光学相干断层扫描血管成像在DR中的诊疗进展

光学相干断层扫描成像(OCT)是眼科影像学中发展最快的技术之一。随着OCT技术逐步改良更新,光学相干断层扫描血管成像(OCTA)随之出现,OCTA在视网膜和脉络膜血流成像中能为多种眼底血管性疾病提供诊疗价值。本文综述了OCTA的原理,以及OCTA观察糖尿病患者眼底的微动脉瘤(MAs)、视网膜缺血、视网膜新生血管(RNV)及其在DR各期组织病理改变的特征、OCTA的局限性及其发展前景。

视网膜类器官治疗视网膜退行性疾病的研究进展

视网膜退行性疾病是导致视力受损与失明的重要原因。目前,对于感光细胞大量丧失的疾病晚期阶段尚无有效的治疗方案。近年来,大量研究提供了感光细胞的移植替代治疗的新思路,而视网膜3D培养技术产生的视网膜类器官能够在体外产生移植所需的感光细胞及组织,为视网膜退行性疾病的移植替代治疗奠定了基础。本文通过综述视网膜3D培养技术以及感光细胞移植的发展,着重阐述视网膜类器官在视网膜退行性疾病移植替代治疗中的现有运用策略以及局限性,以期为视网膜3D培养技术在感光细胞替代治疗中的优化提供理论参考。

Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases

AIM: To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital METHODS: The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative bestcorrected visual acuities(BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed. RESULTS: A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101 y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73%(2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1 d, 1 wk, and 1 mo post surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12%(171/4151) had posterior capsule rupture, 0.79%(33/4151) had iris or ciliary body injury, and 0.048%(2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38%(182/4151) had cornea edema, 7.78%(323/4151) had intraocular hypertension, 0.096%(4/4151) had IOL toxicity syndrome, 0.28%(12/4151) had retained lens cortex, and 0.048%(2/4151) had hyphema. The delayed discharge rate was 0.82%(44/4151) and the unplanned re-admission to the hospital was 0(0/4151). The patient satisfaction rate was 91.42%(3795/4151). CONCLUSION: Day-case cataract surgery is safe and effective with good prospects for development.

抑制视网膜色素上皮细胞发生上皮-间充质转化的研究进展

视网膜色素上皮细胞(retinal pigment epithelium,RPE)的上皮间充质转化(epithelial-mesenchymal transition,EMT)是增殖性玻璃体视网膜疾病(proliferative vitreoretinopathy,PVR)的主要发病机制,也是治疗脉络膜新生血管(choroidal neovascularization,CNV)时,造成抗血管内皮生长因子(anti-vascular endothelial growth factor,anti-VEGF)疗效降低的重要因素。除此之外,随着细胞替代治疗作为年龄相关性黄斑变性(age-related macular degeneration,ARMD)的新型治疗方式而兴起,人类胚胎干细胞(hESC-RPE)、体细胞诱导多能干细胞(iPSC-RPE)定向诱导分化的RPE细胞以及来自于流产胎儿的胎儿视网膜色素上皮细胞(fetal RPE,fRPE)逐渐受到了研究者们的关注。为了发挥最好的治疗效果,保证治疗用细胞的稳定增殖及高效分化是极其重要的。但是在传代扩增的过程中,由于上皮间充质转化的存在,导致这些细胞出现增殖困难以及再分化能力下降,从而影响治疗效果并阻碍了治疗人群的普及,使细胞替代治疗难以推广。所以,鉴于上皮间充质转化在视网膜疾病的发生和治疗中都造成了重要影响,抑制视网膜色素上皮细胞发生上皮间充质转化就显得尤为重要,为此,我们将阻止上皮间充质转化研究的最新进展综述如下。

Optic disc and peripapillary changes by optic coherence tomography in high myopia

Myopia,a worldwide condition,is a multifactorial disease resulting in many ocular complications.Early onset of myopia has a great tendency to develop high myopia and pathological myopia later in life.The pathophysiology and progression of myopia is still unclear.Owing to its involving in visual function,optic disc and peripapillary change in high myopia can＇t be neglected,and it may help in better understanding of the pathophysiology or mechanism of myopia progression.Recently,advanced imaging techniques have been developed,such as optical coherence tomography（OCT）,allowing for better detecting of optic disc and peripapillary change.OCT is a highresolution and noninvasive measurement for detection of ocular structure.Herein,we provide an updated review of optic disc and peripapillary change in OCT image,including its characteristics and clinical significance.We also propose some problems needed further investigation.

Phacoemulsification combined with transpupillary removal of silicone oil and intracapsular intraocular lens implantation

AIM： To estimate the effectiveness of phacoemulsification and foldable intraocular lens（IOL） implantation combined with transpupillary silicone oil removal.METHODS： There were 168 eyes of 168 candidate patients with cataract and silicone oil-filled eyes recruited in our study. All of the patients received the intraocular silicone oil removal surgery by transpupillary drainage and cataract extraction by phacoemulsification. Then the IOL implantation were also performed through corneal incision. RESULTS： The surgery was successfully completed in all eyes. Best corrected visual acuity（BCVA） and postoperative complications were recorded in three months after surgery. There were 143 eyes with BCVA improved, otherwise 25 eyes remained stable at the last follow-up visit. The mean BCVA statistically improved from 20/400±0.02 to 20/100±0.15（P〈0.001） and mean postoperative IOP was 13.85±2.18 mm Hg（P=0.415）. No intra-operative complications were reported.CONCLUSION： Phacoemulsification combined with transpupillary removal of silicone oil is a safe and simple effective method. In general, it enables quick recovery of visual acuity with less complication rate.

A novel xeno-free culture system for human retinal pigment epithelium cells

AIM: To find out an animal-free, xeno-free culture method for human fetal retinal pigment epithelium(fRPE) cells aiming for cell-replacement therapy. METHODS: Human AB serum, knock-out serum replacement(KSR) and B27 were supplemented as a substitute of fetal bovine serum(FBS) in culture medium of human fRPE cells. Cell morphology was examined by light microscope and transmission electron microscope. Proliferation ability was detected by cell cycle analysis and examination of KI67 expression. Apoptosis was analyzed using FACS. The expression ofRPE-specific markers was demonstrated by quantitative real-time polymerase chain reaction(qPCR), Western blot(WB) and immunocytochemistry. Paracrine function was determined using enzyme-linked immunosorbent assay method.RESULTS: Our results indicated that the optimum concentration of KSR was 15%, the optimum concentration of B27 was 2%, and the optimum concentration of human AB serum was 10%. fRPE cells cultured in 15% KSR and 2% B27 media showed repressed propagation and differentiation ability, and gradually lost epithelial morphology and RPE function. While fRPE cells cultured in 10% human AB serum media showed a typical cobblestone morphology with pigmentation, elevated proliferation ability, satisfying paracrine function and expressed RPE-specific markers. CONCLUSION: Our study indicates that culturing fRPE cells in 10% human AB serum-supplemented medium is more favorable compared with KSR, B27 and traditional FBS-supplemented mediums when fRPE cells are to be applied in cell-based therapy.

Displacement of the retina after idiopathic macular hole surgery with different internal limiting membrane peeling patterns

AIM:To explore retinal displacement after surgical treatment for idiopathic macular hole(IMH)with different internal limiting membrane(ILM)peeling patterns.METHODS:Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups,N-T group(11 eyes)and T-N group(11 eyes).For patients in N-T group,ILM was peeled off from nasal to temporal retina.For patients in T-N group,ILM was peeled off from temporal to nasal retina.Preoperative,postoperative 1,3,and 6 mo,autofluorescence fundus images were collected for manual measurement of distances of fixed nasal(N),temporal(T),superior(S),and inferior(I)retinal points(bifurcation or crossing of retinal vessels)around the macula to the optic disc(OD).These were respectively defined as N-OD,T-OD,S-OD,and I-OD.The retinal displacement,macular holeclosure rate,and best corrected visual acuity(BCVA)were compared between the two groups after surgery.RESULTS:At postoperative 1,3,and 6 mo,the macula slipped toward the OD,manifested by the decreased T-OD,N-OD,S-OD,and I-OD(P<0.05).No significant difference was found in the T-OD,N-OD,S-OD,and I-OD between N-T group and T-N group.IMH closure rate was 100%both in N-T group and T-N group.There was no significant difference in BCVA between two groups(P<0.05).CONCLUSION:The macula slips toward the OD after successful macular hole surgery.The two different ILM peeling pattern show similar visual outcome and retinal displacement,which means ILM peeling directions are not the influencing factor of postoperative retinal displacement.

Chordin-like 2 influences the differentiation fate of retinal pigment epithelium cells by dynamically regulating BMP pathway

AIM:To explore the functions of Chordin-like 2,which is encoded by CHRDL2,in the process of retinal pigmented epithelium(RPE)differentiation and damage repair.METHODS:The fetal RPE cells(f RPE)was obtained from aborted fetus which obeyed medical ethics.Real-time quantitative polymerase chain reaction was used to measure expression quantity of CHRDL2 and other functional genes expression.Knocking down and overexpression was used to analyze the functions about Chordin-like 2.Enzyme-linked immunosorbent assay(ELISA)was used to detect the secretion of bone morphogenetic proteins 4(BMP4).Flow cytometry was used to analyze cell cycle.Cell morphology was observed by phase contrast microscope(PCM).RESULTS:In normal RPE cells,CHRDL2 was firstly upregulated and followed a downregulation but eventually,it was expressed higher than the cells which undergone epithelial-mesenchymal transition(EMT).After knocking down CHRDL2,the secretion of BMP4 was decreased,RPErelated genes(OTX2,MITF,RPE65)were downregulated while EMT-related genes(SNAI1,VIM)were upregulated.However,the expression of these related genes after overexpression of CHRDL2 had contrary results.Chordin-like 2 also regulated the cell cycle by regulating BMP pathway.When CHRDL2 was knocked down,more f RPE cells stayed in S phase of cell cycle,while adding BMP4 reduced the proportion of the cells in S phase.However,overexpression of CHRDL2 increased more BMP4 secretion,this effect decreased the number of cells in S phase,but exogenous BMP inhibitor also could change this effect.At last,in the process of RPE cells differentiation,adding BMP4 at early stage could intervene normal RPE differentiation.Compared with BMP4,inhibiting BMP pathway had no significant negative effect at early stage,but suppressed differentiation at late stage.CONCLUSION:BMP pathway can be activated in a correct temporal order,otherwise,the cells have incorrect differentiation orientation.And Chordin-like 2 plays a role in dynamic regulation of BMP pathway and it also regulates the differentiation of RPE cells.Therefore,this research enlightens a new direction to inhibit EMT and promote cell redifferentiation after injury.

Extracting intraocular foreign body at or near the ciliary body with scleral indentation in direct visualization

Dear Editor,I＇m Dr. Qing-Huai Liu from Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University,Nanjing, China. I write to present four cases diagnosed with the intraocular foreign body （IOFB） at or near the ciliary body and to evaluate the effect of extracting IOFB with scleral indentation in direct visualization.

Anthrax lethal toxin suppresses high glucose induced VEGF over secretion through a post-translational mechanism

AIM: To prove anthrax lethal toxin(Le Tx) blocks the mitogen activated protein kinases(MAPKs) activation by degrading the MAPK/ERK kinases(MEKs) to suppress vascular endothelial growth factor(VEGF) secretion.METHODS: Human adult retinal pigmented epithelium(ARPE) cells were cultured and treated with normal glucose, high glucose or high glucose with Le Tx for additional 24, 48 or 72 h for viable cell count. Total RNA from the ARPE was isolated for reverse transcription polymerase chain reaction(RT-PCR). The conditioned medium of ARPE cells treated in different group for 48 h was filtered and diluted to detect the concentration of VEGF by enzyme-linked immunosorbant assays.Evaluate the role of MEK/MAPK pathway in the secretion of VEGF by immunoblotting. RESULTS: In this study, we proved high glucose induced activation of the MAPK extracellular signal-regulated kinase(ERK1/2) and p38 in the ARPE cell line was blocked by anthrax Le Tx. Le Tx also inhibited high glucose induced ARPE cell over proliferation.CONCLUSION: Le Tx suppressed high glucose induced VEGF over secretion in the ARPE cells, mainly through a post-translational mechanism.

Role of microRNA-25 in high glucose cultured Müller glia

AIM:To investigate the role of microRNA-25(miR-25)in proliferation and apoptosis of retinal Müller glia(MG)under high glucose condition.METHODS:The purity of the cultured cells was verified by immunocytochemistry and flow cytometry using antibodies that specifically recognized MG.The expression level of miR-25 under normal and high glucose conditions were validated by quantitative reverse transcription polymerase chain reaction(RT-q PCR).miR-25 mimics and negative control were transfected into MG and multiple functional experiments including cell counting kit-8 assay,EDU assay,and flow cytometry were conducted to explore the effects of miR-25 on the proliferation and apoptosis of high glucose cultured MG(HGMG).RESULTS:Immunocytochemistry and flow cytometry confirmed the high purity of primary cultured MG.RTPCR results showed that the expression level of miR-25 was significantly repressed in HGMG,while overexpression of miR-25 by miR-25 mimic markedly inhibited the high glucose induced cell apoptosis and promoted the proliferation of MG.CONCLUSION:The expression level of miR-25 is significantly downregulated in HGMG and its overexpression could attenuate the high glucose damages on MG by promoting proliferation and reducing apoptosis.