Correlations between Clinical and Histopathologic Characteristics in Idiopathic Epiretinal Membrane.

PURPOSE: To investigate correlations between clinical and histopathologic characteristics of idiopathic epiretinal membrane (ERM). DESIGN: Retrospective interventional case series. PARTICIPANTS: In total, 87 eyes from 87 patients with idiopathic ERM who underwent pars plana vitrectomy with peeling of the ERM from 2019 to 2020 were included. METHODS: The outcomes of clinical ophthalmic examination, including measurement of best-corrected visual acuity (BCVA) and spectral-domain OCT (SD-OCT), before and after surgery were reviewed. Surgical specimens were fixed in formalin and embedded in paraffin for histologic and immunohistochemical analysis. MAIN OUTCOMES MEASURES: The association between morphological characteristics revealed on SD-OCT images and the cellular composition of the surgically excised ERM demonstrated with immunohistochemical staining were the main outcome measures. Changes in the BCVA and central macular thickness (CMT) were assessed through a comparison of preoperative and postoperative measurements. RESULTS: Based on SD-OCT morphological characteristics in the foveal area, 15 cases were classified into group 1A (mainly outer retinal thickening), 39 into group 1B (more tenting of the outer retina and distorted inner retina), and 33 into group 1C (prominent inner retina thickening). Overall, postoperative final BCVA and CMT at 1 year improved in all groups. Patients who presented with a better initial BCVA exhibited a more favorable final BCVA. Epiretinal membranes in group 1C demonstrated the greatest decrease in CMT compared with those in groups 1B and 1A, but the final CMT did not differ among the groups. A negative correlation between the density of hyalocytes (P = 0.003) and myofibroblasts (P = 0.047) was noted between the 3 groups. Total cell density and glial cell density of the ERMs were strongly associated with poor final BCVA and BCVA improvement. CONCLUSIONS: The present study provides new histopathologic information regarding the formation and progression of idiopathic ERM. Glial cell proliferation plays a predominant role in these processes. Epiretinal membranes with high cellularity and glial cell density may cause damage to the retina structure, resulting in poor postoperative visual outcomes. These findings provide additional evidence supporting early surgical intervention in patients with idiopathic ERM reported with visual disturbance.

Step-wise diagnostic approach for patients with uveitis - Experts consensus in Taiwan.

Uveitis is a sight-threatening disease that can be associated with many different etiologies. Successful treatment of uveitis relies on accurate diagnosis and prompt efficient therapy. History taking, physical and ocular examinations, systemic evaluations, and response to treatment provide crucial information to differentiate possible etiologies involved in the pathophysiology of intraocular inflammation. This article provides recommendations for a step-wise approach to patients with uveitis in Taiwan based on an expert meeting and consensus. Systemic evaluations for uveitis should be performed step-by-step and include investigation of patients' general systemic conditions, ruling out infectious etiologies, and obtaining evidential biomarkers to diagnose a specific disease entity.

Visual outcomes and incidence of pseudophakic cystoid macular oedema in eyes with cataract and idiopathic epiretinal membrane after two-step sequential surgery.

OBJECTIVES: To determine whether pars plana vitrectomy (PPV) or cataract surgery should be performed first in concurrent epiretinal membrane (ERM) and cataract treatment with respect to visual outcome and pseudophakic cystoid macular oedema (PCMO) incidence. METHODS: Patients who underwent PPV and cataract surgery sequentially at a tertiary medical centre were retrospectively recruited. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured from optical coherence tomography (OCT) images collected before and after each surgery were documented. OCT-defined PCMO incidence and its influence on visual outcomes were analysed. RESULTS: In total, 259 and 159 eyes received PPV (ERM-CATA) before and after cataract surgery (CATA-ERM), respectively. The ERM-CATA group had better final BCVA (logMAR: 0.274 vs. 0.558, p < 0.001) and greater BCVA gain (logMAR VA change: -0.379 vs. -0.220, p = 0.001) than did the CATA-ERM group. Baseline BCVA was positively correlated with final BCVA (p < 0.001), whereas baseline CMT, final CMT, and postoperative CMT changes were not. PCMO incidence did not differ significantly between the two groups (15.4% vs. 19.5%, p = 0.287), and final BCVA changes did not significantly differ between eyes with and without PCMO. PCMO incidence was much higher (29.40% vs. 16.30%, p = 0.008) in eyes with baseline CMT ≥ 500 µm. CONCLUSIONS: When managing ERM and cataract, PPV should be performed before cataract surgery to yield better visual outcomes. Both surgical sequences yield similar PCMO rates. Greater baseline CMT is a risk factor for PCMO after cataract surgery.

Deep learning and ensemble stacking technique for differentiating polypoidal choroidal vasculopathy from neovascular age-related macular degeneration.

Polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD) share some similarity in clinical imaging manifestations. However, their disease entity and treatment strategy as well as visual outcomes are very different. To distinguish these two vision-threatening diseases is somewhat challenging but necessary. In this study, we propose a new artificial intelligence model using an ensemble stacking technique, which combines a color fundus photograph-based deep learning (DL) model and optical coherence tomography-based biomarkers, for differentiation of PCV from nAMD. Furthermore, we introduced multiple correspondence analysis, a method of transforming categorical data into principal components, to handle the dichotomous data for combining with another image DL system. This model achieved a robust performance with an accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of 83.67%, 80.76%, 84.72%, and 88.57%, respectively, by training nearly 700 active cases with suitable imaging quality and transfer learning architecture. This work could offer an alternative method of developing a multimodal DL model, improve its efficiency for distinguishing different diseases, and facilitate the broad application of medical engineering in a DL model design.

Flow signal change in polyps after anti-vascular endothelial growth factor therapy.

Optical coherence tomography angiography (OCTA) is a novel, non-invasive imaging tool used to detect vascular flow. The absence of a flow signal in OCTA in polyps revealed by indocyanine green angiography (ICGA) in patients with polypoidal choroidal vasculopathy (PCV) may indicate slow or compromised filling of blood flow from choroidal vessels. Naïve patients with PCV treated with intravitreal injections of aflibercept (IVI-A) were enrolled in this study to validate the hypothesis that baseline flow may affect the outcome of polyp regression in ICGA. The flow signal of polyps in OCTA was detected by manual segmentation in the corresponding location by ICGA. Polyps were defined as high-flow if both OCTA and ICGA showed positive findings, and low-flow if OCTA showed a negative flow signal in 3 consecutive horizontal scans at the polyp area shown in ICGA. A total of 24 polyps were identified in 13 PCV patients at baseline. Of these 24 polyps, 22 (91.7%) were high-flow and 2 (8.3%) were low-flow. After 3 monthly IVI-A, all low-flow polyps had complete regression in ICGA. Among 17 (77%) high-flow polyps at baseline that had regression after treatment, 10 (58.8%) became low-flow, while 5 (22.7%) persistent polyps remained high-flow. Flow signal of polyps as detected by OCTA could be a predictive factor for treatment response in patients with PCV. Monitoring changes in flow signal after treatment is clinically relevant.

Connexin channel and its role in diabetic retinopathy.

Diabetic retinopathy is the leading cause of blindness in the working age population. Unfortunately, there is no cure for this devastating ocular complication. The early stage of diabetic retinopathy is characterized by the loss of various cell types in the retina, namely endothelial cells and pericytes. As the disease progresses, vascular leakage, a clinical hallmark of diabetic retinopathy, becomes evident and may eventually lead to diabetic macular edema, the most common cause of vision loss in diabetic retinopathy. Substantial evidence indicates that the disruption of connexin-mediated cellular communication plays a critical role in the pathogenesis of diabetic retinopathy. Yet, it is unclear how altered communication via connexin channel mediated cell-to-cell and cell-to-extracellular microenvironment is linked to the development of diabetic retinopathy. Recent observations suggest the possibility that connexin hemichannels may play a role in the pathogenesis of diabetic retinopathy by allowing communication between cells and the microenvironment. Interestingly, recent studies suggest that connexin channels may be involved in regulating retinal vascular permeability. These cellular events are coordinated at least in part via connexin-mediated intercellular communication and the maintenance of retinal vascular homeostasis. This review highlights the effect of high glucose and diabetic condition on connexin channels and their impact on the development of diabetic retinopathy.

Acute macular edema and peripapillary soft exudate after pancreas transplantation with accelerated progression of diabetic retinopathy.

BACKGROUND: The effect of pancreas transplantation on diabetic retinopathy remains inconclusive. Herein, we report six patients with type 1 diabetes mellitus (DM) who underwent pancreas transplantation and developed acute macular edema and peripapillary soft exudate with rapid progression to proliferative diabetic retinopathy. METHODS: In this retrospective observational study, diabetic patients who underwent pancreas transplantation in a single medical center and developed symptomatic acute macular edema and peripapillary soft exudate within 3 months after the operation were enrolled. The complete ophthalmic course and medical records of the patients were retrospectively reviewed. Diabetic retinopathy and progression following treatment after pancreas transplantation were measured. RESULTS: Six Chinese women with type 1 DM were enrolled in this study. Mean hemoglobin (Hb) A1c was 13.4% prior to transplantation and decreased rapidly to 6.5% within 2 months postsurgery. The patients had no or mild pretransplant diabetic retinopathy and developed acute symptomatic macular edema and peripapillary soft exudate in both eyes after pancreas transplantation. All macular edema resolved either with or without treatment. Five cases progressed to proliferative diabetic retinopathy and received panretinal photocoagulation. Diabetic retinopathy remained stable in all eyes after treatment, and the visual prognosis was good, except in one eye that had macular branch retinal artery occlusion with foveal involvement. CONCLUSION: Acute macular edema after pancreas transplantation has a favorable treatment outcome despite rapid progression to proliferative diabetic retinopathy. High pretransplant HbA1c and abrupt blood sugar normalization may be related to the disease course.

Sensitivity, Specificity, and Limitations of Optical Coherence Tomography Angiography in Diagnosis of Polypoidal Choroidal Vasculopathy.

PURPOSE: To evaluate the sensitivity and specificity of optical coherence tomography angiography (OCTA) in differentiating polypoidal choroidal vasculopathy (PCV) from age-related macular degeneration (AMD). METHODS: Fundus color photographs, spectral-domain optical coherence tomography, and fluorescein angiography (step 1) and OCTA (step 2) of 50 eyes that had PCV or AMD were presented to two ophthalmologists. The final diagnoses of PCV were masked. Sensitivity and specificity were calculated and compared to the 2-step approach (before and after OCTA) in detecting PCV. The limitations were also evaluated. RESULTS: Of the 50 eyes, 31 were PCV and 19 were non-PCV. The sensitivity increased from 69.5% to 90% after OCTA; however, there was no significant improvement in specificity after OCTA. 70.9% of the eyes with PCV had clear or obvious branching vascular nets (BVNs) in OCTA with high sensitivity (97.5%) after OCTA. Contrarily, 29.1% had insignificant BVNs with a low sensitivity (72.5%) after OCTA. 27% of the occult choroidal neovascularization (CNV) cases were overdiagnosed as PCV when OCTA was applied. CONCLUSIONS: OCTA based on clear BVNs at the choroidal level increased sensitivity of diagnosis of PCV by 20%. However, the false-positive rate also increased in occult CNV. Several limitations for a correct diagnosis of PCV were noted.

Molecular and Cytological Comparisons of Chromosomes 7el1, 7el2, 7E(e), and 7E ⁱ Derived from Thinopyrum.

Thinopyrum chromosomes 7el1, 7el2, 7E(e), and 7E(i), homoeologous to group 7 chromosomes of common wheat (Triticum aestivum), were determined to have many useful agronomical traits for wheat improvement. To analyze the genetic relationships among the 4 Thinopyrum 7E chromosomes, the conserved orthologous set markers, genomic in situ hybridization (GISH), and meiotic chromosome pairing were used in this study. The unweighted pair-group method with arithmetical averages (UPGMA) analysis indicated that 7el1, derived from T. ponticum, and 7E(i), derived from T. intermedium, were the most closely related. 7el2, derived from T. ponticum, was relatively distant from the 7el1-7E(i) complex. While 7E(e), derived from T. elongatum, was more distantly related to 7el1, 7el2, and 7E(i). This is the first report showing that 7el1 and 7E(i) may be similar, which could be explained by the similar chromosome signal distribution revealed by GISH as well as UPGMA analysis revealed by both molecular markers and the highest frequency of meiotic pairing. The newly developed genome-specific molecular markers may be useful for marker-assisted selection of Lr19, Bdv3, and Fhblop.

Systolic blood pressure, choroidal thickness, and axial length in patients with myopic maculopathy.

BACKGROUND: In the population-based Shihpai Eye Study, patients aged >65 years with myopic maculopathy were found to have higher systolic blood pressure. This finding deserved further exploration because this is the only correctable factor for preventing maculopathy in patients with high myopia. Therefore, we investigated the association between myopic maculopathy and systolic blood pressure, as well as other ocular parameters in this study. METHODS: A clinic-based, retrospective cross-sectional study at a medical center was conducted between February 2011 and October 2012. Patients with high myopia were included and medical charts were reviewed. High myopia was defined as axial length ≥26.5 mm in at least one eye. Myopic maculopathy was defined as the presence of lacquer cracks, focal areas of deep choroidal atrophy, diffuse chorioretinal atrophy, and macular choroidal neovascularization or geographic atrophy in the presence of high myopia. Systolic blood pressure measurements were collected, and fundus photography and optical coherence tomography were performed. Subfoveal choroidal thickness (SFCT) shown on optical coherence tomography was measured and recorded. RESULTS: The medical records of 187 high-myopic patients (87 without and 100 with maculopathy) were reviewed. Patients with maculopathy were older (56.96 years vs. 42.95 years, p < 0.01), had longer axial length (29.96 mm vs. 27.31 mm, p < 0.01), thinner SFCT (49.71 µm vs. 155.77 µm, p < 0.01), higher systolic blood pressure (132.28 mmHg vs. 125.31 mmHg, p < 0.05), greater prevalence of hypertension (31% vs. 16%, p < 0.05), and longer history of hypertension (2.34 years vs. 0.59 years, p < 0.01) compared to patients without maculopathy. After multivariate adjustment, SFCT and axial length were the only significant factors for maculopathy. CONCLUSION: Thinner SFCT and longer axial length are significant risk factors for myopic maculopathy. Unlike previous epidemiological surveys, results of this clinic-based study suggested that systolic blood pressure is not a significant factor for maculopathy.

Shotgun Analysis of the Secretome of Fusarium graminearum.

Fusarium head blight, caused predominately by Fusarium graminearum, is one of the most destructive diseases of wheat (Triticum aestivum L.) worldwide. To characterize the profile of proteins secreted by F. graminearum, the extracellular proteins were collectively obtained from F. graminearum culture supernatants and evaluated using one-dimensional SDS-PAGE and liquid chromatography-tandem mass spectrometry. A total of 87 proteins have been identified, of which 63 were predicted as secretory proteins including those with known functions. Meanwhile, 20 proteins that are not homologous to genomic sequences with known functions have also been detected. Some of the identified proteins are possible virulence factors and may play extracellular roles during F. graminearum infection. This study provides a valuable dataset of F. graminearum extracellular proteins, and a better understanding of the virulence mechanisms of the pathogen.

Prevalence and associated risk factors of myopic maculopathy in elderly Chinese: the Shihpai eye study.

PURPOSE: To assess the prevalence and associated risk factors of myopic maculopathy in an elderly Chinese population in Taiwan. METHODS: Population-based, cross-sectional study. A total of 1361 Chinese aged 65 years or older residing in Shihpai, Taipei, Taiwan, underwent a detailed ophthalmic examination. Of the 1361 participants, 1058 subjects had at least one gradable fundus photograph and were recruited for analysis. High myopia was defined as spherical equivalent of less than -6.0 diopter (D) in the phakic eyes or axial length greater than 26.5 mm in pseudophakic or aphakic eyes. Myopic maculopathy was defined as the appearance of lacquer cracks, focal area of deep choroidal atrophy and macular choroidal neovascularization, or geographic atrophy in the presence of high myopia. RESULTS: The prevalence of high myopia was 4.2% (44/1058). Signs of myopic maculopathy were present in 32 (72.7%) of the 44 high myopics, representing a prevalence of 3.0% (95% confidence interval, 2.0%-4.0%). Subjects with high myopia with myopic maculopathy had higher systolic blood pressure than those without maculopathy (146.4 ± 16.2 mm Hg vs. 127.0 ± 15.9 mm Hg, P = 0.001), and the difference persisted (P = 0.018) after adjustment for age, sex, smoking, body mass index, diastolic blood pressure, educational levels, alcohol drinking, and histories of diabetes or taking anti-hypertension medication. Of the 65 high myopic eyes, eyes with maculopathy had a greater myopic degree (-12.8 ± 5.1 D vs. -7.6 ± 1.5 D, P = 0.001) and poorer corrected visual acuity (logMAR 0.72 ± 0.6 vs. 0.27 ± 0.2, P = 0.001) than those without. CONCLUSIONS: The prevalence of high myopia and myopic maculopathy in this elderly Chinese population group was high. Of the major risk factors examined, high systolic blood pressure may be associated with myopic maculopathy.

Cytomegalovirus and herpes simplex virus as causes of bilateral anterior uveitis in an immunocompetent patient.

We report a case with two distinct clinical manifestations of bilateral anterior uveitis caused by two different members of the herpes virus group. A 72-year-old immunocompetent man, who had a documented history of two episodes of Posner-Schlossman syndrome in the left eye, presented with multiple mutton-fat keratic precipitates and elevated intraocular pressure (IOP) in his right eye. Herpes simplex virus Type I DNA was detected by polymerase chain reaction in the aqueous humor of the right eye. One year later, the patient appeared with a few round and whitish keratic precipitates and elevated IOP in his left eye. Polymerase chain reaction analysis showed positive for cytomegalovirus in the aqueous humor of the left eye. During both episodes, the anterior uveitis subsided and IOP returned to normal after systemic and topical antiglaucomatous medication as well as topical steroid.

High glucose-induced downregulation of connexin 43 expression promotes apoptosis in microvascular endothelial cells.

PURPOSE: This study aims to determine whether high glucose-induced inhibition of connexin 43 (Cx43) expression and reduced gap junction intercellular communication (GJIC) promote microvascular endothelial cell loss. METHODS: To downregulate Cx43 protein expression in rat microvascular endothelial cells (RMECs), the cells were grown in high (30 mM) glucose medium for 7 days, or transfected with antisense-Cx43 (AS-Cx43) oligonucleotides. Western blot analysis confirmed significant inhibition of Cx43 protein expression. Scrape load dye transfer (SLDT) assay showed significant reduction in GJIC activity in these cells compared to cells grown in normal medium or transfected with random oligonucleotides. In parallel, Cx43 immunostaining showed significant decrease in number of Cx43 plaques in cells with reduced Cx43 expression. DNA ladder assay, TUNEL assay, and differential staining were performed to identify cells undergoing apoptosis. RESULTS: DNA ladder analysis, TUNEL assay, and differential staining indicated a significant increase in the number of apoptotic cells when Cx43 protein expression was reduced in both high-glucose cells or cells transfected with AS-Cx43 oligonucleotides with concomitant downregulation of GJIC activity. Additionally, DNA fragmentation, which was evident in cells with reduced Cx43 expression, suggested early phases of apoptosis. CONCLUSIONS: These results provide the first evidence that high glucose-induced downregulation of Cx43 expression is an early trigger for inducing apoptosis in microvascular endothelial cells. This finding may have important implications toward breakdown of vascular homeostasis and initiation of apoptosis in diabetic retinopathy.

Prevalence and associated risk factors of age-related macular degeneration in an elderly Chinese population in Taiwan: the Shihpai Eye Study.

PURPOSE: To assess the prevalence and associated risk factors of age-related macular degeneration (AMD) in an elderly Chinese population in Taiwan. METHODS: The Shihpai Eye Study was a survey of vision and ocular disease in an elderly Chinese population 65 years of age or older residing in Shihpai, Taipei, Taiwan. Of 2045 elderly residents randomly sampled from the household registration databank, 1361 (66.6%) underwent a detailed ophthalmic examination that included fundus color slides by fundus camera after pupil dilatation. Photographs were graded according to the Wisconsin Age-Related Maculopathy Grading System. RESULTS: Fundus photographs were available for 1105 (54.0% in the eligible, 81.2% in the ocular examined) participants. The 47 (4.3%) participants who had ungradable fundus images were older and had more lens opacity. Of the 1058 gradable photographs, the prevalence of early AMD was 9.2% (95% confidence interval [CI], 7.8-10.8); of late AMD, 1.9% (95% CI, 1.3-2.7); of soft drusen, 42.2% (95% CI, 39.7-44.8); of soft indistinct drusen, 4.1% (95% CI, 3.1-5.2); and of any pigmentary change, 8.6% (95% CI, 7.2-10.2). Age was the most significant factor associated with both early and late AMD. The prevalence of early AMD rose from 5.0% in the 65- to 69-year age group to 24.4% in those 80 years of age and older; and for late AMD, from 1.0% to 9.0%. Those who currently drank alcohol had a lower rate of early AMD than did the nondrinker (adjusted odd ratio 0.32, 95% CI: 0.11-0.93, P = 0.037). CONCLUSIONS: AMD is a common eye disease in the elderly Chinese people in Taiwan. The adjusted prevalence rate of exudative AMD is comparable to that in the Chinese people in the Multiethnic Study of Atherosclerosis (MESA) in the United States but is higher than in the Chinese people in the Beijing study in China. Further studies are needed to clarify the incidence and associated risk factors.

Assessing the natural course of diabetic retinopathy: a population-based study in Kinmen, Taiwan.

PURPOSE: To explore the natural course of diabetic retinopathy among type 2 diabetics using the indirect ophthalmoscope and single-field fundus photographs in Kinmen, Taiwan. METHODS: A screening program for diabetic retinopathy was carried out by a panel of ophthalmologists, who employed the ophthalmoscope and 45-degree retinal color photographs to examine the fundus after pupil dilation. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type 2 diabetes. A multi-state Markov model was used to assess the natural course of diabetic retinopathy among type 2 diabetics. RESULTS: Among the 725 diabetes patients who attended at least two ophthalmological fundus check-ups and were screened, the overall response rate was about 75%. The mean duration of the disease states mild nonproliferative diabetic retinopathy, moderate nonproliferative diabetic retinopathy, severe nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy were 4.05 [95% confidence interval (CI): 3.28-5.32], 4.18 (95% CI: 3.18-6.06), 2.52 (95% CI: 1.78-4.27), and 4.22 (95% CI: 2.88-7.81) years, respectively. Compared to controls, the incidence of blindness reduction for annual, biennial, 3-year, 4-year, and 5-year screenings of diabetic retinopathy were approximately 94.4% (95% CI: 91.6%-96.3%), 83.9% (95% CI: 83.6%-84.2%), 70.2% (95% CI: 69.8%-70.7%), 57.2% (95% CI: 56.7%-57.7%), and 45.6% (95% CI: 45.0%-46.1%), respectively. CONCLUSIONS: In conclusion, the average time for the development of diabetic retinopathy from nonexistence to blindness was approximately 26.5 years. The present recommendation for annual screening in type 2 diabetics with nonproliferative diabetic retinopathy should be retained only for the mild form, not for the moderate or severe forms.

Population-based study of nonproliferative diabetic retinopathy among type 2 diabetic patients in Kinmen, Taiwan.

PURPOSE: This study was conducted to assess the prevalence and associated factors of nonproliferative diabetic retinopathy among type 2 diabetic patients in Kinmen, Taiwan. METHODS: From 1991 to 1993, 971 type 2 diabetic patients in Kinmen underwent diabetic retinopathy screening performed by a panel of ophthalmologists using indirect ophthalmoscopy and 45 degrees color fundus retinal photographs. RESULTS: Of the 971 patients screened in 1991-1993, 578 (59.5%) were examined for this study. Diabetic retinopathy was diagnosed in 127 patients (22.0%), including nonproliferative diabetic retinopathy in 13.3%, proliferative diabetic retinopathy in 1.4%, legal blindness in 1.4%, and ungradable diabetic retinopathy in 5.9%. Significant associated factors of nonproliferative diabetic retinopathy based on multiple logistic regression analysis were fasting plasma glucose (FPG) at baseline [> or =126 mg/dl vs. <126 mg/dl; odds ratio (OR) = 2.89; 95% confidence interval (CI), 1.01-9.09], 2-h postload at baseline (> or =200 vs. <200 mg/dl; OR = 1.48; 95% CI, 1.09-2.07); HbA1c at follow-up (> or =7% vs. <7%; OR = 6.54; 95% CI, 3.01-14.20), duration of diabetes (> or =15 years vs. <10 years; OR = 6.72; 95% CI, 2.13-21.18), and incremental systolic blood pressure between baseline and follow-up (OR = 1.02; 95% CI, 1.00-1.04). CONCLUSIONS: In addition to the longer duration of type 2 diabetes, FPG at baseline, poorly controlled glucose concentration, and altered blood pressure may increase the risk of nonproliferative diabetic retinopathy in type 2 diabetic patients.

Effect of combined antisense oligonucleotides against high-glucose- and diabetes-induced overexpression of extracellular matrix components and increased vascular permeability.

The effect of combined antisense oligonucleotides (AS-oligos) against overexpression of extracellular matrix (ECM) components, fibronectin, laminin, and collagen IV and on cell monolayer permeability was examined in rat microvascular endothelial cells (RMECs) grown in high glucose medium and on retinal vascular permeability in diabetic rats. RMECs grown in high glucose for 10 days and transfected with combined AS-oligos showed a significantly reduced fibronectin, laminin, and collagen IV protein level. In parallel studies, high-glucose-induced excess monolayer permeability was also reduced in RMECs transfected with the combined AS-oligos. Similarly, diabetic rats intravitreally injected with the combined AS-oligos and examined after 2 months of diabetes showed significant reduction in retinal fibronectin, laminin, and collagen IV expression. In addition, vascular permeability, as determined from extravasation of fluorescein isothiocyanate-BSA in the surrounding areas of the retinal capillaries, was partially reduced in the combined AS-oligos-treated diabetic retinas. Our results indicate that the combined AS-oligos strategy is effective in simultaneously reducing fibronectin, collagen IV, and laminin overexpression and reducing vascular leakage in the retinal capillaries of diabetic rat retinas. The findings suggest that abnormal synthesis of ECM components may contribute to vascular leakage in the diabetic retina.

Detection of varicella-zoster virus DNA in the iris of a zoster sine herpete patient.

A 55-year-old man presented with unilateral iridocyclitis and elevated intraocular pressure (IOP) in his right eye. Varicella-zoster virus (VZV) DNA was detected by polymerase chain reaction (PCR) in the iris of a patient of Zoster Sine Herpete. No symptoms or signs of herpes zoster like neuralgia or cutaneous eruptions on forehead were noted. His iridocyclitis was treated and responded well with systemic and topical acyclovior as well as topical steroid. However, the marked elevated IOP could not be controlled by maximal dosage of anti-glaucomatous medicine. The patient underwent trabeculectomy to control his IOP. Samples of aqueous humor and iris tissue were obtained and VZV was checked by PCR. VZV virus DNA was detected from samples of the aqueous humor and iris tissue patient of Zoster Sine Herpete by PCR analysis.

A community-based follow-up study on diabetic retinopathy among type 2 diabetics in Kinmen.

The purpose of this follow-up study was conducted to assess the incidence and risk factors of diabetic retinopathy (DR) among type 2 diabetics in Kinmen, Taiwan. A penal of eye screening regimes were performed yearly for 971 type 2 diabetics by two senior ophthalmologists using indirect ophthalmoscopy and 45-degree color fundus photography to examine fundus after dilating pupils from 1999 to 2002. 74.7% (725/971) of diabetics had been screened at least two times during this period. Among the 548 type 2 diabetics who had no DR at first screening, 93 subjects developed any type of DR. The 3-year 18.2% cumulative incidence was (95% CI: 14.8-21.5%) and incidence density was 6.62% per year (95% CI: 5.36-8.06% per year). Using Cox regression model, HbAlc revealed the significantly dose response relationship to the development of DR (chi2-test for trend = 9.41, p < 0.05) after controlling for confounding factors. Other independent predictors related to the development of DR included duration of diabetes (RR: 1.09, 95% CI: 1.05-1.13), higher systolic blood pressure (>140 vs. < 140 mm Hg, RR: 1.96, 95% CI: 1.23-3.12), and higher triglyceride (> 200 vs. < 200 mg/dl, RR: 1.60, 95% CI: 1.01-2.54). In conclusion, in addition to poor glycemic control of which is the most significant risk factor for the development of DR, longer duration of diabetes, higher systolic blood pressure, and elevated serum triglyceride levels were also associated with the development of DR among type 2 diabetics in Kinmen.