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Central serous chorioretinopathy (CSC) is a primary disease that affects the vision of young and middle-aged people.Its treatment is difficult because of its high incidence and easy recurrence.Currently, the commonly used clinical treatment methods for CSC include photodynamic therapy, traditional laser photocoagulation, subthreshold micropulse laser photocoagulation (SDM), anti-vascular endothelial growth factor therapy, and so on.SDM is a high-frequency, short, subthreshold and selective laser, which is preferred by many clinicians because of its low energy, good safety, small trauma and so on.Different wavelengths of laser can be absorbed by different pigments in the eye, so the therapeutic wavelengths of SDM for different sites of CSC are also different.In SDM treatment, it is necessary to determine the effective treatment range and parameters to avoid undertreatment or overtreatment.In this article, the mechanism of SDM in the treatment of CSC, the difference of SDM under different wavelengths, the selection of treatment site and parameters, the efficacy and safety were reviewed, and the prospect of SDM in the future was envisioned.
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Objective:To analyze the characteristics of eyes with congenital optic disc pits (ODPs) through multimodal imaging.Methods:A cross-sectional study was conducted.Thirty-eight patients (38 eyes) diagnosed with congenital ODPs in the Second Hospital of Hebei Medical University from January 2009 to January 2020 were enrolled.A comprehensive summary analysis of the imaging results including fundus photography, spectral domain-optical coherence tomography (SD-OCT), infrared imaging, fundus autofluorescence (FAF), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) was performed.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of The Second Hospital of Hebei Medical University (No.2021-P011). Written informed consent was obtained from each subject prior to any medical examination.Results:Among the 38 eyes, there were 32 eyes with ODPs located in or below the temporal side of optic disc, 4 eyes with ODPs located above the temporal side of optic disc, and 2 eyes with ODPs located at the center of optic disc, which were round or quasi-circular pale depression, and dark red eminences with clear or unclear boundaries between milk spots were found in 29 eyes with optical-disc macular degeneration (ODP-M) by fundus photography.SD-OCT examination showed that the structure of lamina cribrosa in the lesion area in all ODPs patients was incomplete, which presented a dark area with no tissue reflection, and the fissure led to the deep optic nerve.Fluid was found in the outer nuclear layer in all ODP-M patients, and there were 27 eyes with fluid in the inner nuclear layer, 13 eyes in the ganglion cell layer, and 4 eyes under the inner limiting membrane.Among the 29 eyes with ODP-M, there were 21 eyes with retinoschisis in outer layer, 27 eyes with neuroepithelial detachment.In the 27 eyes with neuroepithelial detachment, spot-like high reflection and reduced or disappeared ellipsoid band reflectance were seen above the neuroepithelium in 18 eyes.In infrared images, there were circular or quasi-circular low-reflection areas in the temporal side of the optic disc, and the lesion of ODP-M eyes presented low-reflection areas.FAF examination showed that in 27 eyes with ODP-M, there was a hypofluorescent region at the posterior pole consistent with the lesion range, among which, there was a granular or sheet-like hyperfluorescence at the center of the hypofluorescent region in 18 eyes.FFA showed that the optic disc depression in the arterial phase of patients was in a localized hypofluorescence state.During the venous phase, fluorescein dye extravasation along the temporal side of the optic disc could be found.A strong fluorescent arc with unclear boundaries at the temporal edge of the optic disc was formed in the late stage of angiography.Among the 29 eyes with ODP-M, the area of the macular lesion showed hyperfluorescence during the late stage of angiography in 27 eyes with neuroepithelial detachment, and no extension of dye toward the macula was found.ICGA showed that the optic disc depression of ODPs patients presented a localized hypofluorescence, and the lesion showed hyperfluorescence in 27 of the 29 ODP-M eyes with neuroepithelial detachment.Conclusions:Multimodal imaging can be helpful to realize the early diagnosis, etiology analysis of ODPs and make treatment plan.
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Objective To measure quantitatively and analysis the differences in the anterior segment biological parameters between the normal subject and patients suffering primary angle closure glaucoma (PACG),as well as the distinction among different stages of PACG by using anterior segment optical coherence tomography (OCT).Methods A retrospective case series study was designed.Medical records of 217 cases (217 eyes) from The Second Hospital of Hebei Medical University from December 2013 to December 2014 were recruited,including 5 groups as follows:35 cases (35 eyes) with pre-clinical stage acute primary angle closure glaucoma (APACG),32 cases (32 eyes) with remission period of APACG,35 cases (35 eyes) with early stage of chronic primary angle closure glaucoma (CPACG),35 cases (35 eyes) with progress period of CPACG and 80 cases (80 eyes) coming for regular eye health examination in general clinic.The anterior segment biological parameters of each group was measured by Heidelberg Spectralis OCT,including the anterior chamber width (ACW),angle opening distance (AOD),trabecular iris area (TISA),iris thickness (IT) and crystalline lens rise (CLR).Results The IT and CLR of APACG and CPACG were significantly greater than normal control group,while other anterior segment parameters were significantly smaller,with significant differences between them (all at P＜0.01).The IT and CLR of APACG was bigger than those of CPACG,with significant differences between them (both at P＜0.05),the ACW,AOD,TISA of the two gruops showed no significant differences.The AOD and TISA of remission period of APACG were significantly decreased than those of pre-clinical stage (all at P＜O.01).The IT and CLR of remission period APACG was significantly greater than pre-clinical stage (both at P＜0.01).The difference in ACW of the two group was not statistically significant (P＞0.05).Compared with progress period of CPACG,the IT of the early stage of CPACG was thicker,while the CLR was smaller (both at P＜0.01).There was no significant difference in ACW,AOD and TISA between the two groups.The IT2000 and ITmax of pre-clinical stage of APACG were significantly smaller than those of early stage of CPACG (both at P＜0.01).There was no significant difference in other parameters between the two groups (P＞0.05).The IT750,IT2 000 and ITmax of the pre-clinical stage of APACG were significantly thicker than those of progress period of CPACG (all at P＜0.05).There was no significant difference in other parameters between the two groups (P＞0.05).Conclusions Compared with normal people,the PACG patients have a more crowding anterior segment structure,smaller AOD,smaller TISA,thicker IT and more anterior located lens.The APACG patient at remission period has a more crowding anterior segment structure,smaller AOD,smaller TISA,thicker IT and more anterior located lens than APACG patient at per-clinic stage.The CPACG patient at progress period has a higher CLR,but thinner IT than patient at early stage.The APACG patients at per-clinic stage has thicker IT and a more crowding anterior segment structure than the CPACG patient at early stage,and the APACG patient at remission period has thicker IT than CPACG patient at progress period.
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Objective To investigate the hemodynamics of ocular vessels of the bilateral eyes in patients with unilateral non-arteritic anterior ischemic optic neuropathy(NAION) . Methods Clinical data of 28 patients with unilateral NAION were collected . The peak systolic velocity ( PSV ) ,end diastolic velocity (EDV) ,resistance index (RI) of ophthalmic artery (OA) ,central retinal artery (CRA) ,nasal short posterior ciliary arteries ( NPCA ) and temporal posterior ciliary arteries ( TPCA ) were comparatively analyzed by color Doppler ultrasonography . Results The hemodynamic parameters of OA in NAION were not significantly different from those in the contralateral eyes ( P ＞ 0 .05 ).PSV of CRA was lower in NAION than that in contralateral eyes ,as well as EDV ( P ＜ 0 .05 ) ,while the RI of CRA was not significantly different between two groups ( P ＞0 .05).PSV of NPCA in NAION was lower than that in the contralateral eyes ( P ＜ 0 .05) ,while EDV and RI of NPCA were not quite different from those in contralateral eyes ( P ＞0 .05).The hemodynamic parameters of TPCA in NAION were not significantly different from those in the contralateral eyes ( P ＞0 .05).Conclusions Color Doppler ultrasonography can non-invasively detect and monitor the hemodynamic changes of ocular vessels in NAION ,which will be of great help in illuminating the pathogenesis of NAION and providing groundbreaking evidence for the diagnosis and prognosis of NAION .
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Background Interleukin-1β (IL-1β) is an important inflammation-related factor in the initial stage of proliferative vitreoretinopathy (PVR).The previous research showed that curcumin can inhibit IL-1 β-induced proliferation of rabbit retinal pigment epithelium (RPE) cells,but the anti-inflammatory mechanism and effect of curcumin are still undefined.Objective This study was to observe the migration of IL-1β-induced rabbit RPE cells,and evaluate the function and mechanism of inhibition of curcumin on IL-1β-induced inflammation of RPE cells.Methods Cultured rabbit RPE cells of generation 4 were used in this experiment.The cells were cultured in serum-free DMEM and 0,0.1,1.0 and 10.0 μg/L IL-1β were separately added in the medium for 24 hours.The expressions of cyclooxygenase-2 (COX-2) protein and mRNA in the cells were detected by Western blot and reverse transcription PCR to determine the optimal concentration of IL-1β.The cells were divided into IL-1β group and curcumin+IL-1β group,and 1.0 μg/L IL-1 or 1.0 μμg/L IL-1 β combined with 10 μg/ml curcumin was respectively added into the medium for 24,48 and 72 hours.The cells cultured by only serum-free medium served as the control group.Hematoxylin and eosin staining was conducted for the cells to count the number of cells migrating into the injured area under the optical microscope.The relative expression levels of COX-2 protein and mRNA in the cells were detected by Western blot and reverse transcription PCR,and the relative expression levels of nuclear factor (NF)-κBp65 and inhibitor of NF-κB-α (IκB-α) protein were also detected by Western blot assay.The expression intensity and location of NF-κBp65,IκB-α and COX-2 in the cells were detected by immunochemistry.Results RPE cells just isolated from the rabbit eyes were in round shape and abundant in melanin.The melanin significantly decreased in the fourth generations of RPE cells.The shape of cells became long and narrow,and net shaped distribution.Immunochemistry demonstrated the strong positive response of RPE cells for keratin (AE1/AE3).There were (31.93 ±1.21),(36.27±2.50) and (38.33±2.40) migratory cells in the control group after 24,48 and 72 hours respectively.The number of migratory cells increased to 45.73 ± 2.30,71.13 ± 1.92 and 80.60 ± 1.71 in the IL-13 group,but obviously decreased to 13.13 ± 2.20,14.93 ± 1.10 and 12.60 ± 1.51 in the curcumin + IL-1β group.A Significant increase in the migrating cell number was found in the IL-1 β group compared with the control group and the curcumin+IL-1β group in various time points (all at P＜0.05).The relative expression levels of COX-2 protein and mRNA peaked in the 1.0 μg/L IL-1β group,so 1.0 μg/L of IL-1β was determined as the optimal concentration in the experiment.In 24,48 and 72 hours after culture,the expression levels of COX-2 protein and mRNA in the cells were significantly lower in the curcumin + IL-1β group than those in the control group (all at P＜0.05).The relative expression level reached peak in NF-κBp65 protein and lowed bottom in IκB-α proteins at 48 hours after cultured in the IL-1β group,and the reverse trend was seen in the curcumin+IL-1β group,with the significant differences between the two groups (both at P＜0.05).Immunochemistry showed that NF-κBp65 was expressed strongly in the cell nuclei and cytoplasm in the IL-1 β group and presented the weaker expression in the control group and the curcumin+IL-1 β group.Compared with the control group,the expression was weaker in IκB-α and stronger in COX-2 in the IL-1β group.In addition,the expression of IκB-α was enhanced and that of COX-2 was attenuated in the curcumin+IL-1β group in comparison with the IL-1β group.Conclusions Curcumin inhibits the movement of rabbit RPE cells induced by IL-1β.IL-1β up-regulates the expression of COX-2 by activating NF-κB signal pathway,and curcumin plays an anti-inflammatory role by blocking this pathway.
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Background Proliferative vitreoretinopathy (PVR) is a common cause of vision loss clinically,and retinal pigment epithelium (RPE) cells play a major part in this disease.Studying the effect of traditional Chinese medicine on RPE cells are of great importance to reveal the pathogenesis and prevention of PVR,which were rarely reported.Objective This study was to study and compare the inhibition effect among curcumin,salvia miltiorrhiza and matrine on IL-1β-induced proliferation of rabbit RPE cells.Methods RPE cells at passages 3-4 were enrolled for the research and identified by transmission electron microscope.The proliferation effect of IL-1 β (2.5,5.0,10.0,20.0 μg/L) and inhibitory effect of curcumin (5,10,20 μg/ml),salvia miltiorrhiza (5,10,20 μg/ml)or matrine (100,200,400 μg/ml) on RPE cells 24,48 and 72 hours after cultivation were studied by MTT assay.The 50％ inhibitory dose (IC50) of the three medicines were analyzed by regression analysis.The use and feeding of the experimental animals were followed by the ARVO Statement.Results RPE cells isolated from the rabbit eye were in round shape and abundant in melanin;The melanin significantly decreased in the fourth generations of RPE cells.Immunohistochemistry showed that the RPE cells was positive for keratin (AE1/AE3).The proliferation rates of RPE cells were statistically different among different concentrations of IL-1β 24,48 and 72 hours after cultivation (Ftime =30.33,P =0.00;Fconcentration =9.37,P =0.00);The proliferation rates of RPE were significantly different among different time points or different concentrations of IL-1β (all at P ＜ 0.05).And the proliferation rate run up to maximum at 10 μg/L after 72 hours of cultivation.The inhibitory rates of the three medicines were statistically different among different time points or different concentrations (curcumin:Ftime =128.75,P =0.00;Fconcentration =334.05,P=0.00.salvia miltiorrhiza:Ftime =39.32,P=0.00;Fconcentration =165.57,P=0.00.matrine:Ftime =267.76,P =0.00;Fconcentration =912.34,P =0.00).The three medicines dose-dependently and time-dependently inhibit IL-1β-induced proliferation of RPE cells,with significant differences between the adjacent time points and concentrations (all at P＜0.05).The IC50 were 26.77,19.01 and 9.45 μg/ml for curcumin;33.72,23.47 and 12.56 μg/ml for salvia miltiorrhiza,570.96,352.25 and 97.50μg/ml for matrine 24,48 and 72 hours after cultivation.Conclusions The proliferation of RPE cells can be stimulated by IL-1β,and the maximal proliferation occurred with a concentration of 10.0 μg/L IL-1β.Curcumin,salvia miltiorrhiza and matrine dose-dependently and time-dependently inhibit proliferation of RPE cells induced by IL-1β.Curcumin is the best medicine to inhibit the proliferation of RPE cells.
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Background Choroidal neovascularization (CNV) is a common pathological basis of many ocular fundus diseases.Some treating methods are proved to be effective on CNV but there exist their own shortages.Celecoxib can inhibit experimental neovescularization.Sustained release drug of celecoxib and application approach can offer a basis for the therapy of CNV.Objective This study was to evaluate the sustained release ability of celecoxib-poly lactide-co-glycolide microsphere (CEL-PLGA-MS) in vitro and its inhibitory ability on experimental CNV in vivo.Methods CEL-PLGA-MS was prepared by Hebei Medical University and examined under the scanning electron microscope.The size of CEL-PLGA-MS was measured by Laser Particle Size Analyzer.The drugloading in vitro releasing was monitored by high performance liquid chromatograph (HPLC).Experimental CNV was induced by laser photocoagulation of retina in the right eyes of 72 male brown Norway (BN) rats and then were randomized into the CEL-PLGA-MS group,celecoxib group,blank PLGA group and PBS group.CEL-PLGA-MS with 320 μmol/L celecoxib,80 μmol/L celecoxib,blank PLGA microspheres solution and 0.01 mol/L PBS was intravitreally injected separately according to the grouping.CNV was assessed by fundus fluorescein angiography (FFA) on the 14th day after injection.The fibrovascular proliferation (FVP) thickness at photocoagulation spots was measured by OCT.The retinal pigment epithelium (RPE)-choroid-sclera sections were prepared for the histopathologieal examination of FVP.On the 7th and 28th day after intravitreal injection,the relative expression levels of VEGF mRNA and COX-2 mRNA in the photocoagulation area were detected by reverse transcription PCR (RTPCR).The use and feeding of the experimental animals were followed by the ARVO statement.Results CELPLGA-MS showed the spherical shape with the mean size of 2 467.9 nm and the drug-loading of 7.77％ and the drugrelease rate of 80.91％ in vitro for 45 days.It presented the controllable release characteristics.CEL-PLGA-MS agglomerated in vitreous body after injection.On the 14th day after intravitreal injection,the mean FVP thicknesses were (94.67±4.64),(98.56±4.72),(71.00±4.77),(50.44±3.01) μm in the blank PLGA microspheres group,PBS group,celecoxib group and CEL-PLGA-MS group,respectively,showing significant increases in mean FVP thickness in the blank PLGA microspheres group and PBS group compared with the celecoxib group and CEL-PLGAMS group (all at P＜0.01),and the CEL-PLGA-MS group appeared a lower mean FVP thickness value than the celecoxib group (P＜0.01).FFA revealed a large number of strong hyperfluorescences at the photocoagulation area in the rat eyes of the blank PLGA microspheres group and PBS group;while only weak hyperfluorescences were seen in the eelecoxib group and CEL-PLGA-MS group.Histopathological examinations verified the same results in the FVP thickness to OCT image.The relative expression levels of COX-2 mRNA and VEGF mRNA in the RPE-choroid-sclera were all significantly elevated in the blank PLGA microspheres group compared with the celecoxib group and CELPLGA-MS group both on the 7th and 28th day after intravitreal injection (all at P＜0.01).On the 7th day after injection,the relative expression levels of COX-2 mRNA were lower on the 7th day and the relative expression levels of COX-2 mRNA and VEGF mRNA were higher on the 28th day in the celecoxib group in comparison with the CEL-PLGA-MS group (all at P＜0.01).Conclusions CEL-PLGA-MSs are even in size with the spherical shape and controllable release characteristics in vitro.CEL-PLGA-MS can inhibit experimental CNV and was more durable effective than celecoxib after intravitrea] injection.
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The hallmark of the recent latest advances in diagnostic fundus imaging technology is combination of complex hierarchical levels and depths,as well as wide-angle imaging,ultra-wide imaging.The clinical application of wide-angle and ultra-wide imaging,not only can reevaluate the role of the peripheral retina,the classification types and treatment modalities of central retinal vein occlusion,and enhance the reliability of diabetic retinopathy screening,improve the classification and therapeutic decision of diabetic retinopathy,and but also can help guide and improve laser photocoagulation.However we must clearly recognize that the dominant role of ophthalmologists in the diagnosis of ocular fundus diseases cannot be replaced by any advanced fundus imaging technology including wide-angle imaging.We emphasize to use the three factors of cognitive performance (technology,knowledge and thinking) to improve the diagnosis of ocular fundus diseases in China.
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Background Culture of retinal pigment epithelium(RPE) cells is very important for establishment of proliferative vitreoretinopathy (PVR) model,prevention and treatment of PVR as well as RPE cell transplantation.Isolation of animal RPE cells by trypsinization is a critical step.ObjectiveThe present study is to establish the methods of isolation and culture of retinal pigment epithelium (RPE) cells in rabbit and comparied with that of pig RPE culture.MethodsRPE cells were isolated by trypsinization in pigmented rabbit and pig and cultured in DMEM containing 20% fetal bovine serum.Cultured RPE cells were identified by immunochemistry.The fourth generations of cells were used in this experiment.Morphology and characteristics of cultured RPE cells from rabbit and pig were examined and compared under the light microscope.ResultsIsolated RPE cells from pig were obtained by once trypsin digestion,but two times of trypsinization were needed in rabbit RPE cells isolation.The differentiation in response to trypsinization was related to anatomic difference between the two types of cells .The adherence time of pig RPE cells was 24 hours ,however,the rabbit RPE needed 48-72 hours after culture.Proliferation and vitality of cultured cells were gradually attenuated and melanin decreased after several times subculture.The morphology of culture RPE cells was obviously different between rabbit and pig because species difference.Immunohistochemistry demonstrated the positive response of RPE cells for keratin.ConclusionRPE cells can be acquired from both rabbit and pig by trypsinization and culture.The culture process of RPE cells of pig is simpler than that of rabbit.Cells within the fourth generations are suitable for experimental application.
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Objective To establish a matrine delivery system in vitreous is very important for the dynamic treatment of proliferative vitreoretinopathy(PVR) . Present study was to evaluate the efficacy of matrine polyactic acid microsphere(MAT-PLA-MS) in prevention of PVR. Methods The suspension of cultured fibroblasts was injected into vitreous cavity of 30 healthy adult New Zealand albino rabbits to induce PVR. Then the experimental rabbits were divided into 3 groups and 10 rabbits for each. The animals received intravitreal injection of 0.3 mL MAT-PLA-MS(4 mg) matrine in MAT-PLA-MS group. Free matrine normal sodium solution 0.3 mL(containing 2mg matrine) was injected in vitreous cavity in free matrine group. 0. 3 mL normal saline solution was injected into the vitreous of the left eyes and the equivalent volume of blank polyaetic acid microsphere(blank-PLA-MS) into the right eyes in control group. The changes of cornea, aqueous humor, lens, vitreous and fundus were examined and recorded by slit lamp biomicroscope, indirect ophthalmoscope, fundus color camera and B ultrasonogram on the 1st, 3rd, 7th, 14th, 21st, 28th and 35th day following injection of drug. The inhibition effect of matrine on PVR was evaluated according to Ryan' s grading criteria of PVR. Results On the 14th days after implantation of MAT-PLA-MS, the rate of retinal detachment was 60%, 10%, 5% and 60% in normal saline group, free matrine group, MAT-PLA-MS group and blank-PLA-MS group respectively. Statistically significant difference was found among normal saline group, blank-PLA-MS group, MAT-PLA-MS group and free matrine group(P ＜0. 05). On the 21st day after injection of fibroblasts, the morbidity of retinal detachment was 80%, 30%, 10% and 80% in normal saline group, free matrine group, MAT-PLA-MS group and blank-PLA-MS group respectively, showing a significant difference among different groups. On the 28th day, the incidence rate of retinal detachment was 90%, 50%, 15% and 90% respectively, presenting statistical difference among various groups (P ＜ 0. 05) as well as between free matrine group and MAT-PLA-MS group (P＜0. 05). On the 35th day, considerably difference also was seen in the morbidity of retinal detachment among various groups (90%, 60%, 15% and 90% respectively) (P＜0.05). Conclusion Implantation of MAT-PLA-M S into vitreous cavity can effectively inhibit the development of PVR induced by fibroblasts in rabbit model.