PURPOSE:To investigate the spatial and temporal relation of fibronectin(Fn),basic fibroblast growth factor(b-FGF)and astrocytes with the retinal vascular developmemt of human fatuses. METHODS:The retinas of 86 human fetuses from 13th week to 40th week were studied by immunohistochemical methods and light microscopy. RESULTS:Fn immunoreativity was localized in spindle cells ,vascular endothelial cells and extracellular matrix ahead of the spindle cells,vascular endothelial cells,ganglion cells and cone cells were b-FGF immunopositive. The b-FGF immunoreactivity in ganglion cells and cone cells appeared earlier than the vascularization nearby.Astrocytes migrated to ora serrata in close association with the spindle cells.and sent numerous processes to ensheath the blood vessels formed in two processes of retinal vascuiarlzation. CONCLUSION:These results suggest that Fn ,b-FGF and astrocytes were involved in modulating both of two processes of retinal vascularizalion. （Chin J Ocul Fundus Dis,1996,12:180-182）
The therapeutic effect of anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) was determined by a number of factors. Comprehensive thorough analysis of clinical features, imaging results and treatment response can predict the potential efficacy and possible vision recovery for the patient, and also can optimize the treatment regime to make a personalized therapy plan. Precise medicine with data from genomics, proteomics and metabolomics study will provide more objective and accurate biology basis for individual precise treatment. The future research should focus on comprehensive assessment of factors affecting the efficacy of anti-VEGF therapy, to achieve individualized precise diagnosis and treatment, to improve the therapeutic outcome of nAMD.
Objective To explore an effect of the artificial nerve graft wrapped in the pedicled greater omentum on the early revascularization and an effectof the increased blood supply to the artificial nerve graft on the nerve regeneration. Methods Seventy-five rabbits were randomized into 3 groups, in which there were 2 experimental groups where the rabbits were made to abridge respectively with the artificial nerve grafts wrapped in the pedicled greater omentum (Group A) and with the artificial nerve grafts only (Group B), and the control group where the rabbits were abridged with the autologous nerve (Group C).On the 3rd, 7th and 14th days after operation, the evans blue bound to albumin (EBA) was injected into the vessels in all the grafts to show their revascularization. Twelve weeks after operation the nerve regeneration was evaluated with theelectrophysiological and histological observations on the serial sections, and was evaluated also with the transmission electron microscope. Results The artificial nerve grafts wrapped in the pedicled greater omentum in Group A and the autologous nerve grafts in Group C showed a beginning of revascularization on the3rd day after operation, and the revascularization was increased on the 7th and14th days. Compared with Groups A and C, the artificial nerve grafts in Group Bshowed a delayed revascularization on the7th day after operation. At 12 weeks after operation, there were no significant differences in the motor never conduction velocity, density of the regenerated myelinated nerve fibers, myelin sheath thickness, and diameter between Group A and Group C(Pgt;0.05). However, both Group A and Group C were superior to Group B in the above variables, with significant differences(Plt;0.05). Conclusion Utilization of the pedicled greater omentum to wrapthe artificialnerve grafts can promote an early revascularization of the artificial nerve graft and an early nerve regeneration of the artificial nerve graft because of an enhanced blood supply to the nerve graft.
OBJECTIVE: To investigate the clinical effects of revascularization in lower extremity for severe ischemia. METHODS: Fifty-six lower limbs with severe ischemia in 49 patients were evaluated retrospectively, who underwent surgical intervention from January of 1995 to December of 2000. By arteriography, the actual anatomic distributions of occlusive disease included infrarenal aorta-bicommon iliac arteries, abdominal aorta-bicommon iliac arteries, iliac artery, and femoral artery or femoropopliteal artery. The indication for surgery was disabling claudication, rest pain and gangrene. Fourteen limbs in 12 cases received arterialization of femoral venous system by artificial venous-arterial fistula. Artificial vascular grafts were implanted in 33 limbs of 28 cases, endarterectomy and patch profundaplasty were performed in 5 limbs of 5 cases, and primary amputation was carried out in 4 cases. RESULTS: During 38 months follow-up in average, 4 limbs were amputated within 52 revascularizated limbs, and accumulated amputation rate was 14.3%. Patency rate was 68.4% in arterial revascularization limbs (26/38 limbs), and limb survival rate was 94.7%(36/38 limbs) by procedure of artificial vascular grafts, endarterectomy and patch profundaplasty. Limb survival rate in procedure of artificial venous-arterial fistula was 85.7%(12/14 limbs). CONCLUSION: In treatment of severe lower extremity ischemia, the effective revascularization can be achieved by artificial vascular bypass, endarterectomy and patch profundaplasty, or arterialization of femoral venous system. Options in the surgical management should depend on individual. Arteriography is essential for revascularization and properly planning a practicable surgical approach.
Since anti-vascular endothelial growth factor (VEGF) therapy has recently become the first-line treatment of wet age related macular degeneration in China, as well as retinopathy of prematurity, neovascular glaucoma and macular edema secondary to diabetic retinopathy or retinal vein occlusion in other countries. It is worth thinking about that how to perform anti-VEGF treatment properly to benefit more patients. We reviewed the fields of clinical researches to explore the best role of anti-VEGF treatment in prevention and treatment of retinal disease in future.
ObjectiveTo observe and investigate the effect of HIF-2α in the process of neovascularization of proliferative diabetic retinopathy (PDR).MethodsRetrospective clinical study. From July 2014 to July 2015, 60 eyes of 57 PDR patients diagnosed in Ophthalmology Department of Affiliated Hospital of Qingdao University were included in the study. Twenty-eight eyes of 27 patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml) at 2-7 days before surgery (ranibizumab group) and other 32 eyes of 30 patients did not (group without ranibizumab). Eighteen eyes of 18 patients with epiretinal membranes were included as controls. Pathological specimens of PDR fibrovascular membrane and premacular membrane were obtained during vitrectomy. The immunohistochemical staining and real-time PCR (RT-PCR) were used to detecting the expression of HIF-2α, Dll4 and VEGF. Kruskal-wallis test was used to compare the expression differences of correlation factors between groups. Spearman correlation analysis was used to analyze the relationship between the two variables.ResultsThe immunohistochemical staining revealed that there were positive expression of HIF-2α, Dll4 and VEGF in all PDR membranes, regardless of the injection of the ranibizumab. The levels of HIF-2α, Dll4 and VEGF protein in the group without ranibizumab were higher than those of the ranibizumab group (t=4.36, 6.01, 4.82; P=0.000, 0.008, 0.016). RT-PCR showed that the differences of the mRNA expression of HIF-2α, Dll4 and VEGF were all statistically significant among the PDR patients and controls (H=18.81,19.60, 20.50; P=0.000, 0.000, 0.000). The expression of HIF-2α, Dll4 and VEGF in the PDR membranes was higher than that of epiretinal membranes from non-diabetic patients. In the PDR patients,the expression of HIF-2α, Dll4 and VEGF of the group without ranibizumab was higher than that of the ranibizumab group. The spearman correlation analysis showed that the expression of mRNA between HIF-2α and Dll4, HIF-2α and VEGF were both significantly correlated (r=0.95, 0.87; P＜0.05).ConclusionsThe expression of HIF-2α in the PDR membranes was higher than that of the controls. It is positively correlated with the expression of the DLL4 and VEGF.
ObjectiveTo observe and classify the characteristics of optical coherence tomography (OCT) for several common diseases which could lead to submacular choroidal neovascularization (CNV), and to provide the warrant to make the differential diagnosis and treatment of CNV.MethodsThe data of OCT of 165 patients (187 eyes) with CNV due to AMD, CEC, high myopia and ICNV diagnosed by fundus photography and fundus fluorescein angiography (FFA) were retrospectively analyzed, and the images of OCT were classified considering the results of FFA, and the characteristics of different types of the images were sumerized.ResultsWell-defined fusiform thickening of retinal pigment epithelial (RPE) and choriocapillary layer in CNV with well-defined border (60 eyes), dispersed backscattering increase in poorly-defined CNV (101 eyes), optic darkspace beneath RPE layer in serous detachment of RPE layer (19 eyes), quickly decreased high backscattering region under RPE layer in hemorrhagic detachment of RPE layer (11 eyes), slight to moderate backscattering region between RPE layer in fibrovascular detachment of RPE layer (10 eyes), and detachment of neurepithelial layer from RPE layer with the optic darkspace between the layers in detachment of neurepithelial layer (45 eyes) were observed.ConclusionsThe images of OCT for the common diseases which could lead to submacular choroidal neovascularization may be divided into 6 types. Analyzing the characteristics of images of OCT is helpful in differential diagnosis and treatment of CNV. (Chin J Ocul Fundus Dis, 2005,21:69-73)
ObjectiveTo observe the imaging characteristics of optical coherence tomography angiography (OCTA) and the changes of choroidal capillary density (CCD) in the eyes of patients with high myopia choroidal neovascularization (mCNV). MethodsA case-control study. From January 2018 to October 2020, 50 cases of mCNV patients with 50 eyes (mCNV group) were included in the study. There were 18 males and 32 females; their age was 42.11±11.66 years old. Fifty eyes of 50 patients with normal fundus with matching myopia refractive power (≥6.00 D) were selected as the simple high myopia group, and 50 normal volunteers (refractive power －0.25-0.25 D) while 50 eyes were selected as the normal control group. There was no statistically significant difference in age (F=0.028) and gender composition ratio (χ2=0.136) among the three groups of patients (P＞0.05); the difference in best corrected visual acuity was statistically significant (F=14.762, P=0.004). Compared with mCNV group and pure high myopia group, the refractive index (t=－0.273) and axial length (t=0.312) of the examined eyes were not statistically significant (P＞0.05). OCTA instrument was used to measure the CCD in the macular area of the examined eye. Analysis of variance was used for comparison of measurement data among the three groups; χ2 test was used for comparison of categorical variables. The paired t test was performed to compare the CCD of the mCNV patient's eye and the contralateral eye. ResultsAmong the 50 eyes in the mCNV group, Ⅰ, Ⅱ, and mixed choroidal neovascularization (CNV) were 12 (24%, 12/50), 34 (68%, 34/50), and 4 (8%, 4/50) eyes, respectively. Corresponding to the OCTA cross-sectional image of the lesion, there was a clear “flower cluster”-like strong blood flow signal. Among them, the focal shape, the filament shape, and the group net shape were 6 (12%, 6/50), 8 (11%, 8/50), and 36 (72%, 36/50) eyes, respectively. The CCD of the eyes in the mCNV group, the pure high myopia group, and the normal control group were (57.39±3.24)%, (59.33±2.23)%, and (61.87±1.62)%, respectively. The CCD of the eyes in the mCNV group was significantly lower than that of the simple high myopia group (P=0.030) and the normal control group (P＜0.001). The CCD of the affected eye and the contralateral eye in the mCNV group were (57.39±3.24)% and (59.82±3.94)%, respectively; there was no statistically significant difference between the CCD of the affected eye and the contralateral eye (t=－0.496, P=0.100). The CCDs of eyes with Ⅰ, Ⅱ and mixed CNV were (57.38±3.31)%, (57.39±2.83)%, and (57.36±4.21)%, respectively. There were no statistically significant differences in CCD (F=1.476), age (F=0.274), sex ratio (χ2=0.825), and diopter (F=0.348) in different CNV types (P＞0.05). ConclusionThe mCNV is mostly type Ⅱ, and OCTA has a "bloom" appearance of abnormal reticular blood vessels; the CCD is significantly reduced, and it is bilateral.
Objective To determine whether kringle 4-5 could inhibit choroidal neovascularization (CNV) in mice induced by argon laser photocoagulat ion. Methods Fundus laser photocoagulation was performed on C57BL/6J mice to induce CNV. In treatment group, 20 μg (low dosage group) and 50 μg (high dosage group) kringle 4-5 were injected retrobulbarly after photocoagulation. In control group, equilibrium liquid was injected retrobulbarly. Choroidal neovascularization was evaluated on the 7th and 14th day after photocoagulation by fundus fluorescein ang iography. The mice were killed on the 14th day after photocoagulation, the lesions were evaluated histologically and immunohistochemically, and the expression of CD105 was detected. The Expression of VEGF and bFGF was detected by immunohist ochemistry on the 4th day after photocoagulation.Results The incidence of CNV was 64.3% in control group, 51.2%（P＜0.05）in low dosage group, and 44. 1% (P＜0.01) in high dosage group. The CNV lesions were smaller in kringle 4-5 injected eyes in a dose-dependent manner and the number of proliferative vascular endothelial cells in the subretinal membrane of the treated eyes was smaller than that of the control eyes. There was no significant difference of the expression of VEGF and bFGF between the mice in control and treatment group.Conclus ions Kringle 4-5 could inhibit the development of choroidal neovascularization in the experimental mice model.(Chin J Ocul Fundus Dis，2003，19：201-268)
Objective To investigate the method and effect of krypton laser photocoagulation for neovascularization in retinal vein occlusion . Methods Tweenty eight eyes of 27 patients with retinal vein occlusion with neovascularization were photocoagulated by krypton green and red laser.The fundus changes were observed by fundus fluorescein angiography after photocoagulation. Results The neov ascularization disappeared completely in 20 eyes and became smaller in 6 eyes,re mained no change in 2 eyes,and the visual acuity improved in 17 eyes (60.7%) after 6 monthes to 2.5 years of follow-up. Conclusion Krypton laser photocoagulation is obviously effective on regression of n eovascularization and prevenion of vitreous hemorrhage in retinal vein occlusion . (Chin J Ocul Fundus Dis, 2001,17:12-14)