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Chinese Journal of Ocular Fundus Diseases.2017;33(2):209-213. doi:10.3760/cma.j.issn.1005-1015.2017.02.027

The suprachoroidal space (SCS) is the potential space between the sclera and choroid.Drugs delivered through SCS can bypass the sclera,avoiding clearance by conjunctival and scleral blood vessels and lymphatic circulation,so that more drugs can reach the disease tissues such as choroid and retina.SCS drug delivery does not disrupt the ocular integrity,is safer than the intravitreal drug injection and more effective than trans-scleral drug delivery.In addition,SCS delivery only needs a very small volume of drug,which makes it possible to be carried out in multiple parts of the sclera,and the specific disease area can be more precisely targeted.SCS drug delivery is suitable for the treatment of choroidal and retinal diseases.However,currently SCS drug delivery is still a novel field and many aspects need to be more in-depth studied,including its safety,delivery methods,drug formulation and effectiveness.

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Mechanisms for the therapeutic effect of fenofibrate on diabetic retinopathy and its clinical application

Ying LIU ; Ximei DUAN ; Jixiong XU

Chinese Journal of Ocular Fundus Diseases.2017;33(2):206-209. doi:10.3760/cma.j.issn.1005-1015.2017.02.026

Chronic inflammation,oxidative stress and retinal ganglion cell apoptosis play important roles in the development of diabetic retinopathy.Fenofibrate,a peroxisome proliferator-activated receptor α agonist,is used for dyslipidemia.In addition to its lipid-modulating effects,fenofibrate also has antiinflammatory,antioxidant,anti-apoptotic and anti-angiogenesis properties that may be useful to delay the progression of diabetic retinopathy.Some clinical studies have already confirmed that fenofibrate has therapeutic effect on diabetic retinopathy.Further studies the application of fenofibrate in the treatment of diabetic microangiopathy to clarify the safety and efficacy of fenofibrate is of great significance.

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The current status and progress of ocriplasmin in treating vitreomacular interface diseases

Jiamin XIE ; Xun XU

Chinese Journal of Ocular Fundus Diseases.2017;33(2):203-206. doi:10.3760/cma.j.issn.1005-1015.2017.02.025

As a potent collagenase activator,ocriplasmin is a recombinant truncated form of serine protease that retains the protease activity of plasmin.Pre-clinical animal experiments,clinical trials and recent clinical studies all indicated a promising outcome of intravitreal injection of ocriplasmin to treat vitreomacular interface diseases,including vitreomacular adhesion (VMA),vitreomacular traction (VMT) and full-thickness macular hole.Ocriplasmin was approved by the Food and Drug Administration of USA in the management of symptomatic VMA,and by the European Medicines Agency in treating VMT-associated macular hole with less than or equal 400 pm.Further randomized controlled clinical trials are needed for further comprehensive observation and evaluation on its efficiency,safety and other noteworthy issues.

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Progress in the study of anti-vascular endothelial growth factor application for the treatment of neovascular age-related macular degeneration and the mechanism of poor and non-response

Zifang CHENG ; Haiyan WANG ; Yusheng WANG

Chinese Journal of Ocular Fundus Diseases.2017;33(2):199-202. doi:10.3760/cma.j.issn.1005-1015.2017.02.024

According to the best corrected visual acuity and the morphological changes of the macular fovea,responses to the neovascular age-related macular degeneration (nAMD) who receive anti-vascular endothelial growth factor (VEGF) therapy show large variability,including poor and non-responders.Various factors will be reviewed to account for poor and non-response to anti-VEGF therapy,such as the related susceptibility genes,factors related with the development of choroidal neovascularization and morphologic parameters,pharmacokinetics and tachyphylaxis.The future research should focus on comprehensive assessment of factors affecting the efficacy of anti-VEGF therapy to improve the therapeutic outcome of nAMD.

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The characteristics of the full-field flash electroretinogram in rats with oxygen induced retinopathy

Li XIE ; Yi LUO ; Ping WANG ; Lan MA ; Na LI ; Linhui XIE

Chinese Journal of Ocular Fundus Diseases.2017;33(2):186-189. doi:10.3760/cma.j.issn.1005-1015.2017.02.017

Objective To observe the characteristics of the full-field flash electroretinogram (F-ERG) in rats with oxygen induced retinopathy (OIR).Methods Twenty-four neonatal Sprague Dawley rats were divided into OIR group and control group.In OIR group,12 rats were exposed to (75 ± 2)％ oxygen for 7 days and then to room air for 7 days;in control group,12 rats were raised in room air for 14 days.At postnatal day 21,F-ERG tests were performed to examine the rod response,the maximum mixing reaction and the cone reaction.Results Compared with the control group,the b-wave amplitudes decreased (t=3.650) and the implicit times increased (t=2.410) in rod response in OIR group,the differences were statistically significant (P＜ 0.05);the a-and b-wave amplitudes decreased (t=3.333,2.562) and the implicit times increased (t=2.725,2.482) in the maximum mixing reaction in OIR group,the differences were statistically significant (P＜0.05).There was no difference between OIR and control group on a-and b-wave amplitudes (t=0.650,0.204) and implicit times (t=0.422,0.076) in cone response (P＞0.05).0.001 cd.s/m2 light intensity stimulation on rats F-ERG wave almost no response.0.010 cd.s/m2 light intensity stimulation on rats can be recorded to the rod response waveform,with the increase of light intensity,the amplitude of b-wave increases,the a-wave extraction.Conclusions F-ERG of OIR rat showed that the amplitude and sensitivity of the rod response and maximal rodcone response was decreased.The intensity of light had effect on the OIR rod cells,and the amplitude of b-wave increased with the increase of light intensity,the a-wave extraction.

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Changes of intraocular drug concentration and pharmacokinetics of bevacizumab with annexin A5-associated liposome topically applied in the rabbit eyes

Haitao ZHANG ; Jie ZHANG ; Feng WANG ; Yanfan REN ; Baojun WANG

Chinese Journal of Ocular Fundus Diseases.2017;33(2):176-180. doi:10.3760/cma.j.issn.1005-1015.2017.02.015

Objectives To explore intraocular drug concentration changes and the pharmacokinetics after topically applied of bevacizumab with armexin A5-associated liposome on rabbit eyes.Methods A total of 105 healthy New Zealand white rabbits were selected and divided randomly into 3 groups (group A,B and C),and each group had 35 rats.Bevacizumab with annexin A5-associated liposome,bevacizumab liposome and bevacizumab were topically applied 50 μl respectively on right eyes of rabbits in group A,B and C,respectively.Aqueous,vitreous body and retina/choroid were obtained at 5,15,30 minutes and 1,2,4,8 hours and the free bevacizumab concentrations in these ocular tissues were measured by ELISA (enzyme linked immunosorbent assay).DAS 2.1.1 software was used to fit the pharmacokinetic parameters.Results The peak drug concentrations in aqueous humor of the eyes in group A,B,C were at 15 minutes after topical administration and the difference was statistically significant (F=301.061,P＜ 0.01).The peak drug concentrations in vitreous of the eyes in the group A,B,C were at 2 hours after topical administration and the difference was statistically significant (F=885.997,P＜ 0.01).The peak drug concentrations in retina/choroid of the eyes in the group A,B,C were at 1 hour after topical administration and the difference was statistically significant (F=644.908,P＜0.01).Least significant difference pair-wise test found that the drug concentrations in aqueous humor,vitreous and retina/choroid of group A was higher than that of the group B and C respectively (P＜ 0.05),while that of the group B and C had no significant different (P＞ 0.05).Pharmacokinetic fitting analysis found that the half-life (t1/2) of bevacizumab in aqueous humor were 1.14,1.29,1.29 hours,the distribution t1/2 were 1.40,1.50,1.42 hours and the eliminated t1/2 were 2.62,2.84,2.73 hours in vitreous,the distribution t1/2 were 2.61,2.99,2.70hours and the eliminated t％ were 2.61,2.99,2.70 hours in retina/choroid respectively for the 3 groups.Changes of bevacizumab concentration in aqueous humor of rabbit eyes for 3 groups was complied with one compartment model,and that in vitreous body and retina/choroid complied with two compartment model.Conclusions Topically applied annexin A5-associated liposome has higher ocular concentrations of bevacizumab than those of controls.Changes of bevacizumab concentration in aqueous humor of rabbit eyes was complied with one compartment model,and that in vitreous body and retina/choroid complied with two compartment model.

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The effects of Crumbs proteins on zebrafish photoreceptors

Jinling FU

Chinese Journal of Ocular Fundus Diseases.2017;33(2):172-175. doi:10.3760/cma.j.issn.1005-1015.2017.02.014

Objective To observe the effects of Crumbs (Crb) proteins on different types ofzebrafish photoreceptors.Methods The retinal cell population dynamics of adult wild-type zebrafish and Tg (RH22:Crb2b-sfEX/RH2-2:GFP)pt108b transgenic zebrafish (called pt108b zebrafish for short) were evaluated by monitoring the densities of three categories of retinal photoreceptors (rod cells,UV cone cells and RGB cone cells) in different retinal regions,which were visualized by Feulgen nuclear staining histology technique.Results The wild-type zebrafish retinal photoreceptor cell densities are generally higher in the central region than the peripheral regions.Compared with wild-type zebrafish,pt108b zebrafish had much less RGB cone cells at the top of outer nuclear layer,and no RGB cone ceils at the central and intermediate regions of retina.While pt108b zebrafish had normal density of UV cone cells at the top of rods and the bottom of outer limiting membrane,they had much higher density of rods.Conclusions Crb proteins may affect the zebrafish retinal cell densities of different photoreceptor types.

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Clinical features of 10 cases with endogenous bacterial endophthalmitis

Chunjie MAO ; Qiang TIAN ; Caiyun YOU ; Wei ZHOU ; Feng JIANG ; Hua YAN

Chinese Journal of Ocular Fundus Diseases.2017;33(2):162-165. doi:10.3760/cma.j.issn.1005-1015.2017.02.012

Objective To observe the clinical features and prognosis of endogenous bacterial endophthalmitis (EBE).Methods Ten eyes of 10 patients diagnosed with unilateral EBE were retrospectively reviewed,including 7 males and 3 females.The mean age was 57.6± 10.8 years old.Eight patients were with diabetes and 7 of them were diagnosed over 5 years.There were 3 patients with hepatocirrhosis,1 patient with hypertension,and 1 patient with coronary disease.Nine cases had infectious diseases,including liver abscess (7 cases),pulmonary infection (3 cases),erysipelas (1 case) and perianal abscess (1 case).Seven cases had fever history.Culture and drug sensitive tests for aerobic bacteria,anaerobic bacteria and fungal were performed for 9 eyes using vitreous samples from the procedures of vitrectomy and/or intravitreal injection.All patients were treated with broad-spectrum antibiotics and adjusted for drug use according to microbiological culture and drug sensitivity test results.After the diagnosis was established,vitrectomy combined with lens removal was performed in 5 hours (3 eyes) and 24 hours (5 eyes);Vitreous tamponade of C3F8 (1 eye) and silicone oil (7 eyes) was used;At the end of the operation,0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (1 mg) were injected into the vitreous cavity.One eye received intravitreal injection of 0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (mg),one eye received evisceration.During the follow up period from 6 to 24 months,visual function,slit lamp and fundus examinations were performed at each office visit.Results All patients complained of blurred vision and 5 patients had ocular pain.The visual acuity was no light perception (3 eyes),light perception (5 eyes);hand motion (1 eye) and 0.1 (1 eye).Corneal edema was found in all 10 eyes;hypopyon in 8 eyes;diffuse vitreous opacity in 10 eyes,including 3 eyes with retinal detachment.For 8 eyes treated by vitrectomy and intravitreal injection,1 eye was eviscerated due to uncontrolled inflammation.The eye treated with intravitreal injection was enucleated for its uncontrolled inflammation.For 9 eyes received vitreous culture and drug testing,8 eyes (88.9％) had positive results,including 5 eyes with Klebsiellar pneumonia,and 1 eye with Staphylococcus aureus,or Streptococcus agalactiae or Enterococcus faecalis respectively.At last office visit,2 eyes were with no light perception;4 eyes were with hand motion;and 1 eye with visual acuity of 0.1.Conclusions Most of the patients with endogenous bacterial endophthalmitis have systemic predisposing factors.Klebsiella pneumoniae is the leading cause of ocular EBE.Vitrectomy combined with intravitreal injection of antibiotics showed efficacy in treating EBE.

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Metamorphopsia and vision-related quality of life and its influencing factor after surgical treatment of idiopathic macular hole

Lina GE ; Xu ZHANG ; Lijun SHEN

Chinese Journal of Ocular Fundus Diseases.2017;33(2):153-156. doi:10.3760/cma.j.issn.1005-1015.2017.02.010

Objective To evaluate metamorphopsia and vision-related quality of life (VRQoL) and its influencing factor after vitrectomy for idiopathic macular hole (IMH).Methods This is a prospective and nonrandomized clinical cohort study.Thirty eyes of 30 IMH patients who received vitrectomy and inner limited membrane (ILM) peeling were included.The best-corrected visual acuity (BCVA),medical refraction test and optical coherence tomography (OCT) were performed.BCVA was recorded as logarithm of the minimum angle of resolution (logMAR).The macular hole index (MHI) was measured using OCT.The average logMAR BCVA and MHI in suffering eyes at baseline were 1.02± 0.07 and 0.47 ± 0.02,respectively.The uncorrected visual acuity of the fellow eyes was less than 0.1.Follow-up period was longer than 6 months.At 6 months after surgery,the central retinal thickness (CRT) was measured by OCT;vertical and horizontal metamorphopsia were measured by metamorphopsia charts;VRQoL was evaluated by Chinese VRQoL-25.Spearman correlation analysis was performed to analyze the relationship of VRQoL and postoperative BCVA,metamorphopsia and preoperative MHI.Results At 6 months after surgery,macular hole closure was confirmed by OCT in all patients.The vertical and horizontal metamorphopsia were (0.17± 0.03)° and (0.11 ± 0.03)°,respectively.The VRQoL-25 composite score was 79.81 ± 1.29.The average BCVA was 0.59±0.05.The average CRT was (155.10± 6.27) μm.The postoperative VRQoL was positive correlated with preoperative MHI (r=0.491,P=0.002),and negative correlated with preoperative BCVA (r=-0.445,P=0.014),postoperative BCVA (r=-0.530,P=0.003) and postoperative metamorphopsia (r=-0.532,P=0.006),but not correlated with the postoperative CRT (r=0.231,P＞0.05).Conclusions IMH patients improved their visual acuity after surgery,but still have metamorphopsia.VRQoL was negative correlated with metamorphopsia,positive correlated with preoperative MHI.

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Visual field outcomes and refractive status of retinopathy of prematurity after laser treatment

Yuou YAO ; Hong YIN ; Xiaoxin LI ; Mingwei ZHAO ; Jianhong LIANG

Chinese Journal of Ocular Fundus Diseases.2017;33(2):148-152. doi:10.3760/cma.j.issn.1005-1015.2017.02.009

Objective To observe visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation.Method The data of 39 ROP patients (73 eyes) who received laser photocoagulation were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex were matched with ROP group.There were 24 males (45 eyes) and 15 females (28 eyes) in ROP group,with an average age of (7.0± 1.28) years.The first laser treatment was carried out at postnatal age (PA) of (38.74±3.82) weeks,the birth weight (BW) of (1402.33 ±369.61) g and the number of laser burns was (517.86 ± 277.40).The control group included 7 females (13 eyes) and 6 males (12 eyes),with an average age of (7.17 ± 0.96) years.The age (t=0.691) and gender (x2=1.425) were comparable between the two groups (P=0.491,0.233).The data of patients and controls were retrospectively analyzed including best corrected visual acuity,refractive examination,automated perimetry test.The differences of the mean deviation (MD) of visual field and the spherical equivalent (SE) between these two groups were comparatively observed.ROP patients were divided into no VF loss group (MD≤2 dB) and VF loss group (MD＞2 dB),mild VF loss group (MD ≤ 6 dB) and moderate VF loss group (MD ＞6 dB) according to the results of automated perimetry test,the differences of gestational age (GA),PA,BW,number of laser burns and SE between these groups were comparatively observed.Results The MD in ROP group and control group were 4.87±5.12 dB and 1.27 ± 3.34 dB,respectively;the difference between the two groups was statistically significant (t=-4.01,P＜ 0.001).The subgroup analysis showed that BW,number of laser burns,and SE were significantly different between no VF loss group and VF loss group (t=2.074,-1.996,-2.162;P=0.042,0.026,0.034);while the GA was not significantly different between these two groups (t=1.973,P=0.052).The difference of PA was not statistical significant different between mild VF loss group and moderate VF loss group (t=2.03,P=0.051) and SE was significantly different between the above two groups (t=3.283,P=0.002).For refractive outcomes,the BW and ROP stage correlated with SE significantly (r=-0.304,-0.387;P=0.015,0.002).The mean BCVA in ROP group was 0.84±0.23,and 59 eyes (91.2％) with BCVA better than 0.5.Conclusion Laser treatment for ROP tends to have less effect on long term refractive status and VF loss,with good visual outcome.

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