Correlation of 1-year vision outcomes with baseline factors in polypoidal choroidal vasculopathy patients after anti-VEGF treatment / 眼科新进展

Objective To analyze the correlation between baseline factors and the best corrected visual acuity (BCVA) after 3 monthly anti-vescular endothelial growth factor (VEGF) therapy in naive polypoidal choroidal vasculopathy (PCV).Methods This was a retrospective cohort study in 44 naive PCV patients (44 eyes) treated in our hospital between July 2015 and December 2016,and BCVA,optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) + indocyanine green angiography (ICGA) examinations were performed at first.All patients were treated with monthly antiVEGF (including ranibizumab and conbercept) injections for 3 consecutive months,followed by the needed retreatment,and BCVA at the 12th month during follow-up after the first anti-VEGF treatment was recorded,following the comparison with baseline BCVA,and then the patients were divided into improved and unimproved groups according to BCVA changes.Finally,univariate and logistic regression analysis were used to analyze the correlation between the baseline factors and BCVA.Results The univariate analysis showed that the improved group had shorter onset time,smaller greatest linear dimension (P =0.045 and 0.037,respectively).Logistic regression showed the difference in choroidal vascular hyperpermeability and greatest linear dimension was statistically significant,suggesting that they were the independent predictors of visual outcome (regression coefficient =0.963 and 0.001,P =0.010 and 0.012,odds ratios =0.083 and 1.002,95％ confidence interval =0.013-0.549 and 1.001-1.004,respectively).Conclusion Choroidal vascular hyperpermeability may be a predictor for poor visual acuity prognosis in PCV patients after anti-VEGF,and greatest linear dimension and the time of onset are also related to postoperative visual acuity in PCV patients after anti-VEGF.

Delayed Absorption of Subretinal Fluid after Retinal Reattachment Surgery and Associated Choroidal Features

PURPOSE: The aim of this study was to investigate the incidence and associated clinical factors of delayed absorption of subretinal fluid (SRF) after surgery for rhegmatogenous retinal detachment. METHODS: This study involved 36 eyes of 36 consecutive patients who underwent successful surgery for rhegmatogenous retinal detachment. A complete ophthalmologic evaluation, including clinical fundus examination, optical coherence tomography, and indocyanine green angiography, was conducted before and after surgery. Delayed absorption was defined as the presence of residual concave SRF or an SRF bleb at 6 months after surgery. Clinical factors and choroidal features on indocyanine green angiography were compared according to the presence and absence of delayed absorption. RESULTS: Eighteen of 36 eyes (50%) showed delayed absorption. Macular involvement and worse preoperative visual acuity were significantly related to the presence of delayed absorption (p = 0.001 and p = 0.034, respectively). On indocyanine green angiography, preoperative choroidal vascular hyperpermeability was noted in 70% of eyes with delayed absorption and in 14% of eyes without it (p = 0.010). CONCLUSIONS: Delayed absorption of SRF after retinal reattachment surgery was not rare, with a 50% of incidence in this study. Macula-off status was significantly related to the incidence of delayed SRF absorption, and choroidal features such as choroidal vascular hyperpermeability might be responsible in part, possibly through the resultant exudative property of choroid.

Propofol inhibits burn injury-induced hyperpermeability through an apoptotic signal pathway in microvascular endothelial cells

Recent studies have revealed that an intrinsic apoptotic signaling cascade is involved in vascular hyperpermeability and endothelial barrier dysfunction. Propofol (2,6-diisopropylphenol) has also been reported to inhibit apoptotic signaling by regulating mitochondrial permeability transition pore (mPTP) opening and caspase-3 activation. Here, we investigated whether propofol could alleviate burn serum-induced endothelial hyperpermeability through the inhibition of the intrinsic apoptotic signaling cascade. Rat lung microvascular endothelial cells (RLMVECs) were pretreated with propofol at various concentrations, followed by stimulation with burn serum, obtained from burn-injury rats. Monolayer permeability was determined by transendothelial electrical resistance. Mitochondrial release of cytochrome C was measured by ELISA. Bax and Bcl-2 expression and mitochondrial release of second mitochondrial-derived activator of caspases (smac) were detected by Western blotting. Caspase-3 activity was assessed by fluorometric assay; mitochondrial membrane potential (Δψm) was determined with JC-1 (a potential-sensitive fluorescent dye). Intracellular ATP content was assayed using a commercial kit, and reactive oxygen species (ROS) were measured by dichlorodihydrofluorescein diacetate (DCFH-DA). Burn serum significantly increased monolayer permeability (P<0.05), and this effect could be inhibited by propofol (P<0.05). Compared with a sham treatment group, intrinsic apoptotic signaling activation - indicated by Bax overexpression, Bcl-2 downregulation, Δψm reduction, decreased intracellular ATP level, increased cytosolic cytochrome C and smac, and caspase-3 activation - was observed in the vehicle group. Propofol not only attenuated these alterations (P<0.05 for all), but also significantly decreased burn-induced ROS production (P<0.05). Propofol attenuated burn-induced RLMVEC monolayer hyperpermeability by regulating the intrinsic apoptotic signaling pathway.

Comparison of Choroidal Hyperpermeability Change after Photodynamic Therapy and Ranibizumab for Chronic Central Serous Chorioretinopathy

PURPOSE: To compare changes in choroidal hyperpermeability after half-energy photodynamic therapy (PDT) and intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC). METHODS: Post-hoc analysis was performed in a randomized, controlled trial comparing half-energy PDT versus intravitreal ranibizumab for chronic CSC; during the experiments, the other treatment was available for salvage treatment if the original was unsuccessful at 3 months. A commercially available image analysis program (Adobe(R) Photoshop(R) CS6 [Adobe Systems, Inc., San Jose, CA]) was used for quantification of change in choriodal hyperpermeability on indocyanine green angiography after half-energy PDT or three consecutive intravitreal injections of ranibizumab. Post-treatment images were subtracted from pre-treatment images after adjustments were made to create images depicting the change in choroidal hyperpermeability with treatment. Integrated gray scale values per area in this image were used for analysis of change in choroidal hyperpermeability. RESULTS: The calculated change in choroidal hyperpermeability was significantly greater in the half-energy PDT group (17.36 +/- 8.74) than in the ranibizumab group (6.78 +/- 5.03) (p < 0.001). All eyes in the half-energy PDT group showed complete resolution of subretinal fluid, and no significant difference in change of choroidal hyperpermeability was found in eyes that received half-energy PDT as primary or salvage treatment. In the ranibizumab-treated group, subretinal fluid resolution was accomplished in 5 eyes, and these eyes showed a significantly larger decrease in choroidal hyperpermeability when compared with eyes showing poor response (10.31 +/- 4.00 vs. 2.74 +/- 2.16, p = 0.005). In the successfully treated eyes with ranibizumab, there was no significant difference in choroidal hypopermeability change when compared to half-energy PDT (p = 0.124). CONCLUSIONS: Using our novel method of analysis of change in choroidal hyperpermeability following treatment for chronic CSC, greater change was found in eyes with good response, and the superior outcome of half-energy PDT over ranibizumab may be attributed to greater influence on choroidal hyperpermeability.

Subfoveal Choroidal Thickness in Fellow Eyes of Patients with Central Serous Chorioretinopathy

PURPOSE: To determine the relationship between subfoveal choroidal thickness of fellow eyes and choroidal vascular hyperpermeability in unilateral central serous chorioretinopathy (CSC). METHODS: Thirty patients with unilateral CSC and 28 normal subjects underwent enhanced depth imaging spectral-domain optical coherence tomography to evaluate bilateral subfoveal choroidal thickness. The subfoveal choroidal thickness was measured from the outer RPE border to the inner sclera border. Choroidal vascular hyperpermeability was visualized with indocyanine green angiography (ICGA) and analyzed. RESULTS: The mean subfoveal choroidal thickness in the affected eyes (439.6 +/- 136.5 microm) was significantly thicker than that in fellow eyes (340.0 +/- 103.3 microm, p = 0.002), and both showed statistically significant difference compared with normal subjects (266.5 +/- 111.5 microm, p < 0.001, p = 0.019). The subfoveal choroidal thickness of fellow eyes with choroidal vascular hyperpermeability was 370.0 +/- 176.5 microm, which differed significantly (p = 0.037) from the choroid without choroidal vascular hyperpermeability. The choroidal thickness of acute CSC was 441.6 +/- 118.6 microm, and that of chronic CSC was 454 +/- 166.5 microm, a difference that was not statistically significant (p = 0.676). CONCLUSIONS: The subfoveal choroid with hyperpermeability was thicker than that without hyperpermeability on ICGA in the fellow eyes of patients with unilateral CSC. Enhanced depth imaging spectral-domain optical coherence tomography can indirectly evaluate the effects of choroidal hyperpermeability by noninvasively measuring the choroidal thickness.

ICGA Findings and Clinical Features of Idiopathic Choroidal Neovascularization

PURPOSE: The purspose of this study was to investigate the ICGA findings and clinical features of idiopathic choroidal neovascularization (CNV) which is one of the important causes of CNV developed under 50 years of age. METHOD: We performed FAG and ICG angiography in 26 eyes (25 patients) which were diagnosed as idiopathic CNV and investigated the visual acuity, associated retinal findings, and treatment modality. RESULTS: The locations of CNV were subfoveal in 11 eyes, juxtafoveal in 11 eyes, extrafoveal in 4 eyes. All CNV were less than 1 disc diameter in size. On ICG angiography, hyperfluorescent neovascular network CNV was visible in early phase in 22 out of 26 eyes. Twelve eyes had dark rim surrouding the CNV, and 10 eyes had focal choroidal vascular dilation near the CNV. Twelve eyes showed obvious choroidal hyperpermeability in late phase, and 3 eyes showed the hypofluorescent dark spot near the CNV. Final visual acuity was improved in 9 eyes, decreased in 4 eyes, and unchanged in 13 eyes. CONCLUSION: Idiopathic CNV was small in size and located mostly in foveal area. ICG angiography showed CNV with various angiographic patterns, and the visual prognosis was relatively good.

Angiographic Findings of Choroidal Lesions in Serous Retinal Detachment

PURPOSE: To study the relationship between the damage of retinal pigment epithelum and the lesion of choroidal vessels in various types of the serous retinal detachment(SRD) on fluorescein angiography(FAG) and indocyanine green angiography(ICGA). METHODS: FAG and ICGA were performed 81 eyes with various types of serous retinal detachment. The series comprised central serous chorioretinopathy(CSC, 63 eyes), toxemia of pregnancy(8 eyes), and Harada's disease(10 eyes). RESULTS: All the eyes showed dye leakage through the retinal pigment epithelium(RPE) by FAG. Of sixty-three eyes with CSC, sixty eyes showed choroidal tissue staining in late phase on ICGA. Delayed filling of ICG dye in early phase was present around the site of leakage on FAG in 48 eyes with CSC. In toxemia of pregnancy and Harada's disease, all the cases showed delayed choroidal circulation and leakage from choroidal vessels on ICGA. As a common feature, ICGA showed choroidal hypoperfusion or delayed choroidal circulation and choroidal vascular hyperpermeability in the three types of SRD. CONCLUSIONS: The authors presume that they might contribute to the damage of RPE. The pathogenesis of SRD may be related to the hypothesis fact that choroidal vascular hyperpermeability probably moves fluid into the subretinal space from the choroid.

Effects of Peritoneal Rest on Peritoneal Fibrosis in CAPD Rats / 대한신장학회잡지

Ultrafiltration failure has been known as a major cause of dropout from long-term peritoneal dialysis and is often related to peritoneal hyperpermeability. This can be explained in part by progressive peritoneal fibrosis. The present experiment has been undertaken to evaluate the effects of peritoneal rest on peritoneal transport and morphology in rat model of peritoneal dialysis. Twenty-four male rats(Sprague-Dawley, 250-300g) were used and divided into three groups : group 1 (control, n=6) without dialysis, group 2(n=9) sacrificed immediately after 3 weeks of dialysis, and group 3 (n=9) sacrificed after 4 weeks of peritoneal rest after 3 weeks of dialysis. Peritoneal dialysis was performed twice a day with 25mL of 3.86% dextrose solution for 3 weeks. Peritonitis was induced by supplementing lipopolysaccharide(5 microgram/mL) in the dialysis fluid on days 8, 10 and 12 of peritoneal dialysis. Peritoneal equilibration tests were performed before dialysis and repeated on the 4th and 8th week of dialysis. Morphometric analysis of the peritoneal membrane and immunohistochemistry for collagen type I and type III were done in tissue specimens obtained at the time of sacrifice. The D/Do ratio for glucose at two hours in groups 2 and 3 at the beginning of week 4 were significantly lower than baseline value, indicating increase in the peritoneal penneability to glucose after 3 weeks of dialysis. D/Do in group 3 at the beginning of week 8, after 4 weeks of peritoneal rest, was significantly higher than at week 4. The drained dialysate volumes in groups 2 and 3 at week 4 were significantly lower than at baseline; however, The drained dialysate volume in group 3 at week 8 was significantly greater than at week 4. The thickness of the parietal peritoneal membraoe in group 2 and 3 were significantly greater than in group 1. Severity of the thickness of the parietal peritoneal membrane in group 3 was not much than that of group 2(group 1, 11.4+/-7.6; group 2, 37.5+/-18.4; group 3, 21.4+/-12.1 micromiter). Histologically, the thickened peritoneum in group 2 showed a monolayer of mesothelial cells and under-lying multilayer of curled collagen bundles. Mononuciear cells and fibroblasts were embedded in these collagen layers and capillary proliferation was present. Immunohistochemistry for collagen type I and Z demonstrated that the distribution of collagen type llI was richer than that of collagen l in group 2 at fibrotic area of submesothelial region. These findings were decreased in group 3. Ultrastructural examination of the peritoneum showed thicker fibrotic zone and the activated fibroblasts in group 2 compared to group 1 and 3. Meso-thelial cells were plump and the number of mesothelial microvilli was decreased in group 2. Nucleus was enlarged and irregular. Intracytoplasmic orga-nelles were also richer than those of group I or 3. In conclusion, peritoneal rest improves ultrafiltration in rats by decreasing the hyperpermeability of glucose and also reduces the degree of peritoneal fibrosis. These data suggest that dialysis-induced changes in peritoneal transport and morphology are reversible under the condition of peritoneal rest in this experimental model.