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Ferroptosis is a unique and new mode of cell death, which is driven by iron-dependent lipid peroxidation and mainly characterized by the accumulation of reactive oxygen species in cytoplasm and lipids. Ferroptosis plays an important role in the pathogenesis of many ocular fundus diseases, such as retinitis pigmentosa, age-related macular degeneration, diabetic retinopathy, retinal detachment, retinoblastoma and so on. The use of ferroptosis-related inhibitors or activators can regulate the course of the disease and provide new ideas for the research, prevention and treatment of ophthalmic diseases.
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Objective:To compare and analyze the application of anti-vascular endothelial growth factor (VEGF) drugs for intravitreal injection in the real world before and after the establishment of one-stop intravitreal injection center, as well as the advantages and disadvantages of different management modes.Methods:A retrospective clinical study. A total of 4 015 patients (4 659 eyes) who received anti-VEGF drugs for ocular fundus diseases at the Tianjin Medical University Eye Hospital from July, 2018 to June, 2022 were included in the study. There were 2 146 males and 1 869 females. The ocular fundus diseases in this study were as follows: 1 090 eyes of 968 patients with wet age-related macular degeneration (wAMD); 855 eyes of 654 patients with diabetic macular edema (DME); 1 158 eyes of 980 patients with diabetic retinopathy (DR); 930 eyes of 916 patients with macular edema secondary to retinal vein occlusion (RVO-ME). A total of 294 eyes of 275 patients with choroidal neovascularization secondary to pathological myopia (PM-CNV); 332 eyes of 222 patients with other fundus diseases. A total of 13 796 anti-VEGF needles were injected. A total of 1 252 patients (1 403 eyes) from July 2018 to June 2020 were regarded as the control group. From July 2020 to June 2022, 2 763 patients (3 256 eyes) who received anti-VEGF treatment in the intravitreal injection center were regarded as the observation group. The total number of intravitreal injection needles, the distribution of anti-VEGF therapy in each disease according to disease classification, the proportion of patients who chose the 3+ on-demand treatment (PRN) regimen and the distribution of clinical application of different anti-VEGF drugs were compared between the control group and the observation group. The waiting time and medical experience of patients were investigated by questionnaire. χ2 test was used to compare the count data between the two groups, and t test was used to compare the measurement data. Results:Among the 13 796 anti-VEGF injections in 4 659 eyes, the total number of anti-VEGF drugs used in the control and observation groups were 4 762 and 9 034, respectively, with an average of (3.39±3.78) and (2.78±2.27) injections per eye ( t=6.900, P<0.001), respectively. In the control and observation groups, a total of 1 728 and 2 705 injections of anti-VEGF drugs were used for wAMD with an average of (5.14±4.56) and (3.59±2.45) injections per eye, respectively; a total of 982 and 2 038 injections of anti-VEGF drugs were used for DME with an average of (4.36±4.91) and (3.24±2.77) needles per eye, respectively. Additionally, a total of 942 and 2 179 injections of anti-VEGF drugs were injected for RVO-ME with an average of (3.98±3.71) and (3.14±2.15) injections per eye, respectively; a total of 291 and 615 injections of anti-VEGF drugs were injected for PM-CNV with an average of (3.31±2.63) and (2.99±1.69) injections per eye, respectively. A total of 683 and 1 029 injections of anti-VEGF drugs were injected for DR with an average of (1.60±1.26) and (1.41±1.05) injections per eye, respectively. The clinical application and implementation of "3+PRN" treatment were as follows: 223 (66.4%, 223/336) and 431 eyes (57.2%, 431/754) in the wAMD ( χ2=8.210, P=0.004), 75 (33.3%, 75/225) and 236 (37.5%, 236/630) eyes in the DME ( χ2=1.220, P>0.05), and 97 (40.9%, 97/237) and 355 eyes (51.2%, 355/693) in the RVO-ME ( χ2=7.498, P=0.006), 39 (44.3%, 39/88) and 111 eyes (53.9%, 111/206) in the PM-CNV ( χ2=2.258, P>0.05), respectively. In addition, the results of the questionnaire survey showed that there were significant differences between the control and observation groups regarding the time of appointment waiting for surgery ( t=1.340), time from admission to entering the operating room on the day of injection ( t=2.780), time from completing preoperative treatment preparation to waiting for entering the operating room ( t=8.390), and time from admission to discharge ( t=6.060) ( P<0.05). Conclusions:The establishment of a one-stop intravitreal injection mode greatly improved work efficiency and increased the number of injections. At the same time, the compliance, waiting time, and overall medical experience of patients significantly improved under centralized management.
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Chronic disease is a major threat to human health. Fundus disease has become a major ophthalmic disease affecting daily life. Although great breakthroughs have been made in the treatment, compared with other chronic disease management, the management of patients with fundus disease is still in its infancy. To strengthen the management exploration of patients with fundus diseases, establish a management model of fundus diseases and strive to improve patients' awareness of fundus diseases and adherence to treatment and follow-up are the great challenges at present. All ophthalmic centers should strengthen patient education, establish a regional cooperation network, support the construction of grassroots medical capacity, cultivate talents, enhance training, promote the standardized treatment of fundus diseases, standardize fundus imaging inspection and diagnosis, and promote the homogeneous construction of diagnosis and treatment of chronic fundus diseases. We will accelerate the construction of a hierarchical diagnosis and treatment system and the ability to link consultation and referral. Through systematic management and intervention of fundus diseases, a large number of patients with fundus diseases will receive early screening, diagnosis, standardized continuous treatment and systematic management, and improve the quality of life of patients with fundus diseases.
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AIM: To analyze the screening status of neonatal fundus disease and the related influencing factors of common fundus retinal hemorrhage in Longhua District of Shenzhen, so as to provide references for the prevention, screening and intervention of neonatal fundus disease in clinical practice.METHODS: A total of 3 101 neonates who received fundus screening in the People's Hospital of Longhua, Shenzen from September 2019 to October 2022 were selected as research objects. The screening results were summarized, and the risk factors for neonatal retinal hemorrhage were analyzed by Logistic regression model.RESULTS: The detection rate of neonatal fundus abnormalities was 12.71%, and the detection rate of neonatal retinal hemorrhage was the highest(12.19%). The other types of fundus abnormalities included periretinal white focus, chromatosis, pigment shedding, choroid coloboma and nystagmus. Hemorrhage grade I accounted for the largest proportion of 378 neonates with retinal hemorrhage(75.66%). Follow-up found that different grades of retinal hemorrhage could be automatically absorbed over time without excessive intervention. Logistic analysis suggested that spontaneous delivery [OR=3.180, 95%CI(1.543～6.555)], twin pregnancy [OR=2.119, 95%CI(1.121～4.007)] and umbilical cord round the neck [OR=1.547, 95%CI(1.239～1.930)] were risk factors affecting neonatal retinal hemorrhage.CONCLUSION: Retinal hemorrhage is the most common type of fundus abnormalities in neonates. Spontaneous delivery, twin pregnancy and umbilical cord around the neck are risk factors of retinal hemorrhage. It is recommended that pay attention to the above factors and choose appropriate intervention means to avoid serious fundus complications.
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@#AIM: To explore the influencing factors and coping strategies of adverse reaction after retinal laser photocoagulation.<p>METHODS: Retrospective analysis of 1 165 cases of adverse reactions in patients with retinal laser photocoagulation in our hospital.<p>RESULTS: The present study included 50 patients with adverse reactions in 1 165 patients(4.29%), including 13 patients with nausea and vomiting(1.12%), 21 patients with dizziness, chest tightness, cold sweat(1.80%), 4 cases with yawning and drowsiness(0.34%), 12 cases with syncope(1.03%), and no death. There was no difference in the incidence of adverse reactions between men and women(3.68% <i>vs</i> 5.14%, χ2=1.474, <i>P</i>=0.225); there was a difference in the incidence of adverse reactions among patients of different ages(χ2=48.817, <i>P</i><0.05)and under 40. The incidence of adverse reactions was higher than that of patients aged 40 and older, and the incidence of adverse reactions in men under 40 was significantly lower than that in women(8.46% <i>vs</i> 18.60%, χ2=6.094, <i>P</i>=0.014). The adverse reactions of patients with different fundus diseases were different.<p>CONCLUSION: The incidence and degree of postoperative adverse reactions in patients with fundus diseases treated by retinal laser photocoagulation are different, so we should understand the history and mental state of the patients in detail before operation, and prepare the patients with high risk factors and possible serious reactions in time to ensure the safety of the patients.
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@#AIM: To investigate the relationship between retinal arteriosclerosisand cardiovascular and cerebrovascular diseases in type 2 diabetes mellitus. <p>METHODS:Totally 85 patients with type 2 diabetes mellitus in our hospital from January 2016 to January 2017 were selected as the research subjects. Fundus examination was carried out to determine the classification of ophthalmic arteriosclerosis. The blood glucose level of the patients was detected and the glycosylated hemoglobin,fasting blood glucose and postprandial blood glucose levels were measured. All patients were followed up for at least 1 and a half years, and the cardiovascular and cerebrovascular diseases rate was statistically analyzed during the follow up period. The blood glucose level and cardiovascular and cerebrovascular diseases rate in patients with different ocular fundus arteriosclerosis grades were compared, meanwhile the relationship between ocular fundus arteriosclerosis grades with the blood glucose levels and cardiovascular and cerebrovascular diseases rate were analyzed. <p>RESULTS: Among the 85 patients, 15%(13/85), 52%(44/85)and 33%(28/85)of the patients were classified asocular fundus arteriosclerosis grades Ⅰ, Ⅱ and Ⅲ respectively. The cardiovascular and cerebrovascular diseases rate during the follow up period was 27%(23/85). The glycosylated hemoglobin,fasting blood glucose, postprandial blood glucose and cardiovascular and cerebrovascular diseases rates were all increased with the elevation of ophthalmic arteriosclerosis(<i>P</i><0.05). Spearman correlation analysis showed that the classification of ophthalmic arteriosclerosis in type 2 diabetes mellitus was positively correlated with glycosylated hemoglobin,fasting blood glucose, postprandial blood glucose level and cardiovascular and cerebrovascular diseases rate(<i>r<sub>s</sub></i>=0.875, 0.792, 0.835, 0.878; <i>P</i><0.05). <p>CONCLUSION:Type 2 diabetes mellitus patients has severe fundus arteriosclerosis, which is closely related to blood glucose level and cardiovascular and cerebrovascular diseases.
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Cysteine-rich protein 61 (CYR61) is a secreted protein.It consists of four different structural domains and plays an important role in all kinds of cell life activities,such as proliferation,migration,adhesion,angiogenesis,inflammation regulation,embryogenesis and cartilage formation,by the means of controlling variety of cytokines and signaling pathways.Meanwhile,it also has been widely concerned because of its critical function in neovascularization.In this paper,we present the research progress in CYR61 and its application in ocular fundus neovascular disease,such as diabetic retinopathy,retinopathy of prematurity and wet age-related macular degeneration,in the structure of review,so as to provide a new perspective on the pathogenesis and therapy of ocular fundus neovascular disease.
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Nuclear factor-E2-related factor 2 (Nrf2) plays a critical role in the regulation of cellular redox status.It induces the expression of antioxidant enzymes and phase 2 by binding to the antioxidant response element (ARE) in the promoter region of the genes.Nrf2 may present anti-inflammation,immunodepression,antiapoptosis and neuroprotection effects when cell redox status is out of balance.It participates in the pathogenesis and development of many ocular fundus diseases,such as age-related macular degeneration,diabetic retinopathy and ischemic-hypoxic retinopathy.This review focuses on the current study and progress in Nrf2 and ocular fundus diseases.
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Toll-like receptors (TLRs) can recognize pathogens associated molecular of micro-organisms,leading to activation of the downstream signal transduction pathway and participate in innate and adaptive immune response.TLRs can also recognize endogenous danger signaling molecule and therefore be involved in pathogenesis of many low-grade chronic inflammatory and autoimmune diseases.TLRs are always expressed on immune cells,and recent studies confirmed that retinal pigment epithelial (RPE) cells also express TLRs.This review focuses on the research progress of fundus diseases and TLRs,such as the recognition of exogenous pathogenic microorganisms and endogenous danger signals in fundus,induction of inflammatory response,phagocytosis of photoreceptor outer segment by RPE and angiogenesis of fundus diseases.
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MicroRNA (miRNAs) are endogenous,small and noncoding regulatory RNAs,which widely exist in eukaryotes.MiRNAs regulate the expression of target gene by translating inhibition or mRNA destabilization.MiRNAs have been recognized as a major regulatory fashion of post-transcriptional gene expression and play important roles in many cellular biological processes,including cellular proliferation,diffcrentiation,cell death.Alteration of expression and/or dysregulation of miRNAs are related to a wide variety of severe fundus diseases,such as diabetic retinopathy,age-related macular degeneration and retinoblastoma.This review aimed to provide a summary of the recent progress in the effect of miRNAs on fundus diseases.