Choroidal neovascularization is the leading causes of central vision loss in wet age-related macular degeneration (wAMD) patients. Smoking not only aggravates the incidence and severity of the choroidal neovascularization of wAMD, but also affects the clinical treatment, making the prognosis worse. Nicotine, as an important harmful substance in tobacco, is an easily addictive and highly toxic alkaloid. Animal experiments and clinical studies have confirmed that nicotine can aggravate wAMD by mediating angiogenesis through nicotinic acetylcholine receptor, bone marrow blasts, inflammation, complement system, etc. Therefore, in order to early take appropriate intervention measures to prevent and delay the development, we should actively explore the exact pathogenesis by which nicotine aggravates the choroidal neovascularization.
Interleukin-18 is an inactive precursor which lacks a signal peptide, it has a role in regulating retinal pathological angiogenesis. It also inhibits experimental choroidal neovascularization (CNV) via interferon-γand thrombospondin-1. Currently little is known about its mechanisms of inhibition for CNV, may be speculated to be due to effects of anti-angiogenesis, down-regulates vascular permeability and lower vascular endothelial growth factor (VEGF) levels via directly acting on the vascular endothelial cell and epithelial cells. Exogenous administration of mature recombinant interleukin-18 has no adverse effect on retinal pigment epithelial cell viability. In addition, the anti-VEGF role of interleukin-18 is tested to be safe and effective for humans. Interleukin-18 alone or in combination with anti-VEGF shows to be a good prospect for improving the prognosis of experimental CNV. However, more large clinical studies are required to confirm the exact efficacy of interleukin-18 for CNV.
Objective To observe the thickness of the retina, retinal nerve fiber layer (RNFL), choroid and sclera among the difference posterior sclera shape (PSS) in high myopia (HM). Methods Sixty HM patients (96 eyes) were enrolled in this study. There were 18 males (25 eyes) and 42 females (71 eyes). The mean age was (51.32±10.06) years. The mean spherical equivalent was (-14.38±6.31) DS. The mean axial length was (29.49±2.44) mm. The eyes were evaluated from deep range imaging optical coherent tomography (DRI-OCT) Atlantis 3D model, and divided as four groups include PSS-Ⅰ (27 eyes), PSS-Ⅱ (46 eyes), PSS-Ⅲ (11 eyes) and PSS-Ⅸ (12 eyes) according to the Curtin classification method. The thickness of the retina, RNFL, choroid and sclera were measured in the EDTRS Grid area. Results There were statistically significant differences in the thickness of retina of the central, first circle, second circle in the EDTRS Grid area among PSS-Ⅰ, PSS-Ⅱ, PSS-Ⅲ and PSS-Ⅸ groups (F=4.48, 5.03, 4.98; P＜0.01). There was no statistically significant differences in the thickness of RNFL among four groups (F=0.13, P=0.93). There was no statistically significant differences in the central choroidal thickness (F=0.31, P=0.81). There were statistically significant differences in the first circle, second circle choroidal thickness among four groups (F=2.86, 2.96; P=0.04, 0.04). There was no statistically significant differences in the thickness of sclera under macular fovea among four groups (F=0.80, P=0.49). Conlusions There are changes of thickness of the retina, choroid present in the difference EDTRS Grid area among the difference PSS in HM, and changes in PSS-Ⅸ is most obvious.
ObjectiveTo observe the changes of choroidal capillary flow area (CBFA) and density in patients with idiopathic macular hole (IMH) before and after surgery.MethodsA prospective clinical study. Thirty patients (60 eyes) with unilateral IMH diagnosed in Department of Ophthalmology of The Second Hospital of Hebei Medical University from February 2017 to March 2018 and 30 age-and sex- matched normal controls were included in this study. All eyes were divided into group A (30 affected eyes), group B (30 fellow eyes) and group C (30 normal eyes of controls). Among 30 eyes in group A, there were 5, 14, 11 eyes with hole in stage Ⅱ, Ⅲ, Ⅳ, respecitvely. The eyes in group A were divided into two subgroups according to the diameter of the holes: group D: hole diameter less than or equal to 500 μm (11 eyes), group E: hole diameter over than 500 μm (19 eyes). All eyes in group A underwent vitrectomy. Spectral-domain OCT was used to observe the diameter size of macular hole and the closure of the hole after vitrectomy in eyes of group A. The CBFA and blood flow density of superficial choroidal capillaries were measured by OCT angiography before and 3 months after vitrectomy in groups A, B and C. Univariate analysis of variance and t test were used for statistical analysis.ResultsBefore surgery, in group A, B and C, the CBFA were 2.84±0.35, 3.19±0.23, 3.26±0.24 mm2, the blood flow density were (20.74±8.26)%, (35.18±5.20)%, (35.20±6.49)%, respectively. The CBFA and blood flow density in group A were significantly lower than those in group B and C (F=19.768, 45.583; P = 0.000, 0.000), but there was no significant difference between group B and C (F=19.768, 45.583; P=0.332, 0.994). The CBFA and blood flow density in group D were higher than those in group E (t=2.230, 2.202; P=0.034, 0.036). The diameter of macular hole was negatively correlated with CBFA and blood flow density (r=－0.377, －0.477; P=0.044, 0.009). Three months after surgery, the macular holes in group A were closed; CBFA and blood flow density in macular area were significantly higher than before surgery (t=－4.126, －4.912; P=0.000, 0.000).ConclusionsCBFA and blood flow density decreased in the macular area of IMH. CBFA and blood flow density can be recovered after vitrectomy.
Objective To observe the peripapillary choroidal thicknesses (pCT) and subfoveal choroidal thicknesses (SFCT) of nonarteritic anterior ischemic optic neuropathy (NAION). Methods Forty-four Chinese patients with unilateral NAION were recruited and compared with 60 eyes of 60 normal age and refractive-error matched control subjects. pCT and SFCT were measured by enhanced depth imaging optical coherence tomography. Choroidal thicknesses of eyes with NAION and unaffected fellow eyes were compared with normal controls. Choroidal thicknesses of NAION eyes with or without optic disc edema were also compared. The correlation between choroidal thickness and retinal nerve fiber layer (RNFL) thickness, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and the mean deviation (MD) of Humphrey static perimetry in NAION eyes were analyzed. Results The pCT at the nasal, nasal inferior and temporal inferior quadrants in NAION eyes with optic disc edema were significantly thicker than that of normal subjects (t=3.152, 3.166, 2.808; P＜0.05). There was no significant difference in the choroidal thicknesses between the unaffected fellow eyes of NAION patients and normal eyes of healthy controls; or between the NAION eyes with resolved optic disc edema and normal eyes (P＞0.05). No significant correlation between choroidal thickness (r=－0.220, －0.140, 0.110), SFCT (r=0.096, －0.148, －0.131) and logMAR BCVA, perimetry MD and RNFL was found in eyes affected by NAION (P＞0.05). Conclusions The peripapillary choroidal thicknesses increase in some quadrants in NAION eyes with optic disc edema. However, the choroidal thickness of NAION eyes is the same in age and refractive error-matched normal subjects.
Objective To compare the clinic therapeutic effect of intravitreal ranibizumab injection versus photodynamic therapy (PDT) combined with intravitreal ranibizumab injection for idiopathic choroidal neovascularizatio (ICNV), and to investigate the clinical effect and safety of treatment. Methods A randomized controlled clinical prospective study was performed for 27 patients (27 eyes) diagnosed as ICNV. Fourteen patients were assigned to receive PDT and intravitreal ranibizumab injection (combination roup.n=14); the control group was treated with only intravitreal ranibizumab injection (single group, n=13).The combination group was treated with an intravitreal injection of ranibizumab (0.5 mg/0.05 ml) 1 week after PDT. The bestcorrected visual acuity (BCVA) (logMAR), examination of the ocular fundus, fluorescence fundus angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were performed respectively at 1, 2, 3, 6 and 12 months after treatment. If choroidal neovascularization (CNV) was only partially regressed or the leakage went on during follow-up, those patients were re-injected with ranibizumab. Results After 12 months, the average vision is 0.22plusmn;0.11 in single group, and 0.21plusmn;0.12 in combination group, and the differences were not significant (t=0.187, P=0.853). In single group FFA and ICGA showed completely closed CNV in 10 eyes (77.92%), and almost closed CNV in 3 eyes (23.08%) with obvious reduction of fluorescence leakage. In combination group FFA and ICGA showed completely closed CNV in 12 eyes (85.71%), and almost closed CNV in 2 eyes (14.29%) with obvious reduction of fluorescence leakage; OCT showed the subretinal fluid absorption and reduction of CNV. The average macular retinal thickness (MRT) in single groups is （167.96plusmn;10.69） m, and in combination groups is （171.64plusmn;11.30）m. In single and combination groups MRT decreased significantly at the final follow-up, but no significant differences in both groups (t=-0.887.P=0.389). The average number of intravitreal injection was （1.5plusmn;0.7） in combination group and （2.4plusmn;1.0） in single group (t=2.821，P=0.009). There were no ocular or systemic adverse events observed except for one patient with subconjunctival hemorrhage in the single group.Conclusions Intravitreal ranibizumab injection and PDT combined with intravitreal bevacizumab injection are both effective and safe for the patients with ICNV. The combined therapy can induce CNV regression, fundus hemorrhage and exudation absorption more effectively, and have less recurred CNV and side effects.
Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a peripheral retinal disease characterized by subretinal hemorrhage and/or subretinal pigment epithelial hemorrhage or exudation. It is often misdiagnosed as age-related macular degeneration, polypoidal chorioretinopathy or choroidal melanoma. With the development of multimodal imaging, PEHCR has different features under different examinations, such as B-scan ultrasound, fluorescein fundus angiography, optical coherence tomography and so on, which contributes to differention from other diseases. Clinical treatments for the disease include intravitreal injection of retinal photocoagulation therapy, anti-vascular endothelial growth factor, pars plana vitrectomyand so on, but there is still no universal consensus. In order to gain a deeper understanding of the clinical features, treatment options and prognosis of PEHCR, minimize missed diagnoses and misdiagnoses, and improve treatment efficiency, further research is required.
Objective To observe macular vascular density and structural characteristics in children with transfusion-dependent β-thalassemia (TDT). MethodsA retrospective clinical study. From October 2022 to December 2023, 29 TDT children (58 eyes) diagnosed and examined at the Department of Hematology, Affiliated Hospital of Guangdong Medical University were included in the TDT group, along with 29 age- and gender-matched healthy children (58 eyes) as the control group. All participants underwent optical coherence tomography and angiography. Measurements included central macular thickness (CMT), subretinal choroidal thickness (SFCT), choroidal thickness (ChT), choroidal vascularity index, blood flow density in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris layer (CC), and choroidal layer of the macular region, as well as the foveal avascular zone (FAZ) area of the SCP and DCP. A generalized estimating equation was used to compare differences in the above parameters between the two groups. Pearson correlation analysis was employed to examine the relationships between fundus structural parameters, blood flow density, and blood indices. ResultsCompared with the control group, the TDT group showed significantly thinner CMT (χ2=6.044) and ChT at 3.0 mm nasal (χ2=4.451) and temporal (χ2=4.767) to the fovea (P＜0.05). The TDT group also demonstrated reduced blood flow density in the inferior DCP (χ2=5.254), whole CC (χ2=3.996), and superior CC (χ2=5.094), as well as enlarged FAZ area in DCP (χ2=4.286) (P＜0.05). Correlation analysis revealed a negative correlation between SFCT and disease duration (r=?0.357, P=0.006). ConclusionsIn children with TDT, CMT and ChT become thinner and the area of FAZ expands. The blood flow densities of DCP and CC in the macular area decreased.
We have studied retrospectively 13 eyes with postoperative choroidal detachment of retinal detachment surgery in 126 cases(129 eyes).The frequency of choroidal detachment in this series is 10.1%(13/129).And we found that the middle-aged patients were more common sufferers,and drainaging the subretinal fluid,the extent of retinal degeneration and the buckling procedure might be the related factors to the occurence of postoperative choroidal detachment of retinal detachment surgery. （Chin J Ocul Fundus Dis,1993,9:210-213）