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Anti-vascular dndothelial growth factor (VEGF) drugs have open up a new treatment channel for ocular neovascular diseases.A lots of clinical data has proved that anti VEGF drugs are effective and safe.But we should also notice that long-term and excessive usage of anti-VEGF drugs brings some new problems and complications,and even affect the normal ocular physiological process of the angiogenesis and retinal blood flow.So,it is necessary to pay attention to the problems and potential risks of excessive usage of anti VEGF therapies for ocular neovascular disease.
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Background Neuromyelitis optica,term of Devic's disease,is characterized by the symptoms of both optic neuritis and myelitis.In clinic,misdiagnosis rate of neuromyelitis is too high to ignore because of the unsynchronous exsist of both optic neuritis and myelitis.Objective This study aims to analyze the clinical characteristics of Devic's disease in order to reduce the misdiagnosis rate.Methods Thirty six patients diagnosed as Devic's disease in General Hospital of PLA from January 2000 through October 2008 were included in this study.The clinical data including sex,age,initial events,clinical signs of optic neuritis and myelitis,misdiagnosis status were analyzed.Results The 21 patients showed the initial events of eye and were diagnosed as neurititis.In all of the 36 patient,the ratio of the patients was from 30 to 50 years.The prevalence of atrophy of optical nerve within 1-3 months was 72.7% and that of above 3 months was 91.4% in these patients.The incidence rate was obviously increased in 1-3 months course group (χ~2=7.59,P=0.009) and ＞3 months course group(χ~2= 20.29,P＜0.001) in comparison with ＜1 month course group.Two patients without clinical signs were determined the diagnosis by visual evoked potential.In 22 patients received magnetic resonance imaging of spinal cord,the lesions of 14 patients located in cervical cord and that of 9 patients was in thoracic cord and only 1 patient in lumbar cord.Conclusion Devic's disease is more common in female patients with the age between 30-50 years.Most patients visit ophtalmologist firstly due to initial events of eye.Occurrence of optic atrophy is associated with disease course.MRI suggest that the lesions of spinal cord are often in cervical cord and thoracic cord.
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Background Retinal vein occlusion (RVO) is a common vasculoretinopathy in ophthalmology.No an effective treating way is confirmed so far,and some new approach is in exploration.Objective The present study aims to investigate the safety and feasibility of injection of tissue plasminogen activator into optic nerve for the treatment of RVO using flash visual evoked potential (F-VEP) and flash electroretinogram(F-ERG).Methods The recording electrodes for F-VEP were implanted into the skull of rabbits to investigate the safety and feasibility of injection of tPA into the optic nerve.25μg of tPA or 12.5μg tPA (0.1 mL) was injected in pars plane via the center of optical disc respectively in different groups (6 eyes in each group),and 0.1 mL of BSS was injected at the same method in control group.Other 6 eyes were as normal control group.Slit lamp biomicroscope,indirect ophthalmoscope,F-VEP and F-ERG examinations were performed in 1 day,3,4,14 and 28 days after injection.All experiments were conducted in accordance with the Association for Research in Vision and Ophthalmology statement on the use of animals in ophthalmic and Vision Research.Results No obvious evidence of optic nerve or retinal toxicity or damage was found by the examination of ophthalmoscope,F-VEP,and F-ERG after injection of tPA.No significantly differences were found in the mean latency of P_1 wave of F-VEP (P=0.411),the mean amplitude of P_1 wave of F-VEP (P=0.065),the mean latency and amplitude of ERG a-waves (P=0.627,P=0.725) as well as the mean latency and amplitude of ERG b-waves (P=0.257,P=0.096) among 25 μg of tPA group,12.5 μg tPA group,BSS group and control group.Conclusion The injection of tPA into optic nerve is a safe and simple procedure.This therapy may is a potential approach to the treatment of RVO.
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@#ObjectiveTo investigate the correlation between the surgical effect and clinical factors in retinal detachments with macular hole patients.Methods71 patients were picked up from the rhegmatogenous retinal detachment (RRD) database in our hospital. All patients were well informed with clinical data and followed up. Logistic regression statistical analysis was performed to analyze correlation between the effect of operation and clinical factors.ResultsAll patients obtained successful retinal replacement and macular hole closure, but retinal detachment was relapsed in 10 patients from 3 days to 3 years after operation. Effect of retinal replacement was related with proliferative vitreoretinopathy (PVR) grade and course (P<0.05), while eyesight improvement was related with PVR grade, age and course (P<0.05).ConclusionAge, PVR grade and course affect the surgical effect.
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Objective To create a calibrated animal model of graded optic nerve injury (ONI) in rats, focusing on quantification of injury intensity, injury severity and the correlation between them. Methods A pair of cross-action forceps with pressure of 148.0 g was used to clip rat optic nerves for 3, 6, 30 and 60 seconds, or a pair of artery clips with constant pressure (32.4 g) used to clip rat optic nerves for 5, 10 and 15 seconds in order to create graded ONI animal models. Transcranial FluoroGold-labeled retinal ganglion cell (RGC) was used to observe the changes of RGC one month after injury, which then could be used to evaluate the injury severity. Ocular blood supply was evaluated by transcardiacly perfused Luxol Fast Blue post-injury. Results The graded ONI animal models were successfully created in rats without retinal ischemia post-trauma. The injury intensity could be well-defined by impulse or averaged impulse, while injury severity could be evaluated by the count of FluoroGold-labeled RGCs. The averaged impulse produced by artery clips clipping rat optic nerves for 15 seconds equalized with that produced by cross-action forceps for three seconds. The severer injury intensity begot less number of RGCs. The correlation between injury impulse and RGCs was fit for power function. Short time clipping of optic nerves could not lead to ischemic injury of the retina. Conclusions A calibrated graded ONI animal model is successfully created by clipping optic nerves with a pair of cross-action forceps. The model can be evaluated with RGCs count, impulse and averaged impulse, the latter two of which stand for injury intensity and injury severity, respectively.
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Objectives:To establish animal model of anterior proliferative vitreoretinopathy (aPVR) with cultured homologous dermal fibroblasts of rabbit, and to provide evidence why hypotony was caused by aPVR. Methods:Animal models of aPVR were established with cultured homologous dermal fibroblasts on pigmented rabbits. Rabbits were sacrificed on the 14th, 28th and 56th day after the operation to prepare naked eyes and to receive histological examinations. Results:Naked eye examination showed that the peripheral retina was detached by dragging in the experimental group 28 and 56 days postoperatively. Microscopic examination showed atrophy or absence of the non-pigmented ciliary epithelium on the 28th and 56th postoperative day in the experimental group. Conclusions:The epiciliary membrane in aPVR dragged the ciliary body, made atrophy of non-pigmented epithelium, which perhaps was the main cause of hypotony.
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Objectives:To investigate the effects of verapamil on serum induced proliferation of rabbit pigment epithelial(RPE) cells so as to search for simple and effective medicine on PVR. Methods:The rabbit RPE cells(passage 2 to 5) were cultured with various concentrations of verapamil in DMEM.The effects of verapamil on the cell cycle of RPE were analyzed with flow cytometry. Results:Verapamil significantly inhibited the serum induced proliferation of RPE cells, prevented RPE from G 1 phase transiting to S phase. Conclusions:Verapamil significantly inhibits RPE cell proliferation, and it may become a promising drug on PVR.
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Objective To investigate the effect of retinectomy 360? for severe ocular rupture and evaluate the related factors associated with prognosis. Methods We retrospectively analyzed 28 consecutive patients (28 eyes), 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and October 2002. The patient′s ages ragned from 16 to 58 years, mean 29 years. According to the internation standardized classification of ocular trauma, the injuries located in zone Ⅰ in 5 eyes, zone Ⅰ-Ⅱ in 8 eyes,zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes, zone Ⅲ in 7 eyes, zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes and zone Ⅲ in 7 eyes. The presenting visual acuity was in grade 4 (0. 02 to light perception) in 19 eyes, and grade 5 in 9 eyes. In 28 patients, 13 had the total absence of iris and lens, 10 had iris deletion more than 1/2, and 15 had lens opacity or rupture. Ultrasound biomicroscopy and B-scan revealed ciliochoroidal detachment in 17 eyes. The B-scan revealed vitreous hemorrhage and retinal detachment in all paitents. The intraocular pressure was from 5 to 11 mm Hg in all patients. The therappeutic operative procedures which were performed by one surgeon in all of the affected eyes included standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation and tamponading with silicone oil in all patients; lensectomy in 15 eyes; 360? retinotomy and retinectomy at anterior equator in 16 patients, and posterior equator in 12 eyes. Results During the operation, all patients were confirmed with vitreous hemorrhage and retinal detachment, including hemorrhagic ciliary body detachment in 9 eyes, suprachoroidal hemorrhage in 12 eyes, retinal twisting like morning glory in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up In 26 eyes who were followed up postoperatively from 6 months to 46 months, retinal reattachment was found in 20 patients (76. 9%) in whom the retina of 3 was reattached after revitrectomy and the silicone oil of 8 was removed at the fourth month after operation. In 20 eyes with reattached retina, 14 (70. 0%) had corrected visual acuity of 0. 02 or more, including 7 (35. 0%) had 0. 05 or more, 3 had 0. 1 or more, and 1 had the best visual acuity of 0. 3. Conclusion Retinectomy may improve the prognosis of severe ocular rupture and save the visual function of some patients.
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To study the pathcytological mechanism of Eales disease and to provide a histological testimony for an effictive therapy.Methods45 cases(48 eyes) of Eales disease that were diagnosed according to vitreous hemorrhage and proliferative vitreoretinopathy or secondary retinal detachment.Cytomorphological examination was taken and vitreous extracts were examined by immunohistochemical staining.ResultLymphocytes and fibroblastes were most of those cells in the vitreous extracts.Immunohistology and electron microscopy revealed that lymphocytes were 78.8% or 61.5% in all specimens,respectively.ConclusionProliferative vitreoretinopathy induced by Eales disease closely relates with lymphocytes.The results suggested that autoimmunity might play an important role in the pathogenic mechanism of the disease
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Objective To evaluate the therapeutic effect of encircling scleral buckling surgery in rhegmatogenous retinal detachement (RRD) with vitrectomy. Methods The records of a series of 118 consecutive patients with RRD undergone encircling scleral buckling surgery and vitrectomy between 1995 1999 were reviewed. All of the patients underwent an onece vitrectomy, and they consisted of with encircling scleral buckling group and without encircling scleral buckling group. The difference of rate of retinal reattachment, and the relationship between the reattachment rate and the grade of PVR, position of retinal tear and the different intraocular tamponade substitute in both groups were analysed and compared. The average follow up period was 6.5 mons (1.5 mons 3 ys). Results The rate of retinal reattachment in this series of 118 cases was 81 4% (96/118) in which the encircling scleral buckling group accounted for 44 7% and the group without encircling scleral buckling accounted for 55.3%. There was no statistical difference of rate of retinal reattachment between both groups with PVR C, different intraocular tamponade and various positions of retinal tears, while the rate of retinal reattachment in cases of PVR D and retinal tears posterior to equator in group without encircling scleral buckling was significanthy higher than that in encircling scleral buckling group ( P
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Objective To investigate the occurrence, progress and conversion of hypotony in anterior proliferative vitreoretinopathy (aPVR), and to provide knowledge about how to prevent and treat it. Methods Animal models of chronic hypotony by aPVR were made with cultured homologous dermal fibroblasts on pigmented rabbits. The intraocular pressure (IOP) and ultrasound biomicroscopy(UBM) examination were taken preoperatively and on days 7,14, 28 and 56 postoperatively. Rabbits were killed on days 14, 28 or 56 postoperatively, prepared for histology and ultrastructure examination. Results The average IOP of experimental group was lower than that of control group on days 7,14,28 and 56 significantly (P
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Objective Through transmission electron microscopy we observe the ultrastructure of optic nerve to evaluate the curative effect of optic nerve incision decompression (ONID) for incomplete injury to optic nerve. Methods The optic nerve was crushed for 30s to produce incomplete injury to the optic nerve in rats, and then the rats were divided into two groups. ONID was performed 6 hours after the injury in one group, and in the other group decompression was omitted(non-ONLD). Ultrastructure of optic nerve was observed 1 month, 2 months, 3 months and 6 months later in both groups. Results After 1 month denaturalization of myelin sheaths and axons of the injured optic nerve was severe in non- ONID group, and after 3 months the optic nerve entirely lost its normal structure. On the other hand, denaturalization of myelin sheaths and axons was evidently less intense in ONID group, and the changes in structure of optic nerve were stabilized. Conclusions ONID reduced the speed of degeneration of the injured optic nerve and postpones the process of axon denaturalization, thus protects the optic nerve from secondary injuries.
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Objective To investigate the gene expression spectrum of retina and optic nerve after partial injury of optic nerve. Methods Sixty SD rats were randomly divided into 4 groups. The optic nerves of the right eyes were clipped for 6 seconds with a pair of cross-action forceps. The retinae and optic nerves in the operation eye and contralateral sham operation eye were removed 3, 7, 14, and 21 days after the injury to detect gene expression patterns with high-density DNA microarrays. Results Changes of a mass of gene expressions were found after the optic nerve injury, and the positive rate of gene expression was 2.35%, 6.48%, 3.82% and 4.09% after 3, 7, 14, 21 days, respectively, and the total positive rate was 11.77%. The functions of positive expression of the gene involved cell survival, cytoskeleton, extracellular matrix and cell adhesion, free radicals and oxidative damage, energy and metabolism, inflammation, neurotransmission and ion transport, signal transduction, structural protein, transcription and translation. Up- or down-regulation of repaired genes was the main part of the changes of gene expression, while the altered-expression destroy genes was the minor part in the whole gene expression spectrum, in which the up- and down-regulation of expression of repaired genes accounted for 13.98% and 24.73% respectively 7 days after the injury, and the down-regulation of expression of repaired genes accounted for 17.20% 14 days after the injury. Conclusions A mass of gene expression changes occurs after the optic nerve injury, and the comprehensive view on the gene expression pattern following the optic nerve injury is crucial to discover the mechanism of post-injury reaction and regeneration.
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Objective To evaluate the 25-gauge (25G) transconjunctival sutureless vitrectomy system (TSV25G) for macular diseases. Methods The clinical data of 18 patients with macular diseases treated by the TSV25G were retrospectively analyzed. The 18 patients included 13 men and 5 women, aged from 25 to 73 years. The disease course ranged from 3.5 to 10 months, including 8 epiretinal membrane, 3 idiopathic macular hole, 3 tranumatic macular hole with submacular heamorrhage, 2 vitreo-macular tractional syntrome and 2 diabetic macular edema. The surgical parameter installation was as follows: high speed cutter with rate of 1500 cuts per minute; the maximum aspiration with a TSV25G were 500-550 mmHg (1 mm Hg=0.133 kPa); the BSS bottle height was 40-50 cm; the intraocular pressure was 29-35 mmHg during the surgery. The postoperative follow-up period was 2.5-10 months. Results Eighteen patients had undergone the vitrectomy successfully with the operative time of 26-44 minutes (mean 35 minutes). No complication was found. Water leakage of the puncture site was found in 1 patient and was sewed up with 8-0 absorbable sutures. The mean time of inpatients were 3.5 days postoperatively. In the postoperative follow-up in 18 patients, the macular edema disappeared totally in 12 patients 3-6 months after the operation; the visual distortion disappeared in 10 and alleviated in 2; the visual acuity regained (0.8 or more) in 6 (33.3%), not changed in 4, and improved in 2. Conclusion TSV25G was safe, time-saving, and effective for macular diseases.
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Objective To observe the changes of electroretinogram(ERG) in temporary traumatic ocular hypotension and to detect the possible mechanism. Method The rabbit model with ocular hypotenstion was made. At the 2nd, 4th, 8th, 16th week after trauma, the ocular tension and ERG was examined. Result Amplitude of b wave in treated group was 2.5 times as high as that in the control at the 2nd week after trauma, and then decrease to 1.5 times as high as that in the control at the 16th week. Conclution Higher amplitude of b-wave of ERG in rabbit with ocular hypotension may be related to blood circulation congestion, which might lead to accumulation of the metabolic toxin.
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ObjectiveTo investigate the etiological factors of endophthalmitis and evaluate the outcomes of vitrectomy for endophthalmitis.MethodsFrom January 1999 to December 2001, 53 consecutive patients (54 eyes ), 38 men and 15 women, diagnosed as endophthalmitis were retrospectively evaluated. The patients′ ages ranged from 1 year to 74 years (mean 32 years). Two patients (2 eyes) with mild inflammation received antibiotic medication therapy, 5 patients (5 eyes) with no light perception and severe inflammation underwent evisceration, and the other 46 patients (47 eyes) underwent pars plana vitrectomy. Postoperative follow-up ranged from 2 to 32 months (mean 10.5 months). ResultsEndophthalmitis was diagnosed as resulting from penetrating injury in 32 eyes (59.26%), endogenous endophthalmitis in 8 eyes (14.81%), cataract surgery in 7 eyes (12.96%), glaucoma surgery in 2 eyes (3.70%), vitrectomy in 3 eyes (5.56%), radial keratotomy in 1 eye (1.85%), and unknown reason in 1 eye (1.85%). The postoperative visual acuities (VA) of these patients increased significantly (P=0.003). The VA of the patients underwent vitrectomy in 3 days was obviously better than those after 3 days (P=0.014), and the VA of the patients underwent vitrectomy in 7 days was obviously beter than those after 7 days (P=0.021). Thirty-seven eyes (68.52%) had functional success (VA≥0.02), 47 eyes (87.04%) had anatomical success (VA
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Objective To determine the affected factors of intraorbital hemodynamic results in diabetic retinopathy (DR) and the risk factors related to the occurrence of DR. Methods Posterior ciliary artery (PCA), central retinal artery (CRA), central retinal vein (CRV), and vortex vein (VV) of 68 patients with DR were measured by color Doppler flow image (CDFI). Thirty-one hemodynamic parameters, including systolic velocity, diastolic velocity, mean velocity, resistive index, pulsatility index and accelerative velocity of ophthalmic artery (OA), and other variates (blood pressure, blood sugar, gender, age, duration of the disease, and so on) were collected and clustered in a principal components analysis following a forward, stepwise logistic regression on these components. Results Nine principal components were extracted from 37 original variates, reflecting the velocity of OA, velocity of PCA, resistance of OA, velocity of CRA, resistance of CRA, resistance of PCA, time-related factor, venous drainage factor and gender factor, respectively. In the result of logistic regression, resistance of OA, velocity of CRA, resistance of PCA, time-related factor, and venous drainage factor were the risk factors related to DR. Conclusion The first risk factor affecting DR is time, and intraorbital hemodynamic abnormity influencing the development of diabetic retinopathy may be the increase of resistance of OA, decrease of velocity of CRA, decrease of resistance of PCA, and increase of venous drainage.
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Objective To examine the expression of proliferating cell nuclear antigen (PCNA) of retinal pigment epithelial (RPE) cells, thus assessing the role of mechanism of contact inhibition playing in the process of experimental retinal detachment and reattachemnt. Methods Retinal detachment was produced in 72 cats by subretinal injection of 0.25% solution of healon through a micropipette three weeks after extracapsular lens extraction and vitrectomy. Some of the detached retinae were reattached 24 hours later. At different time, the cats were killed and eye globes were fixed and embeded in paraffin. Histologic sections were processed for immunohistochemistry examination using an antibody to detect PCNA protein. Labeled RPE cells were identified, and the proliferation was quantified in detached and un detached retinae of detachment group, and also in reattached retinae of reattachment group. The comparsion of PCNA labeled RPE cells in different groups were analyzed by ANOVA. Results In detached regions of detachment group, PCNA expression of RPE cells occured within 24 hours, and reached a maximum after 5 6 days, then gradually declined to barely detectable levels after 20 days. Similar tendency was found in reattached retinae, but the number of PCNA labeled RPE cells was obviously small. Fewer PCNA labeled RPE cells were found in regions of un detached retinae in detachment group. The difference of these three groups was significant. Conclusion Proliferation of RPE cells is induced when they lose contact with neural retina, but inhibited after neural retina reattached to RPE cells. It suggests that the mechanism of contact inhibition plays a role in the proliferative process after retinal detachment and reattachment.