PURPOSE:To verify existance of a-,~-,and 3'-protein kinase C(PKC)subspecies and
their localization in rabbit retina. METHODS: Using an immunohistoehemical technique with mono-
elonal antibodies against PKC isozymes- I (a),-I[ (13),and -~[ (Y) to characterize the distribution of
PKC in rabbit retina. RESULTS:There is a positive immunostaining for a-,13-,and ~-PKC in rabbit
retina. The immunoreactivity of a-PKC was observed mainly in the bipolar cells of inner nuclear layer
and the outer segments of photorecptors. The positive immunostaining of 13-PKC could be seen in the
ganglion cells,inner plexiform layer,inner nuclear layer,and the outer segments of photoreceptors. A
diffuse and weak staining of Y-PKC is recognized in the ganglion cell layer,inner plexifrom layer,inner
nuclear layer, and the outer segments of photoreceptors. CONCLUSION:The protein kinase C sub-
speeies-a,-~,and-'Y are present in retina which is a part of the central nervous system
ObjectiveTo systematically review the efficacy and safety of photodynamic therapy (PDT) and intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV), and to investigate the primary treatment tentatively.
MethodsA systematic search of Pubmed, Embase, the Cochrane Library and the Wanfang Data was performed to identify all comparative studies that compared the outcomes of PDT alone, intravitreal VEGF inhibitors alone and combined intravitreal VEGF inhibitors and photodynamic therapy. Outcomes of interest included the regression and recurrence rate of polypoidal lesions, best corrected visual acuity (BCVA), central retinal thickness (CRT), therapeutic times, and the occurrence rate of adverse events. 2 randomized controlled trials (RCT) and 19 non-RTCs were identified. According to treatment methods, the data extracted was classified to 3 groups, analyzed with odds ratio (OR), weighted mean difference (WMD) and 95%confidence interval (95%CI).
ResultsMeta-analysis suggests that the regression rate of polypoidal lesions (OR=0.34, 0.07; 95%CI=0.13-0.88, 0.02-0.36) and BCVA (WMD=0.25, 0.11; 95%CI=0.14-0.36, 0.01-0.21) in combined therapy group were significantly better than those in PDT group and intravitreal VEGF inhibitors group (P < 0.05). The recurrence rate of polypoidal lesions in PDT group was significantly lower than intravitreal VEGF inhibitors group (OR=0.35, 95%CI=0.16-0.74, P=0.006). BCVA (P=0.025) and the occurrence rate of adverse events (OR=60.36, 95%CI=6.04-603.50, P=0.000 5) in intravitreal VEGF inhibitors group were significant better than PDT group.
ConclusionsCombined treatment appeared to be superior to PDT alone or intravitreal VEGF inhibitors alone. Combined treatment takes priority over all others in the primary treatment of PCV.
Objective To observe the inhibitory effect of Bevacizumab on retinal neovascularization in oxygen-induced retinopathy in the mouse. Methods 90 one-week-old C57B L/6J mice were divided into four groups at random. 15 mice in the 1st group as normal control group, 15 mice in the 2nd group as oxygen control group, 30 mice in the 3rd group as high-dose Bevacizumab treatment group, 30 mice in the 4th group as low-dose Bevacizumab treatment group. The 2nd, 3rd and 4th groups were exposed to 75% oxygen for 5 days and then to room air. At the 12th day, One eye of each mouse of two control groups were received an intravitreal injection with Be vacizumab at 2 mu;l、1 mu;l respectively, and the same volume of BSS was injected into the other eye of the mice. The adenosine diphosphatase (ADPase) histochemical technique was used for retinal flat mount to assess the oxygen-induced change s of retinal vessels. The number of the endothelium cell nuclei of proliferative neovascularization was quantified by retinal microtome chromoscopy. Real-time PCR analysis was performed to examine the expression of VEGF mRNA. Results Comparing with oxygen control group, regular distributions, reduced density of retina l vascular and reduced endothelium cell nuclei which extending retinal membrane were observed in the treatment groups(P＜0.001). But the differences between two treatment groups are not statistically significant (P＞0.05). The expression of VEGF mRNA was not significantly different in oxygen control group whatever it whether accepted Bevacizumab treatment or high or low dose (P＞0.05). Conclusion Intravitreal injection with Bevacizumab can effectively inhibits the retinal neova scularization in oxygen-induced retinopathy in the mouse. Intravitreal injection with Bevacizumab might become to the new method to treat retinopathy of premature. （Chin J Ocul Fundus Dis，2008，24：184-188）
ObjectiveTo observe the clinical efficiency of intravitreal Conbercept on exudative age-related macular degeneration (eAMD).
MethodsThis is an open and prospective study without control trial. Twenty eyes from 20 patients (19 males and 1 female) with eAMD diagnosed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were enrolled in this study. Before the injection, best-corrected visual acuity (BCVA) of early treatment of diabetic retinopathy study (ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, fundus fluorescein angiograph (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were examined. The initial average letters of ETDRS acuity were 41.20±22.61, range from 8 to 80. The initial average central retina thickness (CRT) was (345.25±131.96) μm, range from 152 to 770 μm.All affected eyes were treated with intravitreal conbercept 0.05 ml (10 mg/ml). The patients were followed up for 6 to 9 months, with the mean time of (7.35±0.99) months.The BCVA, CRT after treatment were compared with baseline using paired t-test.
ResultsDuring the 1, 3, 6, 12 months after treatment and the latest follow up, the mean BCVA were all improved with statistically significant difference (t=5.85, 7.09, 7.44, 7.25; P < 0.05). At 1 month ater treatment, the mean BCVA was obviously improved in 6 eyes (30%), improved in 8 eyes (40%), stable in 6 eyes (30%). At latest follow up, the mean BCVA was obviously improved in 6 eyes (30%), improved in 9 eyes (45%), stable in 5 eyes (25%). During the 1, 3, 6, 12 months after treatment and the latest follow up, the mean CRT were all decreased with statistically significant difference (t=3.34, 3.78, 3.47, 3.44; P < 0.05). At latest follow up, the leakage in macula lutea disappeared in 6 eyes (30%), decreased in 11 eyes (55%) and increased in 3 eyes (15%). No adverse events such as secondary retinal detachment or endoophthalmitis were found during the follow-up duration.
ConclusionIntravitreal conbercept is a safe and effective approach for eAMD, may improve visual acuity, exudation and macular edema.
ObjectiveTo observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV).
MethodsEighty-six eyes of 79 patients with PCV were enrolled in this study. There were 60 males (65 eyes) and 19 females (21 eyes). The average age was (64.48±13.15) years old. Best corrected visual acuity (BCVA), slit lamp ophthalmoscopy, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured. The average BCVA was 0.19±0..20. There were three groups in this study including photodynamic therapy (PDT) group (group A, 45 eyes), PDT and intravitreal ranibizumab injection group (group B, 31 eyes), and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C, 10 eyes). Follow up begun at 1 month after the treatment. 40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months. 9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months. Patients with recurrent or worsen lesions were followed by FFA or ICGA. Pre- and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed.
ResultsAll eyes (100.0%) in group A, 20 eyes (64.52%) in group B and 9 eyes (90.00%) in group C received treatment only once. The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061, 3.262, 3.258; P<0.05), but no significant difference was found between the 3 groups (t=1.345, 0.683, 0.168; P>0.05). Compared to pre-treatment measures, the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239, 4.334; P<0.05), but not changed in group C (t=2.286, P>0.05) at 1 month after treatment. Thirteen eyes in group A were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED), 4 eyes with partial closed PCV, 3 eyes with stable PCV and 3 eyes with worsen PCV. Ten eyes in group B were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV, 3 eyes with partial closed PCV, 4 eyes with recurrence PCV. Five eyes in group C were followed by FFA and (or) ICGA, which showed that there were 4 eyes with complete closed PCV, 1 eyes with recurrence PCV.
ConclusionAll 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree.
Objective To observe the visual acuity change in patients with different patterns of optical coherence tomography (OCT) of diabetic macular edema (DME) after intravitreal ranibizumab injection and/or laser photocoagulation. Methods A retrospective observational case series. Seventy patients (99 eyes) with DME were enrolled. Best-corrected visual acuity (BCVA) was evaluated using the international vision test chart, and then convert the result to the logarithm of the minimum angle of resolution (logMAR). According to the morphological characteristics of OCT, the DME was divided into 3 patterns, including diffuse macular edema (DRT), cystoid macular edema (CME) and serous neuroepithelial layer detachment. The average follow-up was (80.43±74.89) days. The patients were divided into 3 groups according to the different treatments, including intravitreal ranibizumab injection group (group A, 21 patients, 25 eyes), intravitreal ranibizumab injection and laser photocoagulation group (group B, 23 patients, 26 eyes), laser photocoagulation group (group C, 26 patients, 48 eyes). The changes of absolute BCVA (ABCVA) and improved visual acuity were compared between different treatment groups and different OCT patterns. ABCVA = logMAR BCVA before treatment－logMAR BCVA after treatment. Improvement more than 0.3 of logMAR value was considered as improved visual acuity. Results There was no significant difference in ABCVA between different treatment groups (F=0.050,P＞0.05). The improved visual acuity in group A and B were great than group C (χ2=5.645, 6.301;P＜0.05). In group A, B and C, there was no significant difference in ABCVA and improved visual acuity between different OCT patterns (P＞0.05). Improved visual acuity of DRT and CME eyes were higher in group A&B (70.59% and 50.00%) than in group C (26.47% and 14.29%), the difference was statistically significant (χ2=5.075, 4.453;P＜0.05). Conclusions There is no obvious change of visual acuity in patients with different OCT patterns of DME after the same treatment by intravitreal ranibizumab injection and/or laser photocoagulation. The improved visual acuity is not consistent in same OCT patterns after different treatment.
Objective
To compare the features of OCT angiography (OCTA) between neovascular age-related macular degeneration (nAMD) and myopic choroidal neovascularization (mCNV) patients before and after intravitreal anti-VEGF treatment.
Methods
A prospective cohort study. Twenty-nine patients (37 eyes) with nAMD (19 males and 10 females, aged 68.20±8.76) and 31 patients (34 eyes) with mCNV (9 males and 22 females, aged 43.10±11.80, with the mean diopter of ?9.71±1.20 D) from Department of Ophthalmology, West China Hospital of Sichuan University during May and December 2017 were included in this study. Ranibizumab or Conbercept (0.5 mg/0.05 ml) was intravitreally injected in all eyes. The patients were follow-up for 3?6 months. The OCTA was conducted before treatment and 1 day, 1 week, 1 month and 3?6 months after treatment. In order to ensure that the scanning position was the same, the tracking mode was adopted for each scanning. According to the OCTA images, the lesion area, parafoveal superficial vessel density and perfusion area were measured and analyzed contrastively between nAMD and mCNV patients.
Results
The mean lesion area before and 1 month after treatment in nAMD patients were 0.38±1.87 mm2 and 0.06±0.12 mm2, while in mCNV patients, those were 0.26±1.06 mm2 and 0.03±0.05 mm2, respectively. There were statistically significant differences (Z=4.181, 4.475; P＜0.001) in CNV lesion area before and 1 month after treatment between nAMD and mCNV patients. Compared with those before treatment, the absolute change (Z=1.853, P=0.064) and the percentage changes (t=2.685, P=0.010) of CNV lesion area 1 month after treatment in nAMD and mCNV patients show a statistical meaning. There were significantly decreases in both parafoveal superficial vessel density (F=8.997, P=0.003) and perfusion area (F=7.887, P=0.015) 3 months after treatment in nAMD patients, while decreases in parafoveal superficial vessel density (F=11.142, P=0.004) and perfusion area (F=7.662, P=0.013) could be detected 1 day after treatment in mCNV patients, before rising 1 month after treatment.
Conclusions
There are significantly differences in lesion area before and after the treatment of intravitreal anti-VEGF between nAMD and mCNV patients by OCTA examination. Moreover, the changes of both parafoveal superficial vessel density and perfusion area after anti-VEGF treatment are statistically different in two groups.
Objective To observe the baseline characteristics and visual outcomes after two years follow-up of exudative age-related macular degeneration (AMD) patients treated with ranibizumb. Methods Forty-four eyes of 44 patients with exudative AMD were enrolled into this retrospective study, 19 were men and 25 were women. The mean age was 78 years (range 64 – 92 years). All patients were underwent best corrected visual acuity (BCVA, Early Treatment of Diabetic Retinopathy Study), fundus color photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). The mean BCVA was (50.36±14.43) letters, the mean central foveal thickness (CFT) was (291.95±82.19) μm, and the fluorescence leakage area of choroidal neovascularization (CNV) was (7.61±5.84) mm2. All patients received three initial intravitreous injection of ranibizumb (IVR) and were retreated with monthly IVR when needed. The mean follow up time was 25.6 months (range 24 – 29 months). On 1, 2, 3, 6, 12, 18 and 24 months after treatment, BCVA and OCT were repeated. On 3, 6, 12, 18 and 24 months after treatment, FFA and ICGA were repeated. The change of BCVA, CFT and fluorescence leakage area of CNV were observed. The association of baseline characteristics and two year visual outcomes were analyzed. Results On 1, 2, 3, 6, 12, 18 and 24 months after treatment, the BCVA were improved significantly (t= ?1.89, ?3.51, ?4.61, ?4.04, ?5.77, ?4.69;P＜0.05), the CFT were decreased significantly (t=1.51, 2.30, 3.40, 3.28, 3.54, 3.88, 3.73;P＜0.05). On 3, 6, 12, 18 and 24 months after treatment, the fluorescence leakage area of CNV were reduced significantly (t=2.12, 2.90, 3.51, 4.12, 4.06;P＜0.05). The lower baseline BCVA, the more improved after treatment. The BCVA improvement degree has a negative relationship with baseline BCVA and fluorescence leakage area of CNV (r=0.505, ?0.550;P＜0.05), but no correlation with baseline CFT (r=0.210,P＞0.05). Conclusion Two year visual outcomes of exudative AMD patients treated with ranibizumb is negative correlated with baseline BCVA and fluorescence leakage area of CNV, but not correlated with baseline CFT.
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.
For choroidal neovascularization (CNV) secondary to pathological myopia, intravitreal injection of anti-VEGF has been widely used in clinic and achieved good outcome. However, due to the differences in the demographic characteristics, stages of disease progression and treatment procedure of CNV, the prognosis of the disease is variable. Complete ellipsoid band, smaller baseline choroidal neovascularization and better baseline vision are important predictors of good outcome of anti-vascular endothelial growth factor treatment. Chorioretinal atrophy or complications related to pathologic myopia indicate a poor prognosis. The influence of age, race, previous photodynamic therapy and early treatment on the prognosis of treatment need to be further studied.
