ObjectiveTo investigate the risk factors for neovascular glaucoma (NVG) after vitrectomy in proliferative diabetic retinopathy (PDR) patients. MethodsThree hundred and one patients (301 eyes) with PDR who underwent vitrectomy between January 2008 and December 2013 in our hospital were retrospectively evaluated. Risk factors for NVG after vitrectomy were identified by multivariate Logistic regression analysis. ResultsTwelve of 301 patients (4.0%) developed postoperative NVG in 2 to 18 months after vitrectomy. The incidence of postoperative NVG peaked in 2 to 6 months after vitrectomy (7 eyes, 58.3%). Logistic regression analysis showed that postoperative retinal detachment was a significant risk factor for postoperative NVG in eyes with PDR (P < 0.001). Eyes with postoperative retinal detachment were more likely to develop NVG after vitrectomy than those without postoperative retinal detachment (OR=17.826). Gender, age, duration of diabetes, preoperative serum creatinine levels, glycated hemoglobin levels, preoperative intraocular pressure, preoperative lens status, combined phacoemulsification surgery and tamponade were not associated with postoperative NVG (P > 0.05). ConclusionPostoperative retinal detachment is a major risk factor for NVG after vitrectomy in PDR.
To observe the efficacy of intravitreal injection of conbercept (IVC) combined with panretinal laser photocoagulation (PRP) in the treatment of diabetic retinopathy (DR) combined with stage I and II neovascular glaucoma (NVG).MethodsA clinical case-control study. From October 2013 to March 2019, 50 eyes (50 patients) with DR and stage Ⅰ to Ⅱ NVG diagnosed in the Department of Ophthalmology, Peoples's Hospital of Xianghe were were included in the study. There were 27 eyes (27 males) and 23 eyes (23 females); all patients were monocular with the average age of 53.5±7.13 years old. Stage Ⅰ and Ⅱ NVG were 11 and 39 eyes, respectively. All patients underwent BCVA, intraocular pressure, and fundus angiography. The BCVA examination adopted the international standard visual acuity chart, which was converted to logMAR BCVA visual acuity in statistics. The patients were divided into the Conbercept+laser therapy (combination therapy) group and the laser therapy group by random number table, with 25 eyes. The age of the two groups of patients (t=0.058), gender composition ratio (χ2=0.081), logMAR BCVA (t=0.294), intraocular pressure (t=－0.070), the number of eyes with different grades of angle and iris neovascularization（χ2=1.683, 0.854）were compared, the difference was not statistically significant (P＞0.05). The changes of BCVA, intraocular pressure, iris neovascularization, and angular neovascularization were compared and observed between the two groups one week after the completion of PRP treatment, 1, 3, 6, and 9 months. Independent sample t test was used for continuous variables. Between the combination treatment group and the laser treatment group, at different time points within the two groups and the interaction of the two factors, a single-factor repeated analysis of variance was used.ResultsCompared with the results before treatment, the combined treatment group and laser treatment group had statistically significant differences in the number of angle and iris neovascularization, intraocular pressure and logMAR BCVA at different times after treatment in the combined treatment group and laser treatment group (F=124.211, 65.153, 69.249, 26.848; P＜0.001). After treatment, the combined treatment group was better than the laser treatment group in terms of the regression of eye angle and iris neovascularization, intraocular pressure and logMAR BCVA, and the difference was statistically significant (F=47.543, 25.051, 12.265, 9.994; P=0.001, 0.001, 0.001, 0.003). At different times after treatment, compared with the laser treatment group, the number of neovascularization in the iris and angle of the eye in the combined treatment group was less, the intraocular pressure was significantly decreased, and the BCVA was increased. The difference was statistically significant (P＜0.05).ConclusionThe efficacy of Kang IVC combined with PRP in the treatment of DR with stage Ⅰ and Ⅱ NVG is better than that of PRP alone.
Objective To detect the levels of vascular endoth elial growth factor (VEGF) in aqueous humor and vitreous of patients with neovascular glaucoma (NVG) and infer their possible effect on the development of neovascularization of iris. Methods The concentration of VEGF in 22 samples of ocular fluid of aqueous humor and vitreous respectively obtained from 11 patients with NVG undergone intraocular surgery were measured by using enzyme linked immunosobent assay (ELISA) for quantitative analysis. As control, 12 samples of ocular fluid of 6 patients with macular hole were detected by the same methods. Results The mean [AKx-]plusmn;s VEGF concentrations in aqueous humor and vitreous from patients with NVG were [(1.451plusmn;0.247)、(1.610plusmn;0.125) ng/ml] higher than those in the cotrol group [(0.189plusmn;0.038)、(0.201plusmn;0.055) ng/ml], there was a significant difference between the two groups statistically (t=12.007，Plt;0001；t=26.0 57，Plt;0.001). Conclusion The patients with NVG have significantly increased level of VEGF in ocular fluid, and VEGF might fill the role in mediating active iris neovascularization. (Chin J Ocul Fundus Dis, 2001,17:305-306)
Objective To observe the effects of stromal cellderived factor 1alpha; (SDF-1alpha;) in secondary neovascular glaucoma (NVG) of proliferative diabetic retinopathy (PDR). Methods The vitreous specimens from 25 PDR patients (31 eyes) were collected with 13 NVG eyes and non-NVG 18 eyes. The concentrations of SDF-1alpha; and vascular endothelial growth factor (VEGF) in those specimens were measured by enzyme-linked immunosorbent assay （ELISA）. Human umbilical vein endothelial cells (HUVEC) were treated by different concentrations of SDF-1alpha;and vascular endothelial growth factor (VEGF) in vitro, and the formation of tube cavity-like structure, length of capillarylike structures and 5prime;-bromo-2prime;-deoxyuridine (BrdU) labeling of treated HUVEC were measured. Results The length of HUVEC tube-like and capillarylike structure formation in 10, 100, 1000 ng/ml SDF-1alpha; and 10 ng/ml VEGF groups were longer than that in the control group, the differences were statistically significant (P＜0.01). The A value of BrdU labeling of 10, 100, 1000 ng/ml SDF-1alpha; and 10 ng/ml VEGF groups were increased than that in the control group, the differences were statistically significant (P＜0.01). The vitreous levels of SDF-1alpha; and VEGF of NVG specimens were higher than those in the non-NVG group, the differences were statistically significant (P＜0.01). Conclusions SDF-1alpha; may promote the migration and proliferation of vascular endothelium cells, and participate in the neovascularization process in NVG patients with PDR.
Objective To analyze the difference of clinical characteristics and vascular risk factors between patients with unexplained non-acute dizziness and headache, so that to bring new perspective on prevention of vascular risk factors and enhancement of symptoms among different patients. Methods The data of patients in the cerebrovascular disease clinic of the Department of Neurology, West China Hospital of Sichuan University between July 1th and September 30th, 2021 were collected retrospectively. The included patients were divided into dizziness group or headache group according to the complained. The clinical characteristics and risk factors of the two groups were compared. Results A total of 273 patients were included. There were 198 cases (72.5%) in dizziness group and 75 cases (27.5%) in headache group. Compared with headache group, patients in dizziness group were older, with a shorter course of disease, and accounted for a higher proportion of patients with symptoms related to body position, higher proportion of patients with hypertension and carotid plaque, and more vascular risk factors (P<0.05). Logistic regression results showed that patients with symptoms related to body position [odds ratio (OR)=7.025, 95% confidence interval (CI) (1.772, 28.488), P=0.007], at least one [OR=2.461, 95%CI (1.298, 4.664), P=0.006], two or more vascular risk factors [OR=2.314, 95%CI (1.033, 5.186), P=0.042] were independently associated with dizziness. The longer course of disease [OR=0.994, 95%CI (0.990, 0.997), P=0.001] was independently associated with headache. Conclusion Patients with non-acute unexplained dizziness and headache, especially those with dizziness, should pay more attention to the inquiry and treatment of vascular risk factors and psychopsychological factors.
Objective To conduct a meta-analysis of the evidence on the efficacy and safety of hyperbaric oxygen therapy for vascular cognitive impairment. Methods China National Knowledge Infrastructure, Chongqing VIP, Wanfang, SinoMed, PubMed, Embase, CINHAL, Cochrance Library were searched for all literatures on randomized controlled trials of hyperbaric oxygen therapy for vascular cognitive impairment from the establishment of databases to May 2022. Literature screening was performed by Endnote X9 software, and meta-analysis was performed by RevMan 5.4.1 software. Results A total of 36 papers were included, with 3093 patients, including 1549 cases in the observation group (hyperbaric oxygen combined with drug treatment) and 1544 cases in the control group (drug treatment alone). Compared with the control group, the effective rate of the observation group [relative risk=1.23, 95% confidence interval (CI) (1.15, 1.30), P<0.00001], the scores of Mini Mental Status Examination [mean difference (MD)=3.19, 95%CI (2.66, 3.73), P<0.00001], and the scores of Montreal Cognitive Assessment [MD=2.98, 95%CI (2.07, 3.89), P<0.00001] were better than those of the control group. There was no significant difference in adverse reactions between the observation group and the control group (P>0.05). For the scores of Activities of Daily Living, subgroup analysis showed high heterogeneity among studies, so pooled analysis was not performed. Conclusion Compared with drug therapy alone, hyperbaric oxygen combined with drug therapy can improve the cognitive function of patients with vascular cognitive impairment to a certain extent without increasing adverse reactions.
Vascular dementia is one of the most common types of dementia in China. How to better prevent and treat vascular dementia is still an unresolved problem, and the risk predictor of vascular dementia may help provide clinical targeted prevention measures to intervene in the development process of vascular dementia early. This article reviews the current research status of vascular dementia predictors from four aspects: blood markers, predictors based on disease characteristics, predictors based on assessment tools and neuropsychological tests, and predictors based on activity dysfunction. It aims to provide a basis for establishing a risk prediction model for patients with vascular dementia suitable for China’s conditions in the future.