OBJECTIVE:To verify the safe dose of cephradine in intravitreal injection. METHODS:After injecting different doses of cephradine(100mu;g,200mu;g,250mu;g,300mu;g,400mu;g)into vitreous cavity of different group of rabbits the activities of the retinal enzymes (SDH,LDH )on different time (Id,3d, 7d ) were determined respectively, and the histological and ultrastructural changes of retinas were also observed simuhaneously. RESULTS:The activity of rellnal SDH and LDH was found to be decreased gradually with tbe icreasing of the dosage of intravitreal cephradine. The activities of SDH and LDH were found in the lowest level on tile 3rd and lsl day,but they recover to normal levels on tile 7th day after intravitreal in}eetion in 100mu;g,200mu;g groups,and still lower tban normal in the other groups. Histologically,retinal edema was found both in 100mu;g and 200mu;g groups,but degradation of retinal cells,and loss of cones and rods were round in the 250mu;g, 300mu;g and 400mu;g groups. CONCLUSION: The safe dose of intravitreal injection of cepbradlnc is 200mu;g. （Chin J Ocul Fundus Dis,1997,13:139-142 ）
ObjectiveTo investigate the therapeutic effects of thrombolysis infusion via microcatheter on the treatment of central retinal artery occlusion(CRAO). MethodsUrokinase (UK) was directly infused via ophthalmic artery (OA) by microcatheter (6 patients) or via intravenous (7 patients) to dissolve the thrombus. The patency of the artery was evaluated by fundus fluorescein angiography (FFA), and the effect of fibrinolytic activity on the systemic changes was observed by blood biochemical examination simultaneously. ResultsIn 6 patients in the microcatheter group, 5 had completely and 1 had partly reopened OA on the morrow of UK infusion with the patency rate of 83.33%, while in 7 patients in vein group, 3 completely reopened, 2 partly reopened and 2 obstructed OA were found with the patency rate of 42.86%. The difference between the two groups was significant. No obvious change of index of blood coagulation system was found in catheter group, which had great disparity compared with the vein group.ConclusionUrokinase infusion via microcatheter in CRAO has better therapeutic impact and smaller effect on systemic action. (Chin J Ocul Fundus Dis, 2005,21:16-19)
Objective To investigate the retinal toxicity and verify the safe dose of intravitreal injection of nonsteroid anti-inflamatory drug,diclofenac sodium.Methods Twenty-eight healthy adult white rabbits were divided at random into 7 groups and received in every right eye the intravitreal injection of a single dose of diclofenac sodium solution ranging from 0.4-0.1 mg/0.1ml respectively ,the left eyes were regarded as conreol ones.Before injection and on the 1st,3rd,7th,14th,21st,and 28th day after injection the electroretinography on both eyes was examined.On the 28th day after injection the retinas of two rabbits of every group were examined by using light microscopy.On the 10th and 30th day after injection the retinal tissues around the optic nerve sisk of two eyes from every group at random were tested by using transmission electron microscopy.Results The retio of amplitude ofb wave of electroretinography in 0.4mg and 0.5mg groups had no sighnificant difference from groups before injection,the retinal tissues showed no structural changes in light and ecectron microscopy examination.The ratio of amplitude ofb wave of photoptic electroretinogrphy in 0.6mg groups in the early stage after injection was markedly reduced（P＜0.05）and returned to that before injection with time,reversible change of the edematou retina was discovered.The ratio of amplitude of b wave of electroretinography in 0.7-1.0mg groups was distinctly descreaded after injection（P＜0.05 or P＜0.01）,the cells of all the retinal layer revealed apparent and irreversible damage.Conclusion The largest dose of safety of intravitreal diclofenac sodium should be not more than 0.6mg.The toxic effect of intravitreal diclofenac sodium on retina is concerned mostly to cones and rods.
Objective To investigate the effects of QUE on proliferation and DNA synthesis of cultured retinal pigment epithelium(RPE) cells with or without EGF. Methods With or without EGF, cultured RPE cells were treated with QUE by various concentrations(200,100,50,1mu;mol/L) and with QUE 200mu;mol/L at different times(24-168 hr), cells proliferation and DNA synthesis were evaluated by cell count method and the uptake of thymidine. The viability of cells was determined by trypanblue exclusion. Results The best concentration of QUE which inhibits proliferation and DNA synthesis of PRE cells was 200mu;mol/L. The significant inhibition effect of QUE occurred at 48hr, and the best inhibition of QUE occurred at 96hr. QUE had more powerful effect of antiproliferation on RPE cells, and the viability of RPE cells was over85%. Conclusion The results suggested that QUE could inhibit the proliferation of RPE cells in a dose-dependent and time-dependent manner, especially inhibit the proliferation induced by EGF stimulating. QUE had no cyto-toxic effect on RPE cells cultured in vitro. (Chin J Ocul Fundus Dis,1999,15:27-29)
ObjectiveTo evaluate the efficacy and security of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsA total of 41 eyes in 37 patients with macular edema who measured up were collected, including 21 eyes of 21 cases in retinal vein occlusion (RVO) group, 17 eyes of 13 cases in diabetic retinopathy (DR) group, and 3 eyes of 3 cases in the other-causes group. Before the treatment, the average visual acuity was 0.07, 0.06, and 0.08 in the 3 groups respectively, and the mean thickness of macular fovea detected by optic coherence tomography (OCT) was (974±394) and (873±213) in RVO and DR group, respectively. Intravitreous injection with 0.1 ml TA (40 mg/ml) was performed on each patient. The average follow-up duration was 8 months after the treatment. The visual acuity, intraocular pressure (IOP), changes of lens and ocular fundus, and retinal thichness at macular area before and after the treatment was observed and compared.ResultsAll eyes except one had improved visual acuity. The mean visual acuity improved to 0.25, 0.20, and 0.35 in the 3 groups respectively 6 months after the treatment. Alleviated or reducing macular edema was found in all of the patients. The average retinal thickness at macular fovea was (173±41) and (204±76) in RVO and DR group respectively 1 month after the treatment, which had statistical significance compared with that before the treatment (t =8.323, 6.842; P＜0.01). The intraocular pressure was ＞21 mm Hg (1 mm Hg = 0.133 kPa) in 6 eyes (14.6%), which mostly happened 1 week to 2 months after the injection, and was controlled to normal level after partially treated with βreceptor retarder. The cataract developed in 1 eye, and another patient with macular edema after vitrectomy due to diabetes had macular hole 2 months after the injection. There were 2 eyes underwent intravitreous injection with 0.1 ml TA 4-5 months after the first treatment due to the recurrence of macular edema in RVO and DR group respectively.ConclusionsIntravitreous injection with TA is a promising therapeutic method for macular edema that fails to respond to conventional treatment. Transient elevation of ocular pressure is the most common side effect. Further study is needed to assess the long-term efficacy and safety. (Chin J Ocul Fundus Dis, 2005,21:209-212)
Objective：To observe the protective effect of ginkgo bilo ba extrac t (EGb 761), a free radical scavenger, on the photoreceptor cells after lighti nduced retinal damage. Methods：Seventytwo female SpragueDa wley (SD) rats we re randomly divided into 4 groups: normal control group, lightinduced retinal da m age model group, model+physiological saline group, and model+EGb 761 group, with 18 rats in each group. All of the rats except the ones in the control group were exposed to white light at (2740plusmn;120) lx for 6 hours after the dark adap tation for 24 hours to set up the lightinduced retinal damage model. Rats in m o del + physiological saline group and model+EGb 761 group were intraperitoneall y injected daily with physiological saline and 0.35% EGb 761 (100 mg/kg), respec tively 7 days before and 14 days after the light exposure. Apoptosis of photorec eptor cells was detected 4 days after light exposure; 7 and 14 days after light exposure, histopathological examination was performed and the layer number of ou ter nuclear layers (ONL) on the superior and inferior retina was counted. Results：Four days after light exposure, the apoptosis of photorecep tor cells was fou nd on ONL in model, model+ physiological saline and model+EGb 761 group, and w as obviously less in model + EGb 761 group than in model and model+physiologic al saline group. Seven days after light exposure, the layers of ONL on the super ior retina were 3 to 4 in model and model+physiological saline group, and 7 to 8 in model+EGb 761 group; the mean of the layer number of ONL in model+EGb 761 group (6.92plusmn;0.82) was less than that in normal control group (8.40plusmn;0.95) (t=-1.416, P＜0.05), but significantly more than that in model (5.96 plusmn;1.36 ) and model+physiological saline group (5.90plusmn;1.40）（t=1.024, 1.084; P＜0.05). Fourteen days after light exposure, the layers of ONL on the superior retina were 0 to 1 in model and model+physiological saline group, and 3 to 4 i n model+EGb 761 group. The mean of the layer number of ONL in model+EGb 761 group (5.5 2plusmn;1.06) was significantly more than that in model (3.44plusmn;2.15) and model + physiological saline group (3.37plusmn;1.91) (t=2.082, 2.146, P＜0.05). Conclusion：EGb 761 can partially inhibit the apoptosis of pho toreceptor cells, thus exert protective effect on photoreceptor cells.
Objective To observe the influence of interleukin-1beta; (IL-1beta;) on the expression of phosphorylated signal transducers and activators of transcription 3 (pSTAT 3) in rat retinal Muuml;ller cells.Methods For in vitro study cultured Muuml;ller cells were treated with IL-1beta; of different concentrations (0, 0.1, 1, 5 and 10 ng/ml) for 24 hours. For in vivo study, 32 Sprague-Dawley（SD）rats were divided into 4 groups randomly (control group，100，500 and 1000 ng/ml group) with 8 rats in each group. After 24 hours of injection with phosphate buffered solution (PBS), or 100,500,1000 ng/ml IL-1beta; into the vitreous cavities of the above rats, retinas were harvested. The expressions of pSTAT3 in cultured Muuml;ller cells or treated retinas were evaluated by indirect immunofluorescence and western blotting.Results After 24 hours of incubation without IL-1beta;, pSTAT3 has little expression in cultured Muuml;ller cells, but was upregulated by 1 ng/ml or higher IL-1beta; in a dosagedependent manner (F=46.64, 43.78;P＜0.01). pSTAT3 was not expressed in adult rat retina, but was upregulated by vitreous injection of 100 ng/ml or higher IL-1beta; in a dosagedependent manner (F=73.53,43.70;P＜0.01).pSTAT3 expressed mainly in inner nuclear layer and ganglion cell layer. Doublelabeling showed that there was no costaining of pSTAT3 and glial fibrillary acidic protein (GFAP) in retina of control group, but there were many costained Muuml;ller cells in retinas treated with IL-1beta;.Conclusions Expression of pSTAT3 in Muuml;ller cells could be activated by IL-1beta; which may represent one pathway link to reactive gliosis.
Objective To analyze the risk factors for postoperative cognitive confusion in a surgical intensive care unit. Methods A total of 388 consecutive patients in Surgical Intensive Care Unit of General Hospital of PLA were retrospectively studied. We posed clinical questions according to the patients with older age and large dosage corticosteroid. Using “Postoperative cognitive confusion” and“Intensive Care” as key words, we searched for evidence from MEDLINE (1968-2004). Results We found 3.1% (10/388) of the patients developed postoperative cognitive confusion. Of the 10 postoperative cognitive confusion patients, 9 were over 65 years old. 6.6% (9/136) of the patients (≥ 65 years old) developed postoperative cognitive confusion. While 0.4%(1/252) of the patients (＜65 years old) developed postoperative cognitive confusion. Older age (≥ 65 years old) may induce more postoperative cognitive confusion (P＜0.05). While 7.0% (5/71) of the patients treated by large dose corticosteroids (≥1 000 mg) developed postoperative cognitive confusion. And 1.65% (5/317) of the patients received corticosteroid with large dosage (＜1 000 mg) developed postoperative cognitive confusion. Large dosage corticosteroid (≥1 000 mg) may induce more postoperative cognitive confusion (P＜0.05). Conclusion Older age (≥ 65 years old) and high dose corticosteroid (≥1 000 mg) may be the two main risk factors for postoperative cognitive confusion.
Objective To observe the effects of intravenous thrombolysis with urokinase for central retinal artery occlusion (CRAO). Methods A total of 115 CRAO patients diagnosed by fluorescence fundus angiography (FFA) were enrolled in this study. The patients included 61 males and 54 females, with a mean age of (56.7plusmn;15.2) years (from 41 to 75 years). The duration ranged from 1 to 30 days. All the patients were affected unilaterally. All the patients were received the treatment of intravenous thrombolysis with urokinase (3000 U/kg, two times per day, continuous treatment for six to seven days) and retrobulbar injection of dexamethasone 2.5 mg (one time per day, continuous treatment for 14 days). Following that, 1.2 mg/kg brain protein hydrolysate (nerve nutrition) and 360 mg troxerutin (vasodilator) were given by intravenous drip (one time per day, continuous treatment for 14 days). Effectiveness of the thrombolytic and subsequent treatments including the recovery of vision and retinal arterial filling time before and after treatment were observed. Comparing the visual acuity of post-treatment and pre-treatment, improving three lines or more is considered as effective markedly, improving two lines as effective, no change or a decline as no effect. With FFA as the retinal circulation recovery index, the arm-retinal circulation time (A-Rct ) le; 15s and all branches of central retinal artery were filled with fluorescence within 2s filling (normal) as effective markedly; A-Rct improved but was in 15 - 20s range, all branches of central retinal artery were filled with fluorescence within 3～8s as effective; A-Rct improved but was still ge; 21s, all branches of central retinal artery were filled with fluorescence within ge;9s as no effect. The relationship between age, gender, the disease course, subsequent treat time and curative effectiveness were analyzed. Results There were 79 patients were examined for FFA again after thrombolysis treatment which including 11 patients with complete obstruction and 68 patients with incomplete obstruction. In 11 patients with complete obstruction, eight patients showed that optic disc vascular retrograde filling disappeared, A-Rct was 28-54s, and the filling time from retinal artery to tip was 18 - 55s; three patients showed persistent optic disc vascular retrograde filling within 3 - 4 minutes of FFA. In 68 patients with incomplete obstruction, A-Rct returned to normal in 35 patients (51.4%), effective in 18 patients (26.5%) and no effect in 15 patients (22.1%). Retinal circulation time was shorter than that before thrombolysis treatment (chi;2=11.4, Plt;0.05). Comparison of distribution of visual acuity before and after thrombolysis treatment, the difference was statistically significant (chi;2=12.1, Plt;0.05). Comparison of distribution of final visual acuity after subsequent treatment with that of after thrombolysis treatment, 48 eyes improved two lines or more, the efficiency was 41.7%, the difference was statistically significant (chi;2=14.6, Plt;0.05). Comparison to that of before treatment, vision changes showed effect markedly in 58 patients (50.4%), effective in 35 patients (30.4%), no effect in 22 patients (19.2%), the difference was statistically significant (chi;2=44.5, Plt;0.05). Comparison the average age to that of effective, valid and invalid patients, the difference was not statistically significant (t=0.98, 1.17, 0.55; Pgt;0.05). There was no relationship between effectiveness and gender (chi;2=2.6, Pgt;0.05). In 76 patients with duration within seven days, 43 patients were effective markedly and 22 patients were effective, the efficiency was 85.5%. In 25 patients with duration of 8 - 15 days, 11 patients were effective markedly and eight patients were effective, the efficiency was 76.0%. In 34 patients who received subsequent treatment 8 - 14 days, 18 patients were effective markedly and nine patients were effective, the efficiency was 79.4%. In 51 patients who received subsequent treatment 15-21 days, 27 patients were effective markedly and 18 patients were effective, the efficiency was 88.2%. Conclusion Intravenous thrombolysis with urokinase was effective in the treatment of CRAO.
ObjectiveTo evaluate the effect of intravitreous injection with triamcinolone acetonide (TA) on macular edema.MothodHaving been examined by ophthalmoscopy, optic coherent tomography (OCT), retinal thickness analyzer (RTA), and fundus fluorescein angiography (FFA), 33 patients (37 eyes) with diffused and (or) cystoid macular edema caused by diabetes and retinal venous occlusion were intravitreously injected with 0.1 ml triamcinolone acetonide (40 mg/ml). During 1-9 month followup period, the visual acuity, intraocular pressure, inflammatory extent, manifestation of lens and fundus were observed, the retinal thickness was examined by OCT and RTA, and vascular leakage were detected by FFA.ResultsMacular thickness was (244.07±118.80), (195.53±57.70), and (181.42±54.79) μm respectively 1, 2, 3 months after treatment; while macular thickness was (724.35±227.41) μm before the treatment. The difference was statistically significant （t =10.72, 12.84, 13.90; P lt;0.001）. The visual acuity was 0.39±0.19, 0.45±0.24, and 0.43±0.21 respectively, comparing with the visual acuity before the treatment (0.20±0.16), the difference was statistically significant （t =4.445, 4.349, 3.474; P lt;0.001, lt;0.001, 0.03）；The result of FFA showed less leakage of fluorescein and proliferative lesion. Four pateints had the ocular pressure ≥25 mm Hg (1 mm Hg=0.133 kPa) in 9 who had ≥20 mm Hg. Recurrence of macular edema was found in 4 eyes of 3 patients 4 and 6 months after the treatment, respectively. No infection or aggravation of lenticular turbidness occurred.ConclusionIntravitreous injection with TA can be used to treat macular edema due to diabetes and retinal venous occlusion, and recurrence of macular edema or increase of intraocular pressure may occur in some patients.(Chin J Ocul Fundus Dis, 2005,21:205-208)