ObjectiveTo observe the clinical characteristics of the patients with positive anti-glial fibrillary acidic protein (GFAP) antibody. MethodsA retrospective study. From January 2017 through December 2021, 4 patients with positive anti-GFAP antibodies hospitalized in Departments of Ophthalmology and Neurology of Xijing Hospital, Air Force Medical University were included in this study. There were 3 patients with optic neuritis (ON) and 1 patient with the spinal and cerebral lesions. All patients were female, with an average age of 35 years. Three patients with ON received the examinations of best corrected visual acuity (BCVA), optical coherence tomography, visual evoked potential and magnetic resonance imaging (MRI) for the head and orbital. Another 1 patient with the spinal and cerebral lesions underwent MRI for the head, cervical and thoracic vertebras. All patients were tested for demyelinating ON-related antibodies in the serum, and the patient with the spinal and cerebral lesions for the antibodies in both serum and cerebrospinal fluid. Patients with ON received intravenous infusion of methylprednisolone sodium succinate in the acute stage, while the patients with spinal cord and brain lesions were given glucocorticoid and immunosuppressive therapy. ResultsThe initial symptoms of the patients with ON were sudden blurred vision in the right eye together with a pain when the eye rotated. BCVA were hand moving/in-front, 0.2 and 0.12, respectively. The serum anti-GFAP antibodies were positive. MRI showed a rough and thickened optic nerve in 1 patient. For patients with BCVA of hand moving/in-front, the BCVA was increased to counting fingers/30 cm on discharge; while the other 2 patients had no changes for BCVA. When followed up on phone 2-3 years after discharge, BCVA of the patients with ON increased to higher than 0.6. No ocular symptoms occurred in the patient with spinal and cerebral lesions and his initial symptoms were numbness, weakness and convulsions of limbs, accompanied by slurred speech. His anti-GFAP antibodies in the serum were negative but positive in the cerebrospinal fluid. MRI showed enhanced cerebellum and spinal dura mater. The initial symptoms were relieved on discharge, and vanished when followed up on phone after discharge. ConclusionsThe patients with positive anti-GFAP antibodies are more common in young and middle-aged women. Monocular optic neuritis is more often seen in the form of sudden blurred vision with an eye-rotating pain. Anti-GFAP antibodies in the serum are positive, and a few patient show a rough and thickened optic nerve. They are sensitive to glucocorticoid therapy with a satisfied prognosis.
Chronic inflammation, oxidative stress and retinal ganglion cell apoptosis play important roles in the development of diabetic retinopathy. Fenofibrate, a peroxisome proliferator-activated receptor α agonist, is used for dyslipidemia. In addition to its lipid-modulating effects, fenofibrate also has anti-inflammatory, antioxidant, anti-apoptotic and anti-angiogenesis properties that may be useful to delay the progression of diabetic retinopathy. Some clinical studies have already confirmed that fenofibrate has therapeutic effect on diabetic retinopathy. Further studies the application of fenofibrate in the treatment of diabetic microangiopathy to clarify the safety and efficacy of fenofibrate is of great significance.
ObjectiveTo observe the changes of choroidal blood perfusion in the macular area and the leakage point of acute central serous chorioretinitis (CSC). MethodsA non-randomized controlled clinical study method was adopted. From March 2022 to March 2023, 70 patients (70 eyes) with monocular acute CSC diagnosed in the Eye Center of the Second Hospital of Hebei Medical University (CSC group) were included in this study. There were 49 male patients with 49 eyes and 21 female patients with 21 eyes. The mean age was (46.70±8.45) years. The duration of disease from symptom onset to presentation was ≤3 months. The contralateral eye of the CSC patient was set as the contralateral eye group. A total of 70 eyes of 70 age-and gender-matched healthy volunteers without systemic diseases were selected as normal control group during the same period. The best corrected visual acuity (BCVA) and swept frequency source optical coherence tomography angiography (SS-OCTA) were performed. BCVA was performed using the international standard visual acuity chart, and was converted to log minimum angle of resolution (logMAR) visual acuity. SS-OCTA examination of macular area was performed using VG200D of Vision Micro Imaging (Henan) Technology Co., LTD. Scanning mode Angio 6 mm×6 mm. According to the classification of diabetic retinopathy Treatment Study Group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, which were the central area with a diameter of 1 mm, the inner ring with a diameter of 1-3 mm, and the outer ring with a diameter of 3-6 mm. The three-dimensional choroidal vascular index (3D-CVI), choroidal vascular volume (3D-CVV), choroidal capillary layer (CCL) and choroidal great vascular layer (CL) perfusion area, choroidal thickness (ChT), and subretinal fluid (SRF) height were recorded by the built-in software of the equipment in the central area, inner ring area, and outer ring area. The Kruskal-Wallis rank sum test was used for comparison between multiple groups. ResultsThe logMAR BCVA was 0.19±0.07 in the CSC group. The subfoveal SRF height was (129±121) μm. Compared with the contralateral eye group and the normal control group, the CCL perfusion area in the central area and the inner ring area of the affected eye in the CSC group was significantly decreased, and the CL perfusion area in the central area was significantly increased (P＜0.05). Compared with the normal control group, 3D-CVI was significantly decreased and 3D-CVV was significantly increased in the CSC group, and the differences were statistically significant (P＜0.05). The difference of 3D-CVV between the contralateral eye group and the normal control group was statistically significant (P＜0.05). The ChT of the central, inner and outer ring regions in the CSC group and the contralateral eye group were significantly higher than those in the normal control group (P＜0.05). The CCL and CL perfusion areas at the leakage point in the CSC group were significantly lower than those in the surrounding area, and the 3D-CVI was higher than that in the surrounding area, the differences were statistically significant (P＜0.05). ConclusionCompared with normal healthy eyes, choroidal thickening and vascular dilatation are found in both the affected and contralateral eyes of patients with acute CSC, and the choroidal capillary hypoperfusion and medium and large vascular dilatation are more obvious in the leakage point of the affected eye than in the surrounding area.