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@# As a major innovation in macular surgery over the past 30 years,internal limiting membrane peeling has now become standard operation after all-round improvements. However, how to achieve optimal response and avoid poor prognosis by peeling the internal limiting membrane, which is the basement membrane of the Müller cells representing the structural interface between retina and vitreous, still needs to be explored. Prof. Peter Wiedemann, the co-editor-in-chief of our journal, in view of his long-term outstanding contributions to retinal surgery and the important progress his team has made in foveal regeneration, wrote this review with a special invitation. He gladly completed this article in 2wk, which is comprehensive, outlined, insightful, concise and shining with wisdom. It summarizes the history, rationale, techniques, indications, size and adverse outcomes of internal limiting membrane peeling and the surgery for refractory macular hole. It not only affirms current cognition, but raises existing problems, which are worthy reading and reflecting, so it was translated for readers' convenience.
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The alignment diagram, also known as nomogram, is a statistical prediction model used to predict the risk of events(such as diagnosis or prediction of disease development and consequences)by obtaining the influence power of each related factor on outcome variables through multivariate analysis. Nomogram turns the complex regression equation to a visualized diagram that is intuitive and easy to understand. It is convenient to be used for evaluating the patient's condition and communicating with doctors and patients. With rapid advances of medical science and technology and increasing demands of personalized medicine, nomograms has attracted more and more attention and applied extensively in clinical medicine. This short article introduces the basic concepts of nomogram and examples of its application in ophthalmology.
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The concept of neurovascular unit(NVU), formalized in 2001 at a stroke conference, emphasizes the intimate relationship between the brain and its vessels, i.e., symbiotic relationship between brain cells and cerebral blood vessels in the developmental, structural and functional interdependence. The retina is a piece of brain. Several researchers have introduced the concept of NVU to the retina since 2007. The NVU in the retina includes neurons, glial cells, microvascular endothelial cells and pericytes. Dysfunctional NVU plays a critical role in diabetic retinopathy(DR). The current limited treatments for DR focus on the late-stage complications, i.e., diabetic macular edema and proliferative DR. While the further study on retinal NVU will develop efficacious therapeutic options for the early and all stages of DR.
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Floaters are entopic phenomenon created by vitreous opacities. Some researchers term it as “symptomatic vitreous turbidity”, which usually refers to primary type in clinic. With the increasing prevalence and aging of myopia worldwide, vitreous floaters are becoming increasingly prevalent in clinics but receiving less attention. Floaters can impair patients' vision and quality of life due to their discomfort and disorientation. A few patients become intolerable and express a strong desire for treatment. YAG laser vitreolysis for floaters has garnered considerable attention in recent years. Although some doctors still have concerns about its efficacy and safety, a handful of studies have found some beneficial effects in recent years. The author has gained expertise in clinical practice in recent years. In this review, we talk about what causes floaters and how to classify them. We also talk about the clinical indications, how YAG laser ablation works, and whether or not it is safe.
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Diabetic macular edema(DME)and age-related macular degeneration(ARMD)are the leading causes of visual impairment and blindness worldwide, and their common pathological features are increased vascular permeability and abnormal neovascularization, in which cytokines such as vascular endothelial growth factor(VEGF)and angiopoietin-2(Ang-2)play an important role. Intravitreal injection of anti-VEGF agents significantly changed the clinical management of DME and ARMD, but limitations such as the non-responsive cases, the treatment burden and risks caused by frequent injections need to be overcome. Faricimab, a novel bispecific monoclonal antibody that simultaneously targets VEGF-A and Ang-2, can effectively reduce vascular permeability, decrease the number of neovascularization and alleviate retinal edema. Registered clinical studies have shown that Faricimab is effective in improving vision and reducing retinal edema, which is non-inferior to Aflibercept and Ranibizumab, maintains a long dosing interval, and has a high safety profile. This article reviews the latest advances in the treatment of DME and ARMD with Faricimab.
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Diabetic retinopathy(DR)is the most prevalent and severe ocular complication in people with diabetes, and it is one of the leading causes of blindness in adults. In recent years, drug therapy represented by anti-vascular endothelial growth factor(VEGF)agents has become the first-line therapy in DR treatment, but it cannot reverse retinal non-perfusion areas, microaneurysms and abnormal teleangiectatic capillaries, those who cannot be treated on time are at risk of disease progression. Laser photocoagulation has been widely applied for more than 40 years, it can effectively reduce the rate of blindness by eliminating the non-perfusion areas of capillaries, and panretinal photocoagulation(PRP)has been the primary treatment for DR. With the continuing innovations in laser technology, on the basis of maintaining the curative effect, the aim of minimizing retinal damage and adverse side effects has been realized. A combination of laser photocoagulation and anti-VEGF agents can achieve complementary advantages and better efficacy. Deepening the clinical research on laser therapy and laser therapy combined with anti-VEGF agents in the treatment of DR may help to establish the personalized treatment corresponds with our national conditions. This article briefly reviews the latest application progress of laser therapy in DR treatment in the era of anti-VEGF agents.
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Diabetic macular edema(DME)has become the leading cause of vision loss in patients with diabetes. Currently, intravitreal injection of anti-vascular endothelial growth factor(VEGF)therapy is the first-line treatment for DME. However, the economic burden and related complications brought by frequent injections should not be ignored. Therefore, the drugs with longer-lasting effects and longer injection intervals must be explored. Brolucizumab is a single-chain antibody fragment(scFv)with a high affinity for VEGF. Compared with other available anti-VEGFs, it has the characteristics of smaller molecular weight, higher tissue permeability and durable therapeutic effect. Clinical studies and real-world evidences showed that Brolucizumab is non-inferior to aflibercept in improving visual acuity in patients with DME. And Brolucizumab is more effective in regressing intra-retinal fluid and reducing central foveal thickness(CSFT)with longer injection interval. At the same time, Brolucizumab has a low incidence of adverse events and favourable safety after intraocular injection. This article reviews the latest progress of Brolucizumab in the treatment of DME.
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AIM: To compare the consistency and feasibility of objective ocular torsion measured with GMPE module-based optical coherence tomography(OCT)and fundus color photography(FCP).METHODS: Patients were enrolled in our strabismus clinic from December 2020 to March 2021, and the objective ocular torsion of the eyes was measured by both GMPE module-based OCT and FCP on the same day. FCP was used to measure the fovea-disc angle(FDA)manually by using the Adobe Photoshop software, while the GMPE module-based OCT software positioned automatically the macula and the center of the optic disc to measure the FDA.RESULTS: Fifty-five patients were included, the FDA measured by OCT was -6.6°±4.5° in the right eye and -8.8°±4.7° in the left eye, respectively; The FDA measured by FCP was -6.6°±4.7° in the right eye and -8.4°±4.1° in the left eye, respectively, with no statistically significant difference between the results of the two methods(Pright eye=0.90, Pleft eye=0.08). In patients with exotropia, the FDA measured by OCT was -5.8°±4.9° in the right eye and -9.1°±4.5° in the left eye, respectively, the FDA measured by FCP was -5.7°±5.0° in the right eye and -8.6°±4.3° in the left eye, respectively,(Pright eye=0.75, Pleft eye=0.15). Similarly, the patients with esotropia, the FDA measured by OCT was -9.0°±7.3° in the right eye and -11.3°±3.5° in the left eye, respectively, while the FDA measured by FCP was -10.0°±7.0° in the right and -10.1°±2.8° in the left eye(Pright eye=0.21, Pleft eye=0.10), respectively. There were no significant differences between the two methods in patients with esotropia or exotropia(P>0.05). The results of both Pearson test and Bland-Altman analysis were highly correlated(rright eye=0.93, rleft eye=0.94, P<0.01). CONCLUSION: GMPE module-based OCT can be used for objective ocular torsion measurement with high reliability and reproducibility, and is a promising clinical alternative to the fundus color photographic method.
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Parafoveal exudative vascular anomalous complex(PEVAC)refers to a large, isolated aneurysmal lesion in the superficial or deep capillary plexus of the parafoveal retina demonstrated by optical coherence tomography(OCT)imaging and has been identified as a new entity. Patients are almost middle-aged and elder people, not accompanied by retinal vascular diseases, but can develop with myopic or age-related macular degeneration(ARMD). It has been defined as PEVAC-resembling lesions when associated with retinal vascular diseases, such as diabetic retinopathy(DR)or retinal vein occlusion. It is non-exudative in the early stage, but later intraretinal exudation may induce metamorphopsia or visual decline. In some cases, the lesion was unchanged or spontaneously resolved during long-term follow-up.Differentiation from type 3 retinal neovascularization(retinal angiomatous proliferation, RAP)and Type I MacTel may be required. The anti-vascular endothelial growth factor(VEGF)therapy is ineffective and micropulse laser treatment could achieve improvement in a few cases. It is speculated that the lesion is associated with degeneration of retinal microvascular pericytes.
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·AIM: To evaluate the effects of foldable capsular vitreous body (FCVB) implantation on the treatment of severe ocular trauma and late silicone oil-dependent eyes due to severe ocular trauma and recurrent retinal detachment. · METHODS: We retrospectively reviewed the four patients (four eyes) with FCVB implantation at our hospital since November 2017. Out of these 4 patients,2 were males and 2 were females, with an average age of 31.5 years and an average intraocular pressure (IOP) of 5.6mmHg pre-operatively. Among those 4 eyes,3 eyes underwent silicone oil tamponade due to severe ocular trauma and the other one was recurrent retinal detachment in silicone oil - filled eye. Standard pars plana vitrectomy (PPV) was performed, and the FCVB was triple folded and implanted in the vitreous cavity of four eyes. The retinal was assessed, as well as visual acuity,IOP, FCVB condition before and after treatment, and applied therapy. ·RESULTS: All of those 4 eyes underwent successfully implantation of FCVB, which remained its proper position. During 1-3mo follow-up, the mean visual acuity was no different compared with pre - operative values.
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AIM:To determine whether acellular porcine cornea stroma (APCS) could support the growth of the rabbit corneal cells in vitro.METHODS: APCS was prepared. The rabbit's corneal epithelium and stromal cells were cultured and seeded on, APCS in vitro.The observation of phase contrast photograph and histological examination were performed.RESULTS: Histological examination showed the epithe- lium grew on the scaffold of APCS in 2-3 layers at 10th day. The stromal cells adhered to the surface of the scaffold after 24 hours and invaded into the interlaminar of the material at 5th day.CONCLUSION: These results indicate that APCS can support the growth and proliferation of the corneal epithelium and stromal cells in vitro.
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AIM:To investigate the characteristics of Ets-1 and VEGF expression and distribution in the experimental diabetic rat retina.METHODS:Diabetes was induced by intraperitoneal injection of streptozotocin (STZ).At 4 weeks after STZ-injection,animals were sacrificed.Total proteins were isolated from retinas of experimental and control eyes and were assessed by Western blot analysis.Frozen cross sections of eyeballs with 14um thickness were used to perform double immunoffuorescence staining with anti-Ets-1 and anti-VEGF antibodies.RESULTS:Both Ets-1 and VEGF expression were up-regulaled in the diabetic retina,the distribution of Ets-1 and VEGF was identical to each other,and the two proteins were almostlocalized in all retinal layers.CONCLUSION:Ets-1 might contribute to the pathologic progress of the diabetic retina induced by VEGF.
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AIM: To determine the involvement of Ets-1 in the pathological progress of the experimental diabetic retina. METHODS: Diabetes was induced by intraperitoneal injection of STZ. Total RNA and Total proteins were isolated from retinas of experimental and control eyes at 4 weeks after STZ-injection and were assessed by Northern blot analysis and Western blot analysis, respectively.RESULTS: Expression of both Ets-1 mRNA and Ets-1 protein was significantly increased in the experimental diabetic rat's retina after STZ-injection compared with the control group (P＜0.001).CONCLUSION: Our results indicated that Ets-1 was involved in the pathological progress of experimental diabetic retina.Further studies should be conducted to focus on the relationship between Ets-1 and VEGF in the diabetic retina.
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AIM: To report a case of wet age-related macular degeneration (AMD) treat with multiple transpupillary themotherapy (TTT) and choroidal neovascularization (CNV) disappeared but retinal pigment epithelial(PRE) and choroidal atrophy occurred with a low vision at the end point.METHODS: Clinical data including fundus hotographs, fundus fluorescein angiography (FFA), indocyanine angiography (ICGA) and optical coherence tomography(OCT) was reviewed.RESULTS: A 72-year-old man complained about blurred vision of his left eye and FFA revealed polypoidal choroidal vasculopathy (PCV) in the macula. His left eye had stable vision of 0.1 for 6 years without any treatment of CNV. About 2 years later, his right eye presented a piece of CNV. During the period of 3 years, the lesion remained more (3×5 PD) and less (1×2PD) in size with remarkable exudates and bleeding, and 7 sessions of TTT were applied with 80-280mW, 2mm of spot, and 60 seconds exposure and with the interval of 3 months or more. The CNV lesion finally disappeared, but there left a white area in the macula and vision decreased from 0.3 to 0.04.CONCLUSION: Although CNV lesion can be eliminated by TTT, obvious atrophy of RPE cells and the choroids can happen and this may not be of help for patient vision. It suggests that the parameters of TTT will be lower than 120 mW/mm and limited less two sessions if applicable, especially for Asia people.
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<p><b>OBJECTIVE</b>To observe the experimental results and histopathological changes of acellular xenogenic dermal matrix (X-ADM) and allogeneic sclera used as wrapping materials of hydroxy apatite (HA) ocular implants in New Zealand white rabbits.</p><p><b>METHODS</b>Twenty-four rabbits received unilateral eye enucleating and the sockets were implanted with HA spherical implants wrapped with either acellular xenogenic dermal matrix or allogeneic sclera at random. The rabbits were examined for inflammation and implant exposure and sacrificed at 1, 2, 4, 6, 8 and 12 weeks after implantation. The sockets with the grafts were exenterated and the specimens were assessed histopathologically and ultrastructurally with light or transmission electron microscopy for the changes in inflammation reaction and vascularization.</p><p><b>RESULTS</b>Compared to allogeneic sclera at the same stage of implantation, acellular xenogenic dermal matrix demonstrated more active and earlier growth of fibroblasts and new vessels with abundant collagen deposition. There were few inflammatory cells and no rejection was found.</p><p><b>CONCLUSION</b>This experiment showed that the acellular xenogenic dermal matrix, with fast neovascularization and low immunity, can be an ideal material of ocular implant and a good substitute for allogeneic sclera.</p>
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Animaux , Femelle , Mâle , Lapins , Derme , Transplantation , Oeil artificiel , Hydroxyapatites , Sclère , Transplantation , Suidae , Transplantation hétérologue , Transplantation homologueRÉSUMÉ
@#ObjectiveTo observe clinical results and histopathological changes of scleral defect repaired with acellular xenogenic dermal matrix (Xeno-ADM) in rabbits.MethodsModel of rabbit sclera defect was established, and repaired with Xeno-ADM. The rabbits were clinically examined for inflammation and eyeball healing. The animals were sacrificed at 2nd and 4th week after operation, and implants were obtained and examined histopathologyically and ultrastructully with light microscopies respectively to evaluating changes of inflammation and vascularization.ResultsThere were no obvious inflammation and eyeball deformation observed. 2 weeks after implantation, the partial inflammatory cell invasion was seen with the light microscopy, and there was an obvious borderline between the Xeno-ADM and the sclera. 4 weeks after implantation, the inflammatory cells were reduced noticeably, the Xeno-ADM and the sclera completely merged with each other.ConclusionThe acellular xenogenic dermal matrix may be an ideal materix with fast neovascularization and low immunity for replace of sclera implants.
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· AIM :To investigate the role of pericytes in growth of retinal microvascular endothelial cells with a co-culture system in order to understand some mechanism of angiogenesis in hypoxia induced retinal neovascular disorders.(RMECs) were isolated by a modified protocol using CD31 coated Dynabeads, and identified by immunocytochemical staining with anti-Factor Ⅷ and CD31 antibodies. Rat retinal pericytes were isolated and characterized by immunofluorescent staining with PDGFR-β; and desmin antibodies. Pericytes and RMECs were cultured in a contact co-culture system both under normoxia and hypoxia by Millicell chamber. RMECs proliferation was evaluated by MTT and cell cycle assay with flow cytometry. RT-PCR was used to detect the alteration of KDR/Flk-1 mRNA level in RMECs under normoxia or hypoxia in the co-culture system.harvested with the modified isolating method. The two cell types were identified by positive Factor Ⅷ, CD31 and PDGFR-β, desmin cytochemical staining respectively.RMECs proliferated significantly under hypoxia from 3 to 9d with a maximal rate on day 6 (24.9%, P ＜ 0.01) by MTT. In the co-culture system, the proliferation of RMECs was inhibited by pericytes. After 6d exposure to hypoxia,the fraction of S-phase RMECs number was greatly increased by 43.9% (P ＜ 0.01). In the co-culture system,RMECs proliferation was inhibited by pericytes through decreasing the fraction of S-phase cell number both under normoxia (3.6%, P＜0.05) and under hypoxia (15.1%,P＜0.01). KDR/Flk-1 mRNA level in single cultured RMECs was shown to increase approximately 1.3-fold when exposed to hypoxia. Compared with single cultured RMECs, co-culture with pericytes could decrease KDR/Flk-1 mRNA by 45.1% (P＜0.05) and 27.7% (P ＜ 0.05) under normoxia and hypoxia condition respectively.pericytes could inhibit proliferation of RMECs under both normoxia and hypoxia. The inhibition effects of pericytes maybe, at least in part, due to downregulation of KDR/Flk-1 of RMECs. These findings confirm that pericytes could be a potential inhibitor in the pathogenesis of retinal neovascularization.