Anti-vascular endothelial growth factor drugs combined with laser photocoagulation maintain retinal ganglion cell integrity in patients with diabetic macular edema: study protocol for a prospective, non-randomized, controlled clinical trial

The integrity of retinal ganglion cells is tightly associated with diabetic macular degeneration that leads to damage and death of retinal ganglion cells,affecting vision.The major clinical treatments for diabetic macular edema are anti-vascular endothelial growth factor drugs and laser photocoagulation.However,although the macular thickness can be normalized with each of these two therapies used alone,the vision does not improve in many patients.This might result from the incomplete recovery of retinal ganglion cell injury.Therefore,a prospective,non-randomized,controlled clinical trial was designed to investigate the effect of anti-vascular endothelial growth factor drugs combined with laser photocoagulation on the integrity of retinal ganglion cells in patients with diabetic macular edema and its relationship with vision recovery.In this trial,150 patients with diabetic macular edema will be equally divided into three groups according to therapeutic methods,followed by treatment with anti-vascular endothelial growth factor drugs,laser photocoagulation therapy,and their combination.All patients will be followed up for 12 months.The primary outcome measure is retinal ganglion cell-inner plexiform layer thickness at 12 months after treatment.The secondary outcome measures include retinal ganglion cell-inner plexiform layer thickness before and 1,3,6,and 9 months after treatment,retinal nerve fiber layer thickness,best-corrected visual acuity,macular area thickness,and choroidal thickness before and 1,3,6,9,and 12 months after treatment.Safety measure is the incidence of adverse events at 1,3,6,9,and 12 months after treatment.The study protocol hopes to validate the better efficacy and safety of the combined treatment in patients with diabetic macula compared with the other two monotherapies alone during the 12-month follow-up period.The trial is designed to focus on clarifying the time-effect relationship between imaging measures related to the integrity of retinal ganglion cells and best-corrected visual acuity.The trial protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Beihua University with approval No.(2023)(26)on April 25,2023,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR2300072478,June 14,2023,protocol version:2.0).

Values of macular ganglion cell-inner plexiform layer and 10-2 visual field measurements in detecting and evaluating glaucoma

AIM:To assess the performance of macular ganglion cell-inner plexiform layer thickness(mGCIPLT)and 10-2 visual field(VF)parameters in detecting early glaucoma and evaluating the severity of advanced glaucoma.METHODS:Totally 127 eyes from 89 participants(36 eyes of 19 healthy participants,45 eyes of 31 early glaucoma patients and 46 eyes of 39 advanced glaucoma patients)were included.The relationships between the optical coherence tomography(OCT)-derived parameters and VF sensitivity were determined.Patients with early glaucoma were divided into eyes with or without central 10°of the VF damages(CVFDs),and the diagnostic performances of OCT-derived parameters were assessed.RESULTS:In early glaucoma,the mGCIPLT was significantly correlated with 10-2 VF pattern standard deviation(PSD;with average mGCIPLT:β=-0.046,95%CI,-0.067 to-0.024,P<0.001).In advanced glaucoma,the mGCIPLT was related to the 24-2 VF mean deviation(MD;with average mGCIPLT:β=0.397,95%CI,0.199 to 0.595,P<0.001),10-2 VF MD(with average mGCIPLT:β=0.762,95%CI,0.485 to 1.038,P<0.001)and 24-2 VF PSD(with average mGCIPLT:β=0.244,95%CI,0.124 to 0.364,P<0.001).Except for the minimum and superotemporal mGCIPLT,the decrease of mGCIPLT in early glaucomatous eyes with CVFDs was more severe than that of early glaucomatous eyes without CVFDs.The area under the curve(AUC)of the average mGCIPLT(AUC=0.949,95%CI,0.868 to 0.982)was greater than that of the average circumpapillary retinal nerve fiber layer thickness(cpRNFLT;AUC=0.827,95%CI,0.674 to 0.918)and rim area(AUC=0.799,95%CI,0.610 to 0.907)in early glaucomatous eyes with CVFDs versus normal eyes.CONCLUSION:The 10-2 VF and mGCIPLT parameters are complementary to 24-2 VF,cpRNFLT and ONH parameters,especially in detecting early glaucoma with CVFDs and evaluating the severity of advanced glaucoma in group level.

Different damage patterns of retinal nerve fiber layer and ganglion cell-inner plexiform layer between early glaucoma and non-glaucomatous optic neuropathy

AIM:To compare the damage pattern of the peripapillary retinal nerve fiber layer(pRNFL)and the macular ganglion cell-inner plexiform layer(mGCIPL)between early glaucomatous and non-glaucomatous optic neuropathy(EGON and NGON).METHODS:It is a cross-sectional study.Thirty-eight healthy controls,74 EGONs and 70 NGONs with comparable average pRNFL loss were included.The NGON group included 23 eyes of optic neuritis(ON),13 eyes of hereditary optic neuropathy(HON),19 eyes of toxic optic neuropathy(TON)and 15 eyes of compressive neuropathy(CON).The sectoral pRNFL and mGCIPL thickness obtained by high definition optical coherence tomography were analyzed.RESULTS:Compared to normal controls,the pRNFL thickness in all quadrants showed a decrease in both EGON and NGON group(P<0.001),but the average pRNFL thickness of EGON group was not different to that of NGON group(P=0.94).The inferior and superior pRNFL was thinner in EGON group compared to NGON group(P<0.001).The temporal pRNFL was thinner in NGON group compared to EGON group(P<0.001).No statistically significant difference was found in nasal pRNFL between EGON and NGON.While the nasal pRNFL was thinner in CON than other three types of NGON(P=0.01),no statistically significant difference was found in other three quadrantal pRNFL among the four types of NGON(P>0.05).The mGCIPL of EGON and NGON group were thinner than control group(P<0.001).In EGON group the severest sites of mGCIPL reduction was located at inferotemporal and inferior sectors.While,compared to EGON group,the average mGCIPL of NGON groupwere significantly thinner,especially in superonasal and inferonasal sectors(P<0.001).CONCLUSION:The damage pattern of pRNFL and mGCIPL caused by glaucoma is distinct from other NGON such as ON,TON,HON and CON,and this characteristic damage pattern is helpful in differentiating early glaucoma from other NGON.

Correlation between macular ganglion cell-inner plexiform layer thickness and visual acuity after resolution of the macular edema secondary to central retinal vein occlusion

AIM： To examine the thickness of the ganglion cell-inner plexiform layer（GCIPL） in eyes with resolved macular edema（ME） in non-ischemic central retinal vein occlusion（CRVO）, applying spectral-domain optical coherence tomography（SD-OCT）, and its relationship with visual acuity.METHODS： The retrospective observational case-control study included 30 eyes of non-ischemic CRVO patients with resolved ME（ME eyes） after treatment, and 30 eyes of non-ischemic CRVO patients without ME（non-ME eyes）. The macular GCIPL thickness, peripapillary retinal nerve fiber layer（p RNFL） thickness and central macular thickness（CMT） were measured on a SD-OCT scan. Linear regression analyses were performed to determine the correlation between the thickness of each and the visual acuity（VA）.RESULTS： No significant difference in average GCIPL thickness, mean pR NFL thickness and CMT were observed between ME group and non-ME group（P=0.296, 0.183, 0.846）. But, minimum GCIPL thickness was reduced in ME eyes compared with non-ME eyes（P=0.022）. Final VA significantly correlated with the minimum GCIPL thickness in ME eyes（r=-0.482, P=0.007）, whereas no correlation was found with average GCIPL thickness, average pR NFL thickness and mean CMT.CONCLUSION： Minimum GCIPL thickness is reduced in ME eyes compared with non-ME eyes, and correlated with the VA in non-ischemic CRVO. These results propose that inner retinal damage occurring in patients with ME secondary to non-ischemic CRVO may lead to permanent visual defect after treatment.

Retinal ganglion cell-inner plexiform and nerve fiber layers in neuromyelitis optica

AIM： To determine the thickness of the retinal ganglion cell-inner plexiform layer（GCIPL） and the retinal nerve fiber layer（RNFL） in patients with neuromyelitis optica（NMO）.METHODS： We conducted a cross-sectional study that included 30 NMO patients with a total of 60 eyes. Based on the presence or absence of optic neuritis（ON）, subjects were divided into either the NMO-ON group（30 eyes） or the NMO-ON contra group（10 eyes）. A detailed ophthalmologic examination was performed for each group; subsequently, the GCIPL and the RNFL were measured using highdefinition optical coherence tomography（OCT）. RESULTS： In the NMO-ON group, the mean GCIPL thickness was 69.28±21.12 μm, the minimum GCIPL thickness was 66.02±10.02 μm, and the RNFL thickness were 109.33±11.23, 110.47±3.10, 64.92±12.71 and 71.21±50.22 μm in the superior, inferior, temporal and nasal quadrants, respectively. In the NMO-ON contra group, the mean GCIPL thickness was 85.12±17.09 μm, the minimum GCIPL thickness was 25.39±25.1 μm, and the RNFL thicknesses were 148.33±23.22, 126.36±23.45, 82.21±22.30 and 83.36±31.28 μm in the superior, inferior, temporal and nasal quadrants, respectively. In the control group, the mean GCIPL thickness was 86.98±22.37 μm, the minimum GCIPL thickness was 85.28±10.75 μm, and the RNFL thicknesses were 150.22±22.73, 154.79±60.23, 82.33±7.01 and 85.62±13.81 μm in the superior, inferior, temporal and nasal quadrants, respectively. The GCIPL and RNFL were thinner in the NMO-ON contra group than in the control group（P〈0.05）; additionally, the RNFL was thinner in the inferior quadrant in the NMO-ON group than in the control group（P〈0.05）. Significant correlations were observed between the GCIPL and RNFL thickness measurements as well as between thickness measurements and the two visual field parameters of mean deviation（MD） and corrected pattern standard deviation（PSD） in the NMO-ON group（P〈0.05）. CONCLUSION： The thickness of the GCIPL and RNFL, as measured using OCT, may indicate optic nerve damage in patients with NMO.

Discriminating performance of macular ganglion cellinner plexiform layer thicknesses at different stages of glaucoma

AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer(GCIPL) parameters between all the consecutive stages of glaucoma(from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer(RNFL) parameters and optic nerve head(ONH) parameters.METHODS: Totally 147 eyes(40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography(OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve(AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients(P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio(AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the bestGC-IPL parameters being minimum and inferotemporal(AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area(AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients.CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other(from glaucoma suspect to moderate-tosevere glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.

中医针刺联合低浓度阿托品对低度近视儿童黄斑微循环的影响

[目的]探究中医针刺联合0.01%阿托品滴眼液对低度近视儿童黄斑血管密度及视网膜厚度的影响。[方法]将84例(156眼)首次诊断为低度近视的患儿随机分为实验组和对照组,实验组使用中医针刺联合0.01%阿托品滴眼液治疗,对照组使用0.01%阿托品滴眼液治疗。两组患儿治疗前及治疗6个月后进行眼科检查,包括裸眼远视力(uncorrected distance visual acuity,UCVA)、眼轴(axial length,AL)、等效球镜度数(spherical equivalent,SE)、裂隙灯检查,使用光学相干断层扫描(optical coherence tomography,OCT)常规模式测量黄斑神经节细胞-内丛状层(macular ganglion cell-inner plexiform layer,mGCIPL)厚度,使用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)测量黄斑区血管密度、中心凹无血管区面积等,比较两组治疗前后各项指标的变化。[结果]治疗6个月后,两组患儿AL及SE均较治疗前增长,差异有统计学意义(P<0.01,P<0.01),但实验组AL、SE差值小于对照组,差异有统计学意义(P<0.05,P<0.05)。两组患儿眼压(intraocular pressure,IOP)较治疗前后无明显变化,差异无统计学意义(P>0.05)。与治疗前比较,实验组及对照组mGCIPL厚度均增加,差异有统计学意义(P<0.01,P<0.05);实验组中心圆黄斑血管密度(central circle macular vessel density,cCVD)增加,差异有统计学意义(P<0.01),外圆黄斑血管密度(outer circle macular vessel density,oCVD)、内圆黄斑血管密度(inner circle macular vessel density,iCVD)、全圆黄斑血管密度(whole circle macular vessel density,wCVD)及黄斑中心凹无血管区(foveal avascular zone,FAZ)无明显改变,差异无统计学意义(P>0.05)。治疗6个月后,实验组cCVD和AL、SE之间均无相关性(P>0.05),cCVD与mGCIPL厚度呈低度正相关(r=0.448,P<0.05)。[结论]中医针刺联合0.01%阿托品滴眼液能够进一步降低低度近视患儿AL增长及屈光度增长速度,并能够增加低度近视患儿cCVD及mGCIPL厚度。

Structural measurements and vessel density of spectraldomain optic coherence tomography in early,moderate,and severe primary angle-closure glaucoma

AIM:To compare the macular ganglion cell-inner plexiform layer(GCIPL)thickness,retinal nerve fiber layer(RNFL)thickness,optic nerve head(ONH)parameters,and retinal vessel density(VD)measured by spectral-domain optical coherence tomography(SD-OCT)and analyze the correlations between them in the early,moderate,severe primary angle-closure glaucoma(PACG)and normal eyes.METHODS:Totally 70 PACG eyes and 20 normal eyes were recruited for this retrospective analysis.PACG eyes were further separated into early,moderate,or severe PACG eyes using the Enhanced Glaucoma Staging System(GSS2).The GCIPL thickness,RNFL thickness,ONH parameters,and retinal VD were measured by SD-OCT,differences among the groups and correlations within the same group were calculated.RESULTS:The inferior and superotemporal sectors of the GCIPL thickness,rim area of ONH,average and inferior sector of the retinal VD were significantly reduced(all P<0.05)in the early PACG eyes compared to the normal and the optic disc area,cup to disc ratio(C/D),and cup volume were significantly higher(all P<0.05);but the RNFL was not significant changes in early and moderate PACG.In severe group,the GCIPL and RNFL thickness were obvious thinning with retinal VD were decreasing as well as C/D and cup volume increasing than other three groups(all P<0.01).In the early PACG subgroup,there were significant positive correlations between retinal VD and GCIPL thickness(except superonasal and inferonasal sectors,r=0.573 to 0.641,all P<0.05),superior sectors of RNFL thickness(r=0.055,P=0.049).More obvious significant positive correlations were existed in moderate PACG eyes between retinal VD and superior sectors of RNFL thickness(r=0.650,P=0.022),and temporal sectors of RNFL thickness(r=0.740,P=0.006).In the severe PACG eyes,neither GCIPL nor RNFL thickness was associated with retinal VD.CONCLUSION:The ONH damage and retinal VD loss appears earlier than RNFL thickness loss in PACG eyes.As the PACG disease progressed from the early to the moderate stage,the correlations between the retinal VD and RNFL thickness increases.

光学相干断层扫描对2型糖尿病患者视网膜神经变性的早期评估价值

目的采用光学相干断层扫描(OCT)检测无糖尿病性视网膜病变(DR)的2型糖尿病(T2DM)患者在糖尿病视网膜神经变性(DRN)早期的视网膜神经厚度变化。方法采用横断面研究,选取2022年1—10月医院收治的32例无DR的T2DM患者(共32眼)作为试验组,以年龄、性别匹配的32名健康者(32眼)作为对照组。将黄斑区分为9个区域(中央区、上方内环区、颞侧内环区、下方内环区、鼻侧内环区、上方外环区、颞侧外环区、下方外环区和鼻侧外环区),采用OCT检测以上区域的黄斑视网膜神经纤维层(mRNFL)、神经节细胞层(GCL)、内丛状层(IPL)、视网膜厚度,并进行比较;将视盘分为4个区域(上方、下方、鼻侧、颞侧),采用OCT检测视盘视网膜神经纤维层(pRNFL)厚度,以及全周pRNFL平均厚度,并对两组各指标比较。结果黄斑区9个区域中,试验组下方外环区、鼻侧外环区mRNFL厚度低于对照组,中央区、上方内环区、颞侧内环区、下方内环区、鼻侧内环区的GCL厚度低于对照组,上方内环区、颞侧内环区、下方内环区、鼻侧内环区的IPL厚度低于对照组,差异均有统计学意义(P<0.05);两组黄斑区9个区域的视网膜厚度比较,差异均无统计学意义(P>0.05)。视盘4个区域中,试验组视盘上方、下方、鼻侧的pRNFL厚度均低于对照组,差异有统计学意义(P<0.05);两组颞侧pRNFL厚度及全周pRNFL平均厚度比较,差异均无统计学意义(P>0.05)。结论DRN早期患者存在mRNFL、GCL、IPL、pRNFL区域性变薄现象,说明在出现临床血管变化之前已经发生DRN,GCL、IPL内环对DRN的预测价值最高。

单侧湿性年龄相关性黄斑变性患者患眼黄斑区GCIPL厚度变化及其与血清IL-8水平的关系

目的 探讨单侧湿性年龄相关性黄斑变性(wetAMD)患者患眼黄斑区神经节细胞-内丛状层(GCIPL)厚度变化及其与血清白细胞介素(IL)-8水平的关系。方法 选取单侧wetAMD患者(wetAMD组)120例,根据荧光素眼底血管造影和吲哚菁绿血管造影检查结果将其分为单侧典型脉络膜新生血管(tCNV)组(45例)以及单侧息肉样脉络膜血管病变(PCV)组(75例)。另选取门诊健康体检眼科检查正常者75例(75眼)作为正常对照组。收集3组受试者的一般资料,并检测研究眼GCIPL厚度参数和血清IL-8水平,比较3组间上述指标的差异。分析GCIPL厚度与血清IL-8水平和wetAMD的关系及其诊断价值。结果 wetAMD组的吸烟比例、伴糖尿病比例以及血清IL-8水平高于对照组,而wetAMD组GCIPL厚度的各测量值均小于正常对照组(均P<0.05)。tCNV组的年龄、吸烟比例、伴糖尿病比例以及血清IL-8水平高于PCV组,而tCNV组GCIPL厚度的各测量值均小于PCV组(均P<0.05)。wetAMD患者患眼GCIPL厚度的各测量值均与血清IL-8水平呈显著负相关(均P<0.05)。多因素Logistic回归分析结果显示,吸烟、糖尿病、平均GCIPL厚度值降低和血清IL-8水平升高是wetAMD发病的危险因素;糖尿病、平均GCIPL厚度值降低和血清IL-8水平升高是wetAMD患者发生tCNV的危险因素(均P<0.05)。平均GCIPL厚度诊断wetAMD的受试者工作特征曲线下面积(AUC)为0.775(95%CI:0.710~0.832),当临界值取75.60μm时,敏感度为63.33%,特异度为81.33%。平均GCIPL厚度诊断tCNV的AUC为0.765(95%CI:0.678~0.837),当临界值取70.20μm时,敏感度为64.44%,特异度为82.62%。结论 wetAMD患者患眼GCIPL厚度值异常降低,且与血清IL-8水平升高有关,其对诊断wetAMD和tCNV具有一定辅助价值。

采用频域OCT观察糖尿病患者早期黄斑区视网膜结构的变化

目的探讨糖尿病患者黄斑区视网膜结构变化的频域OCT(Cirrus HD-OCT)特征,将其测量参数与正常人群的测量结果进行比较。方法回顾性分析了由Cirrus HDOCT测量的糖尿病患者黄斑区视网膜的结构参数。将糖尿病患眼分为了存在糖尿病视网膜病变(diabetic retinopathy,DR)组和不存在DR组(NDR组),纳入与糖尿病患者年龄和性别分布相匹配的健康对照者(对照组),并对三组的黄斑区神经纤维层和神经节细胞-内丛状层(ganglion cell-inner plexiform layer,GCIPL)厚度等参数进行比较。结果本研究纳入了42例(42眼)2型糖尿病患者(DR组26眼,NDR组16眼),以及30例健康对照者(30眼;对照组)。DR组的GCIPL为(77.2±8.7)μm,NDR组为(79.4±11.3)μm,均小于对照组的(83.2±7.6)μm(均为P<0.05)。DR组的最小GCIPL为(65.4±9.3)μm,NDR组为(69.7±7.6)μm,均小于对照组的(76.2±9.2)μm(均为P<0.05)。黄斑区各个扇形区域GCIPL厚度中,DR组的上方、鼻侧和下方区域,以及NDR组的鼻下和下方区域明显变薄,与对照组相比差异均有统计学意义(均为P<0.05)。DR组和NDR组之间的GCIPL厚度相近,差异均无统计学意义(均为P>0.05)。DR组、NDR组和对照组的黄斑区神经纤维层厚度相近,差异均无统计学意义(均为P>0.05)。结论糖尿病患者在DR出现之前就已经出现了GCIPL的变薄,频域OCT可被用于监测糖尿病患者早期出现的视网膜神经退行性改变。

血脂异常ApoE基因缺失小鼠视网膜血管瘤增生及其机制研究

背景视网膜血管瘤增生（RAP）属于新生血管性年龄相关性黄斑变性（AMD）的一种亚型，国内报道较少。目的探讨血脂异常的却OE基因缺失（ApoE-／-）小鼠RAP情况及其机制。方法采用随机数字表法将2月龄以C57BL／6为背景的ApoE-／-小鼠24只分为ApoE-／-高脂模型组和ApoE-／-普通饮食组，每组12只；另用2月龄C57BL／6小鼠12只普通饮食喂养作为对照（C57BL／6普通饮食组）。ApoE-／-高脂模型组小鼠用高脂饲料喂养，普通饮食组小鼠均用普通饲料喂养。3个组小鼠喂养4个月后（6月龄）以过量麻醉法处死，摘取左眼球制备视网膜组织切片，采用免疫组织化学染色法观察并检测3个组小鼠视网膜色素上皮（RPE）细胞中血管内皮生长因子（VEGF）、视网膜外丛状层（OPL）中VEGF受体-2（VEGFR-2）含量、OPL微血管密度（MVD）及微血管面积（MVA），用小鼠右眼视网膜组织行Westernblot检测，定量3个组小鼠视网膜中VEGF蛋白的表达。结果ApoE-／-高脂模型组和ApoE-／-普通饮食组视网膜OPL中MVD分别为（20．67±3．20）个／视野和（19．50±1．87）个／视野，MVA分别为（626．49±120．99）μm2和（514．064-88．83）μm2，均比C57BL／6普通饮食组的（12．50±1．87）个／视野及（336．52±84．96）μm2明显增高，差异均有统计学意义（P〈0．01）；ApoE-／-高脂模型组RPE细胞中VEGF面积为（21048±1849）μm2，明显大于C57BL／6普通饮食组的（171164-2023）μm2，差异有统计学意义（P〈0．01），而ApoE-／-普通饮食组RPE细胞中VEGF面积为（178544-2967）μm2，与C57BL／6普通饮食组比较差异无统计学意义（P〉0．05）。ApoE-／-高脂模型组和ApoE-／-普通饮食组小鼠视网膜OPL内VEGFR-2面积分别为（12193±3806）μm2和（11969±3616）μm2，明显大于C57BL／6普通饮食组的（53874-2225）μm2，差异均有统计学意义（P〈0．01）；ApoE-／-高脂模型组和ApoE-／-普通饮食组小鼠视网膜中VECF蛋白的相对表达量（VEGF／β-aetin）分别为1．514-0．32和1．17±0．39，明显高于C57BL／6普通饮食组的0．28±0．14，差异均有统计学意义（P〈0．01）。结论ApoE-／-小鼠视网膜中的VEGF含量及OPL中的VEGFR-2含量均增高，其视网膜OPL的MVD增加、MVA增大，与RAP发病有关。

神经节细胞-视网膜内丛状层复合体厚度在早期青光眼的诊断价值

目的评估神经节细胞层-视网膜内丛状层厚度(GCIPL)及GCIPL联合神经纤维层厚度(RNFL)参数在诊断青光眼中的作用。方法选择青光眼患者48例(62只眼)及健康志愿者39例(62只眼),分别测试患者每只眼视乳头周边RNFL厚度及黄斑区GCIPL分布图。评估GCIPL、RNFL及GCIPL和RNFL联合参数的敏感性、特异性,阳性似然比(PLR)和阴性似然比(NLR),并判断各参数的诊断效能。结果 GCIPL参数中,下半区域GCIPL厚度有最好的诊断效能,(敏感度88.7%,特异度为98.4%;PLR,55.4;和NLR,0.169)。下四分之一扇区,是RNFL诊断效能最好的参数(灵敏度,90.3%;特异性98.4%;PLR,56.4;和NLR,0.10)。下方区域GCIPL厚度和下四分之一扇区RNFL层厚度的或逻辑的组合具有最佳诊断性能(敏感度96.8%,特异度为98.4%;PRL,60.5;和NLR,0.033),而第6或第7点钟方位RNFL层厚度与下半区域GCIPL层厚度的或逻辑组合拥有最佳的敏感度(敏感度100%,特异度为93.5%;PRL,15.4;和NLR,0)。结论下方区域GCIPL厚度与下四分之一扇区RNFL层厚度的或逻辑的组合具有最佳诊断性能,比单独的GCIPL,RNFL参数拥有更好的诊断性能,该联合参数的使用可以减少一部分早期青光眼的漏诊。

健脾祛瘀法对血脂异常ApoE基因缺失小鼠视网膜血管瘤增殖的影响

目的观察健脾祛瘀中药制剂对血脂异常ApoE基因缺失(ApoE-/-)小鼠视网膜血管瘤增殖的治疗作用。方法采用随机数字表法根据小鼠体质量分层随机分组。将36只2月龄ApoE-/-小鼠分为普通饮食组、高脂模型组及健脾祛瘀治疗组。高脂模型组及健脾祛瘀治疗组小鼠均用高脂饲料喂养,健脾祛瘀治疗组小鼠于实验的最后1个月给予健脾祛瘀制剂灌胃,每次0.3ml,每日2次,而普通饮食组和高脂模型组小鼠用等量生理盐水灌胃。于小鼠7月龄以过量麻醉法处死后制备左眼视网膜组织切片行免疫组化(SP法)染色血管内皮生长因子(VEGF)、血管内皮生长因子受体-2(VEGFR-2),光学显微镜观察并采用Mias 2000图像分析系统半定量检测3组动物视网膜色素上皮细胞(RPEC)内VEGF、视网膜外丛状层(OPL)内VEGFR-2含量、OPL微血管密度(MVD)及微血管腔面积(MVA),提取右眼视网膜组织行蛋白免疫印迹法(Western-Blot)检测3组动物视网膜VEGF蛋白表达。结果 7月龄健脾祛瘀治疗组小鼠视网膜OPL微血管密度、微血管腔面积均比同龄高脂模型组和普通饮食组明显减少(P<0.01-0.001),7月龄健脾祛瘀治疗组小鼠RPE细胞VEGF面积、OPL内VEGFR-2面积均比同龄高脂模型组和普通饮食组显著降低(P<0.05-0.01),7月龄健脾祛瘀治疗组小鼠视网膜VEGF/actin蛋白相对表达量比同龄高脂模型组明显降低(P<0.05),比普通饮食组高(P>0.05)。结论健脾祛瘀中药制剂可降低血脂异常ApoE-/-小鼠视网膜VEGF蛋白表达、RPE细胞内VEGF含量及视网膜外丛状层VEGFR-2含量,使视网膜外丛状层微血管密度降低、微血管腔面积缩小,抑制视网膜血管瘤增殖,对新生血管性年龄相关性黄斑变性有治疗作用。

神经节细胞-内丛状层厚度在视网膜脱离术后变化的临床研究

目的:观察孔源性视网膜脱离患者玻璃体切除联合硅油填充术后视网膜神经节细胞-内丛状层(GCIPL)厚度的变化情况及其与视功能的关系。方法:选取2016年1月~2017年12月上海市第一人民医院眼科收治的孔源性视网膜脱离、累及黄斑并接受玻璃体切割联合硅油注入手术的患者40例,对侧正常眼(40眼)作为正常对照组。所有研究对象分别进行常规眼科检查及Cirrus HD OCT检查,测量黄斑区及其各分区域的GCIPL厚度。不同组间的GCIPL厚度比较采用t检验,GCIPL厚度与视力的相关性分析采用Pearson相关分析。结果:研究组术后3个月的平均GCIPL厚度为(69.3±17.1)μm,低于对照组的(78.7±9.6)μm,差异具有统计学意义(P<0.05)。研究组术后3个月平均GCIPL厚度与术后3个月的视力改变呈正相关(r=-0.425,P<0.05)。结论:孔源性视网膜脱离患者行玻璃体切除联合硅油填充术后GCIPL厚度变薄,且术后3个月的GCIPL厚度与视力改变存在相关关系,GCIPL厚度的变薄是影响患者视力预后的重要因素。

频域光学相干断层扫描检测原发性开角型青光眼视盘及黄斑参数的影响因素分析

目的利用频域光学相干断层扫描(SD-OCT)检测健康对照和早中期原发性开角型青光眼(POAG)患者的视盘及黄斑参数,分析其相关影响因素。方法选择2015年9月至2018年8月在我科就诊的早中期POAG患者40例(40眼),其中20~39岁者20例、60~79岁者20例;纳入同期在我科就诊的40名(40眼)健康对照,其中20~39岁者20名、60~79岁者20名。受试者均接受全面的眼科检查,并利用SD-OCT测量所有受试者视盘周围视网膜神经纤维层(pRNFL)厚度、黄斑区平均神经节细胞层联合内丛状层(GCL-IPL)厚度、黄斑区最薄GCL-IPL厚度和黄斑区平均整体厚度。结果健康对照组和早中期POAG组黄斑区平均GCL-IPL厚度及最薄GCL-IPL厚度均随年龄增长而变薄,差异均有统计学意义(P<0.05,P<0.01);两组黄斑区平均整体厚度随着年龄的增长均无明显变化。在健康对照组,年龄因素对pRNFL厚度影响不大,20~39岁者与60~79岁者pRNFL厚度差异无统计学意义(P>0.05)。在早中期POAG组,20~39岁者和60~79岁者pRNFL平均厚度、上方厚度、下方厚度和颞侧厚度与健康对照组同年龄者相比均变薄,且60~79岁者上述pRNFL厚度与20~39岁者相比更薄,差异均有统计学意义(P<0.01);早中期POAG组pRNFL鼻侧厚度在20~39岁者与60~79岁者之间差异无统计学意义(P>0.05),与健康对照组同年龄者相比差异亦无统计学意义(P>0.05)。结论 SD-OCT测量的pRNFL厚度与POAG有关,可作为早期诊断POAG的检测指标。

无黄斑病变近视患者黄斑区视网膜结构与视功能改变的相关性

目的研究不同近视程度的无黄斑病变患者黄斑区视网膜厚度(retinal thickness,RT)、视网膜神经节细胞和内丛状层(ganglion cell and inner plexiform layer,GCIPL)厚度及微视野改变规律,并分析结构与功能改变之间的相关性。方法收集2018年6至12月就诊于我院的100例(199眼)无黄斑病变的不同程度近视患者资料,记录患者性别、年龄、等效球镜度数、眼轴长度。HD-OCT测量RT及GCIPL厚度;采用MAIA微视野计检测视网膜黄斑区10°范围平均光敏感度(MS)。根据屈光度不同分为A组(-1.0^-3.0 D)、B组(>-3.0^-6.0 D)、C组(>-6.0 D),比较各组所有测量参数的差异。分析患者屈光度与微视野计测量参数的相关性,相同解剖位置的黄斑区RT、GCIPL厚度与MS相关性。结果黄斑区4个方位RT 3组间差异均有统计学意义(均为P<0.05),中心方位组间差异无统计学意义(P>0.05);黄斑区4个方位视网膜GCIPL厚度3组间差异均有统计学意义(均为P<0.05)。黄斑区总体MS,4个方位MS 3组间差异均有统计学意义(均为P<0.05),中心方位视网膜MS 3组间差异无统计学意义(P=0.060)。所有参数在3组间两两比较结果均显示A组与B组、C组间差异均有统计学意义(均为P<0.05),但B组、C组间差异均无统计学意义(均为P>0.05)。总体视网膜MS及4个方位视网膜MS与屈光度均呈显著正相关(均为P<0.05),中心方位视网膜MS与屈光度无相关性(P>0.05)。黄斑区RT与视网膜GCIPL厚度4个方位均呈正相关(均为P<0.05),两者上、下方位2个参数与视网膜MS均呈正相关(均为P<0.05),余方位均无相关性(均为P>0.05)。结论无黄斑病变近视患者即使最佳矫正视力≥1.0,也会有一定程度的黄斑区结构及功能改变,二者具有一定相关性。临床中可采用OCT和微视野二者相结合进行近视患者黄斑区结构与功能改变的监测。

甲状腺相关眼病导致的压迫性视神经病变患者cpRNFL及黄斑区GCIPL厚度变化与视力损害和预后视力的关系

目的分析甲状腺相关眼病(TAO)导致的压迫性视神经病变(CON)患者视盘周围神经纤维层(cpRNFL)及黄斑区节细胞-内丛状层(GCIPL)厚度变化与视力损害和预后视力的关系。方法选取2018年1月至2020年7月郑州大学第一附属医院眼科治疗组门诊和病房收治的有完整临床资料的TAO-CON患者94例146眼。根据患者最佳矫正视力(BCVA)情况,将患者分为轻度(>0.3~1.0)、中度(>0.1~0.3)和重度(无光感~0.1)视力损害组。另选取性别、年龄相匹配,病程相近的TAO无CON患者19例28眼为TAO-NCON组;选取性别、年龄相匹配的49名(49眼)正常人作为正常对照组。采用OCT检测所有受试者cpRNFL、黄斑区GCIPL及内界膜-视网膜色素上皮层(ILM-RPE)厚度。随访规范治疗的TAO-CON患者,检测预后BCVA(logMAR)。比较各组患者cpRNFL、GCIPL及ILM-RPE厚度差异,分析预后BCVA与cpRNFL、GCIPL厚度的关系。结果轻、中、重度视力损害组以及TAO-NCON组患者的cpRNFL厚度,均高于正常对照组(均为P<0.05);中、重度视力损害组患者的cpRNFL厚度均高于轻度视力损害组和TAO-NCON组,差异均有统计学意义(均为P<0.05)。中、重度视力损害组患者的GCIPL厚度均显著低于轻度视力损害组、TAO-NCON组及正常对照组(均为P<0.05);且重度视力损害组患者的GCIPL厚度低于中度视力损害组,差异有统计学意义(P<0.05)。各组间ILM-RPE厚度差异无统计学意义(P>0.05)。轻度视力损害组患者多能恢复较好视力,中、重度视力损害组患者视力恢复至0.5以上者在50%以上。TAO-CON患者预后BCVA(logMAR)与黄斑区GCIPL厚度呈显著负相关(r=-0.928,P=0.008),与cpRNFL厚度无相关性(r=0.095,P=0.571)。结论TAO-CON患者视力损害越重,cpRNFL增厚越多、GCIPL变薄越明显;TAO-CON患者GCIPL厚度与预后视力密切相关。

Cirrus HD OCT测量近视人群的青光眼诊断参数对比研究

目的采用Cirrus HD OCT测量近视人群的青光眼诊断参数差异性及近视人群的特征。方法选取2016年1月至2017年8月,就诊于我院的18~35岁不同近视程度的患者共95例(190只眼)。记录患者性别、年龄,采集其眼轴、医学验光屈光度(等效球镜)、视盘周围视网膜神经纤维层厚度(cpRNFL)包括平均、上下方,颞鼻侧5个参数、黄斑部神经节细胞和内丛状层(GCIPL)厚度包括平均、最小、上下方、鼻颞侧6个参数。根据屈光度分为A组(-0.25~3.0D);B组(-3.25^-6.0D);C组(>-6.0D),采用单因素方差分析进行所有参数的组间比较。采用Pear-son相关性分析不同屈光度与眼轴、GCIPL厚度、cpRNFL厚度的相关性及GCIPL厚度与cpRNFL厚度之间相关性。结果各组的性别及年龄无统计学差异。但各组间平均屈光度差异有统计学意义(F=521.963,P=0.000),眼轴和屈光度之间呈显著负相关(相关系数-0.706,P=0.000)。根据屈光度分组,所有参数各组之间均有显著差异(F=3.396~16.305,P<0.05)。cpRNFL厚度除颞侧外均与屈光度呈负相关(相关系数-0.316^-0.212,P<0.05),GCLIP厚度各参数均与屈光度呈负相关(相关系数-0.205^-0.384,P<0.05)。两种参数之间除颞侧外,其余参数均具呈正相关性(相关系数0.222~0.559),GCIPL与cpRNFL厚度在近视人群中均随屈光度发生一定的改变。结论近视眼cpRNFL厚度上下方及鼻侧象限均随屈光度增大逐渐变薄,颞侧变厚。GCIPL厚度各参数均随屈光度增大逐渐变薄,二者具有很好的一致性。近视人群采用此两种方法评估青光眼损害时,均需要考虑近视程度对参数的影响。

正常老年人群黄斑内层视网膜厚度和视盘周围神经纤维层的改变

目的比较Cirrus HD—OCT测得正常老年人群和年轻人群黄斑神经节细胞一内丛状层（mGCIPL）厚度和视盘周围视网膜神经纤维层（pRNFL）厚度之间的差异，从而对青光眼性视神经病变进展分析提供依据。方法采用前瞻性系列病例分析方法。纳入2016年6—7月北京同仁医院眼科进行体检的某事业单位退休职工（60-80岁）67人114眼作为老年人群组，另选取同期行体检的20～40岁24人42眼作为年轻人群组。应用CirrusHD—OCT测量各组黄斑区总的及各个区域GCIPL和pRNFL厚度参数并比较。结果除pRNFL鼻侧区域外，老年人群组mGCIPL和pRNFL各参数测量值均较年轻人群组薄，差异均有统计学意义（均P〈0．05），其中年龄影响最大的黄斑内层厚度参数是mGCIPL最小值，老年人群组与年轻人群组比较，差异有统计学意义[（74．02±11．01）μm与（82．74±3．94）μm；t=-7．290，P〈0．001]。在pRNFL厚度参数中，颞侧pRNFL厚度受年龄影响最大，老年人群组与年轻人群组比较差异有统计学意义[（70．83±12．30）μm与（82．10±17．02）μm；t=-3．930，P〈0．001]；而鼻侧pRNFL受年龄影响最小，老年人群组鼻侧pRNFL厚度与年轻人群组比较，差异无统计学差异（P=0．056）。结论除pRNFL鼻侧区域外，CirrusHD—OCT测得老年人群mGCIPL厚度参数与pRNFL厚度参数均较年轻人群明显变薄，在青光眼性视神经病变的随访中需要考虑年龄因素的作用。