Objective To evaluate the effectiveness and safety of intraluminal brachytherapy (ILBT) in prolonging survival and the period free of symptoms for patients with unresectable bile duct cancer. Methods We searched MEDLINE (1977 to May 2007), CNKI (1979 to May 2007) and CBM Disk (1979 to May 2007). The qual ity of included studies was assessed according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Results One randomized controlled trial involving 42 patients with unresectable bile duct cancer fulfilled the inclusion criteria. This found that the median survival time was longer for patients treated with endoprostheses and ILBT compared to those treated with endoprostheses alone (387.9 days versus 298.0 days, Plt;0.05). The stent patency time in patients who were treated with endoprostheses and ILBT was longer than for those treated with endoprostheses alone (378.4 days versus 245.5 days, Plt;0.01). The reductions in bil irubin (mol/l) and alkal ine phosphatase (kat/l) before and after drainage in patients who were treated with endoprostheses and ILBT were similar to those treated with endoprostheses alone (Mean ±SD of bil irubin: before: 219.3 ± 40.5, after: 23.1 ± 37.1 versus before: 227.3 ± 39.8, after: 22.5 ± 44.2; Mean ± SD of alkal ine phosphatase: before: 10.3 ± 5.1. after: 3.6 ± 2.9 versus before: 11.7 ± 5.8, after: 3.7 ± 2.9). No severe adverse effects were observed in the trial. Conclusion Current evidence suggests that ILBT for unresectable bile duct cancer may improve the survival time of patients, prolong the time they spend symptom free, improve their quality of l ife and reduce the burden of treatment. However, it may increase toxicity in normal tissues, which can be managed by adjusting radiation dosage. No serious adverse effects were observed in the 42 patients in the trial in this review. More randomized controlled trials with large sample size are needed to provide rel iable results.
Coats disease is a relatively rare and idiopathic disorder characterized by retinal telangiectasia and massive intra-retinal and (or) sub-retinal lipid accumulation, resulting in complications including retinal detachment and neovascular glaucoma. Previous reports have revealed that Coats disease can be associated with other disorders, especially some inherited diseases, such as retinitis pigmentosa (RP) and facioscapulohumeral muscular dystrophy (FSHD). Coats disease associated with other inherited disorders is generally called Coats-like retinopathy, which has some unique features that differs from the classic Coats disease, for example there is no sex and age preference, more bilateral cases, more severe cases and more genetic factors involved. Patients of Coats-like retinopathy with RP and FSHD may have mutations in Crumbs homologue gene 1 and D4Z4 genes.
Intravitreal injection of anti-VEGF drugs for the treatment of retinopathy of prematurity (ROP) is a hot topic of research, and it can be used to treat the ROP (Ⅰzone). The current anti-VEGF drugs include bevacizumab, ranibizumab, aflibercept and conbercept, etc. However, in recent years, several studies have confirmed that anti-VEGF drugs have an increased recurrence rate and a longer recurrence time than conventional laser photocoagulation therapy. The follow-up period should be extended and repeated injections may be required. Due to the lack of large-scale prospective clinical studies, the recurrence rate, time window of recurrence, risk factors and treatment methods of various anti-VEGF drugs for ROP are still unclear. Anti-VEGF drugs in the treatment of ROP needs to accumulate more evidence-based medical evidence.
Combined with leukemia is a risk factor for aggravating diabetic retinopathy. A combination of diabetic retinopathy and leukemia can be expected to have a rapid progression and patients often visit the department of ophthalmology first. In addition to the typical manifestations of diabetic retinopathy such as retinal venous tortuous dilation, microaneurysm, retinal hemorrhage and exudation, patients may also be associated with leukemic retinopathy. Areas of extensive capillary non-perfusion and neovascularization may appear in the early stage of mild microangiopathy. Moreover, severe complications such as vitreous hemorrhage, neovascular membranes and traction retinal detachment appear earlier, which may be a prognostic indicator for poor vision. The causes of leukemia aggravating diabetic retinopathy include retinal ischemia due to hyperviscosity, anemia and thrombocytopenia, direct infiltration of tumor cells, chemotherapy and radiotherapy, high level of vascular endothelial growth factor. In clinic, rapidly progressing diabetic retinopathy should alert the ophthalmologist to the underlying hematological disorder. Patients with both diabetes and leukemia need to be screened much earlier and followed up at shorter intervals. Early detection and aggressive management may help preserve visual acuity in such cases.
ObjectiveTo observe the clinical effect of radial optic neurotomy (RON) for central retinal vein occlusion (CRVO).MethodsThe clinical data of 5 patients with CRVO who had undergone RON after a standard three-port vitrectomy were analyzed retrospectively. In the 5 patents, CRVO was diagnosed in 2 before the surgery, and the examination of visual acuity, fundus photography, fundus fluorescein angiography (FFA), color doppler imaging (CDI), and examination of perimeter and optic coherence tomography (OCT) were performed on them before and after the operations, respectively. Three patients underwent the operation because of the vitreous hemorrhage and CRVO was diagnosed during the surgery. All of the 5 patients suffered from severe macular edema. The results of post-operative visual acuities, fundus examination, fundus photography and OCT were compared with those of the pre-operative ones. The follow-up after the surgery was 12 months. ResultsThe visual acuities improved in 4 patients and decreased in 1. The results of fundus photography and (or) FFA, and OCT revealed that the macular edema was evidently alleviated 1 month after the surgery and the retinal hemorrhage was absorbed ultimately 2 months after the surgery. The result of examination of perimeter performed on 1 case showed the improvement of visual field. In addition, vitreous hemorrhage occurred in 1 patient postoperatively and hemorrhage occurred in 2 in the operation puncturing the optic disk.ConclusionsRON is helpful to ameliorate the macular edema, reduce the retinal hemorrhages, prevent the neovascularization and enhance the visual acuity to some extent, which maybe clinically feasible and valuable in treating CRVO，but more prospective, randomized, and multi-center researches are still needed to verify the efficacy.(Chin J Ocul Fundus Dis, 2005,21:6-9)
Objective To investigate the effects and complications of the vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment. Methods Seventy-seven eyes of 69 cases undergoing vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment were analyzed retrospectively. Results (1) The postoperative visual acuity was enhanced significantly. (2) Complications during the operation in 11 eyes (14.3%): iatrogenic retinal break in 7 eyes, bleeding in 3 eyes and lens damage in 1 eye. (3) Postoperative complications in 20 eyes (26.0%): rebleeding in 14 eyes, elevated IOP in 6 eyes, retinal detachment in 5 eyes, hyphema in 2 eyes, and exudative membrane in anterior chamber in 1 eye. (4) The main long-term complication was cataract formation (9 eyes) and macular disorder (6 eyes). Conclusion Vitrectomy is an effective method to treat Eales′ disease with vitreous hemorrhage or traction retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 215-217)
Objective To evaluate the clinical and histopathological manifestations of sympathetic ophthalmia after pars plana vitrectomy. Methods The clinical data of 8 patients with sympathetic ophthalmia out of 13 000 who underwent pars plana vitrectomy from Jan 1998 to Dec 2004 were retrospectively analyzed. In the 8 patients, 3 evoked eyes underwent ophthalmectomy and were observed histopathologically. Results The incidence of sympathetic ophthalmia was 0.06%. The time from vitrectomy to the occurrence of sympathetic ophthalmia ranged from 7 to 150 days, with a median of (77.8plusmn;50.8) days. All patients had decrease of visual acuity of the sympathetic eye, visual distortion, red eye, and opthalmalgia. The visual acuity was hand moving to 0.5 in the sympathetic eyes, and no light perception to 0.04 in the evoked eyes. Other clinical manifestations included binocular mutton-fat keratic precipitates, anterior chamber flare and cells, vitreous opacity, optic-disc edema and hyperaemia, and retinal edema at the posterior pole; 2 sympathetic eyes had exudative retinal detachment. The visual acuity increased to 0.4-1.2 in sympathetic eyes and light perception -0.25 in evoked eyes in all of the patients after treatment with oral administration of prednisone 1.0-1.5 mg/kg. In the 3 patients who had undergone ophthalmectomy because of total loss of visual acuity, and the pathological examination revealed infiltrated and thickeduvea due to lymphocytes, epithelioid cell nodules, infiltration of lymphocytes to sclerotic passages, and ocular atrophy were observed. Conclusion The incidence of sympathetic ophthalmia is 0.06%, which happened within 3 months after vitrectomy. The clinical manifestations and results of histological examinations accords with the characteristics of sympathetic ophthalmia. (Chin J Ocul Fundus Dis, 2007, 23: 112-114)
ObjectiveTo study the effects and outcomes of green diode laser therapy under indirect ophthalmoscope in the treatment of juvenile Coats disease. MethodsNineteen juvenile Coats disease patients (19 eyes) well enrolled in this study. Average age at presentation was 73.5 months (27-146 months). Best corrected visual acuity (BCVA) was ≥0.1 in 7 eyes; 0.01 to 0.09 in 8 eyes; counting finger in 3 eyes and light perception in 1 eye. The macular of all eyes was involved. There were 3 eyes with macular exudative retinal detachment, 4 eyes with sub-macular fibrosis, 1 eye with macular atrophy. Exudative area was more than two quadrants in 17 eyes, and less than two quadrants in 2 eyes. The abnormal blood vessels located in the superior or nasal-superior retina (2 eyes) or inferior or temple-inferior area (17 eyes). Exudative retinal detachment occurred in 13 eyes, in which macular was not involved in 10 eyes, and macular was involved in 3 eyes. All patients were treated with green diode laser (532 nm) ablation therapy under general anesthesia and indirect ophthalmoscope to areas of the retina telangiectasia. 3 patients received a single intravitreal 2 mg triamcinolone injection (IVTA). Average follow-up was 18.5 months (6-51 months). Main outcome measures included visual acuity, retinal vascular abnormalities, subretinal exudates and exudative retinal detachment. ResultsAmong 3 patients treated with IVTA, one needed cataract extraction and one needed pre-retinal membrane peeling surgery. After laser photocoagulation, resolution of telangiectasia lesions was achieved in all patients at the end of follow-up. Exudation was resolved in 8 eyes, reduced in 9 patients and no change in 2 eyes. Exudative detachment was resolved in 8/13 eyes, reduced in area in 3/13 eyes and no change in 2 eyes. There were 9 eyes with sub-macular fibrosis and 3 eyes with macular atrophy at the end of follow-up. The visual acuity was stable in most cases. BCVA was ≥0.1 in 6 eyes; 0.01 to 0.09 in 11 eyes; counting finger in 1 eyes and light perception in 1 eye. Compared to the normal eyes, eyes with Coats disease tended to be more hyperopic (t=3.6,P=0.003) and astigmatic (t=3.6, P=0.004), but no correction were needed for these refractive errors. ConclusionsGreen diode laser therapy under indirect ophthalmoscope can be an effective treatment for juvenile Coats disease with little complications. IVTA can be helpful, but must be used with cautions as it can induce some complications.
The new mechanisms of automaticity controlled by the calcium and membrane clocks in sinoatrial node are helpful to revealing the sinus arrhythmia, but the present calcium dynamic model is only on the single cell level. In the present study, a central and peripheral single cell model was developed, and by exponentially changing the cell membrane capacitance, size, conductance and gap junction from the center to the periphery, a two-dimensional inhomogeneous sinus and atrial model was created on the basis of the anatomical structure. Five-point difference and finite element methods were used to process the internal grids and the borders. Irregular borders were defined by creating segment trial functions. Quantitative experiments suggested the consistency of the central and peripheral action potentials with related reports in amplitude, cycle length, maximum diastolic potential and upstroke velocity. Functions of the calcium and membrane clocks on the leading pacemaker site and upstroke velocity as well as the effects of the atrial premature beat on the sinus automaticity were also in good agreement with those in other studies. The developed model is helpful for deeply studying relative roles of the calcium and membrane clocks in automaticity and the relations with electrical activities in atrium. At the same time it will lay the foundation for building three-dimensional sinus and atrial organic models.