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 mac...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).展开更多
AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:Th...AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:This is a retrospective case control study.The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor(VEGF)for patients diagnosed with macular edema secondary to DR(DME)or RVO(RVO-ME)at Xijing Hospital from August 2021 to July 2022.Meanwhile,aqueous humor samples during vitrectomy from patients with idiopathic macular hole(IMH)were also collected and served as controls.The aqueous humor concentrations of VEGF,platelet-derived factor(PDGF),interleukin(IL)-6,IL-8,IL-18,tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein 1(MCP-1)were measured with Human Premixed Multi-Analyte Kit(Luminex).The difference of the aqueous cytokines and the correlation between the two diseases were analyzed.RESULTS:A total of 40 eyes of 38 patients were enrolled in the study,including 13 eyes of 11 DME patients(DME group),16 eyes of 16 RVO-ME patients(RVO-ME group)and 11 eyes of 11 IMH patients(control group).The VEGF,PDGF,IL-6,IL-8,and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group(all P<0.05),the levels of TNF-αwas higher in the DME group than in the control group(P<0.05).The VEGF,IL-6,MCP-1,and TNF-αlevels in the aqueous humor were significantly higher in the DR group than those in the RVO group(all P<0.05).Correlation analyses revealed that there were complex positive correlations between IL-6,IL-8,IL-18,MCP-1,and TNF-αlevels in the aqueous humor of eyes with two diseases.CONCLUSION:Although ischemic and inflammatory factors are similarly involved in the pathogenesis of DME and RVO-ME,the roles of these factors are more significant or more likely to be activated in DR patients,suggesting different treatment strategies should be considered for the two diseases.展开更多
AIM:To evaluate the changes in macular morphology and function after a single intravitreal injection of aflibercept in diabetic macular edema(DME)using optical coherence tomography angiography(OCTA)and MP-3 microperim...AIM:To evaluate the changes in macular morphology and function after a single intravitreal injection of aflibercept in diabetic macular edema(DME)using optical coherence tomography angiography(OCTA)and MP-3 microperimetry.METHODS:Twenty-eight patients(42 eyes)diagnosed with DME were treated with intravitreal injection of aflibercept.The changes in best corrected visual acuity(BCVA),central retinal thickness(CRT),foveal avascular zone(FAZ)area,vessel density of superficial retinal capillary plexus(SVD),vessel density of deep retinal capillary plexus(DVD),mean light sensitivity(MLS),2°fixation rate(P1),4°fixation rate(P2),and other indicators 1mo after treatment were compared;of these,BCVA was conver ted into logarithm of the minimum angle of resolution(logMAR),and the correlation among the factors was analyzed.RESULTS:After treatment,logMAR BCVA was 0.47±0.24,which was significantly better than that before treatment(0.63±0.28,P<0.001).The CRT was 359.21±107.87μm after treatment,which was significantly lower than before treatment(474.10±138.20μm,P<0.001).The FAZ area,SVD,and DVD were not significantly changed after treatment compared with the baseline.MLS was 22.16±4.20 dB after treatment,which was significantly higher than before treatment(19.63±4.23 dB,P<0.001).P2 significantly increased after treatment than before treatment(P=0.007).P1 had no significant change after treatment than before treatment(P=0.086).CONCLUSION:A single intravitreal injection of aflibercept effectively reduces macular edema and improves retinal sensitivity,fixation stability,and visual acuity,possibly without causing significant changes in the retinal vascular condition in a short time.展开更多
AIM: To investigate the incidence and subsequent changes of outer retinal tubulations(ORTs) in diabetic macular edema(DME) underwent anti-vascular endothelial growth factor(VEGF) therapy, and to assess the possibility...AIM: To investigate the incidence and subsequent changes of outer retinal tubulations(ORTs) in diabetic macular edema(DME) underwent anti-vascular endothelial growth factor(VEGF) therapy, and to assess the possibility of ORT as a biomarker of DME severity or response to anti-VEGF therapy.METHODS: This retrospective and descriptive study included a total of 228 patients(435 eyes) with DME and treated with intravitreal anti-VEGF agents between March 2016 and January 2018. Patients were divided into 2 groups according to the presence of ORTs. High-resolution spectral-domain optical coherence tomography(SD-OCT) images acquired by vertical and horizontal scans and over consecutive visits were analyzed. The evolution of ORT over time, type of fluid and subfoveal photoreceptor integrity on OCT imaging was also assessed. RESULTS: ORTs were identified in 108 eyes of 435 eyes with an overall incidence rate of 24.83% at baseline. ORTs were prone to locate adjacent to the lesions of exudation and/or cystoid edema and possibly situated in outer nuclear layer(ONL), outer plexiform layer(OPL) and/or inner nuclear layer(INL) in eyes with DME. The formation process of ORT led to focal downward displacement of OPL and INL toward RPE near the lesion. During the follow up, 45 eyes had steady ORTs and 63 eyes had dynamic variants in ORTs, including disappearance, reappearance, collapse, diminution, and enlargement. There were higher proportion of closed ORTs and fewer proportion of forming ORTs in eyes with steady ORTs, which showed a statistically significance when compared with eyeswith variant ORTs(P=0.006, P=0.017, respectively). The eyes without ORTs had significantly better final best corrected visual acuity(BCVA) and more BCVA change than those eyes with ORTs in DME patients after antiVEGF therapy(P=0.023, P=0.009, respectively). The disruption of subfoveal photoreceptor integrity in eyes with ORTs was more serious than that in eyes without ORTs(P=0.013). The proportion of stable vision in eyes with ORTs was significantly higher than that in eyes without ORTs, showing statistical significance(P=0.016). ORTs were associated with worse visual prognosis due to damage of the subfoveal photoreceptor integrity. CONCLUSION: ORTs have a high incidence and changes over time in DME with anti-VEGF treatment and may be located at various retinal layers. Persistent ORT can be as a negative biomarker of outcome of DME.展开更多
Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely ...Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.展开更多
AIM: To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema(DME) determined with optical coherence tomography(OCT). METHODS: In this cross-sectional study, D...AIM: To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema(DME) determined with optical coherence tomography(OCT). METHODS: In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness(DRT), cystoid macular edema(CME) and serous retinal detachment(SRD) and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS: Of the 57 patients with DME, 21(36.8%) had DRT, 24(42.1%) had CME and 12(21.0%) had SRD. Microor macro-albuminuria was significantly higher in the DRT pattern(61.9%) compared with the SRD(50.0%) and CME patterns(25.0%; P=0.040). Hemoglobin A1 c(Hb A1 c) level was significantly higher and patients were younger in the DRT pattern group(P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION: Micro-or macro-albuminuria may be more frequent and Hb A1 c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.展开更多
AIM:To assess the effect of the intravitreal dexamethasone implant(DEX)Ozurdex on the best corrected visual acuity(BCVA)and central retinal thickness(CRT)in patients with diabetic macular edema(DME).METHODS:Totally 43...AIM:To assess the effect of the intravitreal dexamethasone implant(DEX)Ozurdex on the best corrected visual acuity(BCVA)and central retinal thickness(CRT)in patients with diabetic macular edema(DME).METHODS:Totally 43 eyes(24 naive and 19 previously treated)were included in the study.Retrospective and single-center study involved patients with a clinical diagnosed of DME,who received treatment with DEX implant and had a follow-up of at least 12 mo.Primary endpoints included changes in BCVA and CRT.RESULTS:At month 12,mean improvement in BCVA from baseline was 20.4±20.8 letters and 6.8±6.9 letters in naive and previously treated patients,respectively(P=0.0132).The naive patients achieved the BCVA improvement significantly faster(2.4±1.5 mo)than the previously treated ones(3.5±2.4 mo,P=0.0298;MannWhitney test).The proportion of eyes gaining≥15 letters was 54.2%and 21.1%in the non-previously treated and previously treated groups,respectively(P=0.0293).CRT was significantly reduced from 484.0±119.8 and 487.5±159.9μm to 272.0±39.2 and 233.5±65.7μm in the naive and previously treated patients,respectively;P<0.0001 each,respectively.The presence of subretinal fluid was significantly associated with the proportion of patients achieving a BCVA improvement≥5 letters[HR(95%CI),1.23(1.04 to 1.45),P=0.0145];≥10 letters[HR(95%CI),1.75(1.10 to 2.77),P=0.0182];and≥15 letters[HR(95%CI),2.04(1.03 to 4.02),P=0.0407].Naive patients received less DEX implants throughout the study than the previously treated ones(1.8±0.6 vs 2.3±0.6,P=0.0172,respectively).Totally 9 patients(20.9%)have developed ocular hypertension,which was successfully controlled with topical hypotensive drugs.Of the 23 phakic eyes at baseline,5 eyes(21.7%)either had new onset lens opacity or progression of an existing opacity during the study follow-up.Four of them(2 in the naive group and 2 in the previously treated one)required cataract surgery at months 4,6,6,and 6,respectively.CONCLUSION:The results obtained in this study may support the early use of DEX Ozurdex as first line therapy in naive patients.展开更多
AIM: To evaluate the thickness and volume changes of the choroidal, outer retinal layers(ORL) and retinal pigment epithelium(RPE) in patients with diabetic retinopathy(DR) using optical coherence tomography(OCT) and c...AIM: To evaluate the thickness and volume changes of the choroidal, outer retinal layers(ORL) and retinal pigment epithelium(RPE) in patients with diabetic retinopathy(DR) using optical coherence tomography(OCT) and correlate them with visual acuity.METHODS: We carried out a retrospective observational case series. Consecutive DR patients were recruited for color fundus photography and OCT assessment. The RPE, ORL and choroidal thickness were measured. The correlation with the best-corrected visual acuity(BCVA) was also investigated.RESULTS: The study included 128 eyes, comprising 45 eyes of 25 diabetic macular edema(DME) patients, 34 eyes of 20 DR without DME(non-DME) patients, and 49 eyes of 25 age-matched normal individuals. The choroidal thickness in DR patients were decreased statistically significantly compared with the control group(P<0.05). The mean macular ORL thickness in DME(73.02±15.34 μm) and non-DME groups(76.35±7.32 μm) were decreased statistically significantly compared with the control group(80.20±5.85 μm; P=0.006, P=0.013, respectively). In both the non-DME and DME groups, the RPE thickness were decreased compared with the control group(P<0.05), except in the macular and central ring. The BCVA were significant interactions with the total inner retinal volume and macular RPE thickness in the DME group(r=0.115, P<0.001, r=-0.013, P=0.017, respectively).CONCLUSION: The choroid, ORL and RPE thickness are significantly decreased in DR patients compared with controls in different segments.展开更多
AIM: To clarify the mechanism of infliximab treatment in diabetic macular edema (DME) and to provide a new alternative therapy for DME. METHODS: Rats were randomly divided into the control group, the model group ...AIM: To clarify the mechanism of infliximab treatment in diabetic macular edema (DME) and to provide a new alternative therapy for DME. METHODS: Rats were randomly divided into the control group, the model group and the infliximab treatment group. A diabetic rat model was created. The concentration of TNF-α in the vitreous body was detected by ELISA. The expressions of B-Raf, p38, claudin-1 and occludin in the retina were detected by Western blot. The integrity of the blood retinal barrier (BRB) was measured using Evan's blue as a tracer. RESULTS: After three months and six months of the diabetes model, the vitreous TNF-α level in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant (at 3mo, F=857.098, P〈0.001; 6mo, F=1261.897, P〈0.001). The retina B-Raf and p38 levels in the model group were higher than that of the control group. They were also higher in treated group than that of the control group but were lower than that of the model group. The differences among the three groups were statistically significant (B-Raf at 3mo, F=106.596, P〈0.001 and at 6mo, F=200.681, P〈0.001; p38 at 3mo, F=41.662, P〈0.001 and at 6mo, F=67.979, P〈0.001). The retina claudin-1 and occludin levels in the model group were lower than that of the control group. They were also lower in treated group than that of the control group but were higher than that of the model group. The differences among three groups were statistically significant (claudin-1 at3mo, F=-139.088, P〈0.001 and at 6mo, F=128.415, P〈0.001; occludin at 3mo, F=-92.733, P〈0.001 and at 6mo, F--104.478, P〈0.001). The retinal Evans blue leakage in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant (at 3mo, F=-447.946, P〈0.001; at 6mo, F'=-1610.732, P〈0.001). CONCLUSION: In-α diabetic rat model, infliximab may relieve TNF-α induced BRB breakdown via the B-Raf and p38 signaling pathway.展开更多
· AIM: To evaluate the ability of various laser wavelengths in delivering sufficient burns to the retina in eyes with cataract using a new multicolor pattern scan laser with green(532 nm), yellow(577 nm), and red...· AIM: To evaluate the ability of various laser wavelengths in delivering sufficient burns to the retina in eyes with cataract using a new multicolor pattern scan laser with green(532 nm), yellow(577 nm), and red(647 nm)lasers.·METHODS: The relationship between the Emery-Little(EL) degree of cataract severity and the laser wavelength required to deliver adequate burns was investigated in102 diabetic eyes. Treatment time, total number of laser shots, and intra-operative pain were assessed as well.·RESULTS: All EL-1 grade eyes and 50% of EL-2 eyes were successfully treated with the green laser, while 50%of EL-2 eyes, 96% of EL-3 eyes, and 50% of EL-4 eyes required the yellow laser. The red laser was effective in the remaining 4% of EL-3 and 50% of EL-4 eyes.·CONCLUSION: Longer wavelength lasers are more effective in delivering laser burns through cataract when we use a multicolor pattern scan laser system.展开更多
Background:To address the presence and features of outer retinal tubulation(ORT)found in diabetic macular edema(DME)treated with anti-vascular endothelial growth factor(anti-VEGF)and to differentiate between ORT and c...Background:To address the presence and features of outer retinal tubulation(ORT)found in diabetic macular edema(DME)treated with anti-vascular endothelial growth factor(anti-VEGF)and to differentiate between ORT and cystoid DME,which have different plans of management.Methods:This was a retrospective review of a total of 514 patients investigated with spectral domain optical coherence tomography(OCT)in patients with diabetic macular edema treated with anti-VEGF.ORT was seen in 12 eyes of 11 patients.The morphologic characteristics of ORT and its progress over time were examined using OCT data.The retinal images were obtained by horizontal and vertical scans to analyze the possible presence of ORT and to explore their morphologic features and location in the retinal layers.Results:ORT was seen in DME treated with anti-VEGF.ORT was shown as round or ovoid hyporeflective spaces with hyperreflective borders on the B-scans,measuring 30 to 120μm high and 30 to 1775μm wide.The tubules generally remained stable over time.In a retinal practice specializing in advanced diabetic retinopathy clinic,this ORT was seen in 12 eyes of 11 patients during a 12-month period.ORT presented either after receiving 0.05 mL open-label intravitreal injections of 0.5 mg ranibizumab or 1.25 mg bevacizumab.Conclusion:ORT is found in DME treated with anti-VEGF that may show damage to the outer retina secondary to the severity and chronicity of the DME.ORT may be a result of underlying chronic and severe diabetic macular edema that may occur later possibly secondary to retinal layers rearrangement after several anti-VEGF injections.It is important to differentiate between ORT and cystoids DME.The presence of the ORT entity alone without the presence of DME does not require further anti-VEGF re-injections.展开更多
High speed and small gauge vitrectomy systems have made surgical intervention in complications of diabetic retinopathy(DR)safer.The availability of anti-vascular endothelial growth factor(anti-VEGF)compounds for use i...High speed and small gauge vitrectomy systems have made surgical intervention in complications of diabetic retinopathy(DR)safer.The availability of anti-vascular endothelial growth factor(anti-VEGF)compounds for use in DR has significantly improved intraoperative and postoperative outcomes.This review discusses the indications for surgical intervention in DR.The role of anti-VEGF compounds is discussed as surgical adjuvants with an emphasis on timing of treatment before surgery.展开更多
基金supported by Science and Technology Research Project of Jilin Provincial Department of Education,No.JJKH20220072KJ(to XL)Science and Technology Development Program of Jilin Province,No.20200201495JC(to YL)。
文摘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).
基金Supported by National Natural Science Foundation of China(No.81470654)Natural Science Foundation of Shaanxi Province(No.2019SF-047)。
文摘AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:This is a retrospective case control study.The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor(VEGF)for patients diagnosed with macular edema secondary to DR(DME)or RVO(RVO-ME)at Xijing Hospital from August 2021 to July 2022.Meanwhile,aqueous humor samples during vitrectomy from patients with idiopathic macular hole(IMH)were also collected and served as controls.The aqueous humor concentrations of VEGF,platelet-derived factor(PDGF),interleukin(IL)-6,IL-8,IL-18,tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein 1(MCP-1)were measured with Human Premixed Multi-Analyte Kit(Luminex).The difference of the aqueous cytokines and the correlation between the two diseases were analyzed.RESULTS:A total of 40 eyes of 38 patients were enrolled in the study,including 13 eyes of 11 DME patients(DME group),16 eyes of 16 RVO-ME patients(RVO-ME group)and 11 eyes of 11 IMH patients(control group).The VEGF,PDGF,IL-6,IL-8,and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group(all P<0.05),the levels of TNF-αwas higher in the DME group than in the control group(P<0.05).The VEGF,IL-6,MCP-1,and TNF-αlevels in the aqueous humor were significantly higher in the DR group than those in the RVO group(all P<0.05).Correlation analyses revealed that there were complex positive correlations between IL-6,IL-8,IL-18,MCP-1,and TNF-αlevels in the aqueous humor of eyes with two diseases.CONCLUSION:Although ischemic and inflammatory factors are similarly involved in the pathogenesis of DME and RVO-ME,the roles of these factors are more significant or more likely to be activated in DR patients,suggesting different treatment strategies should be considered for the two diseases.
文摘AIM:To evaluate the changes in macular morphology and function after a single intravitreal injection of aflibercept in diabetic macular edema(DME)using optical coherence tomography angiography(OCTA)and MP-3 microperimetry.METHODS:Twenty-eight patients(42 eyes)diagnosed with DME were treated with intravitreal injection of aflibercept.The changes in best corrected visual acuity(BCVA),central retinal thickness(CRT),foveal avascular zone(FAZ)area,vessel density of superficial retinal capillary plexus(SVD),vessel density of deep retinal capillary plexus(DVD),mean light sensitivity(MLS),2°fixation rate(P1),4°fixation rate(P2),and other indicators 1mo after treatment were compared;of these,BCVA was conver ted into logarithm of the minimum angle of resolution(logMAR),and the correlation among the factors was analyzed.RESULTS:After treatment,logMAR BCVA was 0.47±0.24,which was significantly better than that before treatment(0.63±0.28,P<0.001).The CRT was 359.21±107.87μm after treatment,which was significantly lower than before treatment(474.10±138.20μm,P<0.001).The FAZ area,SVD,and DVD were not significantly changed after treatment compared with the baseline.MLS was 22.16±4.20 dB after treatment,which was significantly higher than before treatment(19.63±4.23 dB,P<0.001).P2 significantly increased after treatment than before treatment(P=0.007).P1 had no significant change after treatment than before treatment(P=0.086).CONCLUSION:A single intravitreal injection of aflibercept effectively reduces macular edema and improves retinal sensitivity,fixation stability,and visual acuity,possibly without causing significant changes in the retinal vascular condition in a short time.
基金Supported by the Hubei Provincial Health and Family Planning Commission Joint Fund Project(No.WJ2018H0071)
文摘AIM: To investigate the incidence and subsequent changes of outer retinal tubulations(ORTs) in diabetic macular edema(DME) underwent anti-vascular endothelial growth factor(VEGF) therapy, and to assess the possibility of ORT as a biomarker of DME severity or response to anti-VEGF therapy.METHODS: This retrospective and descriptive study included a total of 228 patients(435 eyes) with DME and treated with intravitreal anti-VEGF agents between March 2016 and January 2018. Patients were divided into 2 groups according to the presence of ORTs. High-resolution spectral-domain optical coherence tomography(SD-OCT) images acquired by vertical and horizontal scans and over consecutive visits were analyzed. The evolution of ORT over time, type of fluid and subfoveal photoreceptor integrity on OCT imaging was also assessed. RESULTS: ORTs were identified in 108 eyes of 435 eyes with an overall incidence rate of 24.83% at baseline. ORTs were prone to locate adjacent to the lesions of exudation and/or cystoid edema and possibly situated in outer nuclear layer(ONL), outer plexiform layer(OPL) and/or inner nuclear layer(INL) in eyes with DME. The formation process of ORT led to focal downward displacement of OPL and INL toward RPE near the lesion. During the follow up, 45 eyes had steady ORTs and 63 eyes had dynamic variants in ORTs, including disappearance, reappearance, collapse, diminution, and enlargement. There were higher proportion of closed ORTs and fewer proportion of forming ORTs in eyes with steady ORTs, which showed a statistically significance when compared with eyeswith variant ORTs(P=0.006, P=0.017, respectively). The eyes without ORTs had significantly better final best corrected visual acuity(BCVA) and more BCVA change than those eyes with ORTs in DME patients after antiVEGF therapy(P=0.023, P=0.009, respectively). The disruption of subfoveal photoreceptor integrity in eyes with ORTs was more serious than that in eyes without ORTs(P=0.013). The proportion of stable vision in eyes with ORTs was significantly higher than that in eyes without ORTs, showing statistical significance(P=0.016). ORTs were associated with worse visual prognosis due to damage of the subfoveal photoreceptor integrity. CONCLUSION: ORTs have a high incidence and changes over time in DME with anti-VEGF treatment and may be located at various retinal layers. Persistent ORT can be as a negative biomarker of outcome of DME.
文摘Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.
文摘AIM: To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema(DME) determined with optical coherence tomography(OCT). METHODS: In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness(DRT), cystoid macular edema(CME) and serous retinal detachment(SRD) and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS: Of the 57 patients with DME, 21(36.8%) had DRT, 24(42.1%) had CME and 12(21.0%) had SRD. Microor macro-albuminuria was significantly higher in the DRT pattern(61.9%) compared with the SRD(50.0%) and CME patterns(25.0%; P=0.040). Hemoglobin A1 c(Hb A1 c) level was significantly higher and patients were younger in the DRT pattern group(P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION: Micro-or macro-albuminuria may be more frequent and Hb A1 c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.
文摘AIM:To assess the effect of the intravitreal dexamethasone implant(DEX)Ozurdex on the best corrected visual acuity(BCVA)and central retinal thickness(CRT)in patients with diabetic macular edema(DME).METHODS:Totally 43 eyes(24 naive and 19 previously treated)were included in the study.Retrospective and single-center study involved patients with a clinical diagnosed of DME,who received treatment with DEX implant and had a follow-up of at least 12 mo.Primary endpoints included changes in BCVA and CRT.RESULTS:At month 12,mean improvement in BCVA from baseline was 20.4±20.8 letters and 6.8±6.9 letters in naive and previously treated patients,respectively(P=0.0132).The naive patients achieved the BCVA improvement significantly faster(2.4±1.5 mo)than the previously treated ones(3.5±2.4 mo,P=0.0298;MannWhitney test).The proportion of eyes gaining≥15 letters was 54.2%and 21.1%in the non-previously treated and previously treated groups,respectively(P=0.0293).CRT was significantly reduced from 484.0±119.8 and 487.5±159.9μm to 272.0±39.2 and 233.5±65.7μm in the naive and previously treated patients,respectively;P<0.0001 each,respectively.The presence of subretinal fluid was significantly associated with the proportion of patients achieving a BCVA improvement≥5 letters[HR(95%CI),1.23(1.04 to 1.45),P=0.0145];≥10 letters[HR(95%CI),1.75(1.10 to 2.77),P=0.0182];and≥15 letters[HR(95%CI),2.04(1.03 to 4.02),P=0.0407].Naive patients received less DEX implants throughout the study than the previously treated ones(1.8±0.6 vs 2.3±0.6,P=0.0172,respectively).Totally 9 patients(20.9%)have developed ocular hypertension,which was successfully controlled with topical hypotensive drugs.Of the 23 phakic eyes at baseline,5 eyes(21.7%)either had new onset lens opacity or progression of an existing opacity during the study follow-up.Four of them(2 in the naive group and 2 in the previously treated one)required cataract surgery at months 4,6,6,and 6,respectively.CONCLUSION:The results obtained in this study may support the early use of DEX Ozurdex as first line therapy in naive patients.
基金Supported by the Science and Technology Commission of Shanghai Municipality,China(No.16DZ0501100)
文摘AIM: To evaluate the thickness and volume changes of the choroidal, outer retinal layers(ORL) and retinal pigment epithelium(RPE) in patients with diabetic retinopathy(DR) using optical coherence tomography(OCT) and correlate them with visual acuity.METHODS: We carried out a retrospective observational case series. Consecutive DR patients were recruited for color fundus photography and OCT assessment. The RPE, ORL and choroidal thickness were measured. The correlation with the best-corrected visual acuity(BCVA) was also investigated.RESULTS: The study included 128 eyes, comprising 45 eyes of 25 diabetic macular edema(DME) patients, 34 eyes of 20 DR without DME(non-DME) patients, and 49 eyes of 25 age-matched normal individuals. The choroidal thickness in DR patients were decreased statistically significantly compared with the control group(P<0.05). The mean macular ORL thickness in DME(73.02±15.34 μm) and non-DME groups(76.35±7.32 μm) were decreased statistically significantly compared with the control group(80.20±5.85 μm; P=0.006, P=0.013, respectively). In both the non-DME and DME groups, the RPE thickness were decreased compared with the control group(P<0.05), except in the macular and central ring. The BCVA were significant interactions with the total inner retinal volume and macular RPE thickness in the DME group(r=0.115, P<0.001, r=-0.013, P=0.017, respectively).CONCLUSION: The choroid, ORL and RPE thickness are significantly decreased in DR patients compared with controls in different segments.
基金Supported by Fujian Provincial Health and Family Planning Commission(No.2014-ZQN-ZD-16)
文摘AIM: To clarify the mechanism of infliximab treatment in diabetic macular edema (DME) and to provide a new alternative therapy for DME. METHODS: Rats were randomly divided into the control group, the model group and the infliximab treatment group. A diabetic rat model was created. The concentration of TNF-α in the vitreous body was detected by ELISA. The expressions of B-Raf, p38, claudin-1 and occludin in the retina were detected by Western blot. The integrity of the blood retinal barrier (BRB) was measured using Evan's blue as a tracer. RESULTS: After three months and six months of the diabetes model, the vitreous TNF-α level in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant (at 3mo, F=857.098, P〈0.001; 6mo, F=1261.897, P〈0.001). The retina B-Raf and p38 levels in the model group were higher than that of the control group. They were also higher in treated group than that of the control group but were lower than that of the model group. The differences among the three groups were statistically significant (B-Raf at 3mo, F=106.596, P〈0.001 and at 6mo, F=200.681, P〈0.001; p38 at 3mo, F=41.662, P〈0.001 and at 6mo, F=67.979, P〈0.001). The retina claudin-1 and occludin levels in the model group were lower than that of the control group. They were also lower in treated group than that of the control group but were higher than that of the model group. The differences among three groups were statistically significant (claudin-1 at3mo, F=-139.088, P〈0.001 and at 6mo, F=128.415, P〈0.001; occludin at 3mo, F=-92.733, P〈0.001 and at 6mo, F--104.478, P〈0.001). The retinal Evans blue leakage in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant (at 3mo, F=-447.946, P〈0.001; at 6mo, F'=-1610.732, P〈0.001). CONCLUSION: In-α diabetic rat model, infliximab may relieve TNF-α induced BRB breakdown via the B-Raf and p38 signaling pathway.
文摘· AIM: To evaluate the ability of various laser wavelengths in delivering sufficient burns to the retina in eyes with cataract using a new multicolor pattern scan laser with green(532 nm), yellow(577 nm), and red(647 nm)lasers.·METHODS: The relationship between the Emery-Little(EL) degree of cataract severity and the laser wavelength required to deliver adequate burns was investigated in102 diabetic eyes. Treatment time, total number of laser shots, and intra-operative pain were assessed as well.·RESULTS: All EL-1 grade eyes and 50% of EL-2 eyes were successfully treated with the green laser, while 50%of EL-2 eyes, 96% of EL-3 eyes, and 50% of EL-4 eyes required the yellow laser. The red laser was effective in the remaining 4% of EL-3 and 50% of EL-4 eyes.·CONCLUSION: Longer wavelength lasers are more effective in delivering laser burns through cataract when we use a multicolor pattern scan laser system.
文摘Background:To address the presence and features of outer retinal tubulation(ORT)found in diabetic macular edema(DME)treated with anti-vascular endothelial growth factor(anti-VEGF)and to differentiate between ORT and cystoid DME,which have different plans of management.Methods:This was a retrospective review of a total of 514 patients investigated with spectral domain optical coherence tomography(OCT)in patients with diabetic macular edema treated with anti-VEGF.ORT was seen in 12 eyes of 11 patients.The morphologic characteristics of ORT and its progress over time were examined using OCT data.The retinal images were obtained by horizontal and vertical scans to analyze the possible presence of ORT and to explore their morphologic features and location in the retinal layers.Results:ORT was seen in DME treated with anti-VEGF.ORT was shown as round or ovoid hyporeflective spaces with hyperreflective borders on the B-scans,measuring 30 to 120μm high and 30 to 1775μm wide.The tubules generally remained stable over time.In a retinal practice specializing in advanced diabetic retinopathy clinic,this ORT was seen in 12 eyes of 11 patients during a 12-month period.ORT presented either after receiving 0.05 mL open-label intravitreal injections of 0.5 mg ranibizumab or 1.25 mg bevacizumab.Conclusion:ORT is found in DME treated with anti-VEGF that may show damage to the outer retina secondary to the severity and chronicity of the DME.ORT may be a result of underlying chronic and severe diabetic macular edema that may occur later possibly secondary to retinal layers rearrangement after several anti-VEGF injections.It is important to differentiate between ORT and cystoids DME.The presence of the ORT entity alone without the presence of DME does not require further anti-VEGF re-injections.
文摘High speed and small gauge vitrectomy systems have made surgical intervention in complications of diabetic retinopathy(DR)safer.The availability of anti-vascular endothelial growth factor(anti-VEGF)compounds for use in DR has significantly improved intraoperative and postoperative outcomes.This review discusses the indications for surgical intervention in DR.The role of anti-VEGF compounds is discussed as surgical adjuvants with an emphasis on timing of treatment before surgery.