Objective Methods Ninety male Wister rats were randomly divided into normal control group, diabetic group and FTY720 group, thirty rats in each group. Diabetes was induced by giving a single intraperitoneal injection of streptozocin. FTY720 group was administered with FTY720 at a dose of 0.3 mg/kg by oral gavage daily for 3 months after establishment of diabetes. All rats were used for experiments following intervention for 3 months in FTY720 group. Immunohistochemical staining was used to observe the expression and distribution of intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1), and the positive cells were counted. Real-time reverse transcription PCR was used to measure mRNA expression of ICAM-1 and VCAM-1. Fluorescein isothiocyanate-Concanavalin A perfusion was used to detect retinal leukocytes adhesion. Evans blue (EB) perfusion was used to analyze retinal vascular permeability. Immunofluorescence staining was used to detect retinal inflammatory cells infiltration. Results In diabetic group, both ICAM-1(t=12.81) and VCAM-1 (t=11.75) positive cells as well as their mRNA expression (t=16.14, 9.59) were increased compared with normal control group, with statistical significance (P < 0.05). In FTY720 group, both ICAM-1(t=-9.93) and VCAM-1 (t=-6.61) positive cells as well as their mRNA expression (t=-15.28, -6.10) were decreased compared with diabetic group, with statistical significance (P < 0.05). Retinal leukocytes adhesion (t=16.32) and EB permeability (t=17.83) were increased in diabetic group compared with normal control group, while they were decreased in FTY720 group compared with diabetic group(t=-9.93, -11.82),with statistical significance (P < 0.05). There were many CD45 positive leukocytes infiltration in retina of diabetic group, including CD11b positive macrophage/activated microglia, while both of them were little in FTY720 group. Conclusions FTY720 can decrease retinal leukocytes adhesion, reduce retinal vascular permeability and inflammatory cells infiltration, which is associated with down-regulation of ICAM-1 and VCAM-1.
Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR). Methods A prospective clinical studies. Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No. 306 Hospital of PLA during January 2014 and December 2015 were included in this study. Among them, 21 eyes of NPDR and 20 eyes of PDR; 13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group). All eyes underwent best corrected visual acuity (BCVA), fundus color photography, fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations. The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field). The BCVA of DR eyes was 0.81±0.28; the VFI and MD values were (89.8±8.4)% and −7.5±3.85 dB, respectively. The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27, the VFI were (90.86±7.86)% and (87.46±9.41)%, the MD values were −6.86±3.43 and 8.87±4.48 dB. PRP was performed on eyes using 577 nm krypton laser. The changes of VFI, MD and BCVA were observed at 1, 3, and 6 months after treatment. Results Compared with before treatment, the VFI of DR eyes decreased by 12.0%, 12.3% and 14.8% (t=7.423, 4.549, 4.79; P＜0.001); the MD values were increased by −4.55, −4.75, 6.07 dB (t=−8.221, −5.313, −5.383; P＜0.001) at 1, 3 and 6 months after treatment, the differences were statistically significant. There was no difference on VFI (t=1.090, −0.486; P＞0.05) and MD value (t=−0.560, −0.337; P＞0.05) at different time points after treatment. Compared with before treatment, the BCVA was significantly decreased in DR eyes at 1 month after treatment, the difference was statistically significant (t=2.871, P＜0.05). Before and after treatment, the BCVA of the DME group was lower than that of the non-DME group, the difference were statistically significant (t=4.560, 2.848, 3.608, 5.694; P＜0.001); but there was no differences on the VFI (t=1.209, 0.449, 0.922, 0.271; P＞0.05) and MD values (t=1.582, 0.776, 0.927, 1.098; P＞0.05) between the two groups. Conclusion The range of 30° visual field loss is about 12%-14.8% after 577 nm krypton laser PRP for DR. VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.
Objective To evaluate the therapeutic effect of intravitreal injection with bevacizumab (Avastin) (IVB)combined with extra panretinal photocoagulation (E-PRP) for highrisk proliferative diabetic retinopathy (PDR).Methods A total of 57 eyes of 53 patients with highrisk PDR underwent intravitreal injection combined with E-PRP. The examinations of vision acuity, intraocular pressure, iris fluorescein angiography (IFA),fundus photos and fundus fluorescein angiography (FFA) were performed on all of the patients before and 1,2,3,and 6 months after the treatment; the results of the examinations before and after the treatment were compared and analyzed.The average follow up was 6 months.Results The mean visual acuity was (0.143plusmn;0.072) before the treatment and (0.218plusmn;0.128) 7 days after the tretment; the difference was significant (t=-7.940, Plt;0.05). The mean visual acuity 1,3,and 6 months after E-PRP (0.228plusmn;0.138, 0.223plusmn;0.125,0.220plusmn;0.134, respectively) differed much from that before IVB (Plt;0.05), but not so much from that after IVB (Pgt;0.05).The mean intraocular pressure of 21 eyes which had the neovascularization of pupil margin and iris surface before and 7 days after IVB was (26.632plusmn;2.629) and (19.316plusmn;3.092) mm Hg(1 mm Hg=0.133 kPa), respectively; the difference was significant (t=12.838, Plt;0.05) . The mean intraocular pressure 1,3,and 6 months after E-PRP was (16.947plusmn;2.345),(16.474plusmn;1.611), and (16.421plusmn;4.702) mm Hg, respectively, which differed much from that before and after IVB (Plt;0.05). Neovascularization on the disc and the retinae of 57 eyes were subsided partly, and a significant reduction or disappeared of the area of retinal neovascularization and the blood vessel leakage were observed 7 days after IVB. The neovascularization of pupil margin and iris surface of 21 eyes disappeared, and the IFA leakage decreased. The results of FFA 2 months after E-PRP showed that the one-off efficiency of E-PRP was 68.4%;12 eyes (21.1%) needed an additional laser, in which 6 eyes (10.5%) underwent vitreous surgery. Conclusion IVB combined with E-PRP as a treatment for highrisk PDR may improve the regression of retinal neovascularization and the reduction of vascular permeability,and prevent or reduce the complications and improve the therapeutic effect.
Diabetic retinopathy is a serious complication of diabetes and is the leading cause of blindness in people with diabetes. At present, there are many views on the pathogenesis of diabetic retinopathy, including the changes of retinal microenvironment caused by high glucose, the formation of advanced glycation end products, oxidative stress injury, inflammatory reaction and angiogenesis factor. These mechanisms produce a common pathway that leads to retinal degeneration and microvascular injury in the retina. In recent years, cell regeneration therapy plays an increasingly important role in the process of repairing diseases. Different types of stem cells have neurological and vascular protection for the retina, but the focus of the target is different. It has been reported that stem cells can regulate the retinal microenvironment and protect the retinal nerve cells by paracrine production, and can also reduce immune damage through potential immunoregulation, and can also differentiate into damaged cells by regenerative function. Combined with the above characteristics, stem cells show the potential for the repair of diabetic retinopathy, this stem cell-based regenerative therapy for clinical application provides a pre-based evident. However, in the process of stem cell transplantation, homogeneity of stem cells, cell delivery, effective homing and transplantation to damaged tissue is still a problem of cell therapy.
Diabetic macular ischemia (DMI) is one of the manifestation of diabetic retinopathy (DR). It could be associated with diabetic macular edema (DME), which may affect the vision of DR patients. FFA is the gold standard for the diagnosis of DMI, but with the advent of OCT angiography, a more convenient and diversified method for the evaluation of DMI has been developed, which makes more and more researchers start to study DMI. Intravitreal injection of anti-VEGF has become the preferred treatment for DME. When treating with DME patients, ophthalmologists usually avoid DMI patients. But if intravitreal anti-VEGF should be the contradiction of DME is still unclear. To provide references to the research, this article summarized the risk factors, assessment methods and influence of DMI. This article also analyzed the existing studies, aiming to offer evidences to a more reasonable and effective treatment decision for DME individual.
The ocular fundus changes and the damage of visual function were various at different stages of diabetic retinopathy (DR). To get hold of timing and different therapic method correctly of early diagnosis, whole body treatment, laser photocoagulation and vitreous-retina surgery and adopting targeted interventions could help patients receiving the most reasonable and effective treatment at different stages, both of them are keys to reduce the damage of visual function. （Chin J Ocul Fundus Dis，2008，24：240-243）
Panretinal photocoagulation (PRP) and macular photocoagulation (MPC) are the gold standard treatments for proliferative diabetic retinopathy (DR) and diabetic macular edema. With the development of equipment and technology advancement, photocoagulation has been gradually applied in many Eye Centers all over China. However, there are still several problems such as no standardized guideline and undesirable therapeutic effects. In this article we will summarize the indications and techniques of photocoagulation, and when and how to apply drug treatments for retinal diseases; aim at improving the criterion and clinical effects of photocoagulation.
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.
ObjectiveTo investigate the clinical outcome and therapeutic efficacy of short-pulse pattern scan laser (PASCAL) photocoagulation for diabetic retinopathy (DR). MethodsForty-three DR patients (70 eyes) including 19 males (32 eyes) and 24 females (38 eyes) underwent short-pulse PASCAL pan-retinal photocoagulation (PRP). There were 24 patients (42 eyes) with proliferative diabetic retinopathy (PDR) and 19 patients (28 eyes) with severe non-proliferative diabetic retinopathy (NPDR). The best corrected visual acuity was better than or equal to 0.1 in 62 eyes, worse than 0.1 in 8 eyes. Diabetic macular edema was found in 18 eyes. Short-pulse PASCAL PRP was applied with multi-spot arrays. Macular edema was treated by PASCAL macular mode (MAC A + MAC B) and/or single spot. Visual acuity and fundus examinations were analyzed at the one-year follow-up procedure. ResultsOne year after short-pulse PASCAL treatment, the final visual acuity was improved in 10 eyes, stable in 53 eyes, decreased in 7 eyes; macular edema was relieved in 38 eyes, aggravated in 12 eyes, and stable in 20 eyes. Of 42 eyes with PDR, neovascularization were regressed in 20 eyes, uncontrolled in 11 eyes which experienced additional photocoagulation (1-2 times) during the follow-up. Among the 11 uncontrolled eyes, 3 eyes (3/11) received vitrectomy due to vitreous hemorrhage. ConclusionPASCAL might stabilize the progress of diabetic retinopathy safely and effectively.
ObjectiveTo observe the effects on the function and structure of retina in diabetic rats by intravitreal transplantation of retinal nerve stem cells (NSC) differentiated from human umbilical cord mesenchymal stem cells (hUCMSCs). MethodsFifty clean male Sprague-Dawley rats were randomly divided into normal control with 9 rats (group A) and diabetes mellitus (DM) group with 31 rats. The DM models were induced by intraperitoneal injection of streptozocin. The rats of DM group were randomly divided into four groups after 10 weeks: rats with DM only (group B), diabetic rats with saline intravitreal injection (group C), diabetic rats with NSC intravitreal injection (group D), and 9 rats for each. The rats in the group A and B received no treatment. The retinal function was examined by the flash-electroretinogram on 2, 4, 6 weeks after intervention, the latency and amplitude of a-wave, b-wave of Rod, a-wave, b-wave of Max reactions (Max-R) and the total amplitudes of OPs were recorded. The morphological changes of retina were observed by hematoxylin-eosin staining. ResultsOn 2 and 4 weeks after the intervention, the differences of latency and amplitude of b-wave of Rod, a-wave, b-wave of Max-R and the total amplitudes of OPs among group A-D were significant (P<0.05). Compared group D with group B, C, the amplitude of b-wave of Rod, Max-R and the total amplitudes of OPs were increased (P<0.05); latency of b-wave of Max-R was decreased (P<0.05). On 6 weeks after the intervention, the amplitude of b-wave of Rod and the amplitude of a-wave, b-wave of Max-R and the total amplitudes of OPs in group D were increased compared with group B and C (P<0.05), the latency of b-wave of Rod and Max-R in group D were decreased compared with group C (P<0.05). On 10 weeks after molding, each retinal layers were disordered in diabetes mellitus group. On 2 weeks after the intervention, the number of cells in the retinal layers in group B and C were reduced compared with group A, and the structure was more disorder. On 4 weeks after the intervention, the structure of each retina layer in group D arranged less disordered, and the number of retinal ganglion cells was more than group B and C. It was also found that the retinal vascular endothelial expanded and retinal blood vessels cells proliferated. ConclusionThe function of retina in diabetes mellitus rats is improved by intravitreal injection of retinal NSCs differentiated from hUCMSCs.