Objective To observe the multimodal imaging features and explore the treatment of parafoveal exudative vascular anomaly complex (PEVAC). Methods A retrospective study. Six patients (6 eyes) with PEVAC diagnosed in Tianjin Eye Hospital were included in this study from July 2018 to December 2021. All patients were female with monocular disease. The age was (61.1±9.3) years. All patients showed a sudden painless decline in monocular vision with metamorphopsia. All patients underwent best corrected visual acuity (BCVA), color fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). Indocyanine green angiography (ICGA) was performed in 4 eyes. In 6 eyes, 3 eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drug; 5 eyes were treated with micropulse laser photocoagulation and/or local thermal laser photocoagulation; 1 eye was treated with photodynamic therapy. Five patients were followed up for (9.2±7.4) months, and 1 patient was lost. At follow-up, the same equipment and methods were used as at the initial diagnosis. The clinical manifestations, multimodal image features and treatment response were observed. Results Baseline BCVA of affected eyes were ranged from 0.1 to 0.5. PEVAC was isolated in 6 eyes, and the fundus showed isolated hemangioma-like leision, accompanied by small bleeding and hard exudation. There were 2 isolated hemangiomatous lesions adjacent to each other in 2 eyes. In the early stage of FFA, punctate high fluorescence lesions near the macular fovea were seen, and the leakage was enhanced in the late stage. There was no leakage in the early stage of ICGA, or slight leakage with late scouring. OCT showed an oval lesion with high reflection wall and uneven low reflection. The central macular thickness (CMT) was (431±76) μm. OCTA showed blood flow signals in PEVAC, 2 eyes in the superficial capillary plexus (SCP), and it was also observed in the deep capillary plexus (DCP), but the intensity of blood flow signal was slightly weaker than that in the SCP. The blood flow signal was visible only in DCP in 2 eyes. SCP and DCP showed similar intensity of blood flow signals in 2 eyes. After treatment, the bleeding was absorbed basically in 4 eyes, the hard exudation partially subsided, the CMT decreased, the intercortical cystic cavity of the fovea nerve decreased, the hemangiomatous lesions narrowed, and BCVA increased. In 1 eye, the macular sac was reduced and partially absorbed by hard exudation, which was later relapsed due to blood pressure fluctuation.ConclusionsThe majority of PEVAC patients had monocular onset. The fundus is characterized by solitary or structure with strong reflex walls, with or without retinal cysts, hard exudates, and subretinal fluid, and visible blood flow signals inside.
Objective To observe the clinical factors and macular microstructural changes associated with the development of epiretinal membrane (ERM) in patients with diabetic macular edema (DME) after intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs. MethodsA retrospective case-control study. A total of 85 patients (108 eyes) with DME, who were diagnosed and treated with intravitreal anti-VEGF injections at Tianjin Eye Hospital between October 2019 and September 2022, were included in this study. Detailed clinical data were collected, including age, duration of diabetes, best-corrected visual acuity (BCVA), and the cumulative number of intravitreal anti-VEGF injections. BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Optical coherence tomography (OCT) was used to measure central macular thickness (CMT), quantify hyperreflective foci (HRF), and assess the presence of disorganization of the retinal inner layers (DRIL). Eyes were divided into an ERM group and a non-ERM group based on the presence of ERM, comprising 37 eyes (34.3%, 37/108) and 71 eyes (65.7%, 71/108), respectively. Clinical characteristics and OCT parameters were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent factors associated with ERM formation, and a five-fold cross-validation approach was used to evaluate the predictive performance of the regression model. ResultsThe mean age in the ERM group and non-ERM group was (58.73±10.76) and (53.51±12.44) years, respectively. The duration of diabetes was (17.89±8.60) and (10.62±6.63) years, respectively. The logMAR BCVA was 0.79±0.36 and 0.62±0.39, respectively. The cumulative number of intravitreal anti-VEGF injections was 6.43±3.81 and 3.79±3.58, respectively. The CMT was (294.95±24.93) μm in the ERM group and (274.66±29.88) μm in the non-ERM group, while the HRF count was 10.43±4.35 and 7.46±4.17, respectively. The presence of DRIL was observed in 11 eyes (29.7%, 11/37) in the ERM group and 6 eyes (8.5%, 6/71) in the non-ERM group. Compared with the non-ERM group, patients in the ERM group were older, had a longer duration of diabetes, worse visual acuity, and received a higher number of intravitreal anti-VEGF injections. These differences were statistically significant (t=?2.267, ?4.495, ?2.263, ?3.491; P＜0.05). In addition, the ERM group showed significantly increased CMT (t=?3.743), higher HRF counts (t=?3.413), and a higher proportion of DRIL (χ2=8.304), all with statistical significance (P＜0.05). Multivariate logistic regression analysis identified diabetes duration [odds ratio (OR)=1.113, 95% confidence interval (CI) 1.002-1.238, P=0.049], CMT (OR=1.027, 95%CI 1.005-1.049, P=0.014), HRF count (OR=1.187, 95%CI 1.053-1.337, P=0.005), and the cumulative number of intravitreal anti-VEGF injections (OR=1.235, 95%CI 1.029-1.482, P=0.023) as independent factors associated with ERM formation. The multivariate model achieved an area under the receiver operating characteristic curve of 0.814 after five-fold cross-validation, indicating good predictive performance. ConclusionThe occurrence of ERM in patients with DME is closely associated with longer diabetes duration, a greater number of anti-VEGF injections, increased HRF count, and thicker CMT.
Objective
To build the lentiviral vectors of pigment epithelial derived factor (PEDF) gene, and investigate their expression in human umbilical cord mesenchymal stem cells (hUCMSCs).
Methods
The PEDF lentiviral vectors (LV-PEDF) were built by DNA recombination and confirmed by DNA sequencing. hUCMSCs were transfected by LV-PEDF with MOI 10, 30, 50, respectively. The transfection efficiency was observed under fluorescence microscope. Cell immunofluorescence, immunocytochemistry and real-time PCR methods were used for detecting the expression of PEDF and VEGF.
Results
The PEDF cDNA was sub-cloned into pCDH-CMV-MCS-EF1-copGFP vector successfully. DNA sequencing analysis confirmed that PEDF gene sequence was exactly the same with that reported in GenBank. pCDH-PEDF infected cells could show green fluorescence under fluorescence microscope. The transfection efficiency was 72.1% in PEDF-MSCs. Immunofluorescence and immunochemical staining confirmed that PEDF protein was overexpressed in hUCMSCs. The relative expression of PEDF mRNA in experimental group and control group was (0.170±0.028) and (0.015±0.007) respectively by RT-PCR, the difference was statistically significant (P＜0.001). The relative expression levels of VEGF mRNA in the two groups were (0.265±0.022) and (0.285±0.049), respectively, with no significant difference (P＞0.05).
Conclusions
We successfully built a lentivirus vector carrying PEDF gene and obtained hUCMSCs with overexpressed PEDF.
