliocyte nuclei in new vessels extending from the retinal inner limiting membrane into the vitreous in ocular cross-sections.The expression of the vascular endothelial growth factor(VEGF)protein was detected by immunohistochemistry.Real-time PCR analysis was performed to examine the expression of VEGF mRNA.The rearing and usage of the animals complied with the Statement of ARVO.Results Less free-vascular areas and new blood vessels were seen in the OIR+light exposure group compared with the OIR model group.On day 17 of the mouse life,the number of the endotheliocyte nuclei in new vessels extending from retinal inner limiting membrane were 0.97±0.83,1.00±0.72,38.57±5.01 and 16.92±3.39 in the normal group,simple light exposure group,OIR model group and OIR+light exposure group,respectively,showing significant differences among them(F =78.767,P =0.000).The number of nuclei in the OIR+light exposure group were less than that of the OIR model group(t=20.446,P＜0.01).Immunochemistry showed that the expression of VEGF in retina was weaker in the OIR+light exposure group than the OIR model group.The relative expression values of VEGF mRNA were 1.00±0.00,0.94±0.07,2.08±0.50 and 1.43±0.21 in the normal group,simple light exposure group,OIR model group and OIR+light exposure group,respectively,showing a significant difference (F=11.268,P =0.003),where the VEGF mRNA level in the OIR+light exposure group was lower than that of the OIR model group(t =20.163,P＜0.05).Conclusions Light exposure at night can weaken retinal neovascularization in OIR mice
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BackgroundSweep pattern visual evoked potential(SPVEP) acuity,as an objective detective technique of visual function,can be used to measure visual acuity in children and uncooperative adults.Recent studies have shown that the amplitude-logarithm of the visual angle (A-LogVA) function regression method was more accurate than the amplitude-spatial frequency (A-SP)function regression method in evaluating SPVEP acuity.Objective This study was to explore the clinical use of SPVEP acuity in visual developing children and compare the evaluating the SPVEP acuity of children between A-SP function regression method and A-LogVA function regression method.Methods Twenty-six eyes of 26 asthenopic children with age range of 3-12 years and 31 age-matched normal children were enrolled in this study.SPVEP acuity was recorded with GT-2000 NV ( GUOTE MEDICAL APPARATUS LTD,China) using sinusoidally modulated horizontal gratings of 10 different spatial frequencies from 0.99 to 12.89 cpd as stimulus.The responses were averaged and displayed through discrete Fourier transformations (DFT) on the monitor display.SPVEP acuity was estimated by using both the SPVEP A-SP function regression method and the SPVEP A-LogVA function regression method.The LogMAR chart was used to acquire LogMAR visual acuity.ResultsIn the normal group,the correlation coefficient between LogMAR visual acuity and acuity calculated by the A-SP function regression method was 0.600 (P＜0.01).The correlation coefficient between LogMAR visual acuity and acuity calculated by the A-LogVA function regression method was 0.733 ( P＜0.01 ).The ANOVA of the LogMAR acuity and the SPVEP acuity calculated from the A-SP function regression method and A-LogVA function regression method were 113.173 (P＜0.01 ),which indicated that there were significant difference among all of subjects.The differences of the mean values of LogMAR visual acuity and the SPVEP acuity calculated from the A-SP function regression method and A-LogVA function regression method were respectively 0.40±0.02,0.26 ±0.02 and 0.14 ± 0.02.In the amblyopia group,the correlation coefficient between LogMAR visual acuity and acuity calculated by the A-SP function regression method was 0.134 (P =0.515 ).The correlation coefficient between LogMAR visual acuity and acuity calculated by the A-LogVA function regression method was 0.456 ( P＜0.05 ).The ANOVA of the LogMAR acuity and the SPVEP acuity calculated from the A-SP function regression method and A-LogVA function regression method were 3.433 (P＜0.05),indicating that there were significant difference among all of subjects.The differences of the mean values of LogMAR visual acuity and the SPVEP acuity calculated from the A-SP function regression method and A-LogVA function regression method were 0.07±0.05,0.12±0.05 and 0.05 ±0.01 respectively.Conclusions SPVEP can evaluate the visual acuity in children,although SPVEP acuity may overestimate or underestimate acuity in comparison with different LogMAR visual acuities.The amplitude-LogVA function regression method is more accurate in extrapolating SPVEP acuity.
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Background Fibrin glue has been utilized to adhere the graft during the pterygium excision with conjunctival autografts.Several relevant clinical randomized controlled trial(RCT) and retrospective studies have been published abroad,but the samples for its effectiveness and safety issue of fibrin glue and suture are still underinvestigation.Objective Current study was to quantificationally assess the efficacy and safety of fibrin glue versus sutures in the application of pterygium excision with conjunctival autografts.Methods Based on established search strategy,a computerized literature search was conducted to identify all citations concerning the RCT for effectiveness and safety evaluation of fibrin glue and suture for the graft fixation during the pterygium excision with conjunctival autografts from MEDLINE ( from 2000 to October,2010 ),EMbase ( from 2000 to October,2010 ),Cochrane Central Register of Controlled Trials ( Issue 4,2010 ),CBMdisc ( 2000 to October 2010 ),CNKI ( 2000 to October 2010 ),and the relevant conference proceedings and references searched by hand was performed as supplement.The included literature was scored with Jadad table.The Cochrane Collaboration' s RevMan 5.0 software was used for the test of heterogeneity or test for overall effect.The effective indexes,such as operative duration,recurrence rate and complication,were evaluated by Meta analysis.Results Six RCTs involving 401 eyes of 377 participants were identified.These literatures were published with English in 2004-2010 from China,New Zealand,Sweden,Israel,Turkey and Malasia and the Jadad scores were 4-5.The quantitatively analysis revealed that fibrin glue appeared to short the operative time compared with suturing method (MD =14.23 ;95％ CI:- 16.18- 12.29;P=0.00) and drop the rate of recurrence ( RR =0.49,95％ CI:0.26 -0.95 ; P =0.03 ).No significant differences were found in the rate of postoperative graft dehiscence or absence (RR =3.41,95 ％ CI:0.85-13.68;P =0.08 ).Conclusions Fibrin glue shows the good effectiveness and easy application during the pterygium excision with conjunctival autografts.Long-term follow-up of multi-central RCTs with a larger number of cases are still needed to support this conclusion.
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Background Sweep pattern visual evoked potential (SVEP) is an objective method of visual test.There is a clear correlation between SVEP acuity and subjective vision,but they are not identical.Recent studies showed that new regression method can improve the accuracy of SVEP acuity. Objective This trial was to investigate and compare the outcome between amplitude-spatial frequency (A-SP) regression method and amplitudelogVA (A-logVA) regression method in extrapolating the SVEP acuity.Methods SVEP was recorded in 113 eyes of 64 subjects using GT-2000 ( Guo Te,China) with the gratings of 10 different spatial frequency from 0.99 to 12.89 cpd as stimulus.The 1 13 eyes included cataract,glaucoma,corneal disease,optical neuropathy,retinal disease,ocular trauma,refractive error and normal eyes.The correlation were analyzed of SVEP acuity,decimal visual acuity and LogMAR visual acuity.The response were averaged and DFT on the monitor display.SVEP acuity was calculated by extrapolating 0 response amplitude.Results The correlation indices of decimal visual acuity curves obtained by the A-logVA function was 0.663,and that obtained by the A-SP function was 0.705.The positive correlation was seen between subjective decimal visual acuity and A-logVA decimal visual acuity (r =0.540,P＜ 0.01 ) and between subjective decimal acuity and decimal acuity calculated by the A-SP regression method (r=0.620,P＜0.01 ).SVEP decimal acuity calculated by the A-SP function regression method was significantly different from the that calculated by the A-logVA function regression method (Z =-8.688,P＜0.01 ).And the correlation indices of LogMAR visual acuity curves obtained by the A-logVA function was 0.733 and that obtained by the A-SP function was 0.715.The positive correlation was found between the subjective LogMAR acuity and that calculated by the A-SP regression method (r=0.700,P＜ 0.01 ) and between the subjective LogMAR acuity and LogMAR acuity calculated by the A-logVA regression method (r=0.710,P＜0.01 ).SVEP LogMAR acuity from A-SP function regression method was significantly different from the LogMAR acuity from A-logVA function regression method (Z=-8.748,P＜0.01 ).No significant differences of VA LogMAR were found in gender,eyes,type of disease and age(x2 =2.171,P=0.338;x2 =0.976,P=0.614;x2 =6.032,P=0.420;x2 =14.720,P=0.257 ).Conclusions SVEP can obtain the visual outcome in human.The amplitude-logVA function regression method is more accurate in extrapolating SVEP acuity.
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Retinopathy of prematurity( ROP),a leading cause of childhood visual impairment,is a vascular proliferative retinopathy in premature infants. Although the hallmark of ROP is abnormal retinal vasculature, a growing body of research in animals and observations in patients support a critical role for the neural retina in the ROP disease process. ROP can affect the foundation of the retina and optical nerve during the development duration in childhood, presenting with abnormalities in electroretinogram and multifocal electroretinogram. In addition,it was found that ROP has different degrees of influence on the development of the dioptric system ,which will result in refractive error as the child progress to adulthood. The relationship of the electrophysiology features or refractive abnormality and ROP was summarized in this article.
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Background Intravitreal injection of triamcinolone acetonide (TA) can effectively eliminate central vein occlusion macular edema and improve visual acuity, and photopic negative response (PhNR) can reflect the inner retinal function of RGCs and their axons. It is possible there is a correlation between these two observations.Objective This study was to evaluate the changes of PhNR of flash electroretinogram (F-ERG) after intravitreal injection of TA for macular edema in central retinal vein occlusion ( CRVO ). Methods Thirteen eyes of 12 patients with macular edema caused by CRVO received an injection of 0. 1 ml (4 rg) of TA. PhNR,visual acuity and retinal thickness of macular area were assessed with Roland RETI scan 3. 15 system,decimal visual chart and Stratus optical coherence tomography (OCT) before and 4 weeks after the administration of TA. Written informed consent was obtained from each subject before any medical procedure. Results Visual acuity was improved in 12 eyes and stable in 1 eye 4 weeks following the intravitreal injection of TA. OCT showed that the retinal thickness of the macular area was reduced ;meanwhile,elevation of the amplitude of PhNR also was seen in the F-ERG after the administration of TA in comparison with before the administration of TA. The calculated results determined that the visual acuities were 0. 32t0. 12 and 0. 48±0. 09 (t=6. 325 ,P=0. 000) ,and the retinal thickness values of the macular area were (459.46± 131.31 ) μm and ( 297.54 ±43.31 ) μm ( t = 5.961, P = 0. 000 ), and the average amplitude of PhNR were ( 80. 23±22.96 ) μV and (61.28 ±20. 16 ) μV ( t = 4. 438, P = 0. 001 ) before and after the intravitreal injection of TA, respectively,showing significant differences. No significant correlation was found between PhNR amplitude and retinal thickness of the macular area both before and after the administration of TA ( before: r = 0. 587, P = 0. 035; after:r=-0. 011 ,P = 0. 971 ). Conclusion PhNR can be used for evaluating the status of inner retina after intravitreal injection of TA for macular edema of CRVO.
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Objective To investigate the waveform of the first-order kernel and second-order kernel of muhifocal electroretinogram stimulated with light emitting diode(LED).Design Prospective,noncomparative,interventional case series.Participant 18 subjects(18 eyes)who had been accepted the mfERG test.Method The patients were devided into two groups,they accepted the muhifocal elec- troretinogram(mfERG)stimulated with cathode ray tube(CRT)and LED using the Roland RETI Scan3.15 system.The first-order kernel or the second-order kernel was analyzed.The stimulation time of LED were changed from 1.7ms to 16.7ms.Five different stimulation time of LED in this study were 1/10(1.7ms),3/10(5ms),5/10(8.3ms),7/10(ll.7ms)and 10/10(16.7ms).Main Outcome Measure The summed responses were observed.The waveform,amplitude and implicit times of mfERG summed response were analyzed.Result The waveforms of the first-order kernel stimulated by LED were similar to those of CRT.In the second-order kernels of mfERG,the wave- forms were obviously different from those stimulated by LED and CRT.The P1 wave stimulated by CRT was sharp,but the P1 wave of LED was broad.The N2 wave of LED was deeper.The amplitude of N1 wave and P1 wave were increased,and their implicit times pro- longed with the stimulation times prolonging.Conclusion In the first-order kernel of mfERG,the waveform of the summed response stimulated by LED was similar to that of LED.In the second-order kernel of mfERG,the waveform stimulated by LED was more com- plicated,may be there were more inner retina information.(Ophthalmol CHN,2006,15:351-355)