ABSTRACT
Size of the macular hole (MH) is an important factor affecting the treatment of MH.MH with a diameter >400 mm was defined as large MH.Pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling or intravitreal gas tamponade, which can effectively relieve the traction of vitreoretinal interface, is the standard surgical technique for idiopathic full-thickness macular hole (FTMH), but its efficacy on refractory large FTMH is very limited.In order to obtain ideal anatomical healing and functional recovery of large FTMH, new surgical strategies, such as reversal of retinal internal limiting membrane (ILM), expanded removal of ILM, transplantation of different tissue valves, application of mesenchymal stem cells and so on, have been the focus of researchers in the field of fundus diseases.More targeted and personalized treatment is the development trend of treatment for large FTMH.The progress of ILM flipping surgery, expansion of ILM removal, transplantation of different tissue valves, biomaterials and other auxiliary techniques in the treatment of large diameter FTMH were reviewed in this article.
ABSTRACT
Objective:To investigate the risk factors of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods:A case-control study was conducted.A total of 1 848 consecutive PDR patients (1 848 eyes) with vitreous hemorrhage receiving first pars plana vitrectomy (PPV) in Tianjin Medical University Eye Hospital from June 2012 to May 2019 were enrolled.There were 979 males and 869 females, with the average age of (55.72±10.39) years.All of the enrolled eyes underwent standard three-channel PPV.The subjects were followed up for 6 to 24 months, with the mean follow-up of (379.34±231.28) days.The eyes were divided into PVH group and non-PVH group according to whether the PVH occurred or not.The PVH group were further divided into early PVH group and late PVH group according to the occurrence time of PVH.There were 170 (9.19%) of 1 848 eyes developed PVH after surgery, including 17.64%(30/170) of eyes with early PVH and 82.36% (140/170) of eyes with late PVH.The PVH occurred at 6 to 450 days after surgery.Baseline systemic parameters including sex, age, diabetes duration, preoperative glycosylated hemoglobin (HbA1c) level, and ocular parameters including whether or not performing panretinal photocoagnlation, whether or not receiving treatment of anti-vascular endothelial growth factor (VEGF) three days before operation, lens status, whether or not being combined with neovascularization of iris (NVI), as well as intraoperative ocular parameters including whether or not having neovascularization of disc (NVD) bleeding, whether or not being combined with cataract phacoemulsification, whether or not receiving postoperative anti-VEGF, were analyzed by multivariate logistic regression analysis to identify the risk factors of PVH after PPV in PDR patients with VH.This study adhered to the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2019KY[L]-09).Results:Multivariate logistic regression analysis revealed that age ( OR=0.940, P<0.01), preoperative high HbA1c level ( OR=1.878, P<0.01), combined with retinal vein occlusion (RVO) ( OR=8.310, P<0.01), diabetes diet to control blood glucose ( OR=3.030, P<0.01), diabetes duration ( OR=1.044, P<0.01), history of hypertension ( OR=1.802, P<0.01), nephropathy or cardiovascular or cerebrovascular diseases ( OR=18.377, P<0.01), preoperative NVI ( OR=7.488, P<0.01), not combined with phacoemulsification surgery ( OR=1.628, P=0.023), NVD bleeding ( OR=2.691, P<0.01), postoperative anti-VEGF treatment ( OR=0.181, P<0.01), postoperative air tamponade ( OR=1.901, P=0.024) were associated with PVH.There were no significant differences in baseline, ocular and intraoperative ocular parameters between early PVH and late PVH groups (all at P>0.05). Conclusions:Younger age, preoperative high HbA1c level, combined with RVO, diabetes diet to control diabetes, diabetes duration, history of hypertension, nephropathy or cardiovascular or cerebrovascular diseases, preoperative NVI, uncombined with cataract surgery, NVD bleeding, without postoperative intravitreal anti-VEGF injection, postoperative air tamponade are the potential risk factors of PVH after PPV for PDR patients with VH.
ABSTRACT
Objective:To characterize proteomic profile in aqueous humor of patients with high myopia using quantitative proteomic analysis.Methods:Sixty-eight age-related cataract patients were divided into high myopic cataract group and simple cataract group according to that they had high myopia or not, with 34 patients (34 eyes) in each group.Aqueous humor samples (100 μl/patient) were collected from each patient using a 1 ml tuberculin syringe during cataract surgery at Tianjin Medical University Eye Hospital from January 2019 to August 2019.Sixteen samples from each group were selected for protein quantification and comparison by BCA method.The differentially expressed proteins between the two groups were analyzed using label-free liquid chromatography tandem mass spectrometry.The function and signal transduction pathways of differentially expressed proteins were further analyzed by Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes.Eighteen aqueous humor samples from each group were selected to verify the results of mass spectrometry by enzyme-linked immunosorbent assay (ELISA). This study protocol adhered to the Declaration of Helsinki.The use of human samples was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2020KY[L]-40). Written informed consent was obtained from each patient prior to surgery.Results:The mean protein mass concentration of aqueous humor sample in the high myopic cataract group was (1 134.91±104.78) ng/L, which was significantly higher than that in the simple cataract group (706.71±85.43) ng/L, showing statistically significant difference ( t=11.977, P<0.01). A total of 463 proteins were identified and 86 proteins were found to be differentially expressed, including 49 up-regulated proteins and 37 down-regulated proteins in the two groups.These differentially expressed proteins were mainly protein-binding activity modulator, extracellular matrix protein, carrier protein, intercellular signal molecule, protein modifying enzyme and so on, accounting for 32.70%, 14.50%, 9.10%, 9.10% and 7.30%, respectively.Bioinformatics analysis showed that 86 differentially expressed proteins were mainly related to biological processes such as complement activation and regulation, acute inflammatory response, and extracellular matrix tissue remodeling.Among them, 21 differentially expressed proteins were enriched in the complement and coagulation cascades pathways, 15 in the extracellular matrix-receptor interaction pathway, and 8 in the PI3K-Akt signaling pathway.ELISA results showed that the expression trends of three randomly selected differentially expressed proteins of the two groups were consistent with the results of label-free quantitative proteomic analysis. Conclusions:There are significant changes in proteomic profiles of aqueous humor between the high myopia cataract patients and simple cataract patients.High myopia is closely associated with inflammation and immune interactions, and remodeling of extracellular matrix.