Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation

Background  To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. Methods  This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher’s Exact test, Pearson Chi-square test, independent t-test, Mann–Whitney U-test, and a repeated ANOVA. Results  The mean age of patients was 52.7 ± 12.6 years in group 1 and 53.2 ± 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 ± 7.6 weeks in group 1 and 34.1 ± 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 ± 0.30 in group 1 and 0.72 ± 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). Conclusion  ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity. The results of this study were presented at the 8th Euretina Congress 2008, Vienna, Austria. The authors have no conflicting interests in the subject matter presented.     

Relation between retrobulbar circulation and progression of diabetic retinopathy

AIMS: To investigate retrobulbar circulatory parameters in type 2 diabetic patients with and without diabetic retinopathy (DR) progression. METHODS: This was a prospective cohort study. One eye of 35 diabetic patients with background DR (BDR) were included in the study. Eyes without DR, with proliferative DR, photocoagulation, past surgical procedures, or other ophthalmic disease except BDR and cataract were excluded. The study was masked. Colour Doppler imaging (CDI) was used to measure the retrobulbar circulation at the beginning of the study and after a mean follow up interval of 21 months. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI) in the central retinal artery and vein and the posterior ciliary artery were measured. RESULTS: 18 patients who developed DR progression showed significantly increased central retinal vein PSV ( 5.6 (3.5-9.1) p = 0.003), EDV ( 3.4 (2.3-4.4) p = 0.04), and RI ( 0.43 (0.20-0.56) p = 0.02) at the final measurement compared to the initial measurement (PSV = 4.6 (3.2-7.0); EDV = 3.0 (2.3-3.7); RI = 0.40 (0.17-0.52)). Circulatory parameters in the central retinal artery and the posterior ciliary artery did not alter significantly after progression of DR. 17 patients were without DR progression and they did not show any significant differences in the measured circulatory parameters on entry compared to the final measurement. CONCLUSION: The authors suggest that the initial changes in the retrobulbar circulation during DR progression occur in the central retinal vein.     

Ocular perfusion pressure and retrobulbar haemodynamics in pseudoexfoliative glaucoma

Background Previous investigations have shown that vascular factors are involved in pseudoexfoliative glaucoma (XFG). The present study aims at comparing ocular perfusion pressure (OPP), diastolic ocular perfusion pressure (dOPP), and retrobulbar haemodynamics in pseudoexfoliative glaucoma and primary open-angle glaucoma (POAG). Methods Forty-seven XFGs, 41 POAGs, and 38 healthy controls were evaluated. OPP and dOPP were calculated. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) were recorded in ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs) by color Doppler imaging (CDI). Correlations between OPP and CDI parameters and between dOPP and CDI parameters were determined. Results OPP and dOPP were significantly lower in XFGs than in POAGs and controls (p < 0.001). CDI investigation revealed decreased EDV of OA, SPCAs, and CRA (p < 0.001) and increased RI of all the three considered vessels in XFGs compared with POAGs and controls (p < 0.001). A negative correlation between OPP and RI of OA and between dOPP and RI of OA was found in XFGs (p = 0.022 and p = 0.015 respectively). Conclusions Ocular perfusion pressure is decreased and retrobulbar haemodynamics are worse in pseudoexfoliative glaucoma patients than in primary open-angle glaucoma patients and healthy controls. An impaired ocular vascular regulation is suggested in pseudoexfoliative glaucoma. The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.     

A 5-year follow-up of photocoagulation in diabetic macular edema: the prognostic value of vascular leakage for visual loss

Aim  To study the long-term visual result of photocoagulation of clinically significant macular edema (CSME) in diabetic patients in relation to baseline retinal vascular leakage assessed by vitreous fluorometry. Methods  The study enrolled 36 eyes in 27 diabetic patients with CSME at baseline, all subsequently treated by photocoagulation. The diagnosis of CSME and treatment procedure followed the ETDRS criteria. The leakage through the retinal vessels was calculated as the blood–retinal barrier permeability. Five years after initial photocoagulation the patients were reexamined. Results  The mean visual acuity decreased with 16 letters at follow-up, and in 15 eyes visual loss was substantial, with a decrease of 15 letters or more, corresponding to at least 3 lines. The baseline permeability was significantly higher in eyes with substantial visual loss than in eyes with more stable vision (14.2 nm/sec and 6.3 nm/sec respectively; p = 0.006), the corresponding odds ratio was 16.1 (95% CI: 1.8–146; p = 0.014). The level of retinopathy was significantly correlated to visual loss (Fisher’s exact test < 0.02). Conclusion  Visual acuity decreased at follow-up, and a substantial visual loss of 3 or more lines in CSME was associated with higher retinal vascular leakage at baseline with an odds ratio of 16.1. For this relatively small sample, neither diabetes duration, age or HbA_1c reached statistical significance, indicating that blood-retinal barrier permability is a strong predictor of the visual outcome. The results support the investigation of triamcinolone or VEGF inhibition in patients with severe leakage, and may help to identify patients in need for intravitreal injection.     

不同剂量川芎嗪治疗非增殖期糖尿病视网膜病变的疗效

目的：探讨不同剂量川芎嗪治疗非增殖期糖尿病视网膜病变(NPDR)的疗效。

方法：前瞻性研究。选取2016-03/2017-03我院治疗的NPDR患者90例,按照随机数字表法将患者分为对照组(DR常规治疗)、常规剂量组(DR常规治疗+川芎嗪120mg)、高剂量组(DR常规治疗+川芎嗪240mg)。比较三组患者血流动力学变化、治疗效果和不良反应发生情况。

结果：三组患者治疗后视网膜中央动脉、睫状后动脉和眼动脉收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)高于治疗前,阻力指数(RI)低于治疗前(P<0.05); 常规剂量组和高剂量组患者治疗后视网膜中央动脉、睫状后动脉和眼动脉的PSV、EDV高于对照组,RI低于对照组(P<0.05); 常规剂量组和高剂量组患者治疗后视网膜中央动脉、睫状后动脉和眼动脉PSV、EDV、RI比较无差异(P>0.05)。对照组、常规剂量组和高剂量组患者的治疗有效率分别为40%、70%、77%,两组间比较有差异(P<0.017)。对照组、常规剂量组和高剂量组患者不良反应发生率分别为17%、23%、27%(P>0.05)。

结论：治疗NPDR时,在常规治疗基础上联合川芎嗪可提高治疗效果,同时改善局部血液循环,并且增加川芎嗪使用量可提高治疗效果,不增加不良反应发生风险,因此,建议使用240mg川芎嗪治疗DR。     

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Background  To determine the efficacy of combined intravitreal triamcinolone (TA) injection and laser photocoagulation in persistent macular edema after branch retinal vein occlusion (BRVO). Methods  Follow-up analysis of a case series of 24 patients with macular edema after BRVO (15 of 24 non-ischaemic, 9 of 24 ischaemic). Patients received an intravitreal injection of 4 mg TA followed by laser photocoagulation within the previously edematous area, applied in one or two sessions. Standardized clinical examinations included best corrected visual acuity testing, anterior and posterior segment biomicroscopy, intraocular pressure, and optical coherence tomography (OCT). Fluorescein angiography was performed before treatment and 3 and 6 months later. Results  Median visual acuity improved significantly from 0.58 logMAR (95%-confidence interval (KI): 0.54 – 0.75, decimal 0.27) at baseline to 0.41 logMAR (KI: 0.37 – 0.64, decimal 0.39) at 1 month (p = 0.001), 0.33 logMAR (KI: 0.32 – 0.62, decimal 0.47) at 3 months (p = 0.002), and 0.41 logMAR (KI: 0.33 – 0.67, decimal 0.39) at 6 months (p = 0.016). A gain of one or more logarithmic lines was evaluated in 16/24 eyes (67 %) and a gain of 3 lines or more in 8/24 eyes (33 %) at 6 months. Three eyes had lost more than 1 line during the follow-up period. Median change of visual acuity at 6 months was +2.0 lines (KI: 0.2 – 2.4). Median central foveal thickness (OCT-CFT) was 423 μm (KI: 378 – 456, n = 24) at baseline and decreased to 270 μm (KI: 249 – 311, n = 24) at 1 month (p < 0.0001), 265 μm (KI: 254 – 344, n = 24) at 3 months (p < 0.0001), and 266 μm (KI: 259 – 365, n = 18) at 6 months (p = 0.001). Conclusions  Macular edema after BRVO can effectively be treated by a combination of intravitreal TA injection and subsequent laser photocoagulation. During a 6-month follow-up this combination treatment resulted in a significant reduction of central foveal thickness and improvement of visual acuity.     

Asymmetric visual field loss and retrobulbar haemodynamics in primary open-angle glaucoma

Purpose To investigate interocular differences in retrobulbar flow velocities in patients with asymmetric glaucomatous visual field loss.Methods Twenty-five patients with primary open-angle glaucoma (POAG) and asymmetric visual field loss were included in this study. Asymmetric visual field loss was defined as a difference of the global index mean deviation (MD) >6 dB between the two eyes. Flow velocities (peak systolic velocity PSV and end-diastolic velocity EDV) and resistive indices (RI) of the ophthalmic artery (OA), central retinal artery (CRA), and nasal and temporal posterior ciliary arteries were measured by means of colour Doppler imaging.Results MD of eyes with more severe glaucomatous visual field loss was −18.3±7.8 dB vs −6.8±5.5 dB (p<0.0001) in the less affected eyes. The PSV and the EDV of the CRA and the PSV of the OA were significantly decreased in eyes with more severe glaucomatous visual field loss (CRA PSV: 7.6±2.0 cm/s vs 8.3±1.7 cm/s, p=0.04; CRA EDV: 2.24±0.5 cm/s vs 2.55±0.6 cm/s, p<0.007; OA PSV: 29.7±9.9 cm/s vs 32.7±11.5 cm/s, p<0.02). None of the other differences in velocity or resistive index were significant.Conclusions Patients with asymmetric glaucomatous visual field loss exhibit asymmetric flow velocities of the CRA and OA. Patients with more severe damage display reduced flow velocities in retrobulbar vessels in POAG.     

Effect of epigallocatechin-gallate on inner retinal function in ocular hypertension and glaucoma: A short-term study by pattern electroretinogram

Background  Epigallocatechin-gallate (EGCG) is a powerful antioxidant with suggested neuroprotective action. The aim of this study was to evaluate the effect of short-term supplementation of EGCG on inner retinal function in ocular hypertension (OHT) and open-angle glaucoma (OAG). Methods  Eighteen OHT and 18 OAG patients (perimetric mean deviation: >−10 dB) were randomly assigned to assume oral placebo or EGCG over a 3-month period in a randomized, placebo-controlled, double-blind, cross-over design clinical trial (clinicaltrials.gov identifier: NCT00476138). Pattern-evoked electroretinograms (PERGs) to 1.6 cycles/degree square-wave gratings, counterphased at 16 reversals/second, and standard automated perimetry (Humphrey 30–2) were assessed at the study entry (baseline), and after 3 months of placebo or EGCG. Results  After EGCG, PERGs of OAG, but not OHT patients were increased in amplitude, compared either to baseline values (mean amplitude change: 0.06 log μV, p < 0.05) or to PERG amplitude values found in the same patients after placebo administration (mean change: −0.02 log μV, p not significant; difference between EGCG and placebo: 0.08 log μV, p < 0.05). In both OHT and OAG patients, standard automated perimetry did not show significant changes after either EGCG or placebo. In individual OAG patients, the magnitude of PERG amplitude increment after EGCG was inversely related (r = −0.8, p < 0.01) to corresponding baseline amplitudes. Conclusions  Although this study cannot provide evidence for long-term benefit of EGCG supplementation in OAG, and the observed effect is small, the results suggest that EGCG might favourably influence inner retinal function in eyes with early to moderately advanced glaucomatous damage. Drs Falsini and Marangoni contributed equally to this article     

Global flash multifocal electroretinogram: early detection of local functional changes and its correlations with optical coherence tomography and visual field tests in diabetic eyes

Purpose To investigate the correlations of the global flash multifocal electroretinogram (MOFO mfERG) with common clinical visual assessments—Humphrey perimetry and Stratus circumpapillary retinal nerve fiber layer (RNFL) thickness measurement in type II diabetic patients. Methods Forty-two diabetic patients participated in the study: Ten were free from diabetic retinopathy (DR), while the remainder suffered from mild to moderate nonproliferative diabetic retinopathy. Fourteen age-matched controls were recruited for comparison. MOFO mfERG measurements were made under high- and low-contrast conditions. Humphrey central 30-2 perimetry and Stratus OCT circumpapillary RNFL thickness measurements were also performed. Correlations between local values of implicit time and amplitude of the mfERG components [direct component (DC) and induced component (IC)], and perimetric sensitivity and RNFL thickness were evaluated by mapping the localized responses for the three subject groups. Results MOFO mfERG was superior to perimetry and RNFL assessments in showing differences between the diabetic groups (with and without DR) and the controls. All the MOFO mfERG amplitudes (except IC amplitude at high contrast) correlated better with perimetry findings (Pearson’s r ranged from 0.23 to 0.36, p < 0.01) than did the mfERG implicit time at both high and low contrasts across all subject groups. No consistent correlation was found between the mfERG and RNFL assessments for any group or contrast conditions. The responses of the local MOFO mfERG correlated with local perimetric sensitivity but not with RNFL thickness. Conclusion Early functional changes in the diabetic retina seem to occur before morphological changes in the RNFL.     

Ophthalmodynamometry and ischemic ophthalmopathy

Background To report on the clinical application of a modified ophthalmodynamometer for the detection of ischemic ophthalmopathy. Methods A 70-year-old patient showed unilateral loss of vision to 1/20, thin retinal arteries, tiny intraretinal hemorrhages, and iris neovascularization. We performed a modified ophthalmodynamometry using a Goldmann contact lens in the holding grip of which a pressure sensor was incorporated. Results Ophthalmodynamometry showed that the diastolic central retinal artery pressure was significantly (p < 0.001) lower in the affected eye than in the contralateral eye (14.6 ± 2.2 arbitrary units versus 45.5 ± 5.1 arbitrary units). These ophthalmodynamometric measurements of both eyes were significantly (p < 0.05) lower than in a control group (73.8  ± 6.2 arbitrary units) consisting of 149 normal eyes. Doppler sonography eventually revealed a marked stenosis of the right internal carotid artery, consistent with the diagnosis of a unilateral ischemic ophthalmopathy. Conclusions Ophthalmodynamometry is a helpful additional tool in the assessment of the oculo-afferent and cerebroafferent vessels in patients with symptomatic ocular ischemia.     

Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS)

Background Sleep-related disorders are among the important risk factors for neurovascular diseases. Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, excessive daytime sleepiness, and insomnia. Our aim was to investigate the presence of glaucoma in patients with OSAS and to reveal vascular pathology related to the pathogenesis of glaucoma in those patients. Patients and methods The study included 31 patients with OSAS and 25 control subjects. Orbital Doppler ultrasonography was used to determine the resistivity index (RI) in the ophthalmic artery and central retinal artery. All patients and controls underwent perimetric examination. Results The prevalence of glaucoma in the group of patients with OSAS was 12.9% (4/31); all of these 4 patients with glaucoma were in the “severe” OSAS group. No statistically significant difference was found between ophthalmic artery resistivity index (OARI), central retinal artery resistivity index (CRARI), and intraocular pressure (IOP) between patients and controls (p > 0.05). There was a positive correlation between OARI and mean defect (MD), CRARI and MD, and CRARI and loss variance (LV) values (p < 0.05). There was also a positive correlation between IOP and the apnea-hypopnea index (AHI) (p = 0.001). Conclusions In patients with OSAS, a high prevalence was found and it is interesting to note that all of the four glaucoma patients were in the severe OSAS group. The positive correlation observed between IOP and AHI suggests that increased IOP values may reflect the severity of OSAS. The positive correlation between OARI and MD and also between CRARI and MD as well as LV suggests that visual field defects may be due to optic nerve perfusion defects and these field defects also increase as the RI increases.     

Diabetic patients with retinopathy show increased retinal venous oxygen saturation

Background  Longstanding diabetes mellitus results in a disturbed microcirculation. A new imaging oximeter was used to investigate the effect of this disturbance on retinal vessel oxygen saturation. Methods  The haemoglobin oxygen saturation was measured in the retinal arterioles and venules of 41 diabetic patients (65 ± 12.3 years) with mild non-proliferative through proliferative diabetic retinopathy (DR). Twelve individuals (61.3 ± 6.2 years, mean ± standard deviation) without systemic or ocular disease were investigated as controls. Measurements were taken by an imaging oximeter (oxygen module by Imedos GmbH, Jena). This technique is based on the proportionality of the oxygen saturation and ratio of the optical density of the vessel at two wavelengths (548 nm and 610 nm). Results  Whereas there were no significant differences in the arterial oxygen saturation between controls and diabetic retinopathy at any stage, the venous oxygen saturation increased in diabetic patients with the severity of the retinopathy: controls 63 ± 5%, mild non-proliferative DR 69 ± 7%, moderate non-proliferative DR 70 ± 5%, severe non-proliferative DR, 75 ± 5%, and proliferative DR 75 ± 8%. Conclusions  The increase of retinal vessel oxygen saturation in diabetic retinopathy points to a diabetic microvascular alteration. This may be due to occlusions and obliterations in the capillary bead and the formation of arterio-venous shunt vessels. On the other hand, hyperglycaemia-induced endothelial dysfunction, with subsequent suppression of the endothelial NO-synthase and disturbance of the vascular auto-regulation, may contribute to retinal tissue hypoxia. Walthard Vilser and Thomas Riemer have proprietary interests in the Vessel Map software. All primary data are under full control of the authors.     

Assessment of selected adhesion molecule and proinflammatory cytokine levels in the vitreous body of patients with type 2 diabetes — role of the inflammatory–immune process in the pathogenesis of proliferative diabetic retinopathy

Background  The aim of the study is to demonstrate the participation of the inflammatory-immune process in the pathogenesis of proliferative diabetic retinopathy (PDR). Methods  Twenty four women and 22 men with type 2 diabetes (mean age 63.97 ± 9.00 years, mean duration of diabetes 12.56 ± 6.87 years) were enrolled in the study. Serum concentrations of soluble forms of ICAM-1, VCAM-1 as well as IL-6 and TNF-α were evaluated in all study subjects. In 19 patients, simultaneous assessment of selected parameter levels in both serum and vitreous samples was performed. Vitrectomy was performed due to intravitreal hemorrhage, accompanied in some patients by traction retinal detachment. The control group consisted of 15 patients having undergone vitrectomy for reasons other than PDR. Tests were performed using the ELISA method. Results  Serum and intraocular concentrations of sICAM-1, sVCAM-1, IL-6, TNF-α were considerably higher in study subjects with PDR than in controls. Simultaneously, a positive correlation was found between intraocular sVCAM-1 (r = 0.590, p = 0.007), TNF-α (r = 0.822, p < 0.001) concentrations and HbA₁c levels. The above-mentioned dependence was not shown for sICAM-1 and IL-6 vitreous concentration. Local vitreous VCAM-1 level increase was also dependent on vitreous TNF-α concentration growth (r = 0.470, p = 0.043). No significant correlation was found between serum and vitreous levels of the selected parameters in the group of 19 patients with PDR. Conclusions  Increase in sICAM-1 and sVCAM-1 levels, as well as their correlation with high vitreous IL-6 and TNF-α concentrations in patients with PDR, seem to confirm the inflammatory–immune nature of this process. In diabetes, inadequate metabolic control remains an important risk factor in the development of PDR. We disclose commercial or similar relationships to products or companies mentioned in or related to the subject matter of the article being submitted. We have full control of all primary data and we agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review our data if requested.     

Diabetic retinopathy and health-related quality of life

Objective  To describe the impact of co-morbidities, visual acuity, diabetic retinopathy (DR) grade, and macular edema (ME) on the health-related quality of life (HRQOL) among patients with diabetic retinopathy. Methods  Analysis of data of 207 patients with diabetic retinopathy from Germany in 2003. HRQOL assessment was done using the generic (SF-12) questionnaire. It was hypothesized that exogenous variables (co-morbidities, visual acuity impairment, DR, and ME) would have an impact on HRQOL. Using a structural equation modelling procedure, the effects of exogenous variables on endogenous variables physical component summaries (PSC) and mental component summaries (MCS) reflecting HRQOL were tested. Results  The number of co-morbidities had a negative effect on visual acuity (b = −0.26, standardized) and a similar negative effect on PCS (b = −0.27). DR grade had a negative effect on visual acuity (b = −0.19) and a positive effect on the variable ME (b = 0.44). ME displayed a negative effect on visual acuity (b = −0.58) and also on MCS (b = −0.29). Visual acuity had a positive effect (b = 0.48) on PCS. Conclusions  Presence of DR and ME, visual acuity impairment and patient co-morbidities lead to significant impairment of both the physical and mental components of HRQOL.     

2型糖尿病视网膜病变眼部血管血流动力学超声检测及其发生发展相关因素分析

目的：利用彩色多普勒超声检测2型糖尿病视网膜病变(diabetic retinopathy,DR)患者的滑车上动脉(supratrochlear artery,STCA)与球后相关动脉的血流动力学变化,并分析影响2型糖尿病DR发生发展的因素,以为糖尿病患者早期发现DR发病趋势、预防DR发生、采取有效干预措施阻止DR进展提供依据。

方法：选取2型糖尿病患者106例106眼,区分为糖尿病视网膜病变组(DR组)56例56眼右眼、糖尿病无视网膜病变组(NDR组)50例50眼右眼,选取同期于我院门诊体检的健康志愿者40例40眼右眼作为对照组(HC组); 彩色多普勒超声检测所有研究对象的STCA、视网膜中央动脉(central retinal artery,CRA)、睫状后动脉(posterior ciliary artery,PCA)的血流动力学变化,观察糖尿病患者血流频谱形态与血流动力学参数收缩期峰值血流速(peak systolic blood flow velocity,PSV)、舒张末期血流速度(end diastolic blood flow velocity,EDV)与血管阻力指数(vascular resistance index,RI)的改变情况; 检测所有研究对象空腹血糖(fasting blood glucose,FBG)、血清总胆固醇(total cholesterol,TC)、甘油三酯(Triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C); 记录DR组与NDR组的糖尿病病程、体重指数(body mass index,BMI)、既往病史(高血压、糖尿病、高血脂等)、家族遗传病史、吸烟饮酒史,对相关因素做非条件Logistic多因素回归分析。

结果：在血流频谱形态方面,DR组与NDR组均发生了较明显的频谱形态改变; 在血流动力学参数方面,STCA、CRA、PCA的PSV、EDV在CH组、NDR组、DR组依次下降,RI依次上升; NDR组、DR组眼部动脉各血流参数值与HC组相比差异均有统计学意义(P<0.05),DR组STCA、CRA、PCA的PSV、EDV、RI与NDR组相比较,差异有统计学意义(P<0.05); 在DR发生发展相关因素方面,DR组与NDR组相比较,糖尿病病程、高血压病史与高血脂病史例数、舒张压、FBG、TG、LDL-C的差异有统计学意义(P<0.05)。

结论：对于糖尿病患者,超声检测血流动力学可作为早期预防DR、早期发现DR的主要手段,视网膜发生明显病变之前眼部血管血流动力学即可发生异常改变,且其改变程度与视网膜病变程度呈正相关,DR的发生发展与血糖、血压、血脂水平以及糖尿病病程等相关因素有密切关系。     

Correlation between capillary blood flow of retina estimated by SLDF and circulatory parameters of retrobulbar blood vessels estimated by CDI in diabetic patients

Background The aim of this study was to investigate the correlation between the recordings of scanning laser Doppler flowmetry (SLDF) of the retina and the recordings of color Doppler imaging (CDI) of the retrobulbar circulatory parameters in diabetic patients without diabetic retinopathy.Methods Twenty-three diabetic patients without diabetic retinopathy were evaluated using SLDF for the apparent retinal circulation and using CDI for the apparent retrobulbar circulation in the central retinal artery, the central retinal vein and the short posterior ciliary artery. The circulatory parameters estimated in the retinal tissue using SLDF were velocity, volume and flow. The Circulatory parameters that were recorded using the CDI method were peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), pulsatility (PI) and resistivity index (RI). We obtained the correlation coefficients between parameters of SLDF and CDI. Multiple regression analysis was performed with flow parameter of SLDF recordings as a dependent variable and all estimated CDI parameters as independent variables. Multiple linear regression was also performed, including the flow parameter of SLDF recordings as a dependent variable and PI of the CDI parameters of all the measured blood vessels as independent variables.Results The velocity parameter of SLDF was significantly correlated with the PI in the central retinal artery (P=0.02), PI and RI in the central retinal vein (P=0.01; P=0.01) and the PSV, MV, PI and RI in the short posterior ciliary artery, as recorded by CDI (P=0.003; P=0.02; P=0.002; P=0.01). The volume parameter of SLDF was significantly correlated with the PI and RI in the central retinal vein (P=0.03; P=0.03) and the PSV in the short posterior ciliary artery (P=0.03), as recorded by CDI. The flow parameter of SLDF was significantly correlated with the PI and RI in the central retinal vein (P=0.01; P=0.01) and the PSV, MV, PI and RI in the short posterior ciliary artery (P=0.003; P=0.03; P=0.002; P=0.01) as measured by CDI. The multiple regression analysis was statistically non-significant (P=0.86). The multiple linear regression analysis indicated that from among the PI of the evaluated blood vessels, the PI of the short posterior ciliary artery was the most significant predictor of the flow parameter of SLDF (P=0.01).Conclusion This study suggests a positive correlation between the recordings of SLDF of the retinal tissue and the retrobulbar circulatory parameters of the CDI in diabetic patients without diabetic retinopathy.     

彩色多普勒超声对糖尿病眼球后血管血流动力学的研究

目的：探讨彩色多普勒超声对糖尿病眼球后血管血流动力学改变的作用。

方法：选取2010-06/2013-05我院收治的2型糖尿病眼病患者80例160眼作为研究组,通过眼底照相和直接检眼镜检查将研究组分为糖尿病无视网膜病变组(DNR组)、糖尿病视网膜病变非增殖期组(NPDR组)、糖尿病视网膜病变增殖期组(PDR组),选取同期眼部正常者60例120眼作为对照组,通过彩色多普勒超声对各组间视网膜中央动脉(CRA)、睫状后动脉(PCA)及眼动脉(OA)的多普勒血流参数指标进行分析。

结果：研究组与对照组在CRA、PCA和OA的血流参数上存在显著差异(P<0.05); DNR组、NPDR组和PDR组在CRA、PCA和OA的收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)与对照组存在显著差异(P<0.05),且PDR组与DNR组、NPDR组也存在显著差异(P<0.05)。

结论：通过彩色多普勒超声动态监测视网膜血流状态并对血流频谱形态进行分析,根据血流变化可以对DR病变程度进行判定,从而为治疗和预后提供参考价值。     

Uveal and capsular biocompatibility of two foldable acrylic intraocular lenses in patients with endogenous uveitis — a prospective randomized study

Background  To compare a hydrophobic and a hydrophilic acrylic single-piece intraocular lens (IOL) in uveitis patients with respect to biocompatibility and visual outcome. Methods  Prospective, randomized study in patients with noninfectious uveitis after phacoemulsification and implantation of either a hydrophobic AcrySof™ (group 1, n = 30) or a hydrophilic Akreos adapt™ (group 2, n = 30), sharp-edged acrylic IOL. The primary outcome was uveal biocompatibility, detected by giant-cell deposition, anterior chamber cell count and laserflare photometry over a 6-month follow-up period. Secondary outcome measures were capsular biocompatibility, as detected by posterior capsule opacification (PCO), lens epithelial cell outgrowth and Nd:YAG capsulotomies, and visual outcome. Results  The groups did not differ with respect to anatomic type of uveitis, immunosuppressive treatment, associated systemic disease, and intraoperative manipulation. The number of giant cells on the anterior IOL surface was higher in group 1 than in group 2 (p = 0.03). The number of anterior chamber cells, laser flare photometry levels, and uveitis reactivations after surgery did not differ between the groups. After 6 months, the number of patients with PCO development (p = 1.0) and Nd:YAG capsulotomies (p = 0.21), lens epithelial cell outgrowth, visual outcome and uveitis complications were comparable in both groups. Conclusions  Both of the acrylic IOLs used had good uveal and capsular biocompatibility, leading to significant improvement in BCVA in patients with noninfectious uveitis. No obvious differences were detected at 6 months with respect to uveal and capsular biocompatibility and visual outcome. The authors have no financial interest in any of the materials used in this study.     

Efficacy and safety of latanoprost in eyes with uveitic glaucoma

Background  To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis. Methods  Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment. Results  Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p = 0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p = 0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 ± 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 ±0.7 for these patients (p = 0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 ± 8.4 mmHg to 18.6 ± 5.3 mmHg (p < 0.001) in the latanoprost group and from 28.2 ±8.1 mmHg to 22.6 ±10.1 mmHg (p < 0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema. Conclusion  Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma. The authors have no proprietary interest in any aspect of this study.     

One-year results of combined photodynamic therapy and intravitreal bevacizumab injection for retinal pigment epithelial detachment secondary to age-related macular degeneration

Background  To evaluate the efficacy of combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in eyes with a serous pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD). Methods  Twenty-two eyes with a serous PED exceeding two disc areas associated with AMD with choroidal vascular abnormalities [choroidal neovascularization (n = 10), polypoidal choroidal vasculopathy (n = 9), and retinal angiomatous proliferation (n = 3)] received combined PDT and intravitreal bevacizumab, and were followed about every 6 weeks for more than 1 year. Additional treatments were given for residual or recurrent lesions. The main outcome measures were changes in the PED height measured by optical coherence tomography, and the best-corrected visual acuity. Results  After one treatment, the PED resolved in 12 eyes (55%) and the PED decreased in ten eyes (45%). There was no recurrence in eight (36%) eyes; however, PED recurred in 14 eyes. At 1 year, the average PED height decreased to 413 microns from the baseline 751 microns (p < 0.001). Twenty eyes (91%) had improved or stabilized vision; two eyes had decreased vision due to a retinal pigment epithelial tear and subretinal hemorrhage. Conclusions  Combined PDT and intravitreal bevacizumab may decrease the PED height and stabilize visual acuity at 1 year. The authors have no proprietary and financial interest in any aspect of this report.