Pyroptosis is an inflammatory form of programmed cell death, including canonical and non-canonical pyroptosis pathway. Studies on pyroptosis have been reported in a variety of retinal diseases, but they are more focused on common diseases such as diabetic retinopathy and age-related macular degeneration. Many retinal diseases are difficult to treat because of the complexity of their etiology and pathogenesis. The discovery of pyroptosis has brought new content to the pathogenesis of these diseases, and also pointed a new direction for the treatment. Pyroptosis does not occur independently, and it is related to apoptosis and autophagy, but the specific mechanism is not clear. However, the most important biomolecule in the process of pyroptosis have been basically determined, and some methods can be used to interfere with pyroptosis, which has obtained preliminary achievement, suggesting that inhibition of pyroptosis may be a new direction for the treatment of retinal diseases and has broad research prospects.
Objective To observe and analyze the causes and prognosis of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR). Methods A total of 160 PDR patients (171 eyes) were enrolled in this retrospective study. There were 85 males and 75 females. The patients aged from 33 to 73 years, with the mean age of (56.40±8.97) years. All the patients were performed 25G pars plana vitrectomy by the same doctor. Fibrovascular membrane peeling and panretinal photocoagulation were performed during the operation. Combined phacoemulsification was performed in one hundred and five patients. Vitreous tamponade was used at the end of surgery, including silicone oil (43 eyes), C3F8 (63 eyes), air or fluid (65 eyes). The follow-up ranged from 6 to 22 months, with the mean follow-up of (9.34±6.97) months. The features of PVH were observed. The difference of age, HbA1c, creatinine level, the severity of the fundus lesions, whether received treatment of anti-vascular endothelial growth factor (VEGF), whether received combined cataract phacoemulsification were analyzed to find out the cause and prognosis of PVH. Results The corrected vision of all the patients after the primary PPV at the latest follow up was finger counting/1 meter. PVH occurred in 15 eyes of 15 patients, the incidence was 8.77%. The PVH occurred 2 weeks to 6 months after surgery. There were significant difference in age (t=2.551), proportion with tractional retinal detachment (χ2=7.431), progressive fibrovascular proliferation (χ2=4.987) and using anti-VEGF (χ2=9.742) between the patients with and without PVH (P＜0.05). There was no significant difference in HbA1c (t=0.501), creatinine level (t=1.529), and the proportion of cataract phacoemulsification (χ2=0.452) between the patients with and without PVH (P＞0.05). During follow-up, neovascularization of iris (NVI) occurred in 1 eye and neovascular glaucoma (NVG) occurred in 4 eyes. Seven eyes underwent reoperation, 7 eyes were spontaneous recovered, 1 eye with NVG give up treatment. Fibrovascular membrane was the major cause of recurrent hemorrhage. At the end of follow-up, hemorrhage was absorbed in all the 14 eyes which were treated, 12 eyes had same visual acuity compared to that before postoperative hemorrhage, 2 eyes with NVG had decreased vision. There was significant difference in the corrected vision between the patients with and without NVI or NVG (P=0.022). Conclusions PVH after PPV for PDR is closely related to the severity of diabetic retinopathy, fibrovascular membrane is the major cause of recurrent hemorrhage. NVG is an important factor related to vision acuity prognosis.
Objective To observe the efficacy and safety of pars plana vitrectomy (PPV) combined with subretinal injection of dexamethasone in treating refractory diabetic macular edema (DME). MethodsA prospective case study. From January 2024 to March 2024, 9 cases with 10 eyes of refractory DME diagnosed at Tianjin Eye Hospital were included in the study. All eyes had a central macular thickness (CMT) of greater than 275 μm despite receiving intravitreal injection of anti-vascular endothelial growth factor (VEGF) drug at least 5 times. All eyes underwent 25G PPV combined with internal limiting membrane (ILM) peeling and subretinal injection of dexamethasone sodium phosphate. Best-corrected visual acuity (BCVA), microperimetry, and optical coherence tomography examinations were performed on all eyes before and 1 and 3 months after surgery. BCVA was assessed using an international standard visual acuity chart and converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Paired t-tests were used to compare changes in BCVA, mean macular sensitivity (MS), and CMT before and after surgery. The intraoperative and postoperative complications were recorded. ResultsAmong the 9 cases with 10 eyes, there were 4 males with 5 eyes and 5 females with 5 eyes. Age ranged from 43 to 79 (65.3±10.8) years. Preoperative and postoperative logMAR BCVA at 1 and 3 months were 0.84±0.25, 0.72±0.31, and 0.63±0.22, respectively. MS was (16.48±5.03), (16.6±6.31), and (18.0±5.33) dB, respectively. CMT was (437.5±90.4), (306.9±87.4), and (288.7±87.3) μm, respectively. Compared with data before surgery, BCVA: the difference was not statistically significant at 1 month (t=2.025, P=0.074), but was statistically significant at 3 months (t=5.161, P=0.001), MS: the differences at 1 and 3 months were not statistically significant (t=－0.078, －1.022, P=0.940, 0.334), CMT: the differences were of statistical significance at both 1 and 3 months (t=2.892, 3.175, P=0.018, 0.011), and the difference between 1 and 3 months post-surgery was also statistically significant (t=2.427, P=0.038). No complications such as macular hole, vitreous hemorrhage, or retinal detachment occurred during or after surgery in any eyes. No cases of increased intraocular pressure or cataracts were reported during the follow-up period. ConclusionPPV combined with ILM peeling and subretinal injection of dexamethasone can effectively reduce CMT in refractory DME eyes and improve visual acuity, with good safety.
ObjectiveTo observe the dynamic characteristics of visual acuity after vitrectomy in different sizes of idiopathic macular hole, and analyze the influencing factors.MethodsA retrospective study. From August 2016 to June 2018, 302 patients (302 eyes) with monocular idiopathic macular hole who underwent 25G vitrectomy combined with the internal limiting membrane peeling in Tianjin Eye Hospital were included in the study. There were 130 males and 172 females, with the mean age of 63.36±6.91 years. There were 158 left eyes and 144 right eyes. The logMAR BCVA was 1.13±0.45. The minimum diameter (422.92±211.73 μm) and basal diameter (835.47±366.42 μm) of macular hole and choroid thickness under fovea (244.84±60.68 μm) were measured by OCT. According to the minimum diameter, the holes were divided into small hole group (≤250 μm), middle hole group (＞250 μm and ≤400 μm) and large hole group (＞400 μm). The logMAR BCVA at 1, 3 and 6 months after surgery in 3 groups were observed. Two-factor repeated measure ANOVA was used to compare the visual acuity of the 3 groups. The generalized estimation equation (GEE) was used to analyze the influencing factors of postoperative visual recovery.ResultsOne month after surgery, all the holes were closed. One, 3 and 6 months after surgery, the logMAR BCVA were 0.33±0.25, 0.23±0.18, 0.16±0.17 in the small hole group; the logMAR BCVA were 0.46±0.25, 0.35±0.26, 0.27±0.28 in the middle hole group; the logMAR BCVA were 0.81±0.51, 0.61±0.48, 0.53±0.37 in the large hole group. Through repeated measurement variance analysis of two factors, it was found that there was an interaction between different groups and different time nodes (F=23.133, P＜0.01). All data were segmented and one-way repeated measure ANOVA was performed. The results showed that there was a statistically significant difference in visual acuity between the small hole group and the middle hole group among preoperative and 1 month after surgery (P＜0.05), while there was no statistically significant difference in visual acuity between 1, 3 and 6 months after surgery (P＞0.05). In the large hole group, among preoperative, 1 months after surgery, 3 months after surgery, the visual acuity difference was statistically significant (P＜0.05), while the visual acuity difference between 3 months after surgery and 6 months after surgery was not statistically significant (P＞0.05). The results of GEE analysis showed that hole size (χ2=4.17, P=0.04), basal diameter (χ2=7.25, P=0.01), disease course (χ2=19.26, P=0.00), and choroid thickness (χ2=4.19, P=0.04) were the influencing factors of postoperative visual acuity.ConclusionsAfter vitrectomy of macular holes of different sizes, the visual recovery trend is different. The visual recovery of small holes and middle holes is faster and basically restored at 1 month. The large holes requires a slow recovery process and stabilizes vision at 3 months. Hole size, basal diameter, course of disease and choroid thickness are the influencing factors of visual acuity recovery.
Circular RNA (circRNA) is a new group of endogenous non-coding RNAs produced by back-splicing, which has multiple molecular functions such as acting as microRNA sponges, regulators of transcription and splicing, adaptors for protein-protein interaction. Recent studies have shown that circRNA play an essential role in development and progression of retinal microvascular dysfunction, diabetic retinopathy, age-related macular degeneration, proliferative vitreoretinopathy, eye diseases caused by hyperhomocysteine and ocular malignancy. In pathological conditions, the differential expression of circRNA alters the transcription and translation of corresponding genes, thus changing the activity and function of cells. CircRNA may become a new marker and prognostic indicator of fundus diseases, and its targeted intervention may also become a potential treatment for fundus diseases.
ObjectiveTo evaluate the effectiveness and safety of glucocorticoids in the treatment of non-arteritic anterior ischaemic optic neuropathy (NAION).MethodsGlucocorticoids published in the National Library of Medicine PubMed; Netherlands Medical Abstracts Database Embase; Cochrane Library, an evidence-based medical library; China Cnkipedia; China Biomedical Literature Service; Chongqing Vipul Chinese Science and Technology Journal Database, and Wanfang Science and Technology Journal Full Text Database were searched about computer. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) for the treatments of NAION were subjected to meta-analysis. The search period was from the establishment of each database to March 2020. The literature was screened and data were extracted according to the inclusion and exclusion criteria. The methodological quality of the RCT and NRCT studies was evaluated using the Risk of Bias Assessment Tool and the MINORS evaluation scale, respectively. The data were analyzed using RevMan version 5.3 software which was provided by the Cochrane Collaboration Network.ResultsAn initial search of 395 papers was conducted, and 10 papers were finally included for this meta-analysis, including 3 RCT studies and 7 NRCT studies. A total of 1057 patients with NAION were included. The 3 RCT studies were analyzed descriptively as the outcome indicators were described in different ways. A meta-analysis of 7 NRCT studies showed that patients in the treatment group showed significantly better visual prognosis (relative risk=1.28, 95% confidence interval 1.09 to 1.51, P=0.003) and retinal nerve fibre layer thickness were obviously improved (mean difference=7.76, 95% confidence interval 1.58 to 13.94, P=0.01) than the control group. Four studies reported the occurrence of adverse reactions in the treatment versus control groups. None of the above studies provided a detailed analysis of the prognosis of patients with adverse reactions.ConclusionThe efficacy and safety of glucocorticoids in the treatment of NAION is unclear and needs to be validated in a larger sample of RCTs.
Objective To observe the clinical characteristics of non arteritic anterior ischemic optic neuropathy (NAION) in patients of different genders. MethodsA retrospective clinical analysis. A total of 183 cases (246 eyes) of NAION with complete diagnosis and treatment confirmed by Departments of Neuro-ophthalmology/Acupuncture and Moxibustion of Eye Hospital, China Academy of Chinese Medical Sciences from June 2018 to December 2023 were included. Among them, 101 cases (138 eyes) were male and 82 cases (108 eyes) were female. Their age was (59.2±9.8) years. The number of right and left eyes were 120 and 126, respectively. The patient's gender, age, disease course, history of hypertension, history of diabetes, history of hyperlipidemia, history of smoking and drinking, best corrected visual acuity (BCVA), intraocular pressure, and peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness were recorded in detail. Visual field defects were classified into diffuse defects, ring scotoma, fan-shaped or wedge-shaped defects, upper and lower half defects, arcuate scotoma, and quadrantanopia. Logistic regression analysis was utilized to determine whether gender was an independent factor affecting the degree of visual field impairment in NAION. ResultsCompared with female patients, male patients showed earlier onset age, a shorter interval between binocular onsets, a higher morbidity rate of hyperlipidemia, and a higher proportion with history of smoking and drinking, with statistically significant differences (P＜0.05). There was no statistically significant difference in disease duration, intraocular pressure, pRNFL thickness, and intraocular perfusion pressure between patients of different genders (P＞0.05). Female patients exhibited better BCVA than male patients, but the difference was not statistically significant (P＞0.05). The degree of visual field impairment in female patients was significantly better than that in males. Males' visual field defects were mostly in the lower half, while females' defects were mostly of arcuate scotoma, with statistically significant differences (P＜0.05). The results of multiple logistic regression analysis showed that the gender of male was an independent risk factor for severe visual field impairment in NAION patients (odds ratio=2.936, 95% confidence interval 1.275-6.763, P=0.011). ConclusionsMale NAION patients have an earlier onset age and a shorter interval between the initial and contralateral eye onset. Male patients exhibit a more severe degree of visual field impairment, which is mostly manifested as lower half visual field defect. While female patients tend to develop arcuate scotoma. After adjusting for other influencing factors, the gender of male remains an independent risk factor for severe visual impairment in NAION patients.
ObjectiveTo observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C3F8) tamponade in the treatment of idiopathic macular hole (IMH).MethodsA retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD＜400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed.ResultsThe postoperative BCVA of group A, B and C was improved obviously, the differences were statistically significant (t=?11.66, ?7.52, ?4.99; P＜0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, ?0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation,ConclusionsThe macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.
ObjectiveTo observe the healing morphology, macular microstructure and visual function of idiopathic macular hole (IMH) after pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) flap.MethodsRetrospective case study. From 2016 to 2018, 39 eyes of 39 patients with IMH diagnosed in Tianjin Eye Hospital were included in the study. Among them, there were 4 eyes in 4 males and 35 eyes in 35 females, with an average age of 64.56±7.2 years. BCVA, OCT, OCT angiography (OCTA) and MAIA microperimetry examination were performed in all patients. BCVA examination was performed with the international standard visual acuity chart, which was converted to logMAR visual acuity when recording. All patients underwent PPV combined with ILM flap covering and air tamponade. According to the characteristics of OCT images postoperatively, the eyes were divided into U-shaped closed group, V-shaped closed group, irregular closed group and flat closed group, with 26, 5, 7 and 1 eyes respectively. There was a significant difference in the minimum hole diameter (F=5.118, P=0.005) and macular hole classification (F=3.608, P=0.024). The shallow capillary layer (SCP) blood flow density in the U-shaped closure group was significantly higher than that in the V-shaped closure group, the irregular closure group and the flat closure group (t=2.079, 2.368; P=0.047, 0.025). At 1, 3, 6 months after the operation, the same equipment and methods were used for relevant examination. The blood flow density of BCVA, SCP, perimeter of foveal avascular zone (PERIM) and mean sensitivity (MS) were compared before and after operation. Independent sample t-test was used for quantitative data comparison between different groups, and χ2 test was used for counting data comparison.ResultsSix months after operation, the logMAR of the eyes in the U-shaped closure group was －0.75±0.29 higher than that before operation, and was better than that in the V-shaped closure group, the irregular closure group and the flat closure group (t=－2.974, －2.518; P=0.006, 0.018). The integrity of external limiting membrane (ELM) and ellipsoid in U-shaped closed group was significantly higher than that in V-shaped closed group, irregular closed group and flat closed group (χ2=15.229, 10.809; P=0.020, 0.013). The percentage of macular central fovea reflex mass in the U-shaped closed group was significantly lower than that in the V-shaped closed group, irregular closed group and flat closed group (χ2=20.107, P=0.000). PERIM in U-shaped closure group was smaller than that in V-shaped closure group, irregular closure group and flat closure group, and the difference was statistically significant (t=－3.391, －2.427; P=0.002, 0.022). The total MS of macular area 10 °in the U-shaped closure group was significantly higher than that in the other V-shaped closure group, irregular closure group and flat closure group (t=2.939, 2.811; P=0.001, 0.001).ConclusionAfter IMH operation, the U-shaped closure showed better BCVA and macular light sensitivity, the proportion of ELM and ellipsoid to restore structural integrity are higher, PERIM is smaller, and there are fewer macular fovea strong reflex masses.
Objective To compare the outcomes of ranibizumab and conbercept adjunct for pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized case-control study. From June 2022 to December 2023, 90 cases (90 eyes) of PDR patients diagnosed through ophthalmic examination at Department of Ophthalmology of Gansu Provincial Hospital were included in the study. All patients underwent the best corrected visual acuity (BCVA), intraocular pressure, B-mode ultrasound, and optical coherence tomography (OCT) examinations. The central macular thickness (CMT) was measured using an OCT instrument. The patients were randomly divided into a intravitreal injection of ranibizumab group (monoclonal-antibody group) and a intravitreal injection of conbercept group (fusion-protein group) using a random number table method, with 45 cases (45 eyes) in each group. Two groups of patients were intravitreal injected with 10 mg/ml ranibizumab or conbercept 0.05 ml, respectively. A standard 23G PPV was performed through the flat part of the ciliary body 3-7 days after intravitreal injection. Relevant examinations were performed using the same equipments and methods as before surgery at postoperative 1 week, 1, 3, 6, and 12 months. The PPV time, intraoperative use of intraocular electrocoagulation, incidence of iatrogenic retinal breaks, and sterile air or silicone oil tamponade rate in the vitreous cavity, the postoperative changes of BCVA and CMT, and incidence of complications were compared between two groups. Independent sample t test was used for inter group comparison. ResultsThe intraoperative utilization rate of intraocular electrocoagulation in the monoclonal-antibody group was higher than that in the fusion-protein group, and the difference was statistically significant (χ2=3.876, P＜0.05). There were no statistically significant differences in the PPV time (t=0.152), intraoperative bleeding rate (χ2=0.800), incidence of iatrogenic retinal breaks (χ2=1.975), and sterile air and silicone oil tamponade rate in the vitreous cavity (χ2=1.607, 1.553) between the two groups (P＞0.05). There were no statistically significant differences in early and late postoperative vitreous hemorrhage (χ2=1.235, 2.355), and re-PPV (χ2=2.355) between two groups (P＞0.05). The BCVA of the fusion-protein group was significantly better than that of the monoclonal-antibody group at postoperative 3 months, and the difference was statistically significant (t=2.428, P＜0.05). The CMT of the fusion-protein group was lower than that in the monoclonal-antibody group at postoperative 1 week, and the difference was statistically significant (t=2.739, P＜0.05). None of the patients experienced endophthalmitis, retinal artery occlusion, or severe cardiovascular events after surgery. ConclusionCompared with intravitreal injection of ranibizumab before PPV, intravitreal injection of conbercept before PPV in PDR patients can shorten the surgical time, reduce intraoperative bleeding rate, lower the rate of electrocoagulation and intraocular tamponade, and incidence of iatrogenic retinal breaks, and improve the visual acuity.