Optical coherence tomography angiography manifestations of different degrees of nonproliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the differences in varying stages of non-proliferative diabetic retinopathy(NPDR)using optical coherence tomography angiography(OCTA).METHODS: Cross-sectional study. A total of 77 cases(77 eyes)of diabetic patients were included, and they were divided into non-diabetic retinopathy(NDR; 23 eyes)and non-proliferative diabetic retinopathy(NPDR; 54 eyes)groups, further subdivided into mild NPDR(20 eyes), moderate NPDR(20 eyes), and severe NPDR(14 eyes). Foveal avascular zone(FAZ)area, superficial and deep capillary plexus densities(SSP and DSP), and visual acuity(LogMAR)were compared between NDR and NPDR groups. Furthermore, the visual acuity, FAZ area and levels of SSP and DSP were compared in different degrees of NPDR. Correlation analysis were conducted to elucidate relationships between FAZ area, visual acuity, SSP, DSP, and severity of the disease.RESULTS: Compared with the NDR group, the visual acuity(LogMAR)and macular FAZ area increased, while SSP and DSP were decreased in the NPDR group(P<0.05); there were significant differences in visual acuity, FAZ area and SSP and DSP levels in different degrees of NPDR(P<0.05). Visual acuity(LogMAR)and FAZ area displayed a positive correlation with the severity of disease, while SSP and DSP showed a negative correlation.CONCLUSION: With the progression of NPDR, the visual acuity(LogMAR)and FAZ area increased, and the SSP and DSP decreased.

Topographic distribution of retinal neovascularization in proliferative diabetic retinopathy using ultra-wide field angiography

Purpose: To analyze the topographic distribution of neovascularization (NV) and capillary nonperfusion (CNP) using ultra?wide field fluorescein angiography (UWFFA) in patients with proliferative diabetic retinopathy (PDR). Methods: This was a prospective, single?center, observational study in which all patients who presented between March 2019 and December 2020 and satisfied the inclusion criteria were recruited. In our study, patients with treatment?naïve PDR without any fibrovascular proliferation underwent UWFFA. The images were analyzed qualitatively for the topographic distribution of NV and the CNP area was quantified. The number of lesions picked by UWFFA was compared with 7 standard field (7SF) image using overlay of 7SF. The main outcome measure was characteristics of neovascularization, such as the number, location, and area of CNP, measured using UWFFA, which was considered with 95% confidence intervals (CI). Results: Two hundred and fifty?three eyes of 187 patients with a mean age of 56.03 ± 8 years were included. Mean neovascularization elsewhere (NVE) was 2.91 ± 3.43. Maximum NVEs were seen in the superotemporal (ST; 0.9 ± 1.13) quadrant, followed by the inferotemporal (IT; 0.7 ± 1.08), inferonasal (IN; 0.66 ± 1.02) and superonasal (SN; 0.66 ± 1.01) quadrants. Maximum CNP area was seen in the SN (13.75 ± 8.83 disc diameter square [DD2]) quadrant, followed by the IN (13.48 ± 8.59 DD2), IT (11.34 ± 8.37 DD2), and ST (11.3 ± 8.34 DD2) quadrants. Mean CNP area was maximum in patients with only neovascularization of disc (NVD; 64.99 ± 41.47 DD2), followed by both NVD and NVE (61.37 ± 35.61 DD2), and was minimum in patients with only NVE (36.44 ± 22.03 DD2). Eighty?one (32%) eyes out of 253 had NVE and 189 (75%) out of 253 had CNP area outside 7SF (overlay) of Early Treatment Diabetic Retinopathy Study (ETDRS). Conclusion: Diabetic NV lesions and CNP areas are distributed asymmetrically throughout the retina and are not restricted to the posterior pole. Compared to conventional 7SF imaging, UWFFA reveals significantly more retinal vascular pathology in patients with PDR.

Comparative proteomics of proliferative diabetic retinopathy in people with Type 2 diabetes highlights the role of inflammation, visual transduction, and extracellular matrix pathways

Purpose: To explore the vitreous humor proteome from type 2 diabetes subjects with proliferative diabetic retinopathy (PDR) in the Indian population. Methods: We performed mass spectrometry?based label?free quantitative analysis of vitreous proteome of PDR (n = 13) and idiopathic macular hole (IMH; control) subjects (n = 14). Nine samples of PDR and 10 samples of IMH were pooled as case and control, respectively, and compared. Four samples each of PDR and IMH were analyzed individually without pooling to validate the results of the pooled analysis. Comparative quantification was performed using Scaffold software which calculated the fold changes of differential expression. Bioinformatics analysis was performed using DAVID and STRING software. Results: We identified 469 proteins in PDR and 517 proteins in IMH vitreous, with an overlap of 172 proteins. Also, 297 unique proteins were identified in PDR and 345 in IMH. In PDR vitreous, 37 proteins were upregulated (P < 0.05) and 19 proteins were downregulated compared to IMH. Protein distribution analysis clearly demonstrated a separation of protein expression in PDR and IMH. Significantly upregulated proteins included fibrinogen gamma chain, fibrinogen beta chain, and carbonic anhydrase 1 and downregulated proteins included alpha?1?antitrypsin, retinol?binding protein 3, neuroserpin, cystatin C, carboxypeptidase E and cathepsin?D. Conclusion: Diabetic retinopathy pathogenesis involves proteins which belong to inflammation, visual transduction, and extracellular matrix pathways. Validation?based experiments using enzyme?linked immunosorbent assay (ELISA) or western blotting are needed to establish cause and effect relationships of these proteins to the disease state, to develop them as biomarkers or drug molecules

Retinal laser – Protocols and practical tips

Background: Many a young doctors in training find retinal laser photocoagulation a daunting task. However, if correct protocols are followed and checklists are observed, then it is not difficult to have a successful laser sitting with a happy patient. Most of the complications can be avoided with correct settings and techniques. Purpose: To enumerate the basic protocols of retinal laser photocoagulation and provide practical tips including laser settings and checklists for hassle?free laser experience. Synopsis: Laser settings for a pan?retinal photocoagulation (PRP) for proliferative diabetic retinopathy differ from those for a focal laser for macular edema. A fill in PRP is indicated when an active Proliferative diabetic retinopathy (PDR) is seen after the initial PRP is completed. The settings and protocols for laser photocoagulation for lattice degeneration are different, and various techniques of barrage laser are discussed. Practical tips and checklists are given, which will not be found in any textbooks. Highlights: Animated illustrations and fundus photos are used to explain the correct techniques of performing laser photocoagulation in different indications and scenarios. Detailed instructions and checklists are provided, which can be very useful to avoid complications and medicolegal problems. The practical tips and guidelines in an easy?to?understand manner make this video highly educational for the novice retinal surgeons who want to perfect their technique of retinal laser photocoagulation.

Application of OCTA in screening microvascular changes in non-proliferative diabetic retinopathy / 西安交通大学学报(医学版)

【Objective】 To investigate the clinical effect of optical coherence tomography angiograph (OCTA) applied in retinal microvascular screening in patients with non-proliferative diabetic retinopathy (NPDR). 【Methods】 Thirty patients with NPDR (NPDR group) diagnosed at The Third Affiliated Hospital of Soochow University and 30 healthy volunteers (control group) were selected to receive OCTA examination. The area, perimeter, and circularity of the fovea avascular zone (FAZ) were measured and blood flow density in the superior, inferior, nasal, temporal quadrants of the macular superficial retinal capillary layer (SCP) and the peripapillary radial capillary layer (RPC) of the optic disc were quantified. 【Results】 In NPDR group, blood flow density in the four quadrants of macular SCP and RPC were decreased significantly compared with that in control group (43.68±3.03 vs. 46.98±3.04, 42.79±3.17 vs. 50.45±2.25, 43.21±2.67 vs. 47.44±2.42, 44.21±3.22 vs. 51.72±5.32, 46.43±3.54 vs. 53.02±2.62, 45.97±3.67 vs. 52.53±2.82, 44.63±2.73 vs. 48.19±3.67, 41.73±3.15 vs. 45.12±3.31) (all P<0.01). The area and perimeter of FAZ in NPDR group were significantly higher than those in control group [(0.50±0.06 vs. 0.43±0.47) mm2, (3.10±0.21 vs. 2.87±0.22) mm]. The circularity of FAZ was significantly lower in NPDR group than in control group [(0.63±0.05 vs. 0.67±0.05)%, P<0.01]. 【Conclusion】 OCTA can detect early retinal microstructure changes in NPDR, and thus can be used as an auxiliary screening of NPDR to provide information for early diagnosis and treatment.

Preliminary clinical application of Keluoxin capsule for treatment of moderate and severe non-proliferative diabetic retinopathy / 中华眼底病杂志

Objective:To observe the safety and efficacy of Keluoxin capsules in the treatment of moderate to severe non-proliferative diabetic retinopathy (NPDR).Methods:An open-label, multi-center, single-arm, phase Ⅱa clinical trial. From May 2014 to December 2016, the patients diagnosed with moderate to severe NPDR who received Keroxin treatment in General Hospital of Central Theater Command, Affiliated Eye Hospital to Nanchang University, Xiyuan Hospital of China Academy of Chinese Medical Sciences, and Eye Hospital China Academy of Chinese Medical Sciences were divided into moderate NPDR group and severe NPDR group. The baseline data of the patients were obtained, best-corrected visual acuity (BCVA), optical coherence tomography, fundus fluorescein angiography and fundus photography were performed. On the basis of maintaining the original diabetes treatment, all patients took Keluoxin capsules orally for 24 weeks; 24 weeks after treatment was used as the time point for evaluating the efficacy. BCVA letters, central macular thickness (CMT) and 6 mm diameter total macular volume (TMV), retinal vascular leakage area, and retinal non-perfusion (RNP) area within an average diameter of 6 mm were compared between the two groups at baseline and 24 weeks after treatment. Independent sample Mann-Whitney U test was used to compare continuous variables between groups. Categorical data were compared by χ2 test. Results:A total of 60 NPDR patients and 60 eyes were included, 9 cases were lost to follow-up, and 51 cases and 51 eyes were finally included, including 37 eyes in the moderate NPDR group and 14 eyes in the severe NPDR group, respectively. At baseline, BCVA in moderate NPDR group and severe NPDR group were (80.1±6.8), (81.4±6.3) letters, respectively. CMT were (249.5±32.1), (258.9±22.2) μm, respectively. TMV were (8.79±1.09), (8.95±1.31) mm 3, respectively. Retinal vascular leakage areas were (7.69±10.63), (10.45±7.65) mm 2, respectively. RNP area were (2.48±5.74), (10.63±20.06) mm 2, respectively. There were 11 (29.7%, 11/37) and 4 (28.6%, 4/14) eyes with diabetic macular edema (DME), respectively; 24 weeks after treatment, BCVA in moderate NPDR group and severe NPDR group increased by (1.3±5.2), (3.2±3.0) letters, respectively. Compared with baseline, there was a statistically significant difference in the severe NPDR group ( t=-3.986, P=0.033). CMT were (252.1±45.6), (269.8± 57.2) μm, respectively. There were no significant differences compared with baseline ( t=-0.567, -0.925; P>0.05). TMV were (9.96±1.16), (10.09±1.32) mm 3, respectively. There were no significant differences compared with baseline ( t=-0.996, -1.304; P>0.05). Retinal vascular leakage area decreased (0.19±6.90), (1.98±7.52) mm 2, respectively. There were no significant differences compared with baseline ( t=0.168, 0.983; P>0.05). RNP area were (3.01±6.47), (10.36±19.57) mm 2, respectively. Compared with baseline, the differences were statistically significant ( t=-1.267, 0.553; P>0.05). There were 8 (21.6%, 8/37) and 3 (21.4%, 3/14) eyes with DME, respectively. Compared with baseline, the difference was statistically significant ( χ2=11.919, 4.571; P=0.001, 0.033). Conclusion:Keluoxin capsules can stabilize or improve BCVA, CMT, TMV and RNP area in patients with moderate and severe NPDR, and reduce the area of retinal vascular leakage.

Vitreous properties in patients with diabetes mellitus and its relationship with proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

When it comes to diabetic patients, persistent hyperglycemia and associated pathological conditions will not only cause diabetic retinopathy(DR)but also have an impact on the metabolism of vitreous, leading to diabetic vitreopathy. Owing to the adjacent anatomical position between the vitreous and retina, diabetic vitreopathy and DR are mutually promoted. Changes in vitreoretinal interface such as posterior vitreous detachment(PVD)and vitreoschisis, provide a scaffold for fibrovascular proliferative membrane and are closely associated with pars plana vitrectomy(PPV). This article sorts out the variation of diabetic patients' vitreous structure and biochemical components, along with the changes in the vitreous-retinal interface, particularly for the related research on its relationship with proliferative diabetic retinopathy(PDR), aiming at providing further cognition of diabetic vitreopathy as well as references for DR treatment and formulation of PPV.

Preoperative intravitreal injection of Conbercept combined with pars plana vitrectomy in the treatment of proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of pars plana vitrectomy(PPV)combined with preoperative intravitreal injection of conbercept in the treatment of proliferative diabetic retinopathy(PDR)and its effect on aqueous humor inflammatory factors.METHODS: A non-randomized controlled clinical trial was designed. The clinical data of 100 patients(100 eyes)with PDR who were admitted to the hospital from March 2019 to January 2022 were collected(the heavier eye was selected when both eyes had PDR, while the right eye was selected when the PDR degree was the same)and divided into control group and combined group according to their treatment wishes. The 48 eyes in the control group received PPV alone, and 52 eyes in the combined group received intravitreal injection of conbercept combined with PPV. Follow-up period was 12mo. The operative time, pre-and post-operative best corrected visual acuity(BCVA LogMAR), central retinal thickness(CRT)and postoperative complications in the two groups were statistically analyzed. And the levels of inflammatory factors(IL-6, IL-10, IFN-γ and TNF-α)in aqueous humor were compared between the two groups.RESULTS: Compared with the control group, the levels of inflammatory factors IL-6, IL-10, IFN-γ and TNF-α in aqueous humor in combination group were significantly decreased. The operation time of the combined group was significantly shorter than that of the control group, and the number of electrocoagulation, iatrogenic retinal hole and silicone oil filling were less in the combined group than those in the control group(all P&#x003C;0.05). There was no significant difference in preoperative BCVA and CRT between the two groups(all P&#x003E;0.05). The BCVA and CRT improved at 1, 6 and 12mo after surgery in both groups, but the improvement was more significant in the combined group(all P&#x003C;0.05). The postoperative incidence of complications in the combined group were lower than that in the control group(11.5% vs. 35.4%, P&#x003C;0.05). There was no significant difference in the recurrence rate of PDR between the two groups(P&#x003E;0.05).CONCLUSIONS: Intravitreal injection of conbercept combined with PPV in the treatment of PDR has a significant effect, which can shorten the operation time, inhibit the inflammatory effect, reduce postoperative complications, and contribute to the improvement of patients' vision.

Effect of panretinal photocoagulation combined with intravitreal Conbercept in the treatment of proliferative diabetic retinopathy with different stages / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effectiveness of panretinal photocoagulation(PRP)combined with intravitreal conbercept(IVC)for patients with different stages of proliferative diabetic retinopathy(PDR).METHODS: Retrospective study. The medical records for 100 patients(100 eyes)with PDR treated with PRP combined with IVC from January 2018 to June 2020 were reviewed, including 34 eyes with early PDR(group A), 43 with high-risk PDR(group B), and 23 with fibrovascular PDR(group C). The baseline information, best corrected visual acuity(BCVA), central macular thickness(CMT), the rate of vitrectomy and retinal detachment of the patients in the three groups at 1, 3, 6mo and the last follow-up after combination treatment were observed.RESULTS: The patients were followed up for 14.60±11.64mo(6-52mo), with a mean age of 54.22 ±9.32 years. We found 15 eyes(15.0%)who underwent vitrectomy after the combination treatment. The vitrectomy rates of the three groups were 2.9% in group A, 13.9% in group B, and 34.7% in group C. We found no instances of retinal detachment after the treatments. Most patients demonstrated improved BCVA and CMT values with the treatments.CONCLUSION: PRP combined with IVC is safe and effective in patients with different PDR stages.

Effect of anti-vascular endothelial growth factor therapy on intraocular inflammatory cytokine levels in the treatment of proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the effects of anti-vascular endothelial growth factor(VEGF)agents(Conbercept)before pars plana vitrectomy(PPV)on inflammatory cytokine levels of patients with proliferative diabetic retinopathy(PDR).METHODS: A total of 49 patients(49 eyes)who diagnosed with PDR at the First Affiliated Hospital with Nanjing Medical University from June 2017 to January 2018 were recruited and randomly divided into two groups. A total of 25 cases(25 eyes)who did not receive intravitreal injection before PPV were included in no-intravitreal injection of Conbercept(IVC)group, and 24 cases(24 eyes)who received IVC 5～7d before PPV were included in IVC group. The vitreous samples were collected from all the patients at the start of PPV. Levels of VEGF-A, monocyte chemotactic protein-1(MCP-1)and inflammatory cytokines in the vitreous humor were measured using Luminex technology.RESULTS: Compared with the no-IVC group, the level of VEGF-A decreased significantly(P&#x003C;0.001), the concentration of IL-6(P=0.004), IL-8(P=0.002), IL-18(P=0.04)and TNF-α(P=0.03)increased remarkably in the IVC group. The other inflammatory cytokines in the vitreous humor showed no significant difference between the IVC and no-IVC groups.CONCLUSION: IVC before PPV can effectively decrease the concentration of VEGF-A, but had limited influence on the level of inflammatory cytokines in the vitreous humor of patients with PDR.

Risk factors associated with neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the risk factors associated with neovascular glaucoma(NVG)after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).METHODS: The PDR patients who received 23G PPV treatment at Shenyang He Eye Specialist Hospital from October 2015 to September 2020 and were followed up for at least 12mo with complete data were retrospectively collected. The patients were divided into two groups according to the occurrence of NVG during follow-up. The preoperative and intraoperative variables between two groups were compared. The cumulative hazard ratio for NVG was evaluated. RESULTS: A total of 151 PDR patients(169 eyes)with a mean follow-up of 18.07±12.55(1～79)mo were included, of which 30(17.8%)eyes developed NVG, the mean time of occurrence was 6.27±4.01(1～17)mo, and 50%(15 eyes)of NVG occurred within 5mo after vitrectomy. The cumulative hazard ratios of NVG at postoperative 3, 6 and 12mo were 4.8%, 12.6% and 18.1%, respectively. Multivariate logistic regression analysis showed that preoperative best corrected visual acuity(OR=3.077, 95%CI: 1.203～7.869, P=0.019), preoperative iris rubeosis(OR=7.897, 95%CI: 1.313～47.498, P=0.024), and contralateral NVG(OR=22.108, 95%CI: 1.562～312.861, P=0.022)were risk factors with the occurrence of NVG, while the number of intraoperative retinal laser photocoagulation(OR=0.772, 95%CI: 0.666～0.893, P=0.001)was the protective factor with the occurrence of NVG.CONCLUSIONS: The incidence of NVG in PDR eyes after PPV was 17.8%, of which 50% occurred within 5mo after surgery. PDR eyes with poor baseline visual acuity, iris rubeosis, and contralateral NVG are prone to postoperative NVG, and sufficient intraoperative retinal laser photocoagulation has a certain protective effect. PDR eyes after PPV should be closely followed up for 1a.

Evaluation of macular microvasculature alterations in patients with proliferative diabetic retinopathy after vitrectomy by swept-source optical coherence tomography angiography / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the changes in retinal and choroidal blood flow after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).METHODS: A cross-sectional study was conducted on 35 patients(35 eyes)who were diagnosed as monocular PDR and received 23GPPV in ophthalmology department of the Second People's Hospital of Hefei between September 2020 and July 2022. All eyes underwent swept-source optical coherence tomography angiography(SS-OCTA)examination. Retinal and choroidal vascular parameters within 3mm×3mm of macular zone were measured by built-in analyzer, and its correlation with postoperative best corrected visual acuity(BCVA)was analyzed.RESULTS: The follow-up was 1～22(average 9.72±6.67)mo. At the last follow-up, flow area(FA)of intermediate capillary plexus(ICP)layer in paranasal foveal region was significantly reduced in PPV eyes(0.31±0.06mm2)compared with contralateral eyes(0.38±0.05mm2), and FA of deep capillary plexus(DCP)in temporal foveal region was significantly lower in PPV eyes(0.19±0.08mm2)than contralateral eyes(0.27±0.07mm2; all P&#x003C;0.05). Choroidal vascularity index(CVI)were lower in PPV eyes than contralateral eyes in parafoveal subregions except temporal region(P&#x003C;0.05). After PPV, BCVA had a certain correlation with the density and FA of middle and deep retinal vessels.CONCLUSIONS: Eyes with severe PDR may be prone to having a decrease in the DCP and parafoveal choroidal perfusion in the parafoveal regions after PPV than contralateral eyes.

Efficacy of preoperative intravitreal injection of Conbercept combined with 25G+ pars plana vitrectomy in the treatment of proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the efficacy of preoperative intravitreal injection of conbercept combined with 25G+ pars plana vitrectomy(PPV)in the treatment of proliferative diabetic retinopathy(PDR).METHODS: The clinical data of 154 patients(176 eyes)with PDR admitted to our hospital from January 2019 to June 2021 were collected for retrospective analysis. According to the treatment methods, 80 patients(92 eyes)in combined treatment group were treated with preoperative intravitreal injection of conbercept combined with 25G+PPV, and 74 patients(84 eyes)in control group were given 25G+PPV only. The postoperative clinical efficacy and levels of adipokines [adiponectin(APN), retinol binding protein 4(RBP4)] before and after surgery were compared between both groups of patients.RESULTS: The combined treatment group showed better clinical efficacy than the control group at 1mo after surgery(P&#x003C;0.05). Both groups had lower RBP4 levels at 3mo after surgery(P&#x003C;0.05), with the combined treatment group showing a lower level than the control group(P&#x003C;0.05). Serum APN levels significantly increased in both groups after surgery(P&#x003C;0.05), with the combined treatment group having a higher level than the control group(P&#x003C;0.05). The combined treatment group had lower incidence rates of retinal proliferation and postoperative complications after than the control group 3mo of follow-up(P&#x003C;0.05).CONCLUSION: Preoperative intravitreal injection of conbercept combined with 25G+PPV is beneficial in improving the therapeutic effect of PDR and reducing the incidence rates of complications, which may be related to the regulations of the expressions of adipokines.

Efficacy of 25G pars plana vitrectomy with Conbercept intravitreal injection at the end of surgery for early proliferative diabetic retinopathy with vitreous hemorrhage / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy and safety of intravitreal injection of Conbercept combined with 25G minimally invasive pars plana vitrectomy(PPV)at the end of surgery for early proliferative diabetic retinopathy(PDR)with vitreous hemorrhage.METHODS: A total of 60 patients(60 eyes)with PDR complicated with vitreous hemorrhage requiring PPV at the Affiliated Eye Hospital of Nanjing Medical University were retrospectively analyzed. Based on the injection timing of Conbercept, the patients were divided into 3 groups: 20 patients(20 eyes)injected at the end of the surgery(group A), 20 patients(20 eyes)injected preoperatively(group B), and 20 patients(20 eyes)without injection(group C). The differences in pre- and post-operative visual acuity, intraocular pressure, intraoperative conditions, prognosis, and complications were analyzed among the 3 groups.RESULTS: There were no significant differences in the preoperative conditions and operation time among the patients. There was no iatrogenic retinal hole or silicone oil tamponade during the operation in the 3 groups, and no recurrent retinal detachment occurred after the operations. Best corrected visual acuity(BCVA)at 1, 3 and 6mo of all groups were improved compared with those before the surgery(P<0.05), and the injection groups(group A and group B)had a significantly better postoperative improvement than the non-injection group(group C), and there were significant differences(P<0.05). The incidence of postoperative late vitreous hemorrhage(1mo after operation)in group A was significantly lower than those in groups B and C(P<0.05). The central retinal thickness of the operated eyes in the injection groups(groups A and B)was significantly lower than that in the non-injection group(group C)at 1, 3 and 6mo after operation(P<0.05).CONCLUSION: Conbercept injection at the end of the surgery and preoperative injection are both safe and effective for early PDR and can significantly improve postoperative visual acuity. However, Conbercept injection at the end of surgery can reduce the risk of late vitreous hemorrhage recurrence, leading to better PPV outcomes and improving patients' retinal and visual function and quality of life.

Effect of 25G+pars plana vitrectomy combined with preoperative intravitreal injection of Conbercept on proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical effect of 25G+pars plana vitrectomy(PPV)combined with preoperative intravitreal injection of conbercept in the treatment of patients with proliferative diabetic retinopathy(PDR), and analyze the influence on visual acuity, central foveal thickness(CMT)and serum vascular endothelial growth factor(VEGF)level.METHODS: A retrospective study was conducted from October 2019 to January 2022. A total of 80 patients(87 eyes)with PDR were divided into the two groups according to the treatment method, with 40 patients(45 eyes)treated with 25G+PPV in the control group, and 40 patients(42 eyes)treated with 25G+PPV combined with preoperative intravitreal injection of conbercept in the observation group. The two groups were compared in terms of the best corrected visual acuity(BCVA), intraocular pressure, CMT and serum VEGF level before treatment and at 2wk, 1 and 3mo after treatment. The patients were followed up for 3mo, with postoperative complications and recurrence recorded.RESULTS: The incidence of intraoperative bleeding in the observation group was significantly lower than that in the control group(P&#x0026;#x003C;0.05). After treatment, the BCVA of the two groups was improved(P&#x0026;#x003C;0.05), CMT and serum VEGF level were decreased(P&#x0026;#x003C;0.05), but there was no significant change in intraocular pressure(P&#x0026;#x003E;0.05). The BCVA and CMT of observation group were lower than those of control group at 1 and 3mo after treatment(P&#x0026;#x003C;0.05). Serum VEGF level in the observation group was lower than that in the control group at 3mo after treatment(P&#x0026;#x003C;0.05). The incidence of complications in observation group(5%)within 3mo after treatment was significantly lower than that in control group(18%; P&#x0026;#x003C;0.05). There was no statistically significant difference in recurrence rate of PDR between the two groups(P&#x0026;#x003E;0.05).CONCLUSION: With few complications, 25G+PPV combined with preoperative intravitreal injection of conbercept is effective in the treatment of patients with PDR, which can better promote postoperative vision recovery, improve macular edema, and reduce serum VEGF level.

Factors affecting the risk of non-proliferative diabetic retinopathy among patients with type 2 diabetic mellitus / 预防医学

Objective@#To investigate the factors affecting the development of non-proliferative diabetic retinopathy (NPDR) among patients with type 2 diabetic mellitus (T2DM), so as to provide insights into manangement of NPDR.@*Methods@#T2DM patients without obvious eye discomfort at ages of 18 years and older admitted to Department of Endocrinology, Jining No. 1 People's Hospital during the period from December 2019 to May 2021 were enrolled. Participants' demographics, smoking, alcohol consumption, medical history of diabetes and use of medicines were collected, and the height, weight and blood pressure were measured. The levels of glycosylated hemoglobin (HbA1c), fasting blood glucose, blood C-peptide, lipid and creatinine were tested, and retinopathy was examined with a non-mydriatic fundus camera. The factors affecting the development of NPDR were identified among T2DM patients using a multivariable logistic regression model.@*Results@#A total of 486 T2DM patients were enrolled, including 354 men (72.84%), with a median age of 48.00 (15.25) years, and median diabetes duration of 35.00 (104.25) months. The prevalence of NPDR was 19.34% among the participants. multivariable logistic regression analysis identified an educational level of senior high school and above (OR=0.546, 95%CI: 0.325-0.918), duration of diabetes (OR=1.008, 95%CI: 1.005-1.012), HbA1c (OR=1.183, 95%CI: 1.034-1.354) and use of non-sulfonylurea insulin secretagogues (OR=1.859, 95%CI: 1.082-3.196) as factors affecting the risk of NPDR among T2DM patients.@*Conclusion@#A high risk of NPDR is found among T2DM patients with a low educational level, long duration of diabetes, poor HbA1c control and use of non-sulfonylurea insulin secretagogues.

Ultrasonic fragmentation for removing thick organized clots during diabetic vitrectomy – A novel technique

A 65?year?old male with proliferative diabetic retinopathy (PDR) and non?clearing vitreous hemorrhage underwent 25G pars plana vitrectomy (PPV). A large disk of thick organized blood of 5 disk diameter (DD) size was encountered in subhyaloid space. All attempts including lower cut rates to remove this disk using a 25G cutter turned futile. We used a 20G fragmatome to safely remove this hard clot from vitreous cavity in 50 s. Surgical time for removal of similar clot of 3 DD by 25G cutter in another eye was 5 min. Removal of thick clotted subhyaloid blood by ultrasonic fragmentation during diabetic vitrectomy is a safe, faster, and useful maneuver.

Efficacy of addition and subtraction of Buyang Huanwu decoction in the adjuvant treatment of non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of addition and subtraction of Buyang Huanwu decoction in the adjuvant treatment of non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis and its effects on traditional Chinese medicine(TCM)syndromes and visual function level. <p>METHODS: A total of 110 patients with non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis in our hospital between January 2017 and December 2019 were selected and divided into observation group(55 cases, 110 eyes)and control group(55 cases, 110 eyes). Patients in control group received conventional treatment according to the condition of patients with reference to relevant guidelines, and patients in observation group were combined with addition and subtraction of Buyang Huanwu decoction adjuvant therapy on this basis. The clinical efficacy after 3mo of treatment, and TCM syndromes scores, clinical indicators(macular edema score, macular retinal volume, macular foveal retinal thickness), visual function(best corrected visual acuity, average visual field sensitivity)and serum biochemical indicators \〖vascular endothelial growth factor(VEGF), hypoxia-inducible factor-1(HIF-1)\〗 before treatment and 3mo after treatment were compared between the two groups.<p>RESULTS: After 3mo of treatment, the total effective rate of treatment in observation group was significantly higher than that in control group(<i>P</i><0.05). After 3mo of treatment, the TCM syndromes scores in the two groups were decreased compared with those before treatment, and the scores in observation group were lower than those in control group(<i>P</i><0.05). After 3mo of treatment, the macular edema score, macular retinal volume and macular foveal retinal thickness in the two groups were reduced compared with those before treatment, and the indexes in observation group were smaller than those in control group(<i>P</i><0.05). After 3mo of treatment, the best corrected visual acuity and average visual field sensitivity in the two groups were improved compared with those before treatment, and the indexes in observation group were higher than those in control group(<i>P</i><0.05). After 3mo of treatment, the levels of serum VEGF and HIF-1 in the two groups were decreased compared with those before treatment, and the levels in observation group were lower than those in control group(<i>P</i><0.05). <p>CONCLUSION: Addition and subtraction of Buyang Huanwu decoction has an exact efficacy in the adjuvant treatment of non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis, and it can improve symptoms and promote visual function recovery by reducing the expressions of VEGF and HIF-1.

Influencing factors and predictive model of macular retinal blood flow density after vitrectomy with PDR / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the changes and influencing factors of macular retinal blood flow density in patients with proliferative diabetic retinopathy(PDR)after vitrectomy, and establish a predictive model.METHODS: The clinical data of 173 patients with 173 eyes in PDR who underwent vitrectomy in our hospital from June 2019 to June 2021 were analyzed retrospectively. According to the changes of macular retinal blood flow density after operation, the patients were divided into normal group(118 cases with 118 eyes)and descending group(55 cases with 55 eyes). The general data, preoperative laboratory examination index and intraoperative condition of the two groups were compared. Multivariate Logistic regression was used to analyze the factors affecting the changes of retinal blood flow density in macular area after operation. Construct the line chart prediction model and evaluate its prediction efficiency.RESULTS: The course of diabetes, proportion of patients with complicated maculopathy, serum TC, TG, LDL-C, HbA1c, vascular occlusion and hyperplastic retinal traction in the decreasing group were significantly higher than those in the normal group, while HDL-C was significantly lower than that in the normal group(P<0.05). Multivariate Logistic regression analysis showed that course of diabetes > 17a(OR=4.526), complicated maculopathy(OR=4.983), HbA1c > 6.25%(OR=4.283), vascular occlusion(OR=5.216)and hyperplastic retinal traction(OR=4.765)were all risk factors of the decrease of macular retinal blood flow density after operation(P<0.05). The line chart prediction model has good differentiation and accuracy, and has high prediction value. CONCLUSION: Course of diabetes, complicated maculopathy, HbA1c, vascular occlusion and proliferative retinal traction are all related to the decrease of macular retinal blood flow density after vitrectomy with PDR. Understanding the risk factors is beneficial to surgical decision-making.

Expression and clinical significance of LncRNA HIF1A-AS1 in proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the expression and diagnostic value of long non-coding RNA(LncRNA)hypoxia-inducible factor 1 alpha antisense RNA 1(HIF1A-AS1)in serum of patients with proliferative diabetic retinopathy(PDR).METHODS: A total of 160 patients with diabetic retinopathy(DR)admitted to our hospital from July 2019 to July 2021 were selected as the research objects. According to the degree of disease, they were divided into PDR group(80 cases)and nonproliferative diabetic retinopathy(NPDR)group(80 cases). At the same time, 100 healthy cases in our hospital were selected as the control group. Detect and compare serum triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), fasting blood glucose(FBG)and the level of glycosylated hemoglobin A1c(HbA1c); The expression level of LncRNA HIF1A-AS1 in serum was detected by real-time fluorescence quantitative PCR(qRT-PCR)method; Logistic regression was used to analyze the risk factors that affected the occurrence of PDR; Receiver operating characteristic curve(ROC)was used to analyze the clinical value of LncRNA HIF1A-AS1 level in the diagnosis of PDR. RESULTS: The expression level of LncRNA HIF1A-AS1 in the serum of the patients in the PDR group was significantly higher than that in the NPDR group and the control group, and the NPDR group was higher than the control group(P&#x003C;0.05); The course of disease, HbA1c, TC, TG, LDL-C, FBG levels in the PDR group and the NPDR group were significantly higher than those of the control group, the HDL-C level in the PDR group was significantly lower than that in the control group(P&#x003C;0.05); The level of LncRNA HIF1A-AS1 was positively correlated with the course of disease, HbA1c, TC, TG, LDL-C and FBG(P&#x003C;0.05), and negatively correlated with HDL-C(P&#x003C;0.05); Logistic regression analysis showed that the LncRNA HIF1A-AS1, course of disease, FBG, HbA1c, TC, TG, LDL-C were all risk factors for PDR(P&#x003C;0.05); ROC results showed that the area under the curve(AUC)of the LncRNA HIF1A-AS1 level predicting PDR was 0.766(95%CI: 0.692～0.829), the corresponding sensitivity was 66.25% and the specificity was 78.75%.CONCLUSION: The level of LncRNA HIF1A-AS1 in the serum of PDR patients is up-regulated, it is a risk factor for the occurrence of PDR and it can be used as a potential serological indicator for predicting the occurrence of PDR.