Comparison of Ophthalmic Artery Morphological Characteristics and Retinal Vessel Diameter for Identifying Ocular Ischemic Syndrome.

Purpose: To investigate the morphological characteristics of the ophthalmic artery (OA) and retinal vessels in ocular ischemic syndrome (OIS) and to compare their ability to identify OIS. Methods: This cross-sectional observational study included 21 patients with unilateral OIS and 17 controls matched for age, sex, degree of internal carotid artery (ICA) stenosis, and cerebral collateral patency. This study used a three-dimensional reconstruction based on computed tomographic angiography to measure the morphological characteristics of the OA and the ICA. Quantitative measurements of retinal vessel diameter were performed using the Integrative Vessel Analysis software. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of the OA diameter and the central retinal artery equivalent (CRAE) to identify OIS. Results: The diameter of the OA (odds ratio = 0.001; P = 0.001) and the CRAE (odds ratio = 0.951; P = 0.028) were significantly associated with the presence of OIS after adjusting for age, sex, and the degree of the ICA stenosis. The areas under the curve for the OA diameter and the CRAE were, respectively, 0.871 (P < 0.001) and 0.744 (P = 0.017) according to the ROC curves analysis. Conclusions: The OA diameter measurement identified OIS better than CRAE measurement. The OA may reflect the changes in ocular blood supply in patients with OIS earlier than retinal vessels. The OA of eyes with OIS may undergo arterial wall remodeling, leading to a decrease in OA diameter and further reduction in blood flow.

Protective Effects of Leukemia Inhibitory Factor on Retinal Vasculature and Cells in Streptozotocin-induced Diabetic Mice.

BACKGROUND: Leukemia inhibitory factor (LIF) has been reported to possess various pharmacological effects, including displaying vascular and neuroprotective properties, during retinal disease. The aim of this study was to investigate the vascular and structural changes in the retina of diabetic mice and to explore whether LIF prevents experimental diabetes-induced retinal injury in the early stages. METHODS: Diabetes was induced in C57Bl/6J mice with streptozotocin (STZ) injections. Successful diabetic animal models were randomly separated into two groups: the diabetic group (n = 15) and the LIF-treated group (n = 15). Normal C57BL/6 mice served as the normal control group (n = 14). Recombinant human LIF was intravitreally injected 8 weeks after the diabetic model was successfully established. Retinas were collected and evaluated using histological and immunohistochemical techniques, and flat-mounted retinas and Western blotting were performed at 18 weeks after the induction of diabetes and 2 days after the intravitreal injection of LIF. The analysis of variance test were used. RESULTS: Histological analysis showed that there were fewer retinal ganglion cells (RGCs) and the inner nuclear layer (INL) became thinner in the diabetic model group (RGC 21.8 ± 4.0 and INL 120.2 ± 4.6 µm) compared with the normal control group (RGC 29.0 ± 6.7, t = -3.02, P = 0.007; INL 150.7 ± 10.6 µm, t = -8.88, P < 0.001, respectively). After LIF treatment, the number of RGCs (26.9 ± 5.3) was significantly increased (t = 3.39, P = 0.030) and the INL (134.5 ± 14.2 µm) was thicker compared to the diabetic group (t = 2.75, P = 0.013). In the anti-Brn-3a-labeled retinas, the number of RGCs in the LIF-treated group (3926.0 ± 143.9) was obviously increased compared to the diabetic group (3507.7 ± 286.1, t = 2.38, P = 0.030), while no significance was found between the LIF-treated group and the control group (4188.3 ± 114.7, t = -2.47, P = 0.069). Flat-mounted retinas demonstrated that a disorganized, dense distribution of the vessel was prominent in the diabetic model group. Vessel distribution in the LIF-treated mouse group was typical and the thickness was uniform. The levels of phosphosignal transducer and activator of transcription 3 activation were obviously higher in the LIF-injected retinas than those in the diabetic control group (t = 3.85, P = 0.019) and the normal control (t = -3.20, P = 0.019). CONCLUSION: The present study provides evidence that LIF treatment protects the integrity of the vasculature and prevents retinal injury in the early stages of diabetic retinopathy in STZ-induced diabetic models.

Long-term effect of prophylactic laser treatment for bilateral soft drusen.

BACKGROUND: Large drusen is a known risk factor for the development of late complications of age-related macular degeneration (AMD) and drusen reduction has been found by our previous study. To prospectively evaluate the efficacy and safety of prophylactic laser treatment in Chinese patients with bilateral soft drusen, we examined the structure and function of the macula 8 years after treatment. METHODS: Ten patients with more than 10 soft drusen (> 125 mm) and best corrected visual acuity ≥ 20/25 in each eye participated in the study. One eye, with relatively more drusen, was exposed to an argon laser (514 nm) to achieve a barely visible retinal lesion. The contralateral eye was used as a control. Fluorescein angiography, Amsler tests, Fourier-domain optical coherence tomography and visual evoked potential tests were carried out 8 years later. RESULTS: No choroidal neovascularization was seen in the laser-treated eyes or control eyes. There were no significant differences in visual acuity or P100 latency and amplitude between the laser treated eyes and contralateral eyes (t = 1.685, 1.184; P > 0.05). The thickness of the retinal pigment epithelium of the treated eyes was less than that of the contralateral eyes (t = -4.540; P < 0.05). The full retinal thickness in treated eyes was slightly, but insignificantly, reduced relative to contralateral eyes (t = -1.746; P > 0.05). CONCLUSIONS: The treatment was associated with a reduction in retinal pigment epithelium thickness elevation compared with the contralateral eyes. Macular function was not impaired.

Determination of drug concentration in aqueous humor of cataract patients administered gatifloxacin ophthalmic gel.

BACKGROUND: Ophthalmic gel has been developed to increase the drug concentration in aqueous humor and to retard the loss of drug from the conjunctival sac. The research was to compare the drug concentration in aqueous humor of cataract patients administered 0.3% gatifloxacin ophthalmic gel with that in patients administered 0.3% gatifloxacin ophthalmic solution. METHODS: Ninety-six patients with cataract (96 eyes) were randomly assigned to 8 groups. The patients in groups 1-4 received topical gatifloxacin 0.3% ophthalmic gel and those in groups 5-8 received gatifloxacin 0.3% ophthalmic solution. The dose regimen was 1 drop, 4 times a day for 3 consecutive days prior to cataract surgery. On the day of surgery, 1 drop was applied at 15, 30, 60 or 120 minutes before commencement of cataract surgery in groups 1 and 5, groups 2 and 6, groups 3 and 7, and groups 4 and 8, respectively. Aqueous humor was extracted during the cataract surgery for the analysis of gatifloxacin concentration.. RESULTS: The concentrations of gatifloxacin in aqueous humor were (0.24 +/- 0.25) microg/ml, (1.11 +/- 0.74) microg/ml, (2.32 +/- 2.01) microg/ml and (1.85 +/- 1.14) microg/ml in groups 1 to 4, and (0.16 +/- 0.25) microg/ml, (0.31 +/- 0.24) microg/ml, (0.75 +/- 0.28) microg/ml and (0.33 +/- 0.22) microg/ml in groups 5 to 8, respectively. Patients receiving gatifloxacin ophthalmic gel showed greater mean values of gatifloxacin concentration in aqueous humor than those receiving gatifloxacin solution, and such differences were significant with P < 0.05 for all comparisons except that between groups 1 and 5. CONCLUSION: Topical gatifloxacin ophthalmic gel can attain significantly greater drug concentrations in human aqueous humor than gatifloxacin ophthalmic solution.

[Clinical characteristics of ocular ischemic syndrome].

OBJECTIVE: To study clinical characteristics of ocular ischemic syndrome (OIS). METHODS: Retrospective study. Data, including sex, age, systemic diseases, best corrected visual acuity, anterior segment, fundus, fundus fluorescence angiography (FFA), transcranial Doppler (TCD) and digital subtraction angiography (DSA), were collected from 10 patients (12 eyes) with ocular ischemic syndrome from February 2008 to April 2009. RESULTS: The mean age was 59 years. There were six males and four females. All patients were combined with heart and/or cerebrovascular diseases. Best corrected visual acuity ranged from hand movement to 1.0. Neovascularization of the iris appeared in 5 eyes. Intraocular pressure over 21 mm Hg (1 mm Hg = 0.133 kPa) was present in 3 eyes. Fundus examination showed narrow retinal arteries, dilated but not tortuous veins, fleck-shaped hemorrhage of the retina, cotton-wool exudates, optic disc edema, optic disc neovascularization, and atypical macular cherry-red spots. TCD showed stenosis of internal carotid artery at different degrees. FFA was performed in 9 patients which showed artery front, prolonged arm-retinal circulation time, retinal circulation time and choroid circulation time. All patients accepted vasodilation and microcirculation improving treatments. Visual acuity was improved at different degrees. One patient (2 eyes) with iris neovascularization was treated with retinal photocoagulation and the neovascularization disappeared after the treatment. There were 3 patients (3 eyes) had neovascular glaucoma. One patient was treated by ciliary cryotherapy. One patient was treated by retinal photocoagulation and internal carotid artery stent implantation and one were treated by internal carotid artery stent implantation. Four patients were examined by DSA. Internal carotid artery stent implantation was performed in 3 patients, subclavian artery stent implantation was performed in one patient and internal carotid artery intima decollement was performed in one patient. CONCLUSIONS: Clinical manifestations of ocular ischemic syndrome patients are complicated which are depended on the different extents of ischemia. The management of ocular ischemic syndrome requires the collaboration of ophthalmologists, neurophysicians and neurosurgeons.

[Prophylactic laser treatment to macular soft drusen in age-related maculopathy of updated results].

OBJECTIVE: To investigate the follow-up results of the prophylactic laser treatment to macular soft drusen in age-related macular degeneration. METHODS: Prospective, 10 persons with bilateral soft drusen and with good visual acuity were observed for 8 years. 10 eyes were treated. The fellow eyes were as control group. Fluorescein angiography and Amsler test were studied after 8 years. Scanning laser ophthalmoscope was performed after 2 years. Some of them were performed multifocal ERG to test the macular function after 3 years. RESULTS: There is no choroidal neovascularization in both the laser group and the control group. There is no differences in the best corrected visual acuity after 8 years. All eyes had good fovea fixation. Light sensitivity of both eyes had no significant difference to be found by scanning laser ophthalmoscope. The latencies and amplitude densities of the N1 and P1 waves in the central first ring remained unchanged at 3 years post-treatment (before treatment t = -0.779, 0.722, -0.491, 0.286; after treatment t = 1.342, 0.043, 0.937, 0.350; P > 0.05) compared with the fellow eyes. CONCLUSIONS: There is no impairment to be found in the macula after preventive laser treatment. The treatment did not demonstrate a clinically significant benefit for choroidal neovascularization in eyes of people with bilateral large drusen.