Obiective lt;brgt;To investigate the change of the activity of proliferation in cultivated Muuml;ller cells treated by advanced glycation endoproducts (AGEs), and the effect of these changes on expression of occludin in bovine retinal vascular endothelial cells (BREC). lt;brgt;Methods lt;brgt;The cultivated Muuml;ller cells were devided into normal growth group and cultured with AGEs group. The cultured BREC were devided into 4 groups:group 1, without any medium; group 2, with normal growth Muuml;ller cell medium (MCM); group 3,MCM treated by AGEs; group 4, without cell as the control. Enzyme-linked immuno sorbent assay was used to detect the content of occludin in the medium in the 4 groups. lt;brgt;Results lt;brgt;The content of expression of occludin was the most in group 2, less in group 1, and the least in group 3. lt;brgt;Conclusion lt;brgt;AGEs may promote the abnormal proliferation of Muuml;ller cells and inhibit the expression of occludin in BREC. lt;brgt;(Chin J Ocul Fundus Dis, 2006, 22: 28-30)
There has been ongoing progress in the new technique and equipment in vitreoretinal surgery in recent years, contributing to the improvement of treatment of various vitreoretinal diseases. The application of 3D heads-up display viewing system (3D viewing system) has been one of the most fascinating breakthroughs in vitreoretinal surgery. Unlike the traditional method in which the surgeons have to look through the microscope eyepieces, this system allows them to turn their heads up and operate with their eyes on a high-definition 3D monitor. It provides the surgeons with superior visualization and stereoscopic sensation. And increasing studies have revealed it to be as safe and effective as the traditional microscopic system. Furthermore, the surgeons can keep a heads-up position in a more comfortable posture and lesson the pressure on cervical spine. Meanwhile, 3D viewing system makes it easier for the teaching and learning process among surgeons and assistants. However, there are still potential disadvantages including the latency between surgeon maneuver and visualization on the display, learning curves and cost. We hope that the 3D viewing system will be widely used and become a useful new tool for various vitreoretinal diseases in the near future with rapid development in the technology and constant upgrade of the system.
ObjectiveThe aim of this study is to observe the clinical characteristics and surgical effects of macular hole retinal detachment in high myopia patients with pars plana vitrectomy (PPV) and secondary internal limiting membrane (ILM) peeling. MethodsThis was a retrospective study. The clinical data of 15 patients (15 eyes)with macular hole retinal detachment and high myopia, who underwent primary PPV and secondary ILM peeling, were analyzed, including disease history, refraction diopter, ocular axis length, posterior scleral staphyloma, BCVA, macular reattachment and macular hole heeling. There were 3 males (3 eyes) and 12 female (12 eyes), the average age was (60.80±5.85)years. All patients were examined by best corrected visual acuity (BCVA), slit lamp microscopy with 90D pre-lens, indirect ophthalmoscopy, A scan and optical coherence tomography (OCT). After the first PPV and silicone oil tamponade, a shallow retinal detachment around the macular hole, especially around the scleral staphyloma was detected by OCT. During the 2nd surgery to remove the silicone oil, ILM peeling and C3F8 tamponade were performed. ResultsThe average refraction diopter was (-12.6±1.86) D, the average ocular axial length (29.82±0.993) mm and the average disease duration was (5.20±1.24) months. All eyes had total retinal detachment of all four quadrants, choroid detachment and macular choroidal atrophy, and type Ⅱ Curtin posterior scleral staphyloma. After the second surgery, all had retina attached by fundus examination. OCT examination indicated that macular hole closure in 7 eye, macular hole attached and retinal attached in 8 eyes. Their BCVA improved after both the first and second surgery (P=0.000), the BCVA after second surgery was better than that after first surgery (P=0.038). ConclusionsThe clinical characteristic of our series of patients were as follows: long history, with choroidal detachment and type Ⅱ Curtin posterior scleral staphyloma. All 15 eyes showed retinal attached after secondary ILM peeling. The secondary ILM peeling and C3F8 tamponade may improve the visual outcome and retinal reattachment rate.
Objective To investingate the ultrastructural changes of retinal pigment epithelium(RPE) and its permeability in spontaneously hypertensive rats(SHR)and explore the relation between these changes and hypertensive retinopathy.MethodsThe ultrastructure of RPE cells in the SHR aged five,six,seven months wasobserved with transmission electronmicroscope and compared to its normotensive control strain(WKY) with the same age.Then,lanthanum tracer procedures were carried out to investigate pathological changes of the blood-retinal barrier.Results (1)In SHR the main pathological changes involved swelling of mitochondria,enlargement of endoplasmic reticula,decrease of RPE cell infolding,and sparseness of microvilli.These degenerations were more serious in older rats with higher blood pressure.(2)The breakdown of outer blood-retinal barrier with permeation of lanthanum tracers were evident in SHR aged six or seven month,however,in WKY and five-month SHR the traces were prevented from passing by tight junctions.ConclusionThe degeneration of RPE owing to ischemia and anoxia arises in early periosd of hypertensive retinopathy.The pathological changes of ultrastructure and permeability might interact with the damage of visual cells and play a main role in the hypertensive retinopathy.
Myopic foveoschisis (MF) has mild early symptoms, however, its course is progressive. When the secondary macular detachment or macular hole occurs, it can cause severe vision loss. Therefore, it is generally believed that MF patients should undergo surgical intervention early after the onset of symptoms to prevent them from further developing into a macular hole or macular hole retinal detachment.It is generally believed that the traction of the vitreous cortex and posterior scleral staphyloma to the retina plays an important role in the occurrence and development of MF. The operation mode is divided into vitreoretinal surgery and macular buckling, the former release the retinal traction via the vitreous body and the latter reattaches the retina via the extrascleral approach. There is no consensus on whether to perform internal limiting membrane peeling and gas tamponade in vitreoretinal surgery and the fovea-sparing internal limiting membrane peeling has become a hot topic in recent years. Compared with vitreoretinal surgery, macular buckling can release the traction of the retina caused by posterior scleral staphyloma, but it cannot relieve the traction in the tangential direction of the retina. Vitreoretinal surgery and extrascleral surgery seems to make up the shortcomings of both, however, the effect of treatment on patients still needs further verification. In clinical work, it is necessary to conduct individualized analysis of MF patients, weigh the advantages and disadvantages of each operation, and choose the most suitable operation mode for patients with different conditions. In the future, the emphasis of our work is to develop operation mode with great curative effect and less complications.
OBJECTIVE:To evaluate the effect and causes of failure of vitreoretinal(VR)surgery in rhegmatogenous retinal detachments associated with choroidal detachment. METHOD:Reviewing the operative effects of the vitreoretinal surgeries in 61patients(61 eyes)with rhegmatogenous retinal detachment associated with choroidal detachment and PVR in this hospital.Vitrectomy,peeling of preretinal membranes,fluid/air echange and inert gas,silicone oil tamponade were used in thesepatients according to need. RESULTS:On discharge from the hospital,the postoperative effect obtained in 40 case(65.57%),and out of 35 eyes receiving the inert gas tamponade 26(74.3%) got effective pesults.Fourteen cases were followed up for 3 months(averge 9.5 months)and 10(7.4%）of themrevealed stable.The factors of influencing VRsurgery seemed to be the range of choroidal detachments,numbers of opreative times,the inert gas tamponede and the time of corticosteroid application.The causes of failure of opreation might relate to severe and antrior PVR,and giant tears. CONCLUSIONS:The VR surgery was thought to be profitable in treating rhegmatogenous retinal detachment associated with choroidal detachment and PVR. （Chin J Ocul Fundus Dis,1996,12: 16-19)
Objective To study the inhibitive effect of adenovirus mediated CD gene and 5-FC on proliferative human retinal pigment epithelial (HRPE) cells, and to search for an effective method to take precautions against proliferative vitroretinopathy (PVR).Method Different concentrations of CD and 5-FC were added respectively to the cultured third-growth-generation HRPE cells.Transferance rate was detected by positive HRPE cells marked by X-gal and LacZ. The number of HRPE cells were counted and evaluated by methylthiazol-tetrazollium (MTT) method. Results The adenovirus mediated CD gene could be transfered into HRPE cells with a dose-dependent manner. Positive HRPE cells with CD gene could transform 5-FC to 5-Fu,which could inhibit the increase of HRPE cells effectively. No obvious bystander effect on the growth of HRPE cells was detected.Conclusions The adenovirus may introduce a foreign gene into cultured HRPE cells efficiently. It could be a good method to treat and prevent PVR by medication. (Chin J Ocul Fundus Dis，2003，19：168-171)
Uveitic macular edema (UME) is a major reason of permanent visual loss. Early treatment is essential for achieving a good visual outcome, but some patients are resistant or nonresponsive to the treatment, which is called refractory UME (RUME). Intravitreous injection of glucocorticoids can improve the intraocular drug concentration and avoid systemic side effects. Immunosuppressive agents have a certain role in improving RUME by inhibiting immune cells through a variety of ways. Non-steroidal anti-inflammatory drugs, carbonic anhydrase inhibitors and new biological agents also can improve RUME outcome, but their effectiveness and safety need to be confirmed by large scale randomized clinical trials. Vitrectomy can improve RUME outcome but whether peeling of internal limiting membrane is necessary or not is still controversial. Peeling the inner limiting membrane can eliminate the potential incentive for macular edema and remove the barrier. But the process of stripping may injury the retinal neurepithelium. To eliminate edema and protect the visual function, we should analysis the causes of RUME and treat it individually.
Vitrectomy and silicone oil injection were performed for treatment of 43 patients with complicated retinal detachment (RD, n=21 ) or subsequent atrophia bulbi (AB, n=22). Retinal reattachment was achieved in 14 (66.7%) of 21 patients with RD, including 11 with idiopathic proliferative vitreoretinopathy (PVR),6 with traumatic PVR, 3 with congenital uveal coloboma or Marfan syndrome. The visual acuity was better than 0.05 in 7(50%) of successful cases,and better than 0.02 in 11 (78.6%).Only 6(27.3%) patients had retina reattached with visual improvement in 22 cases of AB, including 13 of traumatic PVR,8 of idiopathic PVR.However,the intraoccular pressure was stable and shrinkage of the globe was controlled in 21 (95.5%) of 22 patients with AB.The results indicate that silicone off injection following vitrectomy may provide advanced severe PVR with a chance of successful treatment. （Chin J Ocul Fundus Dis,1994,10:4-6）
Objective To compare the efficacy of pars plana vitrectomy (PPV) and nonvitrectomizing vitreous surgery (NVS) in the treatment of idiopathic epimacular membrane (IMEM). MethodsA prospective , randomized and comparative clinical study. From April 2019 to May 2020, 21 eyes of 21 patients with IMEM diagnosed in Chongqing Aier Eye Hospital were included in the study. Among them, 11 males had 11 eyes, and 10 females had 10 eyes. Best-corrected visual acuity (BCVA), optical coherence tomography angiography (OCTA), and corneal, intraocular, and global aberration measurements were performed in all eyes. The international standard logarithmic visual acuity chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The iTrace visual function analyzer was used to measure the corneal, intraocular and whole ocular aberrations, and the dysfunction lens index (DLI) was calculated. Lens density in Scheimpflug images was calculated using Pentacam three-dimensional anterior segment analysis and diagnosis system. The 6 mm×6 mm area of the macular area was scanned by OCTA, which was divided by the software automatically into three concentric circles with the fovea as the center, namely the central area with a diameter of 1 mm, the inner ring area with a diameter of 1-3 mm, The outer ring area of 3-6 mm was used to measure the superficial vessel density (SVD) and superficial perfusion density (SPD) of the entire macular area, the central area, the inner ring area, and the outer ring area. The patients were divided into PPV combined with epimacular membrane (MEM) peeling group (PPV group) and NVS direct peeling MEM group (NVS group) by random number table method, 10 cases with 10 eyes and 11 cases with 11 eyes, respectively. The age of the two groups (t=－0.72), logMAR BCVA (t=－0.98), lens density (t=－1.10), DLI (t=1.15), SVD (t=0.82) and SPD (t=1.19) of entire macular area, corneal aberration (t=0.45), intraocular aberration (t=－0.22), and whole eye aberration (t=0.83), there was no significant difference (P＞0.05). All eyes were operated on with a 27G vitrectomy system. The MEM was removed from the eyes of the NVS group under NVS condition, and the MEM was removed from the eyes of the PPV group under the condition of PPV, and the operation time was recorded at the same time. The follow-up period after surgery was 12 months. Relevant examinations were performed using the same equipment and methods before surgery. Taking the last follow-up as the time point for efficacy judgment, the BCVA, lens opacity, DLI, visual quality, SVD, SPD and MEM recurrence in the macula were compared between the two groups. The two groups were compared by paired t test. ResultsThe operation time of eyes in PPV group and NVS group was 20.81±3.52 and 5.70±1.30 min, respectively, and the difference was statistically significant (t=7.23, P＜0.001). At the last follow-up, the logMAR BCVA of PPV group and NVS group were 0.65±0.25 and 0.44±0.20, respectively, and the difference was statistically significant (t=－2.16, P=0.04); compared with before operation, the BCVA of eyes of the two groups was significantly improved, and the difference was statistically significant. (t=2.52, 4.41; P=0.033, P＜0.001). The lens density and DLI of the affected eyes in the PPV group and NVS group were 10.64±1.58, 6.24±3.99 and 5.77±1.63, 7.74±1.55, respectively, and the differences were statistically significant (t=－3.90, 2.85; P＜0.05). The macular area SVD (t=1.03), SPD (t=1.77), corneal aberration (t=－0.42), intraocular aberration (t=－1.10), and whole-eye aberration (t=－1.17) of eyes of the two groups, the difference was not statistically significant (P＞0.05). During the follow-up period, there were 2 eyes with MEM recurrence, 1 eye in the PPV group and 1 eye in the NVS group; there was no significant difference in the recurrence rate of MEM between the two groups (χ2=0.005, P=0.94). ConclusionCompared with PPV combined with MEM stripping, the BCVA after NVS surgery increases more, has a better protective effect on the lens, and has a shorter operation time.