Cerebral Cortex ; growth & development ; physiology ; Evoked Potentials, Visual ; physiology ; Humans ; Infant, Newborn ; Infant, Premature ; growth & development ; Sensory Thresholds ; physiology ; Vision, Ocular ; physiology ; Visual Acuity ; physiology ; Visual Perception ; physiology

The amino acid L-glutamate is a major excitatory neurotransmitter in the central nervous system of vertebrates(1). NMDA (N-methyl-d-aspartate) is one of the L-glutamate receptor subtypes(2). During a critical period of early postnatal development, the visual cortex is susceptible to experience-dependent modification of neuronal responses. Recently, the activation of NMDA receptors has been supposed as a prerequisite for the induction of such modification(3). We therefore investigated developmental changes of NMDA receptors in the rat visual cortex and questioned whether they could be related to the visual development. We assessed the density of [(3)H]-NMDA receptor in the visual cortex of normally reared rate (Group I) and visually deprived rats (Group II) using quantitative autoradiography(4). The density of [(3)H]-NMDA receptor was significantly lower in Group II than in group I during the early postnatal period, and increased rapidly by postnatal 1 week and, decreased after postnatal 5 weeks. These results suggested that NMDA receptors may play a role in neuronal development in the visual cortex during the early postnatal period.
Animals ; Autoradiography ; Dark Adaptation ; Eyelids/surgery ; Glutamates/metabolism ; Glutamic Acid ; Light ; Rats ; Receptors, N-Methyl-D-Aspartate/*metabolism ; Visual Cortex/growth & development/*metabolism

To investigate the intracellular mechanism of activity-dependent synapses formation and redistribution, we studied the electrophysiological and morphological characteristics of neurons of the developing visual cortex, and observed the level of synchronism of age and changes in the properties. Whole cell patch-clamp recordings and intracellular biocytin staining were used to record postsynaptic currents (PSCs) from neurons in the visual cortex of Sprague-Dawley rats (postnatal d 4-28). The histological processing was made. There were three types of PSCs in 156 cells: silent response, monosynaptic response and polysynaptic response, during the first developmental month. Before eyes opened the number of the neurons with the silent response (57.3%) was significantly higher than that after the eyes opened (11.9%) (P<0.001). However, the incidence of polysynaptic PSCs increased from 12.4% before eyes opened to 28.9% after eyes opened (P<0.01). During postnatal week 1, all cells were classified as immature. The immature cells had very high input resistances (R(N)>1.0 G Omega), low amplitude (-0.87 mA) and short decay time (-0.98 ms). During postnatal week 4, all cells were mature with lower input resistance (R(N)<310 M Omega), larger amplitude (-66 mA), and longer decay time (-225 ms). From postnatal weeks 1 to 3, the cells had electrophysiological properties that were intermediate between the immature and mature types of cells. With biocytin intracellular staining, five types of neurons were obtained: pyramidal cells, satellite cells, basket cells, neuroglial cells and immature cells. On the basis of their electrophysiological and morphological characteristics, pyramidal cells were classified into three categories: immature, intermediate, and mature cell types. During postnatal week 1, cells were immature with very high input resistance. Morphologically immature cells had short simple dendritic arborizations which incompletely penetrated the layer where the cell body lies. From postnatal weeks 2 to 4, the cells were mature with low input resistance. They were morphologically more complex with dendritic arborizations which completely penetrated the whole layers of the visual cortex. From postnatal weeks 1 to 2, a third, intermediate cell type had electrophysiological properties that were intermediate between the immature and mature cell types. Three distinctive types of pyramidal cells in visual cortex only co-exist during postnatal weeks 1 to 2. Data show that activity-dependent synapes are formed and integrated into local neuronal networks with visual stimulation. In the critical period of visual development, the level of synchronism of age and changes in electrophysiological and morphological properties in the visual cortex is higher than that in the subcortex.
Animals ; Animals, Newborn ; Excitatory Postsynaptic Potentials ; physiology ; Neurons ; cytology ; physiology ; Pyramidal Cells ; cytology ; physiology ; Rats ; Rats, Sprague-Dawley ; Synapses ; metabolism ; physiology ; Visual Cortex ; cytology ; growth & development ; physiology

BACKGROUND: Limited data exist on real-world treatment patterns for diabetic macular edema (DME) in Korea. In this study, we investigated DME treatment patterns from 2009 to 2014 and the impact of baseline treatment on healthcare resource utilization and visual acuity (VA) outcomes. METHODS: A retrospective cohort chart review of DME patients treated at 11 hospital ophthalmology clinics between January 1, 2012 and December 31, 2013 was conducted. We collected data on demographics, healthcare resource utilization (clinic visits, treatment visits, and visits for ocular investigations), distribution of DME treatments, and VA. RESULTS: Overall, 522 DME patients (men, 55.2%; mean age, 59 years; mean HbA1c [n = 209], 8.4%) with 842 DME eyes were evaluated. For all treatments, healthcare resource utilization was significantly higher during the first 6 months versus months 7–12, year 2, or year 3 (P ≤ 0.001), but was highest for patients whose first treatment was an anti-vascular endothelial growth factor (VEGF) treatment (visits/quarter; anti-VEGF, 1.9; corticosteroids, 1.7; laser, 1.4). Use of macular laser therapy decreased (44% to 8%), whereas use of anti-VEGF injections increased (44% to 69%) during the study period. However, VA improvement was not commensurate with healthcare resource utilization of anti-VEGF treatment (mean VA gain, 2.7 letters). CONCLUSION: A trend toward increasing use of intravitreal anti-VEGF injections for DME treatment was observed in Korea. However, the frequency of dosing and monitoring was lower in clinical practice versus major clinical trials, which may have led to the less-than-favorable improvements in visual outcomes.
Adrenal Cortex Hormones ; Cohort Studies ; Delivery of Health Care ; Demography ; Endothelial Growth Factors ; Humans ; Intravitreal Injections ; Korea ; Laser Therapy ; Macular Edema ; Ophthalmology ; Practice Patterns, Physicians' ; Retrospective Studies ; Visual Acuity

The Diabetic Retinopathy Clinical Research Network (DRCR.net) performs studies on new treatments for diabetic retinopathy. This review aims to summarise recent findings from DRCR.net studies on the treatment of diabetic macular oedema. We performed a PubMed search of articles from the DRCR.net, which included all studies pertaining to the treatment of diabetic maculopathy. The main outcome measures were retinal thickening as assessed by central subfield thickness on optical coherence tomography and improvement of visual acuity on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Findings from each study were divided into modalities of treatment, namely photocoagulation, bevacizumab, triamcinolone, ranibizumab and vitrectomy. While modified ETDRS focal/grid laser remains the standard of care, intravitreal corticosteroids or anti-vascular endothelial growth factor agents have also proven to be effective, although they come with associated side effects. The choice of treatment modality for diabetic macular oedema is a clinical judgement call, and depends on the patient's clinical history and assessment.
Adrenal Cortex Hormones ; therapeutic use ; Bevacizumab ; therapeutic use ; Biomedical Research ; organization & administration ; Diabetic Retinopathy ; therapy ; Disease Management ; Disease Progression ; Humans ; Light Coagulation ; Macular Edema ; therapy ; Ranibizumab ; therapeutic use ; Retina ; pathology ; Tomography, Optical Coherence ; Triamcinolone ; therapeutic use ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors ; Visual Acuity ; Vitrectomy