Optical coherence tomography (OCT), as a high-resolution, non-invasive, in-vivo image method has been widely used in retinal field, especially in the examination of fundus diseases. Nowadays, the modality has been gradually popularized in most of the national basic-level hospitals. However, OCT is only employed as a diagnostic tool in most cases, ophthalmologists lack of awareness of further exploring the information behind the raw data. In the era of fast-developing artificial intelligence, on the basis of standardized information management, a more comprehensive OCT database should be established. Further original image processing, lesion analysis, and artificial intelligence development of OCT images will help improve the understanding level of vitreoretinal diseases among clinicians and assist ophthalmologists to make more appropriate clinical decisions.
Replacement of diseased retinal pigment epithelium (RPE) cells with healthy RPE cells by transplantation is one option to treat several retinal degenerative diseases including age-related macular degeneration, which are caused by RPE loss and dysfunction. A cellular scaffold as a carrier for transplanted cells, may hold immense promise for facilitating cell migration and promoting the integration of RPE cells into the host environment. Scaffolds can be prepared from a variety of natural and synthetic materials. Strategies, such as surface modification and structure adjustment, can improve the biomimetic properties of the scaffolds, optimize cell attachment and cellular function following transplantation and lay a foundation of clinical application in the future.
ObjectiveTo observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.MethodsA retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients (15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index (MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale -25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters.ResultsAt 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=−0.536, −0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001).ConclusionInternal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%).
ObjectiveTo observe the flow density (FD) of macular and optic disc and area of foveal avascular zone (FAZ) in severe nonproliferative diabetic retinopathy (S-NPDR).MethodsA prospective cross-sectional study. From October 2019 to April 2020, 31 eyes of 25 S-NPDR patients (S-NPDR group) who were diagnosed in the ophthalmological examination of Jiangsu Province Hospital and 30 eyes of 30 age- and sex-matched healthy volunteers (control group) were included in this study. Optical coherence tomography angiography (OCTA) was used to scan the macular area of 6 mm×6 mm and optic disc of 4.5 mm×4.5 mm. The software automatically divides it into three concentric circles centered on the macular fovea, which were foveal area with a diameter of 1 mm, parafoveal area of 1 to 3 mm, and foveal peripheral area of 3 to 6 mm. The area around the optic disc was divided into 8 areas: nasal upper, nasal lower, inferior nasal, inferior temporal, temporal lower, temporal upper, superior temporal and superior nasal. The FD of the optic disc, the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina and FAZ area were measured. The FD and FAZ area were compared between the two groups by independent sample t test. The correlation between FAZ area and FD was analyzed by Pearson correlation.ResultsIn parafoveal and perifoveal area, compared with the control group, the FD of SCP (t=6.470, 5.220; P＜0.001) and DCP (t=7.270, 7.370; P＜0.001) decreased in S-NPDR group. In foveal area, there was statistically significant difference in the FD of DCP between the two groups (t=2.250, P=0.030), while the difference in FD of SCP between the two groups was not statistically significant (t=0.000, P=0.900). The FAZ area in S-NPDR group was larger than that in control group, and the difference was statistically significant (t=2.390, P=0.030). The FD in the S-NPDR group was lower than that in the control group except the superior nasal, the difference was statistically significant (t=7.520, 5.000, 4.870, 3.120, 2.360, 2.120, 5.410, 5.560, 2.640; P＜0.05). Pearson correlation analysis showed that the FAZ area of S-NPDR was negatively correlated with FD of SCP (r=－0.513, P=0.004), and had no correlation with FD of DCP (r=0.034, P=0.859).ConclusionThe overall FD in macular area and optic disc of patients with S-NPDR decreased and the FAZ area enlarged.
Circular RNA (circRNA) is a new group of endogenous non-coding RNAs produced by back-splicing, which has multiple molecular functions such as acting as microRNA sponges, regulators of transcription and splicing, adaptors for protein-protein interaction. Recent studies have shown that circRNA play an essential role in development and progression of retinal microvascular dysfunction, diabetic retinopathy, age-related macular degeneration, proliferative vitreoretinopathy, eye diseases caused by hyperhomocysteine and ocular malignancy. In pathological conditions, the differential expression of circRNA alters the transcription and translation of corresponding genes, thus changing the activity and function of cells. CircRNA may become a new marker and prognostic indicator of fundus diseases, and its targeted intervention may also become a potential treatment for fundus diseases.
Objective To observe the clinical efficacy of pars plana vitrectomy (PPV) combined with dexamethasone intravitreal implant (DEX) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized controlled study. A total of 57 PDR patients with 79 eyes diagnosed by Department of Ophthalmology of The First Affiliated Hospital of Nanjing Medical University from May 2021 to February 2023 were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were performed in all affected eyes. Central macular thickness (CMT) was measured by OCT. The patients were randomly divided into control group and experimental group, with 27 cases and 35 eyes and 30 cases and 44 eyes, respectively. All eyes were treated with routine 25G PPV and intraoperative whole-retina laser photocoagulation. At the end of the operation, the experimental group was given 0.7 mg DEX intravitreal injection. At 1, 4, 12, and 24 weeks after operation, the same equipment and methods were used for relevant examinations. The improvement after surgery was assessed according to the diabetic retinopathy severity score (DRSS). Mixed analysis of variance was used to compare logarithm of the minimum angle of resolution BCVA and CMT between the two groups and within the two groups before and after operation. ResultsAt 1, 4, 12 and 24 weeks after surgery, BCVA was significantly improved at different time points after surgery, and the differences were statistically significant (P＜0.001). At different time after operation, BCVA and CMT in experimental groups were significantly better than that in control group, with statistical significance (P＜0.05). Compared with the CMT before surgery, the CMT at all time point after surgery in experimental group were significantly decreased, and the difference were statistically significant (P＜0.05). There was no significant difference one week after eye operation in control group (P=0.315). At 4, 12 and 24 weeks after operation, CMT decreased in control group, and the differences were statistically significant (P＜0.05). Compared with before surgery, DRSS increased two steps higher at 1, 4, 12 and 24 weeks after surgery in 20 (45.45%, 20/44), 26 (59.10%, 26/44), 32 (72.73%, 32/44) and 31 (70.45%, 31/44) eyes in the experimental groups, respectively. The control group consisted of 15 (42.86%, 15/35), 15 (42.86%, 15/35), 16 (45.71%, 16/35) and 18 (51.43%, 18/35) eyes, respectively. There was no significant difference in DRSS at 1, 4 and 24 weeks after operation between the control group and the experimental group (P=0.817, 0.178, 0.105). At 12 weeks after surgery, the difference was statistically significant (P=0.020). ConclusionPPV combined with intravitreal injection of DEX in the treatment of PDR can improve postoperative visual acuity, alleviate postoperative macular edema and improve the severity of DR.
Single cell RNA sequencing technique provides a strong technical support for the analysis of cell heterogeneity in biological tissues, and has been widely used in biomedical research. In recent years, considerable scRNA-seq data have been accumulated in the research of ocular fundus diseases. The ocular fundus is abundant for the network of vessel and neuron, which leads to the complicated pathogenesis of fundus diseases. Through single cell RNA sequencing technique, the expression of thousands of genes of certain cell types or even subtypes can be obtained in the disease environment. Single cell RNA sequencing technique accurately reveals the pathogenic cell types and pathogenic mechanisms of ocular fundus diseases such as neovascular retinopathy, which provides a theoretical basis for the birth of new diagnosis and treatment targets. The construction of multi-omics single-cell database of ocular fundus diseases will enable high-quality data to be further explored and provide an analysis platform for ophthalmic researchers.
Lactate was originally thought to be a metabolic waste product of glycolysis produced by cells in hypoxic environment. In recent years, increasing evidence has indicated that lactate plays a crucial role in the physiological and pathological processes of the retina. Lactate is transported via monocarboxylate transporters in different retinal cell types such as photoreceptor cells and Müller cells to maintain the high metabolic demand of the retina. In addition to serving as oxiditive substrate for energy, lactate can mediate intracellular signal transduction through receptor G protein-coupled receptor 81, participating in the maintenance of retinal homeostasis and the progression of pathological neovascularization. Moreover, lactate-mediated protein lactylation directly regulates gene expression in microglia and T lymphocytes, which has gradually become a new hotspot in the field of retinal pathological neovascularization and neuroinflammation. Therefore, the regulation of lactate metabolism may provide novel perspectives for the treatment of retinal lactic acid metabolism disorders such as age-related macular degeneration and retinitis pigmentosa.
ObjectiveTo analyze the status and influencing factors of awareness of diabetic retinopathy (DR) knowledge in diabetics in Funing County, Jiangsu Province. MethodsThis is a cross-sectional study. In 2021, a total of 2 125 residents with diabetes in Funing County, Jiangsu Province were recruited using cluster random sampling methods. General examinations were performed and ophthalmological evaluation were conducted including visual acuity in daily life, slit lamp microscope with preset lens, digital non-mydriatic fundus photography. Clinical assessment and classification of DR were according to the international standard clinical classifications of diabetic retinopathy in 2019. DR was classified into no obvious DR, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative diabetic retinopathy (PDR). Field questionnaire surveys were conducted to show the awareness rate of DR knowledge. Then Chi-square test and Logistic regression analysis were used to investigate influencing factors. ResultsAmong 2 125 subjects, 762 (35.86%, 762/2 125) residents were male and 1 363 (64.14%, 1 363/2 125) residents were female. A total of 444 (20.89%, 444/2 125) subjects were diagnosed as DR. Among which, 438 (20.61%, 438/2 125) subjects were NPDR, 6 (0.28%, 6/2 125) subjects were PDR. A total of 419 (19.72%, 419/2 125) subjects were diagnosed as cataract. The topic awareness rates were all below 45.00%. The overall population awareness rate was 19.45% (4 959/25 500). Awareness rate was correlated with age, visual acuity in daily life, education level, family history of diabetes, diabetic retinopathy grades and the type of treatment for diabetes (P＜0.001). Logistic regression analysis showed that the knowledge rate of prevention and treatment of DR Decreased significantly in patients aged 60-79 compared with those aged under 50 (P＜0.05). Compared with those with visual acuity＜0.1 in daily life, the knowledge rate of DR prevention and treatment in those with visual acuity≥0.1 was significantly decreased (P＜0.05). While primary school to college education, with family history of diabetes, with DR, oral hypoglycemic agents and/or insulin treatment were associated with higher awareness rate (P＜0.05). ConclusionsThe DR knowledge level is low among diabetics in Funing County, Jiangsu Province in 2021. Age, visual acuity in daily life, education level, family history of diabetes, with DR and receiving drug treatments are main influencing factors for diabetic’s awareness.