PURPOSE:To observe the clinical features of the macular hemorrhage in myopes. METHOD:Twenty-four patients(30 eyes)with myopic macular hemorrhage were examined with slitlamp biomicroscopy,funduscope,A/B ultrasonography,and fundus fluorecein angiography(FFA). The patients were followed up for 3~18 months(average 12 months). RESULTS: Four of 26 eyes with macular hemorrhage examined with FFA were found to be due to choroidal neovaseulature,and they were associated with posterior staphyloma. The other 22 eyes without neovascular change were thought to be simple type,and 19 of them were associated with lacquer cracks. The hemorrhage in simple type cases deminished usually within 1~3 months. CONCLUSION:Myopic macular hemorrhagic eyes of neovascular type resulted usually in recurrent hemorrhage and worse prognosis in visual acuity than those of simple type. （Chin J Ocul Fundus Dis,1996,12: 220-222）
ObjectiveTo evaluate the operative technique and clinical efficacy of laparoscopic splenectomy (LS) combined with esophagogastric devascularization in treatment of portal hypertension induced by liver cirrhosis. MethodsTwelve cases with esophageal and gastric varices induced by portal hypertension and liver cirrhosis were treated by the LS combined with esophagogastric devascularization in our department from March 2009 to August 2010, which clinical data were analyzed and summarized retrospectively. ResultsThe splenic artery was ligated before the treatment of splenic pedicle in 12 cases, LS combined with pericardial devascularization was successfully performed in 10 cases, 7 cases of which were treated by the level two transection method of splenic pedicle, and 2 cases were converted to open surgery due to intraoperative bleeding. In 10 cases, the operative time was 180-300 min (average 210 min), and intraoperative blood loss was 200-1 000 ml (average 480 ml). The postoperative hospital stay was 8-15 d (average 9 d)， the postoperative complications included plural effusion （lt;300 ml） in 2 cases， mild ascites （lt;300 ml） in 2 cases, and mild pancreatic leakage in 1 case， but all were cured eventually， and no mortality occurred. Followup was conducted in 12 patients for 4 to 20 months (average 7 months), and no rebleeding occurred. ConclusionsLS combined with pericardial devascularization is relatively safe and effective methods in treatment of portal hypertension induced by liver cirrhosis. The keys to success include ligation of splenic artery, and the use of harmonic scalpel combined with ligasure to treat splenic pedicle.
Objective To observe the performance of hyperspectral non-mydriatic fundus camera prototype and its application on ocular fundus diseases. Methods The narrow band filters was inserted into the optical path of the Canon non-mydriatic retinal camera (CR-DGi). The image was converted to digital data by charge-coupled device (CCD), and then analyzed by hyperspectral data software. Twelve volunteers were examined by hyperspectral nonmydriatic fundus camera prototype to confirm the characteristic wavelength spectrums of ocular fundus diseases and the repeatability of prototype. Fifty-nine patients with ocular fundus diseases who underwent fluorescein angiography were also examined by hyperspectral non-mydriatic fundus camera prototype, to compared the images of prototype and fluorescein angiography. Results Each of the highest power of the light at the focus point and the power per unit were safe. 536, 547, 579 nm were selected as the specific retinal imaging spectrums and 608 nm as the specific choroidal imaging spectrum. The intra-observer and inter-observer reproducibility was equal or greater than 0.85. The correlation between hyperspectral non-mydriatic fundus camera prototype and fluorescein angiography in choroidal neovascularization patients were 0.782 and 0.833. Conclusions The hyperspectral nonmydriatic fundus camera prototype is safe and reliable. It shows pathological retinal and choroidal structures with specific spectrums. There are good prospects for the application in clinical diagnosis, especially for macular diseases.
ObjectiveTo study changes in choroidal thickness(CT) with intravitreal injections of ranibizumab treatment. MethodsThis is a prospective, uncontrolled, open-label study. A total of 31 eyes of 31 patients diagnosed with wet age-related macular degeneration (AMD) and 33 eyes of 33 patients diagnosed with choroidal neovascularization (CNV) secondary to pathological myopia (PM) were included in the study. All affected eyes were treated with intravitreal ranibizumab 0.05 ml (10 mg/ml) and followed up monthly until 6 months. Enhanced depth imaging on Cirrus spectral-domain optical coherence tomography was used to measure the CT. The initial CT was compared with the data at 1, 3 and 6 month after treatment, and the correlation between of the decrease of CT at the 6 month and the number of injection times was analyzed. ResultsIn AMD group, the average CT respectively decreased by (9.68±11.02), (12.58±11.04), (13.84±11.67)μm at 1, 3 and 6 month, and the differences were significant(t=4.89, 6.34, 6.60;P < 0.001). In PM group, the average CT respectively decreased by (2.06±10.92), (3.64±8.78), (3.27±7.20)μm at 1, 3 and 6 month. The difference at 1 month was not significant (t=1.08, P=0.287). While after 3 months and 6 months, the differences were significant(t=2.38, 2.61;P=0.024, 0.014). The injection times were not correlated with the CT decreases at 6 month in both groups(r=0.04, 0.30;P=0.815, 0.099). ConclusionIntravitreal injections of ranibizumab can induce choroidal thickness reduction for wet age-related macular degeneration and choroidal neovascularization secondary to pathologic myopia.
Objective To investigate the effects and mechanism of curcumin on the retinal neovasularization in mice with oxygeninduced retinopathy (OIR). Methods A total of 72 C57BL/6J mice were divided into normal, OIR model, vehicle control ［dimethyl sulphoxide (DMSO)］, and curcumin group (100, 50, and 10 mg). The mice in normal group lived in normoxia condition; OIR model was set up according to standard methods in the literature. Five days after OIR establishment, the mice in curcumin group received an intraperitoneal (IP) injection of 0.1 ml curcumin (100, 50, and 10 mg), and the mice in DMSO group received an IP injection of 0.1 ml 1permil; DMSO. All of the mice were executed at the age of postnatal day 17 (P17) and the eyeballs were collected. Endothelial cell nuclei breaking through the internal limiting membrane were counted after stained with hematoxylin and eosin (HE). The expression of vascular endothelial growth factor-A (VEGF-A), vascular endothelial growth factor receptor-2 (VEGFR-2), endostatin (ES), and phosphorylated p38 mitogen-activated protein kinase (p-p38MAPK) in the retina in each group were measured by real-time polymerase chain reaction (RT-PCR) and Western blot methods.Results Compared with the normal group, retinal neovascularization was found in OIR model group (P＜0.05). The number of endothelial cell nuclei was 46.00plusmn;16.00 in OIR model group and 0.17plusmn;0.41 in normal group (P＜0.05). The expression of VEGF-A, ES, and p-p38MAPK in 100 mg curcumin group differed statistically from which in 50 and 10 mg curcumin group (P＜0.05). The expression of VEGFR-2 was same in the three curcumin groups (P＞0.05). Conclusion Curcumin can inhibit the formation of retinal neovascularization; the mechanism may be associated with inhibiting the expression of VEGFA and VEGFR-2, increasing the expression of ES, and inhibiting the p38MAPK signal transduction pathway.
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.
The diagnosis and treatment of age-related macular degeneration (AMD) is an international hotspot of eye research. Successful clinical applications of antiVEGF drugs promoted both basic research and clinical practice of AMD. A number of countries and professional societies have established clinical guidelines for AMD management, including the epidemiology, risk factors, diagnosis, classification, and treatment process. These AMD guidelines are mostly based on recently published results of clinical trials, provided good model of evidence based medicine. It is urgent and necessary to have our own guideline which is suitable for Chinese patients. Reviewing and learning existed guidelines will help us to improve the clinical practice of AMD in China.
ObjectiveTo observe the inhibitory effect of endostatin (ES) on oxygen-induced retinal neovascularization.MethodsThirtyfour 7-day-old C57BL/6J mice were randomly divided into 3 groups: oxygen-exposed group (12 mice), ES group (12 mice) and the control group (8 mice). The mice in oxygen-exposed and ES group were exposed to (75±5)％ oxygen for 5 days and then back to the normal air. In ES group, 1 μg ES endostatin were injected into vitreous in one eye, while PBS was injected into the other eye as the control 12 and 36 hours after being exposed to oxygen. The mice in the control group were fed in normal circumstance. The changes of retinal neovascularization was examined by fluorescence angiography with fluorescein isothiocyanatedextran. The number of endothelial cells breaking through the internal limiting membrane (ILM) was counted and the inhibitory effects of ES on retinal neovascularization was observed.ResultsCompared with the oxygen-exposed group, the branches of retinal vessels went normal without any un-perfused area in ES group. The number of nuclei of endothelial cells breaking through ILM on each retinal crosssection decreased to (5.39±1.52), which differed much from that in the oxygen-exposed group (22.56±2.13) (plt;0.001).ConclusionES can effectively inhibit the formation of retinal neovascularization in rats and might be a new path of the treatment for proliferative retinopathy.(Chin J Ocul Fundus Dis, 2005,21:314-317)
With the rapid development of fundus imaging technology, it is of great significance to establish a new naming system for neovascular age-related macular degeneration (nAMD) based on the multi-mode imaging. In 2020, an international panel of retina specialists, imaging and image reading center experts, and ocular pathologists reached a consensus after repeated discussions, a new name for nAMD subtype and related lesions was established based on the previous knowledge of fundus fluorescein angiography and pathology, combining indocyanine green angiography, optical coherence tomography and optical coherence tomography angiography with current pathological knowledge, in order to help ophthalmologists to study nAMD. The consensus proposed the term "macular neovascularization" and classified it into type 1, type 2 and type 3. Many lesions related to macular neovascularization, such as pigment epithelial detachment, hemorrhage, fibrosis, rip of retinal pigment epithelium and so on, were named. The new designation will help improve clinical communication between different studies, establish standard definitions and terms between reading centers and researchers, and further promote the understanding and communication of nAMD among ophthalmologists.