Objective To detect the apoptosis of vascular endothelial cells and retinal pigment epithelial (RPE) cells in vitro induced by verteporfin-photodynamic therapy. Methods Cultured vascular endothelial cells and human RPE cells were incubated with verteporfin at a concentration of 1.0 mu;g/ml which was equivalent to the initial plasma level of verteporfin in clinical therapy. Each kind of cells were divided into 6 groups according to different time of incubation: 0, 5, 15, 30, 60, and 120 minutes group. After incubated, the cells were illuminated by the laser light with the maximum wavelength of absorption of verteporfin (wavelength: 689 nm, power density: 600 mW/cm2) with the power of 2.4 J/cm 2for 83 seconds. The percentage of cellular apoptosis was measured by flow cytometry 3 hours after PDT, and the measurement was repeated thrice. Results The proportion of cellular apoptosis 3 hours after PDT were 0.01plusmn;0.01, 0.25plusmn;0.02, 0.32plusmn;0.02, 0.41plusmn;0.04, 0.49plusmn;0.03 and 0.61plusmn;0.02, respectively in 0-120 minutes group of vascular endothelial cells; and 0.02plusmn;0.01, 0.22plusmn;0.01, 0.31plusmn;0.02, 0.38plusmn;0.03, 0.47plusmn;0.05 and 0.58plusmn;0.03 respectively in 0-120 minutes group of RPE cells. The proportion of cellular apoptosis of both kinds of the cells increased as the incubation time was prolonged. There was no significant difference of the percentage of cellular apoptosis between the accordant time groups in the two kinds of cells (P＞0.05). Conclusions Cellular apoptosis can be quickly induced by verteporfin-PDT both in human vascular endothelial cells and RPE cells; under the same condition in vitro, PDT has no obvious selection for the apoptosis of the two kinds of cells. (Chin J Ocul Fundus Dis, 2006, 22: 253-255)
Corticosteroids, anti-vascular endothelial growth factor, antibiotics and antiviral were the main 4 classes of drugs for intravitreal injection. Depending on the class and volume of medication, age and gender of patients, ocular axial lengths or vitreous humour reflux, intraocular pressure (IOP) can be elevated transiently or persistently after intravitreal injection. Transient IOP elevation occurred in 2 weeks after intravitreal injection, and can be reduced to normal level for most patients. Only a small portion of such patients have very high IOP and need intervention measures such as anterior chamber puncture or lowering intraocular pressure by drugs. Long term IOP elevation is refers to persistent IOP increase after 2 weeks after intravitreal injection, and cause optic nerve irreversible damage and decline in the visual function of patients. Thus drug or surgical intervention need to be considered for those patients with high and long period of elevated IOP. Large-scale multicenter clinical trials need to be performed to evaluate the roles of the drug and patients factors for IOP of post-intravitreal injection, and to determine if it is necessary and how to use methods reducing IOP before intravitreal injection.
ObjectiveTo understand the adverse effects of perioperative red blood cells (RBC) transfusion on patients after pancreaticoduodenectomy (PD) so as to provide ideas for reducing postoperative complications and improving prognosis. MethodThe relevant literatures at home and abroad in recent years about studies of perioperative RBC transfusion on postoperative complications (focusing on pancreatic fistula and infection) and prognosis of patients with PD were reviewed. ResultsThe rates of postoperative complications and perioperative RBC transfusion after PD were still higher. The perioperative RBC transfusion might increase the rate of postoperative complications, promote early tumor recurrence, and shorten the disease-free survival and overall survival. At present, with the progress of technology, the perioperative RBC transfusion rate was decreasing. At the same time, with the accelerated development of new blood transfusion technologies such as freeze-drying and refrigeration, the decline rate was still expected to be increased. ConclusionsPerioperative RBC transfusion in PD might have adverse effects on postoperative complications and prognosis. Although further research is still needed to explore its necessary connection, this adverse effect needs to be paid enough attention in clinical practice. Early identification of risk factors, strict transfusion indications and minimizing amount or concentration of RBC transfusion might help to avoid or reduce RBC transfusion and minimize its adverse effects.
Anti-vascular dndothelial growth factor (VEGF) drugs have open up a new treatment channel for ocular neovascular diseases. A lots of clinical data has proved that anti-VEGF drugs are effective and safe. But we should also notice that long-term and excessive usage of anti-VEGF drugs brings some new problems and complications, and even affect the normal ocular physiological process of the angiogenesis and retinal blood flow. So, it is necessary to pay attention to the problems and potential risks of excessive usage of anti-VEGF therapies for ocular neovascular disease.
Objective To investigate the refractive changes of ocular measurable factors due to scleral buckling surgery. Methods A total of 86 eyes of successful rhegmatogenous retinal detachment with a higher encircling scleral buckle underwent A-scan and keratometer examination before surgery as well as l week,4 and 12 weeks after surgery.The refractive factors included the depth of anterior chamber,thickness of lens,axial length of eye,corneal curvature and refraction of eye were detected pre- and post-operatively. Results Compared with preoperation,the depth of anterior chamber was decreased significantly at the lst,4th and 12th postoperative week(P＜0.05),while no significant change of the axial length of eye was observed.The thickness of lens was increased significantly and the refractive error was myopic shifted at the lst and 4th week after operation(P＜0.05),but no significant change was observed at the 12th postoperative week.Statistically significant difference was also observed in corneal curvature of central axis in the local bucklele;1 quadrant with encircling group between preoperation and the lst and 4th postoperative week. Conclusions With higher encircling scleral buckle,the refractive change after buckling surgery may be caused primarily by the shallowing of anterior chamber and thickening of lens. (Chin J Ocul Fundus Dis, 1999, 15: 227-229)
Intravitreal anti-VEGF injection have been widely used in retinal vascular diseases and achieved good efficacy. Early pregnancy is an important period for fetal organ formation and vascular development. Studies have proved that VEGF plays an important role in maintaining the fetal and placental vascular system, and its loss or decline will affect embryonic development and lead to abortion. The use of intravitreal anti-VEGF during pregnancy is controversial, which may cause systemic side effects to the mother and fetus. This paper summarizes the literature of 23 cases on the use of anti-VEGF during pregnancy. Three cases reported loss of pregnancy with concomitant exposure to intravitreal bevacizumab, which suggested that we should be careful about the use of anti-VEGF during pregnancy and explain the possibility of ocular and systemic side effects to patients in detail. When deciding whether to use anti-VEGF, we should consider the relationship between exposure time and the critical period of vascular development and the systemic exposure of different drugs. Currently, there is a lack of large sample size studies on the use of anti-VEGF in pregnancy, and its safety needs to be further observed.
Objective To observe the inhibiting effects of alginate sodiumretinoic acid（AGS-RA）microspheres release system on the laser coagulationinduced subretinal proliferation.Methods RA were dissolved by absolute alcohol,then mixed with 1.5% AGS and made into AGSRA microspheres by a microcapsule electrostatic generator. The parameter of laser injury include irradiation time (0.20 s)，spot diameter (200 mu;ｍ) and output power (420 ｍＷ).Thirty pigmented rabbits were randomly divided into 3 groups (laser injury，experimental and control group).After laser coagulation,AGSRA or blank microspheres were immediately injected into the vitrous of experimental and control rabbits respectively.The height,width and area of 6 retinal spots of laser coagulation at each timepoint were analyzed histopathologically with serial retinal sections at 1,2,3,4,and 6 weeks after laser coagulation.Results Histopathological examination showed that there were morphological and distribution changes of retinal cells in all layers, and localized fibroblasts proliferation in the retina after laser injury. The laserinduced responses in experimental group were much milder（P＜0.01）, while the laser injury group and control group have same width（P＞0.05）and height/area of laser spots（P＞0.05）.Conclusion AGSRA release system can alleviate the subretinal proliferate after laser injury.
Objective To evaluate the change of blood sugar in diabetic patients after vitrectomy and analyze the relative reasons. Methods Nineteen diabetes II patients (20 eyes) who underwent vitrectomies received the tests of blood sugar preoperatively, and 1～2 hours, 1, 3, and 5 days postoperatively. Analysis of variance, apaired Studentrsquo;s t-test, and correlation analysis were used to analyze the change of postoperative blood sugar and correlation between postoperative blood sugar change and its relative factors. Results Postoperative blood sugar increased significantly compared with the preoperative one (Plt;0.05),reached the peak 1～2 hours postoperatively, and reached almost the preoperative level 5 days postoperatively (Pgt;0.05). There was a positive correlation between blood sugar increase and operation time, preoperative blood sugar level, and diabetic duration (Plt;0.05). Postoperative blood sugar was relative to potentiated anesthesia. Conclusion There is a regularity that blood sugar increases just postoperatively and reaches the preoperative level 5 days postoperatively. The relative factors to blood sugar change include preoperative blood sugar level, diabetic duration, operation time, and potentiated anesthesia. (Chin J Ocul Fundus Dis,2000,16:157-159)
ObjectiveTo investigate the risk factors of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy (PDR).MethodsFrom June 2015 to June 2017, 103 eyes of 103 patients with PDR diagnosed and underwent minimalvitrectomy in Henan Provincial People's Hospital were enrolled in the study. There were 58 males and 45 females, with the average age of 58.37±10.14 years and diabetes duration of 8.7±7.2 years. Baseline systemic parameters including sex, age, diabetes duration, hypertension, HbA1c, creatinine, whether received anticoagulants, ocular parameters including whether combined with vitreous hemorrhage, whether finished panretinal photocoagulation (PRP), whether received treatment of anti-VEGF, whether combined with iris neovascularization (NVI), lens status preoperatively, whether hypotony postoperatively and intraoperative parameters including whether disc neovascularization (NVD) bleeding, whether fibrovascular membrane (FVM) residual, laser points, whether combined with cataract phacoemulsification were identified by multivariate logistic regression analysis.ResultsTwenty-nine of 103 eyes (28.15%) developed PVH in 1 day to 6 months after surgery, with self absorption of 18 eyes and reoperation of 11 eyes. Univariate analysis showed there were significant differences in age (t=2.124, P=0.036), anti-VEGF(χ2=7.105, P=0.008), NVD bleeding (χ2=10.158, P=0.001) and FVM residual(χ2=8.445, P=0.004) between patients with and without postoperative vitreous hemorrhage. Sex (χ2=0.021, P=0.884), diabetes duration (t=0.87, P=0.386), hypertension (χ2=2.004, P=0.157), HbA1c (t=1.211, P=0.229), creatinine (t=0.851, P=0.397), preoperative oral anticoagulants (χ2=0.985, P=0.321), preoperative vitreous hemorrhage (χ2=0.369, P=0.544), PRP (χ2=1.122, P=0.727), NVI (χ2=2.635, P=0.105), lens status (χ2=0.172, P=0.679), hypotony postoperatively (χ2=1.503, P=0.220), laser points (χ2=1.391, P=0.238) and combined phacoemulsification surgery (χ2=0.458, P=0.499) were not associated with PVH. Multivariate logistic regression analysis revealed the more PVH appeared in younger (OR=1.065, P=0.009) and NVD bleeding (OR=6.048, P=0.001) patients.ConclusionYounger age and NVD bleeding are the important risk factors for PVH after minimal vitrectomy without endotamponade in PDR.
The introduction of anti-vascular endothelial growth factor (VEGF) therapy represents a landmark in the management of wet age-related macular degeneration (AMD). However, as a new therapy, several problems such as durability of the therapeutic effects, medication side effects, and medication selection have emerged. We should make appoint of improving the therapeutic effect and safety by realizing the limitation of the therapy, monitoring the clinical potential adverse reactions of anti-VEGF agents, and recommending individualized treatment.