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Objective To observe the alterations ofmicrovascular structure in patients with macular edema (ME) associated with branch retinal vein occlusion (BRVO) before and after anti-VEGF drug therapy.Methods A retrospective case study.Thirty-two eyes of 32 patients with unilateral BRVO-ME at Department of Ophthalmology in Beijing Hospital during November 2016 to June 2018 were enrolled in this study.There were 14 males (14 eyes) and 18 females (18 eyes),with the mean age of 57.81 ± 10.58 years,and the mean course of the disease of 12.13 ± 7.13 d.The affected eyes was defined as the eyes with BRVO-ME.All the affected eyes received intravitreal anti-VEGF drug injections (3+PRN).BCVA and OCT angiography (OCTA) were performed on the BRVO and fellow eyes before and after intravitreal anti-VEGF drug injections.The scanning region in the macular area was 3 mm × 3 mm.Macular blood flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP),macular hemodynamics parameters [foveal avascular area (FAZ) area,perimeter (PERIM),acircularity index (AI) and vessel density within a 300um width ring surrounding the FAZ (FD-300)] and central retinal thickness (CRT) were measured in all eyes.Paired samples t-test and Univariate Linear Regression were used in this study.Results Comparing with fellow eyes,the mean macular blood flow density measured in the entire scan was lower in BRVO-ME eyes in the SCP (t=6.589,P=0.000) and DCP (~9.753,P=0.000),PERIM (t=4.054,P=0.000)),AI enlarged in BRVO-ME eyes (t=4.988,P=0.000),FD-300 was lower in BRVO-ME eyes (t=2.963,P=0.006),FAZ area enlarged in BRVO-ME eyes (t=0.928,P=-0.361).The blood flow density in the DCP was the parameter most significantly correlated with BCVA and FAZ area (r=0.462,-0.387;P＜.05).After 3 intravitreal injections of anti-VEGF drug,the CRT and FD-300 decreased,BCVA increased (t=9.865,3.256,-10.573;P＜0.05),PERIM and AI was not changed significantly (t=0.520,2.004;P＞0.05).The blood flow density in the SCP decreased (t=2.814,P＜0.05),but the blood flow density in the DCP was not changed significantly (t=0.661,P=-0.514).Contrarily,comparing with after 1 antiVEGF drug injection,the blood flow density in the DCP increased after 2 anti-VEGF drug injections (t=3.132,P＜0.05).FAZ area enlarged in BRVO-ME eyes (t=5.340,P＜0.001).Comparing with last anti-VEGF drug injection,FAZ area enlarged after every anti-VEGF drug injection (t=2.907,3.742,2.203;P＜0.05).Conclusions In BRVO-ME eyes,the blood flow density in the SCP and DCP are decreased.The blood flow density in the DCP is positively correlated with BCVA and negatively correlated with FAZ area.After antiVEGF drug therapy,the blood flow density is decreased in the SCP and increased in the DCP,FAZ area enlarged gradually,PERIM and AI are not changed significantly.
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Objective To compare the one year efficacy of intravitreal injection with ranibizumb for macular edema (ME) secondary to ischemic and non-ischemic central retinal vein occlusion (CRVO).Methods A total of 88 patients (88 eyes) with ME secondary to CRVO were enrolled in this retrospective study.The best corrected visual acuity (BCVA) was detected by the Early Treatment Diabetic Retinopathy Study Chart.The optical coherence tomography was used to measure the foveal retinal thickness (CRT) and macular edema volume.The patients were divided into non-ischemic group and ischemic group,44 eyes of 44 patients in each group.There was no significant differences in age (t=0.650,P=0.517) and gender (x2=0.436,P=0.509) between the two groups.Compared with the ischemic group,the CRT was significantly decreased in the non-ischemic group (t=-2.291,P=0.024),and the edema volume in the macular area was significantly reduced (t=-2.342,P=0.022).All eyes were treated with continuous intravitreal injection of ranibizumab three times,and repeated injections were performed as needed.The patients without obvious ME regression after treatment were combined with triamcinolone acetonide injection.The patients with peripheral retinal non-perfusion area were combined with peripheral retinal laser photocoagulation.The follow-up was 1 year.The number of injections was counted.The changes of BCVA,CRT and edema volume in the macular area were compared between the two groups.Results During the 1-year follow-up period,88 eyes were injected 1 to 10 times,with the mean of 4.51 ±2.33.The number of injections in the ischemic group and non-ischemic group were 4.55± 1.59 and 4.48 ± 2.91,respectively.There was no significant difference in the average number of injections between the two groups (t=0.136,P=0.892).The number of acetonide injections and laser treatment in the ischemic group was significantly higher than that in the non-ischemic group (t=3.729,9.512;P＜0.001).At the last follow-up,compared with the ischemic group,the BCVA was increased (t=8.128),the CRT was decreased (t=-7.029) and the edema volume in the macular area was decreased (t=-7.213) in the non-ischemic group (P＜ 0.001).Conclusion Compared with ME secondary to ischemic CRVO,intravitreal injection of ranibizumab for ME secondary to non-ischemic CRVO has the better outcome of vision improvement and edema regression as well as less fiequent of acetonide injections and laser treatment.
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Objective To observe the alterations of macular vascular density and the area of foveal avascular zone (FAZ) in branch retinal vein occlusion (BRVO) eyes.Methods A retrospective case-control study. Forty-five patients with unilateral BRVO and macular edema were enrolled in this study. Optical coherence tomography angiography (OCTA) was performed on the BRVO and fellow eyes. The scanning region in the macular area was 3 mm×3 mm. Macular vascular density and FAZ area in the superficial and deep retinal capillary plexi were measured in all eyes. The values of macular vascular density and FAZ area between BRVO eyes and fellow eyes, affected sector and unaffected sector were compared.Results The mean overall vascular density measured in the entire scan was lower in BRVO eyes compared with fellow eyes in both the superficial and deep capillary plexus (t=14.186, 9.468;P<0.05). The reduce degree of vascular density in the deep capillary plexus (7.65％) was higher than that in the superficial plexus (7.27％). In the superficial plexus, the vascular density was lower in the affected sector and the unaffected sector of the BRVO eyes compared with the corresponding sector in the fellow eyes (t=15.386, 9.435;P<0.05). The FAZ area enlarged in the BRVO eyes compared with the fellow eyes in the superficial capillary plexus and in the deep capillary plexus (t=3.216, 5.119;P<0.05). The degree of enlargement of FAZ area in the deep capillary plexus (0.19 mm2) was higher than that in the superficial plexus (0.11 mm2).Conclusions In eyes with BRVO, quantitative OCTA measurements confirm that vascular density decreased and FAZ area enlarged in the superficial and deep capillary plexi. The reduce degree of vascular density and enlargement degree of FAZ area in the deep capillary plexus are higher than those in the superficial plexus.
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In this report, highly water soluble esters of scutellarin with different molecular weight polyethylene glycol (PEG) were synthesized in order to improve the bioavailability of scutellarin. The physicochemical properties, the stabilities under different conditions and the in situ intestinal absorption in rats of the conjugates were investigated. By PEG modification, the greatly increased water solubility and desirable partition coefficient of scutellarin were obtained. These compounds function as prodrugs i. e. breakdown occurred in a predictable fashion: the t1/2 of them in PBS buffer at pH7.4 was above 12 h (37 degrees C) in vitro, while in plasma a rapid breakdown was observed, with a t1/2 of about 1. 5-3 h. The stabilities of the prodrugs were improved according to the increase of the molecular weight of PEG, thus, PEGylated prodrugs with desirable rates of hydrolysis could be obtained by the use of variable molecular weight PEGs. The PEGylation could enhance the absorption of scutellarin in rat intestine, and the absorption of scutellarin and its PEG conjugates by intestine was mainly via passive transport, for when the concentration was raised, the uptake did not appear saturable, and the permeability coefficient kept at an equilibrium level. When the molecular weight of PEG increased from 200 to 1000 Da, the absorption of the conjugates decreased. In conclusion, by overall consideration of the yield, stability and absorption, the present authors estimate that the PEG molecular weight used for the PEGylation of scutellarin should be within the range of 400-1 000 Da.
Subject(s)
Animals , Rats , Apigenin , Chemistry , Pharmacokinetics , Biological Availability , Drug Carriers , Glucuronates , Chemistry , Pharmacokinetics , Intestinal Absorption , Polyethylene Glycols , Chemistry , Pharmacokinetics , Random Allocation , Rats, WistarABSTRACT
OBJECTIVE: To analyze the requirement of pharmaceutical care among physicians, nurses and patients and to explore work mode of clinical pharmacists. METHODS: The requirement of pharmaceutical care in concrete cases was summarized by combining with experience of author as clinical pharmacist in cardiology department. RESULTS: The advantage of clinical pharmacist and convenient consultation for selection of drugs contribute to complementary with physicians’ work. CONCLUSION: Clinical pharmacist provides various pharmaceutical care according to the requirement of doctors, nurses and patients.