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.
Objective To evaluate the correlation of oxygen saturation of retinal vessels and diabetic retinopathy (DR) stages or HbA1c level in patients with DR. Methods Cross sectional study. A total of 102 patients (102 eyes) with DR and 20 age-matched healthy controls (20 eyes) (normal control group) were enrolled in this study. DR patients were divided into mild and moderate non-proliferative DR (NPDR) group (55 patients), severe NPDR group (26 patients) and proliferative DR (PDR) group (21 patients). DR patients were also divided into 3 groups according to the HbA1c level including HbA1c＞9% (8 patients), HbA1c 7% – 9% (33 patients) and HbA1c＜7% group (61 patients). The oxygen saturation of retinal vessel was measured by spectrophotometric oximetry unit in the retinal vessels with a diameter greater than 60 μm in the area around the optic disc. Results The retinal artery oxygen saturation of patients in severe NPDR group was significantly higher than that in mild to moderate NPDR group and normal control group (F=13.670,P＜0.05). The retinal vein oxygen saturation of patients in PDR group was significantly higher than that in mild to moderate NPDR group and normal control group (F=6.379,P＜0.05). The difference between retinal artery and vein oxygen saturation of patients in severe NPDR group was significantly bigger than that in mild to moderate NPDR group and PDR group (F=5.536,P＜0.05). The retinal artery and vein oxygen saturation in patients of HbA1c＞9% group were significantly higher than that in HbA1c 7% – 9% group and HbA1c＜7% group (F=9.989, 10.208;P＜0.05). The differences between retinal artery and vein oxygen saturation were same between patients in HbA1c＞9%, HbA1c 7%＜9% and HbA1c＜7% group (F=1.836,P＞0.05). Conclusions The retinal artery and vein oxygen saturation in DR patients are related to the DR stages. Severe NPDR patients show the highest retinal artery oxygen saturation as well as biggest difference between retinal artery and vein oxygen saturation. There is also a trend that retinal vein oxygen saturation increases with higher DR stages. In addition, there is a positive correlation between the levels of HbA1c and retinal vessel oxygen saturation.
ObjectiveTo observe the effect of tert-butyl hydroquinone (tBHQ) on type 2 diabetic rats retinal nuclear factor E2-related factor 2 (Nrf2) and hemeoxygenase-1 (HO-1). Methods60 Sprague Dawley rats were randomly divided into normal control group (NC group, n=20) and model group (n=40). The rats in model group were intraperitoneal injected with streptozotocin (30 mg/kg) to establishing type 2 diabetic mellitus (DM). There were 35 rats successfully established and they were randomly divided into diabetic group (DM group, 17 rats) and tBHQ group (18 rats). The rats in tBHQ group were fed with high fat and sugar diet with 1% tBHQ. After 4 weeks and 12 weeks of tBHQ intervention, hematoxylin eosin staining of retinal sections, immunohistochemical staining and quantitative polymerase chain reaction (PCR) of Nrf2 and HO-1 were performed. ResultsIn tBHQ control, the retina of rats was normal and individual cells showed slightly edema at 4 weeks; the retinal structure of rats was clear and part of cells showed edema at 12 weeks. At 4 and 12 weeks, the expression of Nrf2 (t=3.115, 3.781) and HO-1 (t=3.485, 3.785) protein in DM group were higher than that in NC group (P < 0.05); the expression of Nrf2 (t=2.473, 2.576) and HO-1 (t=2.785, 2.879) protein in tBHQ group were higher than that in DM group (P < 0.05). In DM group, the expression of Nrf2 protein at 12 weeks was higher than that at 4 weeks (t=0.276, P < 0.05). In tBHQ group, the expression of Nrf2 (t=2.516) and HO-1 (t=2.776) protein at 12 weeks were higher than that at 4 weeks (P < 0.05). 4 and 12 weeks, the expression of Nrf2 (t=4.758, 4.285) and HO-1 (t=5.114, 4.514) mRNA in DM group were higher than that in NC group (P < 0.05); the expression of Nrf2 (t=5.133, 4.976) and HO-1 (t=4.758, 4.251) mRNA in tBHQ group were higher than that in DM group (P < 0.05). In DM gruop, the expression of Nrf2 protein at 12 weeks was higher than that at 4 weeks (t=5.114, P < 0.05). In tBHQ group, the expression of Nrf2 (t=4.292) and HO-1 (t=4.974) protein at 12 weeks were higher than that at 4 weeks (P < 0.05). ConclusiontBHQ intervention can increased the expression of Nrf2, HO-1 significantly in the retina of type 2 diabetic rats.
Objective To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and macular retina after acute primary angle closure. Methods Prospective clinical case-control study. A total of 26 patients (30 eyes) with acute primary angle-closure glaucoma (APACG) were in the APACG group, whose intraocular pressure were control after a single episode acute primary angle closure; 30 age-and sex-matched healthy subjects (30 eyes) in the control group. All subjects underwent three dimensional optical coherence tomography (3D-OCT) examination with 3D optic disk scanning or circle optic disk scanning and 6 mm×6 mm macular scanning. The parameters included average thickness of entire CP-RNFL, thickness of nasal, superior, temporal and inferior quadrant of CP-RNFL, disc area, disc cup area, rim area, cup/disc (C/D) area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio. The foveal retinal thickness, center retinal thickness (≤1 mm from the fovea), 4 quadrants of macular inner-ring ( > 1 mm but≤3 mm from the fovea) retinal thickness, 4 quadrants of macular outer-ring ( > 3 mm but≤6 mm from the fovea) retinal thickness, average thickness of macular retinal thickness and macular volume were measured and analyzed. Results The disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group (t=3.22, 4.12, 3.90, 3.00, 3.23; P < 0.05), rim area was smaller than the control group (t=-2.63, P < 0.05). The average thickness (t=-6.68) and the thickness of superior (t=-5.90), temporal (t=-11.64) and inferior (t=-5.06) quadrants of CP-RNFL, center retinal thickness (t=-2.50), 4 quadrants of macular inner-ring retinal thickness (t=-4.91, -4.88, -2.83, -3.59), nasal (t=-2.13) and superior (t=-2.49) quadrants of macular outer-ring retinal thickness as well as average thickness of macular retinal thickness (t=-2.65) were significantly thinner than the control group (P < 0.05), and the macular volume (t=-2.69) was significantly smaller than the control group (P < 0.05). There was no statistically difference at nasal CP-RNFL (t=-0.11), foveal retinal thickness (t=-0.59), temporal (t=-0.67) and inferior (t=-1.02) quadrants of macular outer-ring retinal thickness between two groups (P > 0.05). Conclusions In comparison with the healthy subjects, the disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio, C/D vertical diameter ratio in APACG eyes were bigger, while rim area was smaller; the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL, fovea, temporal and inferior quadrants of macular outer-ring retinal.
Purpose To observe the features of multi-focal electroretinogram (mERG) in Stargardtprime;s disease, and evaluate the validity of mE RG on diagnosis of this disease. Methods mERG had been recorded in 7 cases (14 eyes) of Stargardtprime;s disease with VERIS 4.0，and the findings were compared with normal individuals. Results The mERG were remarkably abnormal in all cases of the disease, as the amplitudes of N1 and P1 waves were seriously decreased and the latencies were prolonged in all the 6 regions (Plt;0.01). The degrees of the amplitude changes of N1, P1 waves were not the same in those areas,and the most decreased part was in fovea. The responses of N1, P1waves from the fovea of patients were about 19 and 10 percent respectively of which in controls. As the eccentricity enlarged, these differences had a tendency of reduction. The mERG topography of this disease could be divided to two types, i.e. central decreased and diffuse decreased types. Conclusion There are remarkably abnormalities on mERG in Stargardtprime;s disease,and the most damaged location of macular function is in fovea. (Chin J Ocul Fundus Dis, 2001,17:271-273)
Objective To assess the change of the motion perception of cones in patients with AMD. Methods Motion perceptions of B、G and R cones of 20 eyes with dry type AMD were isolated by blue,green and red random dots stimulus displayed on the yellow,purple and blue-green background respectively,and keeping equiluminance between stimulus and background. Results The detecting displacement threshold and identifying threshold of motion perception from B,G and R cones were all damaged in eyes with dry type AMD compared with the normal group. Conclusion The abnormal changes of motion perception may reveal preclinical damage of visual function damage in dry type AMD. (Chin J Ocul Fundus Dis, 1999, 15: 219-221)
ObjectiveTo investigate the effects and mechanisms of G protein-coupled receptor 91 (GPR91) on blood-retinal barrier (BRB) in diabetic rats. MethodsA lentiviral vector of shRNA targeting rat GPR91 and scrambled shRNA were constructed. Healthy male Sprague-Dawley (SD) rats were selected in this study. The 60 rats were randomized into 4 groups and treated as follows:(1) control group (Group A, n=15), the rats received injections of an equal volume of 0.1% citrate buffer; (2) streptozocin (STZ) group (Group B, n=15), the rats received injections of STZ; (3) LV.shScrambled group (Group C, n=15), diabetic rats received an intravitreal injection of 1 μl 1×108 TU/ml scrambled shRNA lentiviral particles at 2 weeks after the induction of diabetes; (4) LV.shGPR91 group (Group D, n=15), diabetic rats received an intravitreal injection of 1 μl 1×108 TU/ml pGCSIL-GFP-shGPR91 lentiviral particles. At 12 weeks after intravitreal injection, immunohistochemistry and Western blot were used to assess the expression of GPR91, p-extracellular signal-regulated kinase(ERK)1/2, t-ERK1/2, p-Jun N-terminal kinase (JNK), t-JNK, p-p38 mitogen-activated protein kinase (MAPK) and t-p38 MAPK. Haematoxylin and eosin (HE) staining and Evans blue dye were used to assess the structure and function of the retinal vessel. Immunohistochemistry enzyme-linked immunosorbent assay (ELISA) was used to test the protein level of VEGF. ResultsImmunohistochemistry staining showed that GPR91 was predominantly localized to the cell bodies of the ganglion cell layer. Western blot showed that GPR91 expression in Group D decreased significantly compared with Group C (F=39.31, P < 0.01). HE staining showed that the retina tissue in Group B and C developed telangiectatic vessels in the inner layer of retina, while the telangiectatic vessels attenuated in Group D. It was also demonstrated in Evans blue dye that the microvascular leakage in Group D decreased by (33.8±4.11)% compared with Group C and there was significant difference (F=30.35, P < 0.05). The results of ELISA showed the VEGF secretion of Group B and C increased compared with Group A and the VEGF expression in Group D was significantly down regulated after silencing GPR91 gene (F=253.15, P < 0.05).The results of Western blot indicated that compared with Group A, the expressions of p-ERK1/2, p-JNK and p-p38 MAPK were significantly upregulated (q=6.38, 2.94, 3.45;P < 0.05). Meanwhile, the activation of ERK1/2 was inhibited by GPR91 shRNA and the difference was statistically significant (F=22.50, P < 0.05). ConclusionsThe intravitreal injection of GPR91 shRNA attenuated the leakage of BRB in diabetic rats. GPR91 regulated the VEGF release and the leakage of BRB possibly through the ERK1/2 signaling pathway.
Objective To verifying the characteristics of optical coherence tomography(OCT) in exudative age-related macular degeneration (AMD). Methods The patients being investigated in this series included 16 cases (19 eyes) of exudative age-related macular degeneration diagnosed by FFA and OCT examinations, among them 4 cases (6 eyes) were examined with ICGA. The color photographs of ocular fundi, FFA, ICGA and OCT were investigated by contrasting each other. Results As compared with the FFA and ICGA examinations, the characteristic findings found in OCT in patients with exudative AMD in this series were as the following:①serous detachment of neurosensory epithelium in 11 eyes,②retinal hemorrhage in 2 eyes,③serous detachment of retinal pigment epithelium in 5 eyes,④hemorrhagic detachment of retinal pigment epithelium in 10 eyes,⑤disciform scar in 4 eyes,⑥fibrovascular pigment epithelial detachment and occult CNV in 12 eyes. Conclusion OCT can supply a comprehensive survey of exudative AMD, in making the diagnosis as an important complementary examination of FFA and ICGA. (Chin J Ocul Fundus Dis,2000,16:220-223)
ObjectiveTo observe the changes in choroidal characteristics of polypoid choroidal vascular disease (PCV) eyes after intravitreal injection of anti-VEGF drugs, and to preliminarily evaluate its predictive effect on the response of PCV anti-VEGF drugs.MethodsA retrospective clinical study. From January 2015 to May 2020, 63 eyes (63 PCV patients) diagnosed in NanJing Medical University Eye Hospital were included in the study. There were 39 eyes (39 males) and 24 eyes (24 females); all were monocular, with the average age of 62.53±6.05 years old. All eyes were treated with intravitreal injection of ranibizumab, and those with poor response after treatment were treated with photodynamic therapy (PDT) combined with anti-VEGF drugs. Among the 63 eyes, 38 eyes did not respond or responded poorly after treatment, and 25 eyes responded well. Based on response results, patients were divided into the poor response group and the good response group. The confocal laser synchronous angiography system (HRA+OCT) enhanced depth scanning technology of Herdelberg (Germany) was used to measure the foveal choroid thickness (SFCT) and the choroidal large vessel thickness (LCVT). The choroidal hyperpermeability (CVH) was judged based on the ICGA inspection results. CVH: In the middle and late stages (10-15 min after indocyanine green injection), the choroid of the posterior pole can be seen with multifocal strong fluorescence with blurred edges. The SFCT and LVCT changes of the two groups of eyes before treatment and 6 months after treatment in the good response group, and 6 months after the treatment of the poor response group combined with PDT were observed. SFCT and LCVT were compared with t test before and after treatment.ResultsBefore treatment, of the 63 eyes, 38 eyes (60.3%) with CVH manifestations, of which 5 eyes (20.0%, 5/25) and 33 eyes (86.8%, 33/ 38). The SFCT and LCVT of the good response group and the poor response group were 244.16±23.74, 152.76±22.70 μm and 367.34±35.21, 271.84±35.42 μm, respectively. The comparison of SFCT and LVCT between the two groups of eyes before treatment showed statistically significant differences (t=7.24, 6.87; P=0.01, 0.01). Six months after treatment, the SFCT and LVCT of the eyes in the good response group were 241.04±32.56 and 150.44±23.45 μm, respectively; compared with those before treatment, the difference was not statistically significant (t=5.35, 8.64; P=0.08, 0.07). Six months after the poor response group combined with PDT treatment, SFCT and LCVT were 311.63±25.36 and 220.11±41.30 μm respectively; compared with those before treatment, the difference was statistically significant (t=6.84, 9.23; P=0.02, 0.01). After treatment, the CVH manifestations of all the eyes did not change significantly, but the eyes of the poor response group were treated with PDT, and the multifocal strong fluorescence was significantly weakened.ConclusionsPCV thick choroid is mostly caused by abnormal thickening of choroidal large vessels. Eyes with thick choroid and CVH have poor response to anti-VEGF drug therapy alone, and combined PDT therapy may be more suitable for this type of patients.
Objective To observe the effect of different concentration netrin-1 on retinal vascular permeability in diabetes mellitus (DM) rats. Methods Eighty adult Sprague-Dawley rats were randomly divided into 8 groups, 10 rats in each group, including normal control group (group A), normal＋balanced salt solution (BSS) group (group B), normal＋netrin-1 (500 μg/ml) group (group C) and DM group (50 rats in 5 sub-groups). DM rats were induced by intraperitoneal injection of streptozocin. Three months after intraperitoneal injection, 10 DM rats in the control group were injected with BSS (group D). Forty DM rats were injected with 5 μl of different concentrate netrin-1, and were divided into DM+netrin-1 10 μg/ml group (group E), DM+netrin-1 50 μg/ml group (group F), DM＋netrin-1 100 μg/ml group (group G), DM＋netrin-1 500 μg/ml group (group H) according to the different concentration. Non-DM rats in group C were injected with netrin-1 500 μg/ml. The expression of occludin was determined by immunohistochemistry for protein, and by real-time fluorescence quantitative reverse transcription polymerase chain reaction for mRNA level. Retinal vascular permeability was measured by Evans blue infusion. Results The expression of occludin protein and mRNA in group D were less than group A (t=27.71, 8.59;P=0.00, 0.00). However, the retinal vascular permeability increased in group D (t=?42.72,P=0.00). The expression of occluding protein, occludin mRNA and retinal vascular permeability showed significant differences between group D, E, F, G and H (F=146.31, 16.54, 67.77;P=0.00, 0.00, 0.00). Compared the group B with group C, there was no significant differences between the expression of occludin protein, occludin mRNA and the retinal vascular permeability (t=?1.13, 0.93, 1.04;P=0.27, 0.36, 0.31). The concentrate of netrin-1 showed a significant positive correlation to the expression level of occludin and occludin mRNA (r=0.73, 0.81;P=0.00, 0.00), but negative correlation to the vascular permeability (r=?0.61,P=0.00). Conclusion Netrin-1 can reduce the DM rats' retinal vascular permeability, which depended on the concentration of netrin-1.