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Objective:To investigate the promoting effect of Difrarel ? on retinal function following panretinal photocoagulation (PRP) in the eyes with diabetic retinopathy. Methods:A non-randomized controlled study was performed.A total of 108 eyes of 108 patients with non-proliferative diabetic retinopathy (NPDR) were enrolled in Tongren Ophthalmology Center and Beijing Daxing District People's Hospital from December 2014 to February 2020.The patients were divided into PRP group and PRP+ Difrarel ? group according to different therapies under patients' selection.Difrarel ? was orally administered after PRP in 56 patients of PRP+ Difrarel ? group, and only PRP was given in 52 patients of PRP group.The visual acuity, 30°~60° circular visual field and multifocal electroretinogram were examined before and 1 day, 1 month, 3 months, 6 months, 12 months after PRP.The central macular thickness (CMT) was measured by optical coherence tomography, and fundus neovascularization was observed by fluorescein fundus angiography at 6 and 12 months after PRP.The study protocol was approved by an Ethics Committee of Beijing Daxing District People's Hospital (No.2021-F4). Results:Visual improvement rate was 57.14% (32/56) and 32.69% (17/52) in PRP+ Difrarel ? group and PRP group at the end of following-up, respectively, showing a significant difference between two groups ( χ2=3.56, P<0.05). The visual field mean sensitivity was significantly different at different time points in two groups ( Fgroup=4.77, P<0.05; Ftime=6.51, P<0.05), and was lower after PRP than those before treatment in both groups (both at P<0.05), and was significantly higher in PRP+ Difrarel ? group than PRP group at 3, 6, 12 months after PRP (all at P<0.05). The P1 amplitude density in 3 to 5 rings in PRP+ Difrarel ? group were higher than those in PRP group, and the differences were statistically significant (all at P<0.05). There was no significant difference in CMT between the two groups at different time points ( Fgroup=3.57, P>0.05; Ftime=1.23, P>0.05). No new blood vessels and non-perfusion area were found in both groups. Conclusions:Oral Difrarel ? can improve retinal function after PRP in the eyes with NPDR.
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RESUMEN Introducción: La retinopatía diabética es una microangiopatía retiniana. Provoca cambios anatómicos progresivos en la retina de pacientes diabéticos de larga evolución, es la tercera causa de ceguera a nivel mundial y primera en personas de edad productiva en países en vías de desarrollo, que conlleva a pérdida irreversible de la visión si no se diagnostica y se trata a tiempo. Objetivo: Describir el comportamiento de los factores de riesgo en los pacientes con retinopatía diabética que asistieron a la consulta de retina. Métodos: Se realizó un estudio observacional, descriptivo, transversal en 115 pacientes que acudieron a la consulta de retina con diagnóstico de retinopatía diabética en el periodo de octubre 2020 a febrero 2021 y cumplieron con los criterios de inclusión, se aplicó un formulario para recoger los datos. Los resultados se relacionaron con las variables: tipo de diabetes (tipo I, tipo II), tratamiento actual, control glucémico, factores de riesgo de retinopatía diabética y severidad de esta. Resultados: Fueron más frecuente los pacientes con diabetes tipo II y la retinopatía diabética proliferativa, en pacientes con diabetes tipo I. El tratamiento con hipoglucemiantes orales fue más frecuente seguido de la insulina, la mayor cantidad de pacientes presentaron control glucémico deficiente, el mayor número de pacientes tenían más de 15 años de enfermedad como factor de riesgo, seguida de la hipertensión arterial. Solo la nefropatía no se comportó como factor de riesgo. Conclusiones: La diabetes tipo II fue más prevalente. La retinopatía diabética proliferativa fue más frecuente en pacientes con diabetes tipo I. Los hipoglucemiantes orales constituyen el tratamiento más utilizado. La insulina se utilizó en pacientes con retinopatía diabética no proliferativa severa y retinopatía diabética proliferativa. Predominó el deficiente control glucémico. A mejor control glucémico menos severidad de la retinopatía diabética. Existió asociación estadística entre retinopatía diabética y la mayoría de los factores de riesgo.
ABSTRACT Introduction: Diabetic retinopathy is a retinal microangiopathy that provokes anatomical progressive changes in the retina of the patients with diabetes mellitus of long evolution, it is the third worldwide cause of blindness but the first in old fellows productive in developing countries, that it entails an irreversible loss of vision if one does not diagnose and he talks to each other in good timing. Objective: To describe the behavior of the risk factors in the patients with diabetic retinopathy that attended the retinal consultation of the Hospital Universitario Manuel Ascunce Domenech. Methods: A descriptive transverse study, in diabetic patients that attended the retinal consultation with the diagnosis of diabetic retinopathy was carried out in the period understood of October from 2020 to February 2021. The population was composed of 115 diabetic patients that attended the consultation, and they fulfilled the criteria of inclusion, they were applied a fill-out form to pick up data. The results related with the following variables: Type of diabetes (type 1, type 2), present-day treatment, glycemic control and risk factors of diabetic retinopathy and severity of the same. Results: It was more frequent the patients with diabetes type 2, and the proliferative diabetic retinopathy in patients with diabetes type 1. The treatment with hypoglycemic pray to them it was more frequent in frequent users of insulin, the most patients presented glycemic deficient control, the bigger number of patients they had more of 15 years of disease as risk factor, followed of high blood pressure. Only nephropathy did not entail itself as risk factor. Conclusions: Diabetes type 2 was more frequent than diabetes type 1. The proliferative diabetic retinopathy was frequent in the patients with diabetes type 1. The treatment more used was the oral hypoglycemic ones. Insulin was the treatment used in patients with diabetic retinopathy not proliferative severe and proliferative diabetic retinopathy. The bigger group presented deficient glycemic control. To better glycemic control less severity of her diabetic retinopathies. There was statistical association between diabetic retinopathy and most of the risk factors.
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Objective:To evaluate the efficacy of intravitreal ranibizumab (IVR) injection and/or laser photocoagulation on diabetic macular edema (DME) of different morphologic patterns based on optical coherence tomography (OCT).Methods:A non-randomized controlled clinical trial was conducted.A total of 79 diabetic patients (108 eyes) who were diagnosed as DME in Affiliated Hospital of Nanjing University of Chinese Medicine from March 2017 to February 2018 were enrolled.The subjects were divided into diffuse macular edema (DRT) group (41 eyes), cystoid macular edema (CME) group (37 eyes) and serous retinal detachment (SRD) group (30 eyes) according to the morphological characteristics of OCT, and received intravitreal injection of 0.05 ml (0.5 mg) ranibizumab and/or laser photocoagulation according to treatment guidelines.Best corrected visual acuity (BCVA), central macular thickness (CMT) of the subjects were recorded before treatment and 1 month, 3, 6 and 12 months after treatment.The morphologic changes of macular edema and complications were recorded.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Affiliated Hospital of Nanjing University of Chinese Medicine (No.2017NL-13-03). Written informed consent was obtained from each patient before any medical examination and treatment.Results:The 1-, 3-, 6- and 12-month post-treatment average BCVA (LogMAR) of the DRT, CME and SRD groups were improved in comparison with before treatment, and the average CMT of the three groups at various time points after treatment was reduced than that before treatment (all at P<0.05). For the 39 eyes who received IVR treatment, the 12-month post-treatment average BCVA (LogMAR) of the DRT group was 0.41±0.40, which was significantly better than 0.60±0.40 of the CME group ( P=0.039). The 12-month post-treatment CMT of the DRT group was (286.05±109.56) μm, which was significantly thinner than (338.30±101.87)μm of the SRD group ( P=0.045). For the 69 eyes who received IVR combined with laser photocoagulation treatment, the 6- and 12-month post-treatment average BCVA (LogMAR) of the DRT group were significantly better than those of the CME group ( P=0.048, 0.043), and the average CMT at 12 months after treatment in the DRT group was (304.59±106.66)μm, which was significantly smaller than (369.34±107.80)μm in the SRD group, showing a statistical significance ( P=0.041). During the follow-up, 5 eyes with SRD turned to DRT, and 3 SRD eyes turned to CME.No eye changing from DRT and CME to SRD was found. Conclusions:Intravitreal ranibizumab injection and/or laser photocoagulation can significantly improve BCVA and reduce CMT of DME patients, and the efficacy is better in eyes with DRT than eyes with SRD or CME.
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RESUMEN Fundamento: la retinopatía diabética es una enfermedad ocular a consecuencia de la diabetes mellitus y causada por una alteración microvascular de los vasos retinianos. Es la principal causa de pérdida de visión entre los 30 y los 60 años de edad. La autofluorescencia es una prueba importante en la detección temprana de las complicaciones de la retinopatía diabética, se puede actuar a tiempo para disminuir la incidencia de alteraciones visuales irreversibles. Objetivo: realizar una revisión actualizada sobre la retinopatía diabética y las indicaciones de la autofluorescencia en esta enfermedad. Métodos: se realizó una revisión bibliográfica en las bases de datos LILACS, MEDLINE y SciELO. Los descriptores utilizados fueron: retinopatía diabética, autofluorescencia, complicaciones, terapia diagnóstica por imagen. Con los datos bibliográficos obtenidos en 80 artículos publicados se seleccionaron 34 (27publicados en los últimos cinco años y siete de años anteriores). Resultados: se contemplaron aspectos establecidos tradicionalmente y otros que se encuentran en discusión por muchos autores. Conclusiones: la retinopatía diabética es una causa importante de pérdida visual en adultos, con consecuencias médicas, sociales y financieras significativas. Sus complicaciones son evitables en el 80-90 % de los casos. La autofluorescencia es una prueba importante en la detección temprana de las complicaciones de la retinopatía diabética, que permite actuar a tiempo para disminuir la incidencia de alteraciones visuales irreversibles.
ABSTRACT Background: diabetic retinopathy is an ocular disease due to diabetes mellitus and caused by a microvascular alteration of the retinal vessels. It is the main cause of vision loss between 30 and 60 years of age. Auto-fluorescence is an important test in the early detection of complications of diabetic retinopathy, and it can act in time to reduce the incidence of irreversible visual alterations. Objective: to carry out an updated review on diabetic retinopathy and the indications of auto-fluorescence in this pathology. Methods: a literature review was carried out in the Lilacs, Medline and Scielo databases. The descriptors used were: Diabetic retinopathy, auto-fluorescence, complications, diagnostic imaging therapy. With the bibliographic data obtained in 80 published articles, 34 (27 published in the last 5 years and 7 of previous years) were selected. Results: traditionally established aspects and others that are under discussion by many authors were contemplated. Conclusions: diabetic retinopathy is an important cause of visual loss in adults, with significant medical, social and financial consequences. Its complications are avoidable in 80-90 % of cases. Auto-fluorescence is an important test in the early detection of complications of diabetic retinopathy, which allow to act in time to reduce the incidence of irreversible visual alterations.
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Diabetic macular ischemia (DMI) is one of the manifestation of diabetic retinopathy (DR).It could be associated with diabetic macular edema (DME),which may affect the vision of DR patients.FFA is the gold standard for the diagnosis of DMI,but with the advent of OCT angiography,a more convenient and diversified method for the evaluation of DMI has been developed,which makes more and more researchers start to study DMI.Intravitreal injection of anti-VEGF has become the preferred treatment for DME.When treating with DME patients,ophthalmologists usually avoid DMI patients.But if intravitreal anti-VEGF should be the contradiction of DME is still unclear.To provide references to the research,this article summarized the risk factors,assessment methods and influence of DMI.This article also analyzed the existing studies,aiming to offer evidences to a more reasonable and effective treatment decision for DME individual.
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Objective To analyze the expression of VEGF,IL-33 and NO concentration after laser photocoagulation and subthreshold micropulse laser photocoagulation conventional in proliferative diabetic retinopathy (PDR) patients.Methods A case control study.The clinical data of 39 patients of PDR and 11 patients of idiopathic macular pucker (IMP) from Department of Ophthalmology,Central Theater General Hospital during November 2015 were collected in this study.PDR patients were assigned randomly into three groups.Fifteen PDR patients with 15 eyes were treated with conventional laser as group A.Thirteen PDR patients with 13 eyes were treated with subthreshold micropulse laser as group B.Eleven PDR patients with 11 eyes without any laser therapy were grouped as C.Eleven IMP patients were grouped as D.There was no difference of age (F=0.53,P=0.23),gender ratio (x2=0.55,P=0.91),body mass index (F=2.62,P=0.07),duration diabetes (F=0.29,P=0.75),glycoslated hemglobin (F=1.72,P=0.19) in four groups.All PDR patients were examined with FFA.Total protein was quantified by a bicinchoninic acid assay kit.Levels of VEGF,IL-33,NO were determined using enzyme-linked immunosorbent assay kits.Results There was no difference of total protein in four groups (F=1.78,P=0.17).Group C had a higher VEGF level than group A and B (F=7.84,P=0.002).Group A had a higher IL-33 level than group C (t=4.15,P=0.02).There was no difference of IL-33level in group B and C (t=1.34,P=0.20).Group D had a lower NO level than group A,B,C (F=38.42,P＜0.001).There was no difference of NO level in group A,B and C (F=3.29,P=0.06).Conclusions Both conventional laser photocoagulation and subthreshold micropulse laser photocoagulation can decrease vitreous VEGF level and subthreshold micropulse laser photocoagulation can induce less IL-33 level.
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Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR).Methods A prospective clinical studies.Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No.306 Hospital of PLA during January 2014 and December 2015 were included in this study.Among them,21 eyes of NPDR and 20 eyes of PDR;13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group).All eyes underwent best corrected visual acuity (BCVA),fundus color photography,fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations.The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field).The BCVA of DR eyes was 0.81 ± 0.28;the VFI and MD values were (89.8± 8.4)％ and-7.5 ± 3.85 dB,respectively.The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27,the VFI were (90.86±7.86)％ and (87.46± 9.41)％,the MD values were-6.86± 3.43 and 8.87 ± 4.48 dB.PRP was performed on eyes using 577 nm krypton laser.The changes of VFI,MD and BCVA were observed at 1,3,and 6 months after treatment.Results Compared with before treatment,the VFI of DR eyes decreased by 12.0％,12.3％ and 14.8％ (t=7.423,4.549,4.79;P＜0.001);the MD values were increased by-4.55,-4.75,6.07 dB (t=-8.221,-5.313,-5.383;P＜0.001) at 1,3 and 6 months after treatment,the differences were statistically significant.There was no difference on VFI (t=1.090,-0.486;P＞0.05) and MD value (t=-0.560,-0.337;P＞0.05) at different time points after treatment.Compared with before treatment,the BCVA was significantly decreased in DR eyes at 1 month after treatment,the difference was statistically significant (t=2.871,P＜0.05).Before and after treatment,the BCVA of the DME group was lower than that of the non-DME group,the difference were statistically significant (t=4.560,2.848,3.608,5.694;P＜0.001);but there was no differences on the VFI (t=1.209,0.449,0.922,0.271;P＞0.05) and MD values (t=1.582,0.776,0.927,1.098;P＞0.05) between the two groups.Conclusion The range of 30° visual field loss is about 12％-14.8％ after 577 nm krypton laser PRP for DR.VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.
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Objective To evaluate the clinical efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema (DME).Methods Retrospective case series study.A total of 30 patients (35 eyes) with center-involving DME were enrolled in this study.All the patients received the examinations of best corrected visual acuity (BCVA),fundus colorized photography,fluorescein fundus angiography (FFA) and optical coherence tomography (OCT).BCVA was measured by Early Treatment Diabetic Retinopathy Study charts.The average retinal thickness (ART),total macular volume (TMV) and the retinal thickness (RT) and macular volume (MV) of 9 ETDRS domains were measured by the Japanese Topcon 3D-OCT 2000 instrument.The mean BCVA was 62.4± 10.5 letters.The mean ART was 327.3± 41.2 μm.The mean TMV was 9.24 ± 1.17 mm3.All patients were treated with 577 nm subthreshold micropulse laser treatment.Subthreshold micropulse laser were performed in the micropulse mode,using a 200 μm spot diameter,a 0.2 s duration with 5％ duty cycle and its treatment energy was 6-7 times of threshold energy.Three months after treatment,re-treatment was performed on patients with incomplete absorption of macular edema.The treatment was the same as before.The BCVA,ART,TMV and the RT and MV of each ETDRS domain were compared and analyzed before and after treatment.The possible complications of micropulse laser treatment were also observed and the safety was evaluated.Results The difference of BCVA were statistically significant in month 3 and month 6 (t=-5.58,-7.24;P＜0.05),but not in month 1 (t=-1.82,P＞0.05).The average CRT (t=4.11,4.17,5.96),CMV (t=3.92,4.05,5.80) significantly decreased in 1,3 and 6 months after treatment,the difference was statistically significant (P＜0.05).At sixth months,the average retinal thickness (t=3.53,5.07,5.02,4.87,4.94,3.48,4.03,3.17,3.73) and retinal volume (t=3.54,5.16,4.99,4.91,5.05,3.47,4.08,3.10,3.70) of the 9 ETDRS subdomains significantly decreased,and the difference was statistically significant (P＜0.05).There was no visible laser spots,changes in the outer retina and complications of neovascularization and subretinal fibrosis in the fundus of all patients.Conclusion 577 nm subthreshold micropulse laser can reduce the CMT,CMV and improve the BCVA of DME patients with high security.
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Macular edema is a common cause of visual loss in patients with retinal vascular diseases represented by diabetic retinopathy and retinal vein occlusion.Laser photocoagulation has been the main treatment for this kind of diseases for decades.With the advent of antagonist of vascular endothelial growth factor and dexamethasone implant,diabetic macular edema and macular edema secondary to retinal vein occlusion have been well controlled;the use of laser therapy is decreasing.However,considering possible risks and complications,lack of extended inspection of efficacy and safety of intravitreal pharmacotherapy,laser therapy cannot be replaced by now.Therefore,the efficacy and safety of laser therapy will improve by sober realization of role of photocoagulation and proper selection of treatment indication.
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Diabetic retinopathy is a serious complication of diabetes and is the leading cause of blindness in people with diabetes.At present,there are many views on the pathogenesis of diabetic retinopathy,including the changes of retinal microenvironment caused by high glucose,the formation of advanced glycation end products,oxidative stress injury,inflammatory reaction and angiogenesis factor.These mechanisms produce a common pathway that leads to retinal degeneration and microvascular injury in the retina.In recent years,cell regeneration therapy plays an increasingly important role in the process of repairing diseases.Different types of stem cells have neurological and vascular protection for the retina,but the focus of the target is different.It has been reported that stem cells can regulate the retinal microenvironment and protect the retinal nerve cells by paracrine production,and can also reduce immune damage through potential immunoregulation,and can also differentiate into damaged cells by regenerative function.Combined with the above characteristics,stem cells show the potential for the repair of diabetic retinopathy,this stem cell-based regenerative therapy for clinical application provides a pre-based evident.However,in the process of stem cell transplantation,homogeneity of stem cells,cell delivery,effective homing and transplantation to damaged tissue is still a problem of cell therapy.
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Objective To observe the visual acuity change in patients with different patterns of optical coherence tomography (OCT) of diabetic macular edema (DME) after intravitreal ranibizumab injection and/or laser photocoagulation.Methods A retrospective observational case series.Seventy patients (99 eyes) with DME were enrolled.Best-corrected visual acuity (BCVA) was evaluated using the international vision test chart,and then convert the result to the logarithm of the minimum angle of resolution (logMAR).According to the morphological characteristics of OCT,the DME was divided into 3 patterns,including diffuse macular edema (DRT),cystoid macular edema (CME) and serous neuroepithelial layer detachment.The average follow-up was (80.43 ± 74.89) days.The patients were divided into 3 groups according to the different treatments,including intravitreal ranibizumab injection group (group A,21 patients,25 eyes),intravitreal ranibizumab injection and laser photocoagulation group (group B,23 patients,26 eyes),laser photocoagulation group (group C,26 patients,48 eyes).The changes of absolute BCVA (ABCVA) and improved visual acuity were compared between different treatment groups and different OCT patterns.ABCVA =logMAR BCVA before treatment-logMAR BCVA after treatment.Improvement more than 0.3 of logMAR value was considered as improved visual acuity.Results There was no significant difference in ABCVA between different treatment groups (F=0.050,P＞0.05).The improved visual acuity in group A and B were great than group C (x2=5.645,6.301;P＜0.05).In group A,B and C,there was no significant difference in ABCVA and improved visual acuity between different OCT patterns (P＞0.05).Improved visual acuity of DRT and CME eyes were higher in group A&B (70.59％ and 50.00％) than in group C (26.47％ and 14.29％),the difference was statistically significant (x2=5.075,4.453;P＜0.05).Conclusions There is no obvious change of visual acuity in patients with different OCT patterns of DME after the same treatment by intravitreal ranibizumab injection and/or laser photocoagulation.The improved visual acuity is not consistent in same OCT patterns after different treatment.
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Objective To observe the efficacy of intravitreal injection of ranibizumab (IVR) for different patterns of optical coherence tomography (OCT) of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes.Methods Eighty-five IVR treated eyes were enrolled.The examination of BCVA was according to Early Treatment Diabetic Retinopathy Study,and the results were recorded as logarithm of the minimum angle of resolution (logMAR).Frequency-domain OCT was used to measure the central foveal thickness (CFT) and the integrity of ellipsoidal zone.All eyes were classified as diffuse macular edema (DRT group,31 eyes),cystoid macular edema (CME group,29 eyes),and serous retinal detachment (SRD group,25 eyes).All the patients were treated with intravitreal injection of 0.05 ml (0.5 mg) ranibizumab.The mean follow-up time was (9.21+3.56) months after IVR treatment.The changes of BCVA and CFT in 3 groups were compared and analyzed after 3,6 and 12 months.According to visual acuity at different ranges,the relationship between integrity of ellipsoidal zone and BCVA was analyzed.Results Compared with the average logMAR BCVA before treatment,except for 12 months after treatment in group SRD (t=2.104,P=0.053),the average logMAR BCVA after IVR at 3 months,6 months and 12 months improved in DRT group (t=7.847,6.771,6.426;P=0.000,0.000,0.000),CME group (t=8.560,6.680,5.082;P=0.000,0.000,0.000) and SRD group (t=5.161,3.968,2.104;P=0.000,0.001,0.053).The average logMAR BCVA of the DRT group was lesser than that in CME and SRD group after 12 months treatment (t=-2.043,-3.434;P=0.030,0.001).The average CFT after IVR at 3 months,6 months and 12 months reduced significantly in DRT group (t=12.746,10.687,9.425;P=0.000,0.000,0.000),CME group (t=13.400,11.460,10.169;P=0.000,0.000,0.000),and SRD group (t=1 1.755,10.100,9.173;P=0.000,0.000,0.000).After 12 months of treatment,the average CFT of the SRD group was thicker than that in DRT group and CME group (t=-3.251,-1.227;P=0.003,0.025);there was significant difference in the integrity of ellipsoidal zone among 3 groups (x2=1.267,P=0.531).The results showed that there were significant differences in the integrity of ellipsoidal zone with different ranges of BCVA before and after 12 months treatment (x2=20.145,41.035;P=0.000,0.000).Conclusions IVR could significantly improve the visual acuity of different patterns of DME,reduced the CFT,and had the best efficacy in the DRT group.There was relationship between the integrity of ellipsoidal zone and the visual acuity outcomes.
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Diabetic retinopathy (DR) is a common complication of eye in diabetics and is one of the major causes of blindness in adults.The current treatments of DR include surgery and laser therapy,but this does not fundamentally cure DR.Recent studies have found that mesenchymal stem cells (MSCs) for cell therapy to DR have a wide range of applications.MSCs have regenerative potential and play a role in the repairment of the retina,but the survival and homing ability of MSCs are poor after transplantation,which reduces the therapeutic efficiency of MSCs.Statins have a variety of beneficial effects independent of lipid regulation,which can promote the proliferation of MSCs and inhibit the apoptosis of MSCs.This paper reviewed the application and mechanism of MSCs combined with statins in the treatment of DR.
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Proliferative diabetic retinopathy (PDR) is one of the serious ocular complications of patients with diabetes mellitus and also the leading cause of blindness.Pars plana vitrectomy (PPV) is an effective treatment for severe vitreous hemorrhage and PDR.The intraocular concentration of vascular endothelial growth factor (VEGF) of patients with PDR usually increase abnormally,which promote growth of neovessels and make it early to leak and bleed.Numerous neovessels in vitreous cavity and retinal surface can lead to intraoperative bleeding and may affect the definition and precision of operation and prolong surgical time.If we conduct gas/fluid exchange regardless of severe active bleeding,proliferate membrane may reoccur at a high rate postoperatively due to the residual platelet and impair the success rate of surgery seriously.In addition,with the high activity of neovessels,anterior chamber,vitreous and retinal hemorrhage may appear as well as other postoperative complications like postoperative high intraocular pressure caused by inflammation or hemorrhage and traction retinal detachment because of reoccurrence of fibro membrane,which directly affect the postoperative visual function recovery and long-term prognosis.As wide clinical application of anti-VEGF agents in recent years,studies found that preoperative intravitreal injection of anti-VEGF drugs assisted PPV can limit the activity of neovessels and significantly reduce the incidence of intraoperative and postoperative bleeding,facilitate operation,shorten surgical time and improve the success rate of surgery.In this paper,the mechanism,effectiveness,clinical utility and safety of anti-VEGF therapy assisted vitrectomy for the treatment of PDR are reviewed.
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Objective To assess the clinical efficacy of vitrectomy with intravitreal ranibizumab (IVR) at different injection time for proliferative diabeticretinopathy (PDR).Methods This was a prospective,comparative,and randomized study.Ninety-seven eyes of 97 patients were enrolled and randomly assigned to three different treatment groups:30 eyes (30 patients) in the preoperative IVR group,32 eyes (32 patients) in the intraoperative IVR group and 35 eyes (35 patients) in the no IVR injection group.The best corrected visual acuity (BCVA) (F=0.18) and the grading of vitreous hemorrhage (x2 =1.39) before surgery did not differ significantly among the 3 groups,respectively (P ＞ 0.05).All eyes enrolled underwent conventional 23-gauge pars plana vitrectomy (PPV).The preoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection 3 to 7 days before PPV,intraoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection at the end of PPV and non-drug injection group received PPV only.Postoperative BCVA,fundus color photography,optical coherence tomography examination was performed in all eyes at 1 week and 1,3,6,9,12 months after surgery.Early RVH was defined as RVH occurred within 1 week to 1 month postoperatively;while late RVH was defined as RVH occurred 1 month later after the operation.Results The mean BCVA were all improved among the 3 groups compared with the preoperative vision at 1 month after operation.At the beginning of 3 months after surgery,the average BCVA of the preoperative injection group and the intraoperative injection group tended to stable;while 3 eyes in the non-drug injection group began to decreased.There was no significant difference in average BCVA at 1,3 and 12 months of follow-up periods among the 3 groups (F=1.42,1.17,0.26;P＞0.05).The incidences of early RVH were 16.7％,9.4％,28.6％ in the preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =5.12,P＜0.05).The incidence of early RVH in the intraoperative injection group reduced compared to preoperative injection group and non-drug injection group (x2 =4.04,4.93;P＜0.05).The incidences of late RVH were 13.3％,9.4％,14.3％ in preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =0.47,P＞0.05).The average centeral foveal thickness (CFT) decreased among the 3 groups in different degrees at 1 month when compared with that of 1 week after operation and the decreasing was statistically significant (F=59.50,P＜0.05).A subgroup pairwise analysis showed no significant difference of decreasing CFT in preoperative injection group compared with that of intraoperative injection group (t=0.23,P＞0.05).The average CFT of the 3 groups had different degrees of thickening at 3,6,9,12 months after surgery,and the increasingof CFT among the 3 groups were not differ significantly (F=2.92,2.86,3.07,3.12;P＞0.05).Conclusions The adjunctive use of IVR can reduce the incidence of early postoperative RVH in vitrectomy for PDR,decrease in macular thickness and obtain favorable visual recovery.The effect of preoperative IVR injection was slightly better than that of the intraoperative IVR injection.
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Objective To observe the clinical efficacy of enhanced external counterpulsation (ECP) in the treatment of non-proliferative diabetic retinopathy (NPDR).Methods It was a case-control study.83 patients (166 eyes) of NPDR were randomly divided into ECP treatment group (ECP group) and conventional therapy group (drug group) by date of visit odd and even number,each with 42 patients of 84 eyes and 41 patients of 82 eyes respectively.The blood glucose,glycated hemoglobin (HbAlc),low-density lipoprotein (LDL-C),corrected visual acuity,stages of diabetic retinopathy (DR) and hemodynamic index such as peak systolic velocity (PSV),diastolic velocity (EDV),resistance index (RI) of ophthalmic artery (OA) and central retinal artery (CRA) were not statistically different between these two groups (P＞ 0.05).All patients were regularly educated for lifestyle management and diabetes mellitus.The following parameters were controlled by drugs including blood glucose＜8.0 mmol/L,HbA1c＜7.5 ％,blood pressure ＜140/90 mmHg (1 mmHg=0.133 kPa) and LDL-C＜3.1 mmol/L.The ECP group received both ECP and medical treatments.The ECP parameters were gasbag pressure 0.35-0.45 kg/cm2,40 min/each time,1 time/d.35 days of ECP was one course,one course each year for 3 years.The treatment effectiveness was determined at the end of follow-up after 3 years of treatment.The blood glucose,HbA1c,blood pressure,LDL-C,visual acuity,fundus changes and hemodynamic index of OA and CRA before and after treatment were comparatively analyzed.Improved or stable visual acuity and fundus condition was judged as effective treatment.Results At latest follow up,the differences of blood glucose,HbA1c,blood pressure and LDL-C were not statistically significant (P＞0.05).Compared to drug group,the PSV and EDV of OA and CRA were increased,but RI of OA and CRA was decreased in ECP group (P＜0.05).The vision effective ratio was 91.67％ and 30.49％ in ECP group and drug group respectively with a significant different (x2 =65.56,P＜0.05).The fundus effective ratio was 92.86％ and 48.78％ in ECP group and drug group respectively with a significant different (x2 =43.38,P＜ 0.05).During follow-up,1 eye (1.19％) progressed to proliferative DR (PDR) in ECP group,while 6 eyes (7.32％) progressed to PDR in drug group.The difference of PDR incidence rate between two groups was significant (x2 =3.87,P＜ 0.05).During the ECP treatment,there were 2 patients with small blisters in the skin of lower limb and cured finally.There were no other treatment-related complications.Conclusion ECP in the treatment for NPDR can improve PSV and EDV,reduce RI of OA and CRA;improve vision and fundus state,reduce the incidence of PDR.
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Objective To observe the effect of panretinal photocoagulation (PRP) on the expression of cyclooxygenase-2 (COX-2),vascular endothelial cell growth factor (VEGF) in epiretinal membrane of proliferative diabetic retinopathy (PDR).Methods A total of 35 patients (35 eyes) with PDR and underwent plana vitrectomy were enrolled in this study.The patients were divided into non-PRP group (19 patients,19 eyes) and PRP group (16 patients,16 eyes) depends on if they had received PRP before surgery.The epiretinal membranes stripped during operation were collected for pathological examination.The histopathological features was observed by haematoxylin and eosin stain.The expression of CD34,COX-2 and VEGF,and microvessel density (MVD) were measured by immunohistochemistry method.Results Many new dispersed capillary blood vessels were found in the thick epiretinal membranes of nonPRP group,while scattered small blood vessels were found in the relatively thin epiretinal membranes of PRP group.MVD value was (7.42± 1.39) in the non-PRP group and (4.56± 1.22) in the PRP group,which was lower than the non-PRP group (t=6.41,P＜0.01).The expression of CD34,COX-2 and VEGF in the tissues of epiretinal membrane in PRP group were obviously lower than the non-PRP group (t=6.147,5.944,7.445;P＜0.01).Conclusion PRP can effectively inhibit the expression of COX-2 and VEGF in epiretinal membrane of PRP patients.
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Objective To compare the therapeutic effects of 577 nm laser and 532 nm laser panretinal photocoagulation (PRP) in the treatment of non-proliferative diabetic retinopathy (NPDR).Methods This is a prospective controlled study.A total of 23 patients (41 eyes) with clinically diagnosed severe NPDR were randomly divided into two groups including 577 nm group (11 patients,20 eyes) and the 532 nm group (12 patients,21 eyes).577 nm group and 532 nm group received 3-4 times PRP with single-point mode.The laser energy and the number of laser spots were compared,and the laser energy density was calculated.Before treatment and 1 day,1,3,6 and 12 months after treatment,the changes of best corrected visual acuity (BCVA),average threshold sensitivity,a/b-wave amplitude of flash ERG (F-ERG) in the 30°-60° visual field,and fundus fluorescein angiography (FFA) were compared between two groups.Results The response rate was 85.0％ and 23.8％,respectively in the 577 nm and 532 nm group,the difference was statistically significant (x2 =15.43,P ＜ 0.05).Compare to the pre-treatment measurement,the average threshold sensitivity,a/b wave amplitude of F-ERG and the 30°-60°visual field were reduced at 1 day after treatment both in the 577 nm and 532 nm group,the difference were statistically significant (F =8.68,7.57,4.52;P＜0.05).The average threshold sensitivity (t=2.41,3.48,1.23),a/b wave amplitude (a wave:t=5.82,4.45,7.83;b wave:t=5.40,3.23,4.67) of F-ERG were different between 577 nm and 532 nm group at 3,6 and 12 months after treatment (P＜0.05).There was no retinal neovascularization and non-perfusion region in two groups at 6 months after treatment.The average laser power were (436.25 ±54.65) and (446.43 ± 35.61) mW,number of laser spots were (1952.95 ± 299.09) and (2119.05 ± 302.69) spots,energy density were (7.60±1.30) and (7.60±3.00) mW× ms/μm2 in the 577 nm group and 532 nm group,respectively.There was no difference in average laser power (t=1.35),number of laser spots (t=2.85) and energy density (t=1.99) between two groups (P＞0.05).Conclusion Compared with the 532 nm laser,577 nm laser treatment has better visual outcomes for NPDR patients.
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Laser photocoagulation,intravitreal injection of antibody against vascular endothelial growth factor (VEGF) or corticosteroids and pars plana vitrectomy are current popular therapeutic approaches for diabetic retinopathy (DR).However,some DR patients still progress to irreversible blindness even after the above treatments which do not aim at the pathological mechanisms and influence factors for DR.Thus,with the further elucidation on the molecular pathological mechanisms and overall understanding of the factors affecting DR development,more and more potential therapeutic interventions such as neuron protection,vascular reconstruction and protection,gene therapy,non-VEGF dependent antineovascularization agents have been explored.Individual precise therapy based on the potential therapeutic targets would provide the promising future for DR patients.
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Objective To evaluate the effect of FTY720 on retinal leukocytes adhesion and vascular permeability in diabetic retinopathy (DR) model,and explore its mechanism.Methods Ninety male Wister rats were randomly divided into normal control group,diabetic group and FTY720 group,thirty rats in each group.Diabetes was induced by giving a single intraperitoneal injection of streptozocin.FTY720 group was administered with FTY720 at a dose of 0.3 mg/kg by oral gavage daily for 3 months after establishment of diabetes.All rats were used for experiments following intervention for 3 months in FTY720 group.Immunohistochemical staining was used to observe the expression and distribution of intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1),and the positive cells were counted.Real-time reverse transcription PCR was used to measure mRNA expression of ICAM-1 and VCAM-1.Fluorescein isothiocyanate-Concanavalin A perfusion was used to detect retinal leukocytes adhesion.Evans blue (EB) perfusion was used to analyze retinal vascular permeability.Immunofluorescence staining was used to detect retinal inflammatory cells infiltration.Results In diabetic group,both ICAM-1(t =12.81) and VCAM-1 (t=11.75) positive cells as well as their mRNA expression (t=16.14,9.59) were increased compared with normal control group,with statistical significance (P＜ 0.05).In FTY720 group,both ICAM-1(t=-9.93) and VCAM-1 (t=-6.61) positive cells as well as their mRNA expression (t=-15.28,-6.10) were decreased compared with diabetic group,with statistical significance (P＜ 0.05).Retinal leukocytes adhesion (t=16.32) and EB permeability (t=17.83) were increased in diabetic group compared with normal control group,while they were decreased in FTY720 group compared with diabetic group(t=-9.93,-11.82),with statistical significance (P＜0.05).There were many CD45 positive leukocytes infiltration in retina of diabetic group,including CD11b positive macrophage/activated microglia,while both of them were little in FTY720 group.Conclusions FTY720 can decrease retinal leukocytes adhesion,reduce retinal vascular permeability and inflammatory cells infiltration,which is associated with down-regulation of ICAM-1 and VCAM-1.