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ChatGPT is a large language models(LLMs)that uses deep learning techniques to produce human-like responses to natural language inputs. It belongs to the family of generative pre-training transformer(GPT)models currently publicly available developed by OpenAI in November 2022. ChatGPT is capable of capturing the nuances and intricacies of human language, generating appropriate and contextually relevant responses. It can assist medical professionals in various tasks, such as research, diagnosis, patient monitoring, and medical education, from identifying research programs to assisting in clinical and laboratory diagnosis, to know new developments in their fields and scientific writing. ChatGPT has also attracted increasing attention and widely used in ophthalmology. However, the use of ChatGPT and other artificial intelligence tools in such tasks comes now with several limitations, ethical and legal concerns, such as credibility, plagiarism, copyright infringement, and biases. Future research can focus on developing new methods to mitigate these limitations while harnessing the benefits of ChatGPT in medicine and related aspects.
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AIM: To observe the outcome of intravitreal balanced salt solution(BSS)injection to increase intraocular pressure(IOP)after extrascleral subretinal fluid drainage, then scleral buckling(SB)to treat superior bullous retinal detachment(SBRD), and compare it with the effect of conventional surgery(without any intravitreal filling)and postoperative air filling.METHODS: Retrospective case-control study. A total of 72 patients(73 eyes)who underwent SB for SBRD from January 2018 to December 2022 in ophthalmology department of Xijing Hospital were included. The extrascleral subretinal fluid drainage was performed in all eyes. According to whether intravitreal injection was performed and different injections, patients were divided into three groups: with 24 cases(24 eyes)in the conventional group(no intravitreal injection), 23 cases(23 eyes)in the air group(sterile air was injected after surgery), and 25 cases(26 eyes)in the BSS group(BSS was injected during extrascleral subretinal fluid drainage). All patients were followed up until subretinal fluid was absorbed completely. The average surgery time, postoperative IOP, retinal reattachment rate, subretinal fluid absorption, visual acuity(LogMAR)and major complications were compared.RESULTS: All surgeries were completed successfully. The average surgery time of the conventional group, air group and BSS group were 63.17±13.22, 61.65±15.55 and 57.30±11.70 min, respectively. There had no significant difference among these groups(F=0.825, P=0.443). On the first post-operative day, the average IOP of the conventional group, air group and BSS group were 13.69±2.69, 16.40±2.86 and 18.35±2.88 mmHg, respectively. The average IOP of the air group and the BSS group were significant higher than that of the conventional group(F=17.18, P<0.001). Primary reattachment rates were 88%, 96%, and 100%, respectively. The postoperative BCVA was 0.71±0.42, 0.59±0.44, and 0.91±0.50, respectively, which were significantly higher than those before operation(all P<0.05), but there was no significant difference among groups(F=3.046, P>0.05). The main complications included subretinal hemorrhage in 1 eye from the conventional group and 1 eye from the air group, and a new retinal tear in 1 eye from the air group, resulting in localized retinal detachment.CONCLUSIONS: For SBRD patients with hypotony during SB surgery, intravitreal injection of BSS to properly increase the IOP and then complete the surgery can improve the reattachment rate and reduce postoperative complications. This method is safe and effective for selected SBRD patients.
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Drusen is one of the early hallmark changes of AMD. The oxidative stress and inflammatory reaction caused by oxidative phospholipids (OxPLs) in drusen can lead to retinal pigment epithelium (RPE) cell death (apoptosis, pyroptosis, etc.) and the formation of choroidal neovascularization, which is the pathogenesis of AMD. Pyroptosis, also known as inflammatory necrosis, is one of the main forms of OxPLs induced cell death. Proinflammatory factors released by pyroptic cells can in turn aggravate the inflammatory reaction, leading to further damage. In order to prevent AMD, inflammatory response and cell death may be reduced by regulating lipid metabolism, reducing OxPLs endocytosis and increasing cholesterol efflux. In-depth understanding effects of OxPLs, inflammation and RPE pyrosis in the pathogenesis of AMD in elucidate the pathogenesis of AMD and to seek new treatment measures has important clinical significance.
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The prevalence of diabetes mellitus in adults of China has reached 12.8%. Diabetic retinopathy (DR) accounts for approximately 1/4-1/3 of the diabetic population. Several millions of people are estimated suffering the advanced stage of DR, including severe non-proliferative DR (NPDR), proliferative DR (PDR) and diabetic macular edema (DME), which seriously threat to the patients' vision. On the basis of systematic prevention and control of diabetes and its complications, prevention of the moderate and high-risk NPDR from progressing to the advanced stage is the final efforts to avoid diabetic blindness. The implementation of the DR severity scale is helpful to assess the severity, risk factors for its progression, treatment efficacy and prognosis. In the eyes with vision-threatening DR, early application of biotherapy of anti-vascular endothelial growth factor can improve DR with regression of retinal neovascularization, but whether it is possible to induce capillary re-canalization in the non-perfusion area needs more investigation. Laser photocoagulation remains the mainstay treatment for non-center-involved DME and PDR.
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Retinal break is the cause of primary retinal detachment,which remains a main cause for visual loss,and closure of the breaks is the principle of treatment.Currently surgical treatment can successfully reattach the retina in most cases.However,some basic questions still beset treatment of the disease,such as the cause responsible for development of retinal breaks and how to prevent it,and how the visual recovery can be satisfactory after reattachment surgery.Recent research indicates that the development of retinal breaks is associated with the process of vitreous liquefaction,posterior vitreous detachment (PVD) and abnormal vitreoretinal adhesion and traction.The retinal breaks can occur in the posterior margin of the vitreous base in the eye with complete PVD.Partial PVD may cause posterior breaks especially in cases of myopic traction maculopathy associated with schisis-like thickening in the outer retina (foveoschisis) and vitreomacular traction.It is known that microstructural changes and atrophy of the macula,and epiretinal membrane formation are the reasons for poor vision after the retina is reattached.Therefore,more attention should be paid to further understand the vitreous pathology and traction mechanism,to research for methods of its clinical evaluation and strategy of prevention and treatment,and to accelerate visual recovery after reattachment surgery,in order to raise the standard of the disease treatment.
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Background Researches have demonstrated that ocular hypertension induces the ischemia-reperfusion of retina and further leads to the degeneration of retinal ganglion cells,but its mechanism is beyond understanding.Objective The present study aims to observe the effects of static pressure on the morphology,proliferation activity and viability of cultured retinal microvascular endothelial cells (RMECs) and evaluate the expression of ET-1 and NO in these cells under variant static pressure.Methods RMECs were isolated from 30 healthy Wistar rats and cultured using explant culture method by Ⅷ factor antibody and PECAM-1 antibody.The static pressure of 1.33kPa,2.67kPa,5.33kPa and 10.67kPa was used in culture bottle respectively.The RMECs without static pressure were used as normal control group.The morphology of RMECs under the different static pressure was observed by inverted phase contrast microscopy,and the number of RMECs was counted using the counting plate.Cellular viability was studied by trypan blue staining.The changes of ET-1 and NO_2~-/NO_3~-,two metabolic products of NO,in the medium were detected by radioimmunoassay and Griess's nitrate reductase method.The expression of ET-1,eNOS and iNOS mRNA in RMECs was analyzed by semi-quantitative RT-PCR 24 hours after treatment of variant static pressure.Results Cultured RMECs sticked well at 24 hours and reached to confluence at 48 hours and showed the red fluorescence for Ⅷ factor antibody and PECAM-1 antibody.Enlargement of nuclei,extenders of cell bodies and suspension of RMECs in medium were observed.The number of RMECs was gradually increased.The cell viability was reduced with the raise of static pressure among these four groups(F=12.205,P＜0.01;F=11.180,P＜0.01).The static pressure increased the content of ET-1 released by RMECs in 2.67kPa,5.33kPa and 10.67kPa of static pressure groups,and concentrations of NO_2~-/NO_3~- in the medium showed a significant increase in 5.33kPa and 10.67kPa of static pressure groups compared with normal and 1.33kPa of static pressure groups(P＜0.01).The expressions of ET-1 mRNA,eNOS mRNA and iNOS mRNA were considerably enhanced in 5.33kPa and 10.67kPa of static pressure groups compared with normal control group(P＜0.01).Conclusion Raised static pressure causes the alteration of RMGCs structure and morphology.Static pressure could upregulate the expressions of ET-1,eNOS and iNOS mRNA in RMECs and increase the release of ET-1 and NO.This pathway might be one of pathologic mechanisms of retinal injury induced by high intraocular pressure.
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Objective To observe the influence of the expression of CD18 on the neutrophile and the leukocyte adhesion to retinal vascular endothelium by hypoxia-inducible factor-1 alpha (HIF-1α) in early diabetic retinopathy rats. Methods Male Sprague-Dawley rats received intraperitoneal injection of streptozotocin to induce diabetes model. 18 diabetic rats were divided into 3 groups randomly after 2 months of diabetes induction, including diabetic group (group B), HIF-1α anti-sense oligonucleotides (ASODN) injection group (group C) and HIF-1α sense oligonueleotides (SODN) injection group (group D), the age and weigh matched health rats were chosen as control group (group A), with 6 rats in each group. Then group A and B rats received 5 % glucose solution caudalis veins injection, group C and group D rats received HIF-1α ASODN and HIF-1α SODN caudalis veins injection, respectively(0.25 mg/kg). The level of CD18 on the neutrophil isolated from the peripheral blood was measured by flow cytometry. Retinal leukostasis was quantified with acridine orange leukocyte fluorography. Results The percentage of CD 18 positive neutrophil cell was (44.93±3. 60)% in group B, (18.66±1.52)% in group A, (31.66±4.72)% in group C,(51.00±5.66)% in group D. Compared with each other groups,the differences are statistically significant (F= 42. 46, P<0.001). The number of positive staining cells of retinal leukocyte was (46.16±10.68)in group A, (133.83±20.43)in group B, (99.83±9.28)in group C, (121.33±10. 23) in group C. Compared group B with group C,the number of positive staining cells raised about 2.89 times;compared group B with group C and D,the differences are statistically significant (P= 0.12, 95% confidence interval -3.69～28. 69 ). Conclusions In vivo, HIF-1α can decreased the expression of CD18 on neutrophils from diabetic rats' peripheral blood and the collection of retinal leukos- tasis in the diabetic animals. HIF-1α may serve as a therapeutic target for the treatment and/or prevention of early diabetic retinopathy.
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Study of new or previously known drugs for new applications in the treatments of eye diseases hasbeen one of the ma ior subjects in the ophthalmic field.However,we had found several caveats in the recently publishedpapers on experimental ophthalmic drug studies,such as new-drug trials lack of systemic designing,experimentalstudies without following the standard guidelines,in-vivo animal tests bypassed the necessary in-vitro cell screenings,and studies lack known-drug controls,etc.In order to improve the quality of such kind of studies,researchers should befamiliar with the standard procedures of new drug testing,and with the basic rules for drug screenings and efficacyassessments by in-vitro cell culture systems and in-vivo animal models.
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Objective To investigate the effect of dissociation of the human retinal pigment epithelium (RPE) cells by ficoll hypaque gradient centrifugation. Methods The primary human RPE cells and subcultured human RPE cells were dissociated with ficoll gradient centrifugation solution (d= 1.077 g/ml) and the same divided cells as the control were dissociated with routine normal culture medium centrifugation. The Trypan blue (0.4%) rejection staining was used, and the mouse anti-human monoclonal antibody and fluorescein isothiocyanate (FITC) labeled rabbit anti-mouse IgG were utilized for indirect immunoreactivity for the test of human cytokeratin (CK) in active RPE cells cytoplasm. Flow cytometry assay was used to analyzed the percentages of CK positive staining RPE cells. simultaneously, the cells configuration, growth condition, the rate of clone formation, and the purifying result were observed under the fluorescent and confocal microscope. Results The survival rate and positive rate of CK of RPE cells in experimental group were higher than those in the control ( P
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0.05).Statistical analysis showed that there was a correlation between the expression of CTGF and TGF-?RⅡ,FN,and collagen Ⅰ and Ⅲ protein,respectively. Conclusions The expression of CTGF and TGF-?RⅡ protein is up-regulated in PRM of PVR,which suggests that the activation of TGF-?RⅡ is involved in the production of CTGF,and CTGF is closely related to the production of ECM and play an important role in the pathogenesis of PVR.
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Objective To establish a hemorrhagic retinal detachment (HRD) model for the study of the damage and treatment of HRD. Methods Fourteen rabbits (28 eyes) were divided into the HRD (12 eyes) and control (16 eyes) group randomly. Autologous anticoagulated blood (0.2 ml) was transvitreally injected into the rabbits′ subretinal space with a special glass micropipette in HRD group (12 eyes); while 0.2 ml saline with or without heparin sodium (2.5 U/ml) was respectively injected into subretinal space respectively of the rabbits in heparin saline control group (6 eyes) and saline control group (3 eyes); furthermore, another 2 control groups, i.e.,pseudo injection group (3 eyes, single retinal puncturing without subretinal injection) and normal group (4 eyes of 2 normal rabbits) were also set. The conditions of the occurrence and representation of the retinal detachment (RD) were observed and analysed by means of ophthalmoscopy, optical coherence tomography (OCT) and ultrasound A and (or) B scan examinations in the subsequent 28 days after the operation. Results After the operation, HRD occurred in all eyes of the rabbits in HRD group. The area of HRD extended from 10 to 12 disc diameter(DD). The obvious elevation of RD maintained to 14 days, and the residual subretinal hemorrhage was still observed till 28 days. The obvious RD of the rabbits in heparin saline and saline control group was only kept for no more than 12 hours. The retinal puncture hole in pseudo injection group disappeared 2 days after the operation, and there was no change in retina of rabbits in normal control group. Conclusion It is convenient, practical and effective to establish a HRD model by means of transvitreal subretinal injection of autologous anticoagulated blood.
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Objective To assess the effectiveness of transpupillary thermotherapy (TTT) for the treatment of central exudative chorioretinopathy. Methods Tweenty nine eyes with central exudative chorioretinopathy were treated with Iris 810 nm diode laser TTT. The laser beam size was 1.0, 2.0 or 3 0 mm with power settings between 80 300 mW and treatment time 60 sec. The follow up periods were wihzin 4 40 weeks. The therapeutic effect was accessed by visual acuity examination,dinect ophthalmoscopy and fluorescein or indocyanine green angiography. Results The visual acuity improved in 8 eyes (28%), remained no change in 19 eyes (65%) and decreased in 2 eyes (7%). Choroidal neovascularization were closed in 12 eyes in fundus angiography. The symptoms alleviated in 10 patients. Conclusion Transpupillary thermotherapy is a potential treatment for the central exudative chorioretinopathy.
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Objective To investigate the expression of hepatocyte growth factor receptor (HGFR) in epiretinal membranes (ERM) of eyes with proliferative vitreoretinopathy (PVR) and cultured retinal pigent epithelium (RPE) cells. Methods Fifteen human epiretinal membranes were obtained from eyes undergone vitrectomy for rhegmatogenous retinal detachment complicated with PVR and observed by immunohistochemical examination to study the expression of HGFR. Using the immunohistochemical technique to evaluate the expression of HGFR in cultured RPE cells. Results In 6 membranes of PVR grade C, HGFR were expressed in 5/6, and 7 cases were detected in 9 membranes of PVR grade D.RPE cells express readily detectable levels of HGFR. Conclusion The findings indicate that HGF might be involved in the formation of epiretinal membranes in PVR.
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To detect the effects of adrenaline and dexamethasone on proliferation of the lens epithelial cells and discuss the mechanism, the central area 5～7mm in diameter of the anterior capsule was obtained in cataract surgery (phacoemulsification, Phaco), and the specimens were divided into three parts, and were cultured in vitro and treated with 10 -6 mol/L adrenaline and dexamethasone for 48 hours. And then the positive area ratio of proliferating cell nuclear antigen (PCNA) in immunohistochemistry was estimated by medical color image analysis. The data were analyzed with the statistical software. The results indicated that the 10 -6 mol/L adrenaline and dexamethasone had obvious inhibition on LEC proliferation. The positive area ratio of PCNA was (2 614?0 922)%( t =5 594, P =0 0000) and (3 338?0 838)%( t =3 361, P =0 0013). It is suggested that adrenaline and dexamethasone could inhibit the proliferation of LEC and could be used to treat PCO after cataract surgery. The experiments provide the scientific basis for selection of drugs to prevent PCO after cataract.
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Objective To investigate the effects of genistein with different concentration on proliferation and apoptosis of cultured human retinal pigment epithelial (RPE) cells in vitro. Methods The effect of genistein with the concentration of 5,10,25,50,75,and 100 mg?L -1 on the proliferation of cultured RPE was examined by tetrazolium salt (MTT) assay and AgNORs staining. The cell apoptosis was detected by terminal deoxynucleotidyl transferase-mediated deoxyuridine 5-triphosphate nick-end labeling (TUNEL) methods, in the mean time, the morphologic changes of cell apoptosis were observed by light microscopy and transmission electronic microscopy, the results of which were compared with the normal RPE cells. Results Genistein with the concentration of 25, 50, 75, and 100 mg?L -1 had a dose-dependent and time-dependent antiproliferative effects on RPE cells with the inhibitory rate of 12.0%-64.6% (P
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Objective To investigate the effects of platelet-derived growth factor(PDGF) on the expression of ?-smooth muscle actin(?-SMA) of cultured human retinal pigment epithelium cells(RPE). Methods Cultured human RPE cells of the 4-6 th passages were divided into two groups: Delbecco′s modified Eagle′s medium (DMEM) and 2%DMEM (20 g/L foeta calf serum+DMEM). PDGF (0,1,50 ng/ml) was added to medium.The expression of ?-SMA was detected and quantitatively analyzed by image process of immunofluorescence. Results PDGF stimulated the expression of ?-SMA of human RPE cells.In group of DMEM, The rate of RPE of ?-SMA expression was 40%-50% and the intension of fluorescence was 8 08 without PDGF. After stimulated by PDGF(1 ng/ml,50 ng/ml), the rates were 80% and 90% respectively, and the intension of fluorescence were 12.35 and 17.23. In 2%DMEM group, The rates of RPE of ?-SMA expression were 85% without PDGF, and 95% ,100% respectively treated with PDGF (1 ng/ml,50 ng/ml). The intension of fluorescence was 14.79 without PDGF, and after stimulated by PDGF, they were 16.28 at 1 ng/ml and 21.36 at 50 ng/ml,which was 2.7 times stronger than that in DMEM group without PDGF. Conclusion PDGF could stimulate RPE cells to express ?-SMA.
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Objective To observe the expression of proinflammatory factors messenger RNA (mRNA) in periretinal membrane of proliferative vitreoretinopathy. Methods Fourteen specimens of periretinal membrane were collected during vitrectomy, and they were made into paraffin sections.The presence of mRNA coding for IL-1,IL-6,IL-8 and TNF alpha was observed by in situ hybridization(ISH) with biotin labeled oligonuclotide probes respectively.The eyeball after corneal grafting was made as normal control. Results No expression of proinflammatory factors mRNA was found in normal human retina.Positive staining was present in 5 specimens.In these specimens, IL-1? mRNA was found in 3 specimens and TNF? mRNA was found in 3 specimens,there is 1 specimen expressed IL-8 mRNA and 3 specimens expressed IL-6 mRNA.In these positive specimens, one contained cells expressing mRNA for IL-1 ? beta and IL-6, and one exhibited cells expressing mRNA for IL-1??IL-8 and TNF ?,two membranes possessed positive cells for IL-6 and TNF? mRNA, one membrane contained IL-1? mRNA positive cells only. Conclusion These findings suggest that these cytokines may be locally produced by cells infiltrating epiretinal membranes. The expression of IL-1?, IL-6, IL-8 and TNF? mRNA within retinal membranes provides further evidence of a pathogenic role of these cytokines in proliferative vitreoretinopathy.
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Objective To investigate the effect of HGF on proliferation and migration in cultured human RPE cells. Methods Human RPE cells cultured in serum-free medium were treated with HGF(1,2,10,50,100 ?g/L), and MTT assay was used to detect the growth of the cells; an in vitro wound healing model was used to count the number of cells that had entered the denudate area in RPE migration treated with HGF (1,2,10,50,100 ?g/L) after 20 h. Results HGF(10,50,100 ?g/L) increased proliferation rates of cultured human RPE (18 2 % to 34 8 %), and at a concentration of 50 ?g/L on day 3 HGF induced the maximal increase of proliferation( P
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Objective To investigate the expression and role of inflammatory cytokines like interleukin-1β(IL-1β)、interleukin-6(IL-6)、interleukin-8(IL-8) and tumor necrosis factor-alpha(TNF-α)in epiretinal membranes(ERM)of eyes with proliferative vitreoretinopathy(PVR).Methods Nineteen epiretinal membranes were obtained from eyes undergoing vitrectomy for retinal detachment complicated with PVR and observed by immunohistochemical methods.Results Expression of IL-1β、IL-6、IL-8 and TNF-α were observed in 9、12、11and 15 membranes respectively, with positive staining mostly in the extracellular matrix of epiretinal membranes. Only one membrane showed positive to IL-6 intracellularly, expression for all the cytokines simultaneously in 4 membranes.Conclusion The findings indicate that cytokine-mediated pathways of inflammation are involved in the pathogenesis of PVR.
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Objective To investigate the effects of cytokines on the expression of syndecan-1 in cultured human retinal pigment epithelial (RPE) cells and the signal transduction pathway. Methods Reverse transcription polymerase chain reaction and immunofluorescence staining were used to detect the expression of syndecan-1 mRNA and protein in normal RPE cells. The expression of syndecan-1 in RPE cells stimulated by different cytokines was detected and quantitatively analyzed by image process of immunofluorescence. The stimulation included 7 and 35 ng/ml tumor necrosis factor (TNF)-? for 24 hours, 1 and 6 ?g/ml lipopolysaccharide (LPS) for 11 hours, 7 ng/ml TNF-? for 0 to 24 hours (once per 2 hours, and 13 times in total), and 30% supernatant of monocyte/macrophage strain (THP-1 cells) for 3, 14 and 43 hours. The effect of 30% supernatant of THP-1 cells was assayed after pretreated by PD098059 [the specific inhibitor of extracellular signal regulated kinase(ERK) 1/2] for 2 hours. After exposed to 30% supernatant of THP-1 cells for 3 hours and treated by 0.25% trypsin for 5 minutes, RPE cells attaching was evaluated by methyl thiazolyl tetrazolium assay. Results In normal human RPE cells, expressions of syndecan-1 mRNA and protein were detected, and strong syndecan-1 positive yellowish green fluorescence was found in the cell membrane and cytoplasm while light green fluorescence was in the nucleus. As the concentration and stimulated time of TNF-? or LPS increased, the fluorescence intensity decreased(P