To evaluate the tberapeutlc effect of diode laser photocoagulation trearment on eases of diabetic retinopathy with certain degree of refractive media opacity. METHODS: Diode laser photocoagulation treatment were given to 36 selected cases (40 eyes )of diabetic retinopathy who can not be treated with argon laser because of refractive media opacity, Before and after treatment,visual acuity and fundus were examined and fundus fluorescein angiography and retinal color photographp were taken. The follow-up period was 8~14 months (with an average of 11 months) RESULT:Visual acuity were improved or maintained in 29 eyes(about 73%)of the 34 eyes of proliferative diabetic retinopathy ,retinal new vessels partly or entirely regressed in 25 eyes(about 74%). CONCLUTION ;Tbe effect of diode laser treatment on patients with diabetic retinopatby with certain degree of lens/vitreous opacity is relatively safisfactory. （Chin J Ocul Fundus Dis,1996,12:111- 113）
ObjectiveTo observe the effects of human umbilical cord mesenchymal stem cells (hUCMSCs) on blood glucose levels and diabetic retinopathy in diabetes mellitus (DM) rats. MethodA total of 45 healthy male Sprague-Dawley rats were randomly divided into normal control group (group A, 10 rats) and DM group (33 rats). Diabetic model was established in DM group by tail vein injection of streptozotocin.The DM group was further randomly divided into 3 groups (11 rats in each group), including group B (no transplantation), group C (hUCMSC was injected through tail vein) and group D (hUCMSC was injected into the vitreous). Blood glucose, retina wholemont staining and expression of brain derived neurotrophic factor (BDNF) in the retina were measured at 2, 4, 6, 8 weeks after hUCMSC injection. The blood glucose was significantly different between A-D groups before injection (t=-64.400, -60.601, -44.065, -43.872; P=0.000) BDNF expression was studied by real time fluorescence quantitative polymerase chain reaction (RT-PCR) and immunohistochemistry staining. ResultsThe blood glucose was significantly different between A-D groups after hUCMSC injection (F=400.017, 404.410, 422.043, 344.109; P=0.000), and between group C and group B/D (t=4.447, 4.990; P < 0.01). Immuno-staining shown that BDNF was positive in ganglion cell layer (RGC) of group A, weak in group B while BDNF expression increased in group C/D. BDNF mRNA expression was significantly different between group B, C and D at 4, 6 and 8 weeks after hUCMSC injection (F=29.372, 188.492, 421.537; P=0.000), and between group B and C/D (t=66.781, 72.401, 63.880, 88.423, 75.120, 83.002; P < 0.01) by RT-PCR analysis. The BDNF mRNA expression was significantly different between C and D groups only at 8 weeks after hUCMSC injection (t=127.321, P=0.005). ConclusionsTail vein injection of hUCMSCs can significantly reduce the blood glucose levels of rats. Intravenous and intravitreal injection of hUCMSCs can increase the expression of BDNF.
ObjectiveTo evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Methods35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT. Best-corrected visual acuity(BCVA), central macular thickness (CMT) were measured before and after treatment (1, 3 and 6 months). The mean BCVA was 0.28±0.22, mean CMT was(384.5±85.0)μm. The situation of subretinal fluids (SRF) absorption was observed. ResultsIn 35 eyes, SRF of 29 eyes (82.9%) completely absorbed and 6 eyes (17.1%) not completely absorbed after one month of treatment. SRF of all eyes (100.0%) completely absorbed after three months of treatment. After 6 months of treatment, SRF of 3 eyes (8.6%) were recurrence, which might be completely absorbed when a half-dose maintenance therapy PDT was used again. The mean BCVA significantly improved to 0.14±0.13 at 1 months, 0.05±0.11 at 3 months and 0.05±0.12 at 6 months after PDT (t=5.410, 7.830, 7.758; P < 0.05). The mean CMT decreased to (224.3±61.4) μm at 1 months, (199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856, 11.781, 11.900; P < 0.05). The mean CMT of controlled 32 eyes after treatment was (198.5±33.9) μm, much lower than the fellow eyes(232.3±17.5) μm (t=-3.988, P < 0.05). ConclusionsHalf-dose verteporfin PDT was safe and effective in treating chronic CSC, but may cause thinning of CMT.
Macular edema is a common cause of visual loss in patients with retinal vascular diseases represented by diabetic retinopathy and retinal vein occlusion. Laser photocoagulation has been the main treatment for this kind of diseases for decades. With the advent of antagonist of vascular endothelial growth factor and dexamethasone implant, diabetic macular edema and macular edema secondary to retinal vein occlusion have been well controlled; the use of laser therapy is decreasing. However, considering possible risks and complications, lack of extended inspection of efficacy and safety of intravitreal pharmacotherapy, laser therapy cannot be replaced by now. Therefore, the efficacy and safety of laser therapy will improve by sober realization of role of photocoagulation and proper selection of treatment indication.
Objective To investigate the therapeutic effect of different wavelength krypton lasers on diabetic retinopathy. Methods A total of 55 eyes (35 cases) with diabetic retinopathy underwent different wavelength k rypton lasers photocoagulation treatment, according to the different manifestati on of the affected eyes. The visual acuity, intraocular pressure，visual field,visual evoked potential were examined, and slit-lamp, ophthalmoscopy, Bultraso nography, and fundus fluorescein angiography were performed preoperatively. The patients were followed up for at least 12 months after krypton laser treatment. Results The resulting effect on visual acuity after 12 months of photocoagulation in this series revealed that, 20 eyes (36.4%) i mproved, 34 eyes (61.8%) remained no change, and one eye (1.8%) decreased. Conclusions Different wavelength krypton lasers photoco agulation can be used in treatment of diabetic retinopathy and can improve the visual acuity at certain extent. (Chin J Ocul Fundus Dis, 2001,17:178-180)
Objective To evaluate the visual prognostic factors in vitreoretinal surgery for diabetic tractional retinal detachment (DTRD). Methods 102 eyes of 86 consecutive patients with DTRD underwent vitreoretinal surgery were analyzed retrospectively. All cases diagnosed via indirect ophthalmoscope and B ultrasonic scan after mydriasis. Followup duration varied from 12 to 56 months (mean: 23 months). Best corrected visual acuity (BCVA) and anatomic success were observed postoperatively. The patients were divided into visual acuity improved group and didn't improved group. Ttest, Chisquare test and Multivariate Logistic regression analysis were performed to predict the prognosis of visual acuity. Results After primary vitreoretinal surgery, 87 eyes (85.3%) were anatomically reattached, 15 eyes (14.71%) needed reoperation because of the recurrence of retinal detachment (RD). Postoperative BCVA improved and better than 0.05 in 49 eyes (48.04%), reduced or increased but less than 0.05 in 53 eyes (51.96%). Comparing natural factors between these two groups, only combined cataract surgery and optic nerve atrophy were significant different (chi;2=5.266,9.274;P=0.022,0.002). Among post-operative complications only the RD recurrence was significant different (chi;2=12.059，P=0.000). Multivariate Logistic regression revealed recurrence of RD and optic nerve atrophy were two independent risk factors in the final BCVA (P=0.003,0.041;OR=33.518、4.079). Preoperative PRP was identified as the only protecting variable in the final BCVA(P=0.034，OR=0.270).Conclusion This study revealed recurrence of RD and optic nerve atrophy were two independent risk factors in final BCVA of DTRD patients.
Diabetic retinopathy (DR) is a major and irreversible blinding eye disease in working aged adults. Diabetic macular edema (DME) is a complication of the further development of DR, and it is one of the main causes of vision loss in DR patients. The emergence of anti-VEGF drugs has changed the treatment model of DR and DME. Firstly, for the treatment of DME, the previous focal/grid-like laser photocoagulation is converted to anti-VEGF drugs as the first-line treatment. Secondly, for the treatment of proliferative DR (PDR), panretinal photocoagulation (PRP) was the gold standard in the past, and now anti-VEGF drugs have become an alternative treatment for some PDR patients. In varying degrees of DR and DME, the option of treatment, anti-VEGF drug therapy replacing PRP, and the era of anti-VEGF drug therapy on DR treatment modes are worthy questions for consideration by clinicians. In-depth study of the clinical study of PRP and anti-VEGF drugs in the treatment of DR, the changes attention in clinical guidelines and expert consensus, the gradual establishment of treatment of DR and DME suitable, and the personalized treatment of DR patients may help improve the level of DR treatment in China.
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 compare the therapeutic effects of 577 nm laser and 532 nm laser panretinal photocoagulation (PRP) in the treatment of non-proliferative diabetic retinopathy (NPDR). Methods This is a prospective controlled study. A total of 23 patients (41 eyes) with clinically diagnosed severe NPDR were randomly divided into two groups including 577 nm group (11 patients, 20 eyes) and the 532 nm group (12 patients, 21 eyes). 577 nm group and 532 nm group received 3 - 4 times PRP with single-point mode. The laser energy and the number of laser spots were compared, and the laser energy density was calculated. Before treatment and 1 day, 1, 3, 6 and 12 months after treatment, the changes of best corrected visual acuity (BCVA), average threshold sensitivity, a/b-wave amplitude of flash ERG (F-ERG) in the 30° - 60° visual field, and fundus fluorescein angiography (FFA) were compared between two groups. Results The response rate was 85.0% and 23.8%, respectively in the 577 nm and 532 nm group, the difference was statistically significant (χ2=15.43，P < 0.05).Compare to the pre-treatment measurement, the average threshold sensitivity, a/b wave amplitude of F-ERG and the 30° - 60°visual field were reduced at 1 day after treatment both in the 577 nm and 532 nm group, the difference were statistically significant (F=8.68, 7.57, 4.52; P < 0.05). The average threshold sensitivity (t=2.41, 3.48, 1.23), a/b wave amplitude (a wave: t=5.82, 4.45, 7.83；b wave: t=5.40, 3.23, 4.67) of F-ERG were different between 577 nm and 532 nm group at 3 , 6 and 12 months after treatment (P < 0.05). There was no retinal neovascularization and non-perfusion region in two groups at 6 months after treatment. The average laser power were (436.25±54.65) and (446.43±35.61) mW, number of laser spots were (1952.95±299.09) and (2119.05±302.69) spots, energy density were (7.60±1.30) and (7.60±3.00) mW×ms/μm2 in the 577 nm group and 532 nm group, respectively. There was no difference in average laser power (t=1.35), number of laser spots (t=2.85) and energy density (t=1.99) between two groups (P > 0.05). Conclusion Compared with the 532 nm laser, 577 nm laser treatment has better visual outcomes for NPDR patients.
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.