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Objective@#To evaluate the efficacy and outcome of 25 gouge (25G) minimally invasive vitrectomy combined with cataract extraction and trabeculectomy surgeries for malignant glaucoma.@*Methods@#Retrospective cohort study was performed.Clinical data of 19 malignant glaucoma patients (19 eyes) who received 25G minimally vitrectomy from January 2012 to January 2017 in Wuxi People's Hospital were reviewed retrospectively.The operative methods were selected according to the predisposing cause.25G vitrectomy combined with cataract extraction and posterior capsulotomy were performed on the malignant glaucoma eyes after trabeculectomy, and 25G vitrectomy combined with cataract extraction, trabeculectomy and posterior capsulotomy were performed on the malignant glaucoma eyes after non-trabeculectomy.Best corrected visual acuity (BCVA) was examined by international visual acuity chart.The ocular axis length and intraocular pressure (IOP) were measured with A-mode ultrasonic apparatus and non-contact tonometer, respectively.The anterior chamber depth was measured with ultrasound biomicroscope (UBM). The study followed the declaration of Helsinki and all patients signed informed consent before surgery.@*Results@#The operation was successfully completed in 19 patients.All patients suffered moderate to severe anterior chamber inflammation after operation.The average age of onset in the patients was (58.00±6.20) years, and the mean ocular axial length was (20.81±0.56)mm.Malignant glaucoma occurred in 11 eyes after trabeculectomy, 2 eyes after combination of anti-glaucoma with cataract extraction, 2 eyes after laser iridotomy, 2 eyes after paracentesis of anterior chamber and 2 eyes with unknown causes.The visual acuity was significantly improved 3 months after operation in comparison with before operation (Z=-3.826, P<0.001). The mean IOP was (12.16±2.27)mmHg (1 mmHg=0.133 kPa) in postoperation, which was significantly lower than (38.84±5.97)mmHg in preoperation (t=17.68, P<0.05). The depth of anterior chamber was increased from preoperative (0.95±0.28)mm to postoperative (2.43±0.15) mm (t=20.06, P<0.05). UBM image showed that the position of ciliary body was normal without edema.@*Conclusions@#The combination procedure of 25G minimally invasive vitrectomy with relative surgery for malignant glaucoma is effective by lowing IOP, rescuing visual acuity and reducing surgical risk.
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Objective To measure the concentration of serum transthyretin (TTR) of patients with different stages of diabetic retinopathy (DR).Methods A total of 176 patients with diabetes mellitus were included in this study.There were 104 males and 72 females.The patients aged from 21 to 74 years,with the mean age of(56± 11) years.The diabetes duration raged from 1 to 30 years,with the mean diabetes duration of (10 ± 7) years.The HbA 1C was 5.2％-14.1％,with the mean HbA 1C of (8.6 ± 2.0)％.According to the fundus examination,58 patients had DR (33.0％),but the other 118 patients not (67.0％).For these DR patients,10 patients were in stage Ⅰ (5.7％),26 patients in stage Ⅱ (14.8％),8 patients in stage Ⅲ (4.5％),and 14 patients in stage Ⅳ (8.0％).The concentration of serum TTR was measured by enzyme-linked immunosorbentassay kit.The differences in the concentration of serum TTR between different DR stages were compared.Bivariate analysis was used to analyze the influencing factors of TTR.Results The concentrations of serum TTR of the patients without DR or with DR of stage Ⅰ to Ⅳ were (224.96±65.47),(383.68± 102.99),(247.44±63.21),(228.2 ± 45.89),(189.34± 70.12) mg/L,respectively.The difference between different DR stages was statistically significant (F=14.690,P＜ 0.001).Bivariate analysis showed that the concentration of TTR was correlation to DR (r=0.179,P=0.017).There was no correlation between the concentration of TTR and diabetes duration (r=-0.027,P=0.727),hypertension (r=0.018,P=0.810),hyperlipoidemia (r=0.101,P=0.182),and the use of insulin (r=-0.032,P=0.675).Conclusion The concentration of serum TTR was increased in early DR patients,and gradually decreased with the progression of DR.The concentration of TTR is correlated to DR.
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Background As a main cellular component of retinal microvascular,retinal vascular endothelial cells (RVECs) play critical roles in the occurrence and development of diabetic retinopathy (DR) by proliferating,migrating and angiogenesis.Apolipoprotein A-Ⅰ (ApoA-Ⅰ) is the major apolipoprotein of high density lipoprotein.ApoA-Ⅰ is overexpressed in the retina of diabetic patients and plays different effects on RVECs upon different microenvironments,but its relationship with RVECs in high glucose environment is still not elucidated.Objective This study was to investigate the effects of ApoA-Ⅰ on proliferation,migration,tubulogenesis and vascular endothelial growth factor (VEGF) expression in human RVECs (hRVECs) in high glucose environment.Methods hRVECs were cultured with DMEM containing 10％ fetal bovine serum and passaged,and the cells at generation 3 to 6 were used in the study.The cells were divided into low-glucose group,low-glucose+ApoA-Ⅰ group,high-glucose group and high-glucose+ApoA-Ⅰ group,and the low concentration glucose (5 mmol/L),high contration glucose (25 mmol/L)and ApoA-Ⅰ (30 μg/ml) was added separately according to grouping.The proliferation and migration rate of the cells were evaluated by cell counting kit-8 (CCK-8) assay and scratch wound test respectively.The tubulogenesis of the cells was examined by tube formation test.The mRNA and protein expression of VEGF in the cells was detected by using real-time fluorescence quantitative PCR and Western blot.Results The prolifative value (absorbancy) and migration rate of the cells in the high-glucose group were significantly higher than those in the low-glucose group,and those in the high-glucose+ApoA-Ⅰ group were significantly reduced in comparion with the high-glucose group (A value:P =0.001,0.033;migration rate:P =0.001,0.010).The number of tubes in the low-glucose group,low-glucose+ ApoA-Ⅰ group,high-glucose group and high-glucose+ApoA-Ⅰ group was 7.250±2.217,9.250±2.630,19.000± 3.916 and 11.500±3.697,showing a significant difference among the groups (F=10.335,P=0.001).The number of tubes in the high-glucose group was more than that in the low-glucose group,and the number of tubes in the highglucose+ApoA-Ⅰ group was less that that in the high-glucose group (P=0.001,0.037).The relative expression levels of VEGF mRNA were 0.944 ± 0.083,1.117 ± 0.204,1.768 ± 0.164 and 1.301 ± 0.077,and those of V EGF protein were 1.000±0.130,1.217±0.152,1.871 ±0.101 and 1.609±0.087 in the low-glucose group,low-glucose+ ApoA-Ⅰ group,high-glucose group and high-glucose+ApoA-Ⅰ group,respectively,with significant differences among the groups (mRNA:F =18.640,P =0.001;protein:F =10.335,P =0.001),and the expressions of VEGF mRNA and protein in the high-glucose group were significantly higher than those in the low-glucose group and high glucose+ ApoA-Ⅰ group (mRNA:P=0.000,0.004;protein:P=0.000,0.029).Conclusions ApoA-Ⅰ plays inhibitory effects on the proliferation,migration and tubulogenesis of hRVECs in high glucose environment,which may be associated with the downregulation of VEGF expression.