ABSTRACT
@#AIM: To explore the effects of internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling in treatment of idiopathic macular hole(IMH)and the influence on macular structure and choroidal thickness.<p>METHODS: Clinical data of patients with IMH who were treated in the hospital between January 2017 and December 2019 were retrospectively analyzed. All patients were treated with standard vitrectomy combined with internal limiting membrane stripping and gas-liquid exchange. On this basis, patients treated with internal limiting membrane transplantation(28 cases, 29 eyes), inverted internal limiting membrane flap(26 cases, 28 eyes)and autologous blood filling(25 cases, 25 eyes)were included in the internal limiting membrane transplantation group, inverted internal limiting membrane flap group and autologous blood filling group, respectively. The situation of hole closure and shape of the closed hole were observed. The best corrected visual acuity(BCVA), hole photoreceptors inner segment/outer segment ellipsoid zone(EZ)and external limiting membrane(ELM)defect diameter, perimeter of foveal avascular zone(PERIM), superficial capillary plexus(SCP)blood flow density, subfoveal choroidal thickness(SFCT), temporal choroidal thickness(TCT)and nasal choroidal thickness(NCT)were determined. <p>RESULTS: All patients in the 3 groups successfully completed the surgery. The BCVA of internal limiting membrane transplantation group and inverted internal limiting membrane flap group was better than that of autologous blood filling group at 3mo after surgery(<i>P</i><0.05). There were no significant differences in macular hole closure rate and ellipsoid closure rate among the 3 groups(<i>P</i>>0.05). However, there were significant differences in morphological classification of the closed macular hole(<i>P</i><0.05), and the proportion of U-shaped hole was the highest in inverted internal limiting membrane flap group. The diameters of EZ defect and ELM defect of internal limiting membrane transplantation group and inverted internal limiting membrane flap group were smaller than those of autologous blood filling group at 3mo after surgery(<i>P</i><0.05). There were no significant differences in PERIM, SCP blood flow density, SFCT, TCT and NCT among the 3 groups before and after surgery(<i>P</i>>0.05). <p>CONCLUSION:Internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling can restore the closure of the macular hole. However, internal limiting membrane transplantation and inverted internal limiting membrane flap can better restore the macular structure and improve visual acuity, compared with autologous blood filling.
ABSTRACT
To observe the expression of N - cadherin and fibronectin in retinal pigment epithelium ( RPE) cells in vitro under high glucose conditions, furthermore, to explore the effects of high glucose on epithelial -mesenchymal transition (EMT) in RPE cells. ●METHODS: Human RPE (hRPE) cells were cultured in vitro. Containing a final concentration of 60mmol/ L glucose was used for high glucose treatment. The cells were divided into normal glucose group (5. 5mmol/ L, NG) and high glucose group (24, 48 and 72h) respectively. The expression of N - cadherin and fibronectin in hRPE cells were evaluated by immunofluorescence and real -time PCR. ●RESULTS:RPE cells became disorganized and swollen over time under high glucose conditions, especially in 72h subgroup. lmmunohistochemical analysis revealed that the expression of N - cadherin in RPE cells under high glucose conditions was decreased compared with that in the control group, while the expression of fibronectin was increased. Real - time PCR results showed that the expression of N - cadherin mRNA in high glucose group was decreased at 24h compared with that in the control group, and declined markedly at 72h ( F = 12. 252, P =0. 000). There were no significant differences between the control group and the high glucose group at 24h, while the differences between the control group and the high glucose group (48 and 72h) were significant respectively (P ●CONCLUSlON: The expression of epithelium marker N-cadherin is down - regulated under high glucose conditions in hRPE cells in vitro. Meanwhile, the expression of mesenchymal maker fibronectin is induced and appeared to EMT changes. Results of this study will enrich our growing understanding in proliferative diabetic retinopathy and hopefully lead to novel insights for the pathogenesis and therapeutic treatments.