Objective To observe the clinical efficacy of pars plana vitrectomy (PPV) combined with dexamethasone intravitreal implant (DEX) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized controlled study. A total of 57 PDR patients with 79 eyes diagnosed by Department of Ophthalmology of The First Affiliated Hospital of Nanjing Medical University from May 2021 to February 2023 were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were performed in all affected eyes. Central macular thickness (CMT) was measured by OCT. The patients were randomly divided into control group and experimental group, with 27 cases and 35 eyes and 30 cases and 44 eyes, respectively. All eyes were treated with routine 25G PPV and intraoperative whole-retina laser photocoagulation. At the end of the operation, the experimental group was given 0.7 mg DEX intravitreal injection. At 1, 4, 12, and 24 weeks after operation, the same equipment and methods were used for relevant examinations. The improvement after surgery was assessed according to the diabetic retinopathy severity score (DRSS). Mixed analysis of variance was used to compare logarithm of the minimum angle of resolution BCVA and CMT between the two groups and within the two groups before and after operation. ResultsAt 1, 4, 12 and 24 weeks after surgery, BCVA was significantly improved at different time points after surgery, and the differences were statistically significant (P＜0.001). At different time after operation, BCVA and CMT in experimental groups were significantly better than that in control group, with statistical significance (P＜0.05). Compared with the CMT before surgery, the CMT at all time point after surgery in experimental group were significantly decreased, and the difference were statistically significant (P＜0.05). There was no significant difference one week after eye operation in control group (P=0.315). At 4, 12 and 24 weeks after operation, CMT decreased in control group, and the differences were statistically significant (P＜0.05). Compared with before surgery, DRSS increased two steps higher at 1, 4, 12 and 24 weeks after surgery in 20 (45.45%, 20/44), 26 (59.10%, 26/44), 32 (72.73%, 32/44) and 31 (70.45%, 31/44) eyes in the experimental groups, respectively. The control group consisted of 15 (42.86%, 15/35), 15 (42.86%, 15/35), 16 (45.71%, 16/35) and 18 (51.43%, 18/35) eyes, respectively. There was no significant difference in DRSS at 1, 4 and 24 weeks after operation between the control group and the experimental group (P=0.817, 0.178, 0.105). At 12 weeks after surgery, the difference was statistically significant (P=0.020). ConclusionPPV combined with intravitreal injection of DEX in the treatment of PDR can improve postoperative visual acuity, alleviate postoperative macular edema and improve the severity of DR.
Objective To compare the outcomes of ranibizumab and conbercept adjunct for pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized case-control study. From June 2022 to December 2023, 90 cases (90 eyes) of PDR patients diagnosed through ophthalmic examination at Department of Ophthalmology of Gansu Provincial Hospital were included in the study. All patients underwent the best corrected visual acuity (BCVA), intraocular pressure, B-mode ultrasound, and optical coherence tomography (OCT) examinations. The central macular thickness (CMT) was measured using an OCT instrument. The patients were randomly divided into a intravitreal injection of ranibizumab group (monoclonal-antibody group) and a intravitreal injection of conbercept group (fusion-protein group) using a random number table method, with 45 cases (45 eyes) in each group. Two groups of patients were intravitreal injected with 10 mg/ml ranibizumab or conbercept 0.05 ml, respectively. A standard 23G PPV was performed through the flat part of the ciliary body 3-7 days after intravitreal injection. Relevant examinations were performed using the same equipments and methods as before surgery at postoperative 1 week, 1, 3, 6, and 12 months. The PPV time, intraoperative use of intraocular electrocoagulation, incidence of iatrogenic retinal breaks, and sterile air or silicone oil tamponade rate in the vitreous cavity, the postoperative changes of BCVA and CMT, and incidence of complications were compared between two groups. Independent sample t test was used for inter group comparison. ResultsThe intraoperative utilization rate of intraocular electrocoagulation in the monoclonal-antibody group was higher than that in the fusion-protein group, and the difference was statistically significant (χ2=3.876, P＜0.05). There were no statistically significant differences in the PPV time (t=0.152), intraoperative bleeding rate (χ2=0.800), incidence of iatrogenic retinal breaks (χ2=1.975), and sterile air and silicone oil tamponade rate in the vitreous cavity (χ2=1.607, 1.553) between the two groups (P＞0.05). There were no statistically significant differences in early and late postoperative vitreous hemorrhage (χ2=1.235, 2.355), and re-PPV (χ2=2.355) between two groups (P＞0.05). The BCVA of the fusion-protein group was significantly better than that of the monoclonal-antibody group at postoperative 3 months, and the difference was statistically significant (t=2.428, P＜0.05). The CMT of the fusion-protein group was lower than that in the monoclonal-antibody group at postoperative 1 week, and the difference was statistically significant (t=2.739, P＜0.05). None of the patients experienced endophthalmitis, retinal artery occlusion, or severe cardiovascular events after surgery. ConclusionCompared with intravitreal injection of ranibizumab before PPV, intravitreal injection of conbercept before PPV in PDR patients can shorten the surgical time, reduce intraoperative bleeding rate, lower the rate of electrocoagulation and intraocular tamponade, and incidence of iatrogenic retinal breaks, and improve the visual acuity.
ObjectiveTo observe the effect of mild anemia on prognosis of hyperplastic diabetic retinopathy (PDR) treated by pars plana vitrectomy (PPV). MethodsA retrospective case-control study. From January 2021 to December 2022, 147 PDR patients with 147 eyes who received PPV treatment at Shenyang He Eye Hospital were included in the study. There were 147 eyes in 147 cases, 82 eyes in 82 males and 65 eyes in 65 females. Age was 25-79 (53.54±12.74) years old. A hemoglobin (Hb) of 90 to 120 g/L in men and 90 to 110 g/L in women was defined as mild anemia. According to Hb results, the patients were divided into mild anemia group and non-anemia group, with 39 cases (39 eyes) and 108 cases (108 eyes), respectively. The best corrected visual acuity (BCVA) test was performed using the international standard logarithmic visual acuity scale before and after the surgery, which was statistically converted to minimum resolved logarithmic (logMAR) visual acuity. The logMAR BCVA of the affected eye was 0.2-2.5 (1.60±0.62) before surgery. According to whether the BCVA improved by more than 3 lines 6 months after surgery, the affected eyes were divided into BCVA improved by more than 3 lines and BCVA improved by less than 3 lines, 117 eyes and 30 eyes, respectively. The patient's body mass index (BMI), BCVA at 6 months after surgery, and the occurrence of neovascular glaucoma (NVG) and recurrence of vitreous hemorrhage (RVH) were recorded. Independent sample t test was used for comparison between groups. Multivariate logistic regression analysis was performed to analyze the influencing factors of increased BCVA ≥3 rows after surgery. ResultsSix months after surgery, the logMAR BCVA of patients in mild anemia group and non-anemia group were 0.97±0.87 and 0.68±0.63, respectively. BCVA increased ≥3 in 26 (66.7%, 26/39) and 91 (84.3%, 91/108) eyes, respectively. logMAR BCVA (t=2.234) and BCVA increased by ≥3 rows of eyes (χ2=5.460) between the two groups, the differences were statistically significant (P=0.027, 0.019). Logistic regression analysis showed that baseline logMAR BCVA [odds ratio (OR) =4.291, 95% confidence interval (CI) 1.918-9.600, P＜0.001)], BMI (OR=1.248, 95%CI 1.057-1.472, P=0.009), the number of retinal laser photocoagulation during surgery (OR=1.001, 95%CI 1.000-1.002, P=0.038), mild anemia (OR=0.360, 95%CI 0.131-0.993, P=0.048), postoperative NVG (OR=0.156, 95%CI 0.033-0.726, P=0.018) and RVH (OR=0.264, 95%CI 0.086-0.808, P=0.020) were independent factors for BCVA improvement ≥3 lines after PPV. ConclusionsMild anemia has a certain effect on BCVA improvement after PPV of PDR. Mild anemia, post-operative NVG and RVH were independent risk factors for increasing BCVA ≥3 lines after PPV in PDR patients.
Objective To observe the effect of bone forming protein 4 (BMP4) on the proliferation and migration of human retinal pigment epithelium (RPE) cells under oxidative stress, and to preliminarily explore its effect on epithelial-mesenchymal transition (EMT) of RPE cells. MethodsHuman RPE cells cultured in vitro were divided into normal group, pure 4-hydroxynonenal (HNE) group (4-HNE group), 4-HNE+NC group and 4-HNE+ small interfering BMP (siBMP4) group. The effect of 4-HNE on the proliferation of RPE cells was detected by thiazole blue colorimetry. The effects of 4-HNE and BMP4 on cell migration were determined by cell scratch test. The expression of BMP4 was detected by immunofluorescence staining, Western blot and real-time quantitative polymerase chain reaction. The transfection efficiency of siBMP4 was observed by fluorescence microscopy. Mitochondrial reactive oxygen species (MitoSOX) were detected by flow cytometry. The expression of EMT markers E-cadherin and Fibronection were detected by immunofluorescence assay. t-test was used for comparison between the two groups, and one-way analysis of variance was used for comparison between the three groups. ResultsCompared with normal group, cell proliferation and migration ability of 4-HNE group were significantly enhanced, with statistical significance (t=21.619, 24.469; P＜0.05). The expression of BMP4 in cells was significantly increased, and the difference was statistically significant (t=19.441, P＜0.05). The relative expression levels of BMP4 mRNA and protein were also significantly increased, with statistical significance (t=26.163, 37.163; P＜0.05). After transfection with siBMP4 for 24 h, the transfection efficiency of BMP4 in RPE cells was＞90%. Compared with 4-HNE group and 4-HNE+NC group, the relative expression levels of BMP4 protein (F=27.241), mRNA (F=36.943), cell mobility (F=46.723) and MitoSOX expression levels (F=39.721) in normal group and 4-HNE+siBMP4 group were significantly decreased. The differences were statistically significant (P＜0.05). The epithelial marker E-cadherin increased significantly, while the mesenchymal marker Fibronection decreased significantly, with statistical significance (F= 51.722, 45.153; P＜0.05). ConclusionsBMP4 inhibits RPE proliferation and migration under oxidative stress. BMP4 is involved in inducing EMT in RPE cells.
Objective Mendelian randomization (MR) was used to analyze the potential relationship between blood pressure and proliferative diabetic retinopathy (PDR). MethodsTwo-sample MR analysis was performed using summary statistics from genome-wide association studies. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were selected as the exposure, PDR as the outcome. The instrumental variable of SBP and DBP came from the publicly available data of the the UK Medical Research Council Comprehensive Epidemiology Unit and Neale Laboratory; the outcome data (8 681 cases in the case group, 204 208 cases in the control group, European population) are from the FinnGen database. Inverse variance weighting (IVW) and weighted median (WM) were used to analyze the potential relationships between SBP, DBP and PDR. ResultsMR analysis showed that IVW [SBP: odds ratio (OR)=1.36, 95% confidence interval (CI) 1.17-1.57, P=4.22E-05; DBP: OR=1.29, 95%CI 1.11-1.51, P=8.6E-04], WM (SBP: OR=1.33, 95%CI 1.07-1.66, P=0.009; DBP: OR=1.28, 95%CI=1.03-1.59, P=0.002). The results showed that elevated SBP and DBP increased the risk of PDR. ConclusionBlood pressure (SBP, DBP) change is positively correlated with the risk of PDR.
Proliferative diabetic retinopathy is a serious complication of diabetes in the eye that can lead to severe vision loss or even complete vision loss. In recent years, with the rapid development of surgical equipment and fundus examination technology, the indications for pars plana vitrectomy based surgical treatment have been expanded, surgical improvement and application, combined application of drugs, such as anti-vascular endothelial growth factor drugs, glucocorticoids, and surgical evaluation have made new progress. Surgical evaluation based on imaging can continuously monitor patients' eye conditions before, during and after surgery, and clinicians can choose different surgical plans and timing for different patients, which can help reduce patients' pain and achieve better visual outcomes.
Proliferative diabetic retinopathy (PDR) is more advanced stage in diabetic retinopathy (DR), often with vitreous hemorrhages and traction retinal detachment which seriously affects patients' vision and even leads to severe visual impairment. Pars plana vitrectomy is an effective treatment for PDR. However, the operation procedure is quite complexed. Inadequate management can negatively impact postoperative vision or even lead to complications. Therefore, it is very important to clarify the surgical indications and standardize the operating procedures of PDR. To this end, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association, Expert Group of Expert consensus for pars plana vitrectomy treatment of type 2 diabetic retinopathy focus on 9 key clinical issues, based on the latest evidence-based medical evidence, combined with international guidelines and China's social and economic development. Recommendations were made on the selection of DR Surgery timing, perioperative blood glucose management, surgical mode selection, formulation of surgical operation plan, drug combination or laser therapy, etc., which formed China's expert consensus on pars plana vitrectomy in the treatment of type 2 DR. This consensus is applicable to Chinese doctors specializing in fundus diseases and doctors engaged in fundus diseases, aiming to provide scientific guidance for vitreous surgery treatment of PDR patients, assist clinical decision-making, and further improve the level of surgical treatment of DR in China.
ObjectiveTo explore the differences in metabolomic changes and metabolic pathways between the vitreous humor and serum of patients with early-onset proliferative diabetic retinopathy (PDR). MethodsA prospective observational study. From January to June 2025, 30 patients with PDR who underwent pars plana vitrectomy (PPV) in the Department of Ophthalmology, Peking University People's Hospital were included in the study. Patients were categorized into an early-onset PDR group (diagnosis age ≤40 years, n=10) and a late-onset PDR group (diagnosis age ＞40 years, n=20) based on the age at diabetes diagnosis. Fasting serum samples collected preoperatively and vitreous humor samples obtained intraoperatively were analyzed using untargeted metabolomics via ultra-high-performance liquid chromatography coupled with electrostatic field orbitrap tandem mass spectrometry. Differential metabolites were screened with thresholds of P＜0.05, variable importance in projection＞1, and fold change＞1.200 or ＜0.833. Pathway enrichment analysis was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG). The Mann-Whitney U test was used to compare clinical data between the two groups. ResultsSignificant differences were observed between the early-onset and late-onset PDR groups in the age at diabetes diagnosis and diabetes duration (Z=?4.41, ?2.62; P＜0.05). Metabolomic analysis identified 37 differential metabolites in the vitreous humor (34 upregulated, 3 downregulated) and 42 in the serum (10 upregulated, 32 downregulated). The two most abundant classes of differential metabolites common to both sample types were carboxylic acids and derivatives (16.2% in vitreous, 16.7% in serum) and fatty acyls (13.5% in vitreous, 11.9% in serum). KEGG enrichment analysis revealed the tryptophan metabolism pathway was significantly enriched in the vitreous humor (enrichment factor=0.024, P＜0.05), with L-kynurenine and indole-3-acetamide as key differential metabolites. In the serum, the taurine and hypotaurine metabolism pathway was significantly enriched (enrichment factor=0.042, P＜0.05), with hydroxyethanesulfonic acid identified as a differential metabolite. ConclusionsEarly-onset PDR has characteristic metabolic disorders. The dual activation of the kynurenine and indole branches of tryptophan metabolism in the vitreous humor, alongside increased consumption in the taurine pathway in serum, may underlie its pathophysiology. Additionally, abnormalities in serum steroids and steroid derivatives suggest that dysregulated steroid hormone metabolism might contribute to disease progression.
ObjectiveTo investigate the expression and clinical significance of long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and miR-199b in the peripheral blood of patients with proliferative diabetic retinopathy (PDR). MethodsA retrospective clinical study. A total of 473 patients with type 2 diabetes (T2DM) who visited Department of Ophthalmology of West China Airport Hospital of Sichuan University from February 2022 to July 2024 were included in the study. According to the diagnostic criteria for diabetic retinopathy (DR) in the Chinese Clinical Diagnosis and Treatment Guidelines for Diabetic Retinopathy, the T2DM patients were divided into three groups: the non-DR group (NDR group, 130 cases), the non-PDR group (NPDR group, 132 cases), and the PDR group (211 cases). Another 120 patients of the same age and gender who underwent simple cataract surgery during the same period were selected as the cataract group. Blood pressure, and laboratory data including fasting blood glucose (FBG), fasting insulin (FINS), glycated hemoglobin (HbA1c), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were collected in detail for the T2DM group patients. Fasting peripheral venous blood was collected from T2DM group patients; aqueous humor was collected from 45 PDR and NPDR patients with concurrent macular edema before intravitreal injection of anti-vascular endothelial growth factor drugs. The expression levels of lncRNA MALAT1 and miR-199b mRNA in peripheral blood and aqueous humor were detected by quantitative real-time polymerase chain reaction. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the efficacy of lncRNA MALAT1 and miR-199b alone and in combination for predicting PDR occurrence. One-way analysis of variance was used for comparisons among multiple groups. The correlation between the expression levels of the two indicators and each clinical parameter was analyzed using Pearson correlation analysis. ResultsCompared with the NPDR group and the NDR group, the systolic blood pressure, FBG, HbA1c, FINS and TG levels of patients in the PDR group were significantly increased, while HDL-C levels were significantly decreased. The differences were statistically significant (F=42.207, 52.320, 478.335, 107.676, 86.273, 77.653; P＜0.05); the expression of peripheral blood lncRNA MALAT1 was significantly increased, while the expression of miR-199b was significantly decreased, and the differences were statistically significant (F=31.773, 152.784; P＜0.05). Compared with the NPDR group and the cataract group, the expression of lncRNA MALAT1 in the aqueous humor of patients in the PDR group was significantly increased, and the expression of miR-199b was significantly decreased (F=159.700, 114.667; P＜0.05). The correlation analysis results showed that the expression of peripheral blood lncRNA MALAT1 was positively correlated with systolic blood pressure, FBG, HbA1c, TG, and FINS (r=0.318, 0.358, 0.689, 0.474, 0.498), and negatively correlated with miR-199b (r=?0.526) and HDL-C (r=?0.489) (P＜0.05). The expression of miR-199b showed an opposite correlation with the above metabolic indicators (r=?0.419, ?0.425, ?0.712, ?0.516, ?0.541, 0.529; P＜0.05). The expression levels of lncRNA MALAT1 and miR-199b in the peripheral blood and aqueous humor of PDR patients were significantly positively correlated (r=0.732, 0.675; P＜0.05). ROC curve analysis showed that the AUC values of peripheral blood lncRNA MALAT1, miR-199b alone and in combination for predicting PDR were 0.684, 0.796, and 0.861, respectively. ConclusionsPatients with PDR exhibit high expression of lncRNA MALAT1 and low expression of miR-199b in peripheral blood. The expressions of these markers are consistent between peripheral blood and aqueous humor and are associated with glucose and lipid metabolism. Their combination demonstrates high predictive value for the occurrence of PDR.
