Objective lt;brgt;To evaluated the effect of transpupillary thermotherapy (TTT) on age-related macular degeneration (AMD). lt;brgt; lt;brgt;Methods lt;brgt;Sixty-two cases (62 eyes) of exudative AMD were managed with TTT. Before treatment, 58 cases underwent fundus fluorescein angiography(FFA),42 cases underwent simultaneous indocyanine green angiography (ICGA), and 56 cases underwent optic coherence tomography (OCT).TTT was delivered using a 810 nm diode laser with variable spot sizes 0.5-3.0 mm and power range 60-40 mW,60 seconds duration. Sixty-two cases were followed up for 1-10 months with 4.8 months average. lt;brgt; lt;brgt;Results lt;brgt;The visual acuities of last visit were compared with those before the treatment. The visual acuity was unchanged in 43 cases (69.3%), improved in 15 cases (24.2%), and declined in 4 cases (6.5%). OCT was re-done in 51 cases and compared with OCT images before TTT treatment. The height of macular edema was unchanged in 29 cases (56.9%), decreased in 18 cases (35.3%), and increased in 4 cases (7.8%). The amelioration of visual acuity was compatible with that of macular configuration in the majority of cases (74.5%). Only in 13 cases (25.5%) the amelioration of visual acuity lagged behind that of macular configuration. The re-treatment was performed in 18 cases (29.1%), probably due to insufficiency of laser power. No side-effect was found. lt;brgt; lt;brgt;Conclusion lt;brgt;TTT makes most of the cases of exudative AMD retaining or improving their visual acuity. The employment is secured. Further exploration is needed in order to obtain the parameters of the laser treatment. (Chin J Ocul Fundus Dis, 2002, 18: 180-183)
Objective To investigate the correlation of microperimetric parameters, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME) eyes. Methods It is a prospective, no controlled, open study. Twenty-four consecutive patients (40 eyes) with DME were included. There were 10 males (18 eyes),14 females (22 eyes); aged from 41 to 79 years, with the mean age of (56.84±8.96) years. All the patients were type 2 diabetes, the average duration of diabetes was 8 years. BCVA was evaluated using the international Snellen E vision test chart, and then recorded as logarithm of the minimum angle of resolution (logMAR). CRT was measured by Cirrus HD-OCT4000. MAIA microperimetric parameters were evaluated, including average threshold (AT) of retinal sensitivity, macular integrity index (MI), fixating points within a circle of 1° (P1) and 2° of radius (P2), bivariate contour ellipse area (BCEA) considering 63% and 95% of fixating points (A63,A95), and horizontal and vertical axes of that ellipse (H63,H95,V63,V95). Pearson correlation analysis was performed to evaluate the association between these variables. The independent factor influenced the type of fixation was analyzed by multiple linear regression analysis. Results Strong correlations of logMAR BCVA with CRT (r=0.58,P=0.000), V63 (r=0.44,P=0.004), V95 (r=0.41,P=0.008), MI (r=0.36,P=0.024), AT (r=?0.61,P=0.000), P1 (r=?0.41,P=0.009), P2 (r=?0.38,P=0.015) were found. AT was correlations with P1 (r=0.53,P=0.000), P2 (r=0.51,P=0.001), A63 (r=?0.39,P=0.012), A95 (r=?0.40,P=0.012), V63 (r=?0.53,P=0.000), V95 (r=?0.46,P=0.003), MI (r=?0.50,P=0.001). There was no correlation between AT and CRT (r=?0.21,P=0.190). Forty eyes were included in this study, 8 eyes (20%) had stable fixation,14 eyes (35%) had relatively unstable fixation,18 eyes (45%) had unstable fixation. Multiple linear regression analysis showed that fixation classification was independently affected by P1. Conclusions In DME eyes, logMAR BCVA was positively correlated with CRT, negatively correlated with AT, P1 and P2. There is no correlation between AT and CRT. The fixation classification was independently affected by P1.
Purpose To evaluate shortterm visual acuity effects of a single photodynamic therapy(PDT) treatment with Visudyne (CIBA Vision Corp, Duluth, Ga) for choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods Definitely diagnostic AMD patients with classic CNV were treated with PDT (5 cases, 7 eyes). The data of visual acuity testing, ophthalmic examination, color photographs, optic coherence tomography, fluorescein angiograms and indocyanine green angiogram before photodynamic therapy and 1 week ,1 month after it were used to evaluate the effects of a single treatment of PDT with Visudyne. Results The visual acuity of all the treated eyes at the follow-up examination at 1 month after PDT were not reduced. Distinct reduction of fluorescein leakage from CNV was noted in all patients by 1 week after PDT. Fluorescein leakage from a portion of the CNV reappeared by 1 month after treatment in 2 eyes. Conclusion PDT with Visudyne achieved short-term cessation of fluorescein leakage from CNV without loss of vision or growth of classic CNV in some patwo ients with AMD. (Chin J Ocul Fundus Dis,2000,16:213-216)
ObjectiveTo seek the evidencebased medicine (EBM) evidences of curative effects of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsAll articles of intravitreous injection TA for macular edema published in English or Chinese were picked up from databases of MEDLINE and CNKI and then evaluated according to EBM standard. The data in accord with research standard were selected by using excluding and including criteria, and classified according to the appraisal standard of clinical therapeutic documents. ResultsIn the selected papers, none in gradeⅠevidence; 1 in gradeⅡevidence; 7 in grade Ⅲ evidence; 24 in grade Ⅳ evidence; and 19 in gradeⅤevidence. Forty-two papers reported that intravitreous injection with TA had significant effect for macular edema within 3 months, and the improvement of visual acuity was recorded in these papers. Regression of macular edema was recorded in 23 papers. Among 20 papers, side-effect was found in 93 eyes (31.41%) and the serious sideeffect in 4 eyes (1.35%).ConclusionsIntravitreous injection with TA has some curative effects for macular edema in short term, but the quality of current study has not been encouraging. There are no grade I document and lack of the study of validity in long term and essentiality and validity of retreatment. The special attention should be payed on the increasing persistency of efficacy and preventing the serious side-effects in the future investigation.(Chin J Ocul Fundus Dis, 2005,21:220-223)
Purpose To investigate the histopathologic changes of macula lutea retinae in the elderly Chinese population,and to provide information for the cause of visiual disturbance in an autopsy study. Methods Two hundred and twelve eyes from 108 consecutive cases of postmortem (mean age of 78.4 years old) sections of the area of macula lutea retinae were studied by histopathology. Results Among the 212 eyes,hard drusen were found in 36.3% of eyes and soft drusen in 19.3% of eyes.The eyes with both of the above mentioned 2 types of drusens were found to be combined with RPE atrophy and RPE detachment;and subretinal neovascularization were found in 5.7% of these eyes and they were associated with obvious RPE atrophy and photoreceptor loss;3.2% eyes had posterior scleral staphyloma showing thinning of the sclera and choroid,RPE atrophy and apparent photoreceptor loss;2.4%eyes showed CME with the history of cataract surgery. Conclusion The macular affections,age-related macular degeneration,myopic macular degeneration and post-perative cystoid macular edema are varying in number in the above mentioned order successively,in elderly Chinese at an autopsy study. (Chin J Ocul Fundus Dis,2000,16:233-235)
Pyroptosis is an inflammatory form of programmed cell death, including canonical and non-canonical pyroptosis pathway. Studies on pyroptosis have been reported in a variety of retinal diseases, but they are more focused on common diseases such as diabetic retinopathy and age-related macular degeneration. Many retinal diseases are difficult to treat because of the complexity of their etiology and pathogenesis. The discovery of pyroptosis has brought new content to the pathogenesis of these diseases, and also pointed a new direction for the treatment. Pyroptosis does not occur independently, and it is related to apoptosis and autophagy, but the specific mechanism is not clear. However, the most important biomolecule in the process of pyroptosis have been basically determined, and some methods can be used to interfere with pyroptosis, which has obtained preliminary achievement, suggesting that inhibition of pyroptosis may be a new direction for the treatment of retinal diseases and has broad research prospects.
Age-related macular degeneration (AMD) is a fundus disease characterized by degeneration of retinal photoreceptor cells, RPE cells and choroidal capillaries. The pathogenesis is not clear and there is no effective treatment. Cell therapies can slow or reverse the vision loss of AMD in animal models, which include implantation of bone marrow mesenchymal stem cells, pluripotent stem cells, RPE cells into the subretinal cavity. Therefore, cell therapy is a promising strategy for the treatment of AMD.
Macular edema is an important cause of visual impairment in many eye diseases such as diabetic retinopathy, retinal vein occlusion and uveitis. Optical coherence tomography (OCT) provides high-resolution image of retinal microstructures in a non-contact and rapid manner, which greatly improves the ability of diagnosis and follow-up to macular edema patients. OCT has been widely used in the clinical detection of patients with macular edema. No matter what the cause of macular edema is, it can be observed in OCT images that there are spot-like deposits with strong reflection signals in the retina, which are mostly distributed discretely or partially convergent, and are called hyperreflective foci. At present, the nature or source of hyperreflective foci is not clear, however, may involve the destruction of the blood retina barrier, retinal inflammatory reaction, neurocellular degeneration, and so on. These mechanisms are also the key physiological mechanisms in the development of macular edema. The clinical research on hyperreflective foci provides a new direction for understanding the pathogenesis of macular edema and predicting the prognosis of macular edema. The distribution and quantity characteristics of hyperreflective foci may be an important biological marker to predict the prognosis of macular edema.nosis of macular edema. foci provides a new direction for understanding the pathogenesis of macular edema and predicting the prognosis of macular edema. The distribution and quantity characteristics of HRF may be an important biological marker to predict the prognosis of macular edema.
ObjectivesTo evaluate the effect of peeling of internal limiting membrane (ILM) on the postoperative visual acuity in patients with diabetic macular edema, and to detect the role indocyanine green (ICG) plays in the surgery of peeling of ILM. MethodsThirty patients (31 eyes) with diabetic retinopathy at proliferative stage with macular edema underwent vitrectomy. The patients were randomly divided into two groups: 16 eyes in group A underwent single vitrectomy with panretinal photocoagulation and ocular filling with 20% SF6; 15 eyes in group B underwent vitrectomy and peeling of ILM after the posterior pole was stained with ICG. All of the patients were asked to keep the posture of facing down for 10-14 days. The follow-up lasted 3-12 months.ResultsIn 16 eyes in group A, the visual acuity increase of 2 or more lines in 10 (62.5%) and alleviation of macular edema in 9 (56.2%) were found; the postoperative average macular retinal thickness examined by optic coherence tomography (OCT) was 393 μm. In 15 eyes in group B, the visual acuity increase of 2 or more lines in 14 (93.3%) and alleviation of macular edema in 14 (93.3%) were found; the postoperative average macular retinal thickness was 319 μm. The postoperative improvement of visual acuity in group B was much better than that in group A (X2=4.210, P=0.05), while the postoperative macular retinal thickness in group B was obviously lower than that in group A (P＜0.01). The operative sample was proved to be the ILM. ConclusionsVitrectomy is effective for diabetic macular edema and the curative effect may be improved by peeling of ILM; ICG can dye ILM well, which ensures the safe and accurate peeling of ILM.(Chin J Ocul Fundus Dis, 2005,21:138-141)