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Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy.Methods Sixty-four cases (90 eyes) with severe non-proliferative diabetic retinopathy from July 2014 to June 2016 in our hospital were randomly divided into two groups according to the digital table.The observation group (32 cases,46 eyes) underwent intravitreal injection of reizumab combined with panretinal photocoagulation,and the control group (32 cases,44 eyes) were treated with only panretinal photocoagulation.The visual acuity,fundus,fundus fluorescein angiography and macnlar thickness postoperative 1 month,3 months,6 months were observed and detected.The mean thickness of the retinal neuroepithelium in the macular region and total volume of the 6 mm diameter neuroepithelium in the macular area were compared and statistically analyzed.The laser energy,number of spots and energy density were calculated and recorded.Results BCVA at postoperative 1 month,3 months,6 months in the observation and the control group were better than that before treatment(all P ＜ 0.05),and the observation group was better than the control group (all P ＜ 0.05).In the control group,BCVA had no statistically significant difference between 3 months and 6 months (P ＞ 0.05),and the differences were statistically significant among other time points (all P ＜ 0.05).In the observation group,the differences were statistically significant among all time points after treatment (all P ＜ O.05).In the comparison of mean thickness of the retinal neuroepithelium in the macular region and total volume of the 6 mm diameter neuroepithelium in the macular area in the control group and the observation group before and after treatment,there were statistically significant differences at different time points between the two groups (all P ＜ 0.05).Moreover,the average thickness of the retinal neuroepithelium and total volume of 6 mm diameter neuroepithelium in the macular region at postoperative 1 month,3 months,6 months were better than those in the control group (all P ＜ 0.05).The laser energy,spot number and energy density of the observation group were significantly lower than those of the control group (all P ＜ 0.05).Conclusion Intravitreal injection of ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy can accelerate retinal neovascularization in a short period of time,reduce macular edema and improve the visual function of patients with less laser energy,the curative effect is better than application of retinal laser photocoagulation alone,is worthy of clinical promotion.
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BACKGROUND:Retinal contusion injury is one of the leading causes for vision impairment, and clinical treatment is difficult. Although fundus change after retinal contusion injury has been ful y understood, the pathogenesis and drug treatment stil remain controversial. OBJECTIVE:To explore the apoptosis and related mechanism of optic nerve cel s in rabbit model of retinal contusion injury. METHODS:Forty-eight healthy adult rabbits without oculopathy were divided into eight groups:1 hour, 3 hours, 1 day, 3 days, 7 days, 14 days, 28 days after contusion and normal control, with six rabbits in each group. Right eye of each rabbit was treated with Al en’s reformative hitting method as contusive retinopathy model. The eyebal s were enucleated at different time points after injury in rabbit retina. The pathological section of optic nerve 5 mm posterior to sieve plate was harvested. The morphologic changes of optic nerve were observed and number of glial cel s was measured using hematoxylin-eosin staining. Electron microscope and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling technique were used to assess apoptosis. RESULTS AND CONCLUSION:In the normal control group, glial cel s presented cylinder shapes and neural fibers arranged neatly. The trend of the glial cel s was as the same as the neural fibers. But the optic nerve fibers arranged in disorder and the glial cel s lost polarity in the groups of 1 hour, 3 hours, 1 day, 3 days, 7 days after retinal contusion injury. The number of glial cel s in 1 hour, 3 hours, 1 day, 3 days, 7 days, 14 days, and 28 days was extremely significantly reduced compared with normal control group (P<0.01). There was cel apoptosis in optic nerve after retinal contusion injury, but almost not observed in optic nerve from normal control group, 1 hour and 28 days after injury. The apoptotic cel s were abundant at 3 hours, 1 day, 3 days, 7 days, 14 days after injury, and peaked at 3 days, showing extremely significant differences compared with normal control group (P<0.01). Apoptosis occurs in optic nerve after contusion of retina, which may be one of the reasons for incomplete recovery of retinal function.