الملخص
Objective To investigate the effect of the HtrA serine peptidase 3(HTRA3)gene on choroidal neovascu-larization(CNV)and M2 macrophage polarization.Methods Fasting venous blood was collected from 30 patients with wet age-related macular degeneration(wAMD group)and 30 healthy subjects(normal group).The serum HTRA3 messen-ger ribonucleic acid(mRNA)level was detected by quantitative reverse transcription polymerase chain reaction(qRT-PCR).RF/6A cells were randomly divided into the control group,NC-sh group and HTRA3-sh group.Lentiviral vectors of NC-shRNA and HTRA3-shRNA were transfected into RF/6A cells in the NC-sh group and HTRA3-sh group by Lipo-fectamine2000.HTRA3 transfection was detected by qRT-PCR and Western blot.Then,the RF/6A cells were randomly di-vided into the N group,H group,H+NC-sh group and H+HTRA3-sh group.After cell transfection,RF/6A cells in the N group were cultured in a RPMI 1640 complete medium at a normoxia state,and cells in other groups were cultured in a RP-MI 1640 medium with 200 mmol·L-1 CoCl2 at a hypoxia state.Tubule formation was measured by Matrigel.The C57BL/6J mice were divided into the control group,CNV group,CNV+NC-sh group and CNV+HTRA3-sh group,with 12 mice in each group.Mice in the control group were unmodeled mice,and mice in the other groups were laser-induced CNV model mice.NC-shRNA and HTRA3-shRNA lentiviral vectors with a titer of 1 × 1011 TU·mL-1 were administered to mice in the CNV+NC-sh group and CNV+HTRA3-sh group via intravitreal injection.Mice in the control group and CNV group were in-jected with phosphate buffered saline.After 7 days of treatment,the mice were examined by fundus fluorescein angiogra-phy,and the eyeballs received hematoxylin & eosin staining.The mRNA levels of HTRA3,chitinase-like protein 3(Ym-1),arginase 1(Arg-1),inducible nitric oxide synthase(iNOS),cyclooxygenase-2(COX-2)and vascular endothelial growth factor(VEGF)in RF/6A cells or choroidal tissues were detected by qRT-PCR.The protein expression levels of HTRA3,VEGF and nuclear factor kappa B(NF-κB)p65 in RF/6A cells or choroidal tissues were detected by Western blot.Re-sults Compared with the normal group,serum HTRA3 mRNA level of patients in the wAMD group increased(t=11.804,P＜0.001).Compared with the control group and NC-sh group,the expressions of HTRA3 mRNA and protein in RF/6A cells in the HTRA3-sh group decreased(all P＜0.05).Compared with the N group,the number of closed lumen and the mRNA and protein expressions of HTRA3 and VEGF in RF/6A cells in the H group increased(all P＜0.05).Compared with the H+NC-sh group,the number of closed lumen and the mRNA and protein expressions of HTRA3 and VEGF decreased in RF/6A cells in the H+HTRA3-sh group(all P＜0.05).Compared with the control group,the mRNA and protein expression levels of HTRA3 increased,the relative fluorescence intensity of CNV increased,the mRNA levels of Ym-1 and Arg-1 in-creased,the iNOS and COX-2 mRNA levels decreased,and the NF-κB p65 protein expression level increased in mice of the CNV group(all P＜0.05).Compared with the CNV+NC-sh group,the mRNA and protein expression levels of HTRA3 de-creased,the relative fluorescence intensity of CNV decreased,the mRNA levels of Ym-1 and Arg-1 decreased,the mRNA levels of iNOS and COX-2 increased,and the NF-κB p65 protein expression level decreased in mice of the CNV+HTRA3-sh group(all P＜0.05).Conclusion Down-regulation of HTRA3 can inhibit the formation of CNV and the polarization of M2 macrophages.HTRA3 may be an important potential target for the prevention and treatment of wAMD.
الملخص
Wet age-related macular degeneration(wARMD)emerges as a primary contributor to irreversible vision impairment in the aging demographic. In clinical practice, anti-vascular endothelial growth factor(VEGF)therapies exhibit pronounced success in managing wARMD. However, in the actual clinical application, there are significant individual differences in the prognosis of anti-VEGF drug therapy, and some patients show poor response to the treatment, which may be related to the morphological differences of retinal layers in macular area, genetics, systemic conditions and other factors. It will help develop a more rational and individualized treatment plan to judge the prognosis of patients according to their different clinical manifestations in advance, so as to reduce overtreatment and the risk of retinal damage. In recent years, most studies on treatment response mainly focus on fundus morphology, genetics and so on. In this study, the relevant factors affecting adverse response to wARMD were reviewed, aiming to provide with more accurate treatment and prognostic monitoring programs for clinicians.
الملخص
AIM: To evaluate the clinical efficacy of Mongolian medicine Mingmu-11 Pills combined with conbercept in the treatment of wet age-related macular degeneration(wARMD).METHODS: Prospective study. All cases in this study were wARMD patients(72 cases, 72 eyes)admitted to the Ophthalmology Department of Affiliated Hospital of Inner Mongolia University from November 2020 to December 2021. They were randomly divided into a combined treatment group and a control group, each with 36 eyes, and the control group received intravitreal injection of conbercept 0.05 mL for 3 consecutive months. The combined treatment group was given Mingmu-11 Pills twice a day after surgery, with 3 wk as a course of treatment, a total of 3 courses, and the control group was not given Mongolian medicine treatment. The best corrected visual acuity(BCVA), changes in central macular thickness(CMT)in the macular area, and changes in N1, P1 wave amplitude density and latency were observed after treatment in both groups.RESULTS:The BCVA(letter number)of the two groups were improved(P<0.05), and the CMT were decreased(P<0.05). The improvement of BCVA(letter number)in the combined treatment group was better than that in the control group at 3 mo(17.42±3.29 vs 14.61±3.14, P<0.001)and 5 mo(19.75±3.25 vs 16.81±2.77, P<0.001)after treatment; compared with the control group, CMT of the combined treatment group was thinner than that of the control group at 3 mo(304.58±53.34 vs 351.94±52.99 μm, P<0.001)and 5 mo(274.17±62.26 vs 321.78±63.22 μm, P<0.05)after treatment. The amplitude density of N1 and P1 wave in mfERG in both groups at 3 mo after treatment was higher than that before treatment(P<0.05), and r1-r3 latency of P1 wave was shorter than that before treatment(P<0.05), with no differences in the r1-r3 latency of N1 wave(P>0.05). In addition, the amplitude density of N1 and P1 wave in the combined treatment group was higher than that in the control group at 3 mo after treatment(P<0.05), the latency of P1 wave in the treatment group was significantly shorter than that in the control group(P<0.05), and there was no significant difference in the latency of N1 wave between the two groups(P>0.05).CONCLUSIONS:Mingmu-11 Pills combined with intravitreal injection of conbercept in the treatment of wARMD has obvious efficacy in improving vision and reducing macular edema.
الملخص
AIM: To compare the efficacy and safety of intravitreal injection of aflibercept combined with posterior sub-fascial injection of triamcinolone acetonide in the treatment of wet age-related macular degeneration(ARMD)with poor response to anti-vascular endothelial growth factor drugs.METHODS: Retrospective cohort study. From June 2018 to May 2020, a total of 60 patients(60 eyes)with refractory ARMD who had poor response to the treatment of anti VEGF drug ranibizumab were randomly divided into the control group of aflibercept and the observation group of triamcinolone acetonide combined with aflibercept, with 30 patients(30 eyes)in each group. Once a month, the patients in the two groups received intravitreal injection of aflibercept alone or intravitreal injection of aflibercept combined with posterior sub-fascial injection of triamcinolone acetonide for three consecutive times. The changes of best corrected visual acuity(BCVA), central macular thickness(CMT)and intraocular pressure were reviewed before injection and 1, 3 and 6mo after the third injection.RESULTS: The BCVA and CMT of the two groups were significantly improved 1, 3 and 6mo after the injection of the drug(P<0.05). The mean intraocular pressure in the combined group was higher at 1mo after treatment than before, but it still within the normal range. There was a significant difference in intraocular pressure between the two groups(17.50±4.60 vs. 18.30±3.73mmHg, P<0.05).CONCLUSION: Triamcinolone acetonide injection under the posterior fascia of the eyeball combined with intravitreal injection of aflibercept in the treatment of wet ARMD can effectively reduce macular edema and improve vision, which is more safe and reliable.
الملخص
AIM: To observe the clinical efficacy of Yishen Yanggan Mingmu formula combined with anti-vascular endothelial growth factor(VEGF)in the treatment of wet age-related macular degeneration(wARMD).METHODS: A total of 58 patients(58 eyes)with wARMD who were treated in Ningbo Eye Hospital from September 2020 to November 2022 were collected. They were divided into two groups according to randomized digital table: 29 patients(29 eyes)for the combination group and the other 29 patients(29 eyes)for the injection group. The injection group was only given intravitreal injection of conbercept; the combination group was orally administrated with Yishen Yanggan Mingmu formula combined with intravitreal injection of conbercept. The best corrected visual acuity(BCVA), central macular thickness(CMT)and the improvement of traditional Chinese medicine(TCM)syndromes after 3mo of treatment were observed and the clinical efficacy was evaluated.RESULTS: After 3mo of treatment, the total improved effective rate of the combination group(76%)was higher than the rate of the injection group(66%). After the treatment, the BCVA of the two groups was both higher than that before treatment(P<0.05), the CMT in both groups was lower than that before the treatment(P<0.05), and the improvement of CMT of the combination group was better than the injection group(-155.93±143.79μm vs. -95.36±56.81μm, P<0.05). After 3mo of treatment, each kinds of TCM syndrome in the combination group were significantly improved compared with those syndromes before the treatment(P<0.001). In the injection group, only blurred vision was improved(P<0.05). After the treatment, the scores of dizziness and insomnia, soreness and weakness of waist and knees, paleness and cold limbs, dry eyes and fatigue in the combination group were significantly lower than the injection group(P<0.001).CONCLUSIONS: The Yishen Yanggan Mingmu formula combined with intravitreal anti-VEGF drug injection is effective in the treatment of wARMD.
الملخص
AIM:To evaluate the clinical efficacy of traditional Chinese medicine(TCM)combined with intravitreal injection of anti-vascular endothelial growth factor(VEGF)or anti-VEGF medicines alone in the treatment of wet age-related macular degeneration(wAMD).METHODS:A total of eight databases were searched for relevant literatures in English and Chinese, including Chinese National Knowledge Infrastructure(CNKI), Wanfang, CQVIP, SinoMed, PubMed, Web of Science, Cochrane Library, Embase. Taking patients with wAMD as research objects, the Chinese and English clinical randomized controlled trials(RCTs)published from the databases' inception to April 20, 2022, which compared TCM combined with anti-VEGF drugs with anti-VEGF drugs alone were selected. The outcome indicators were best corrected visual acuity(BCVA)and central macular thickness(CMT). Traditional Meta and network Meta analysis were used to examine the data.RESULTS:There were 39 eligible studies among the 617 retrieved articles, involving 28 oral administration of Chinese herbal medicines and 2 757 participants. For BCVA improvement, results of TCM combination therapy were more favorable than anti-VEGF alone(MD=0.07, 95%CI: 0.05～0.09). Sheng Puhuang Decoction(SPD)ranked highest in 1 and 2mo after treatment, and Xuefu Zhuyu Capsule(XZC)ranked highest in 3mo after treatment. In terms of reducing CMT, TCM combination therapy were better(MD=-25.32 μm, 95%CI: -30.06～-20.57). Danggui Mingmu Decoction(DMD)ranked the highest in 1mo after treatment. Bushen Huoxue Decoction(BHD)ranked the highest in 2mo. Erchen Erhuang Decoction(EED)ranked the highest in 3mo.CONCLUSIONS: Compared with anti-VEGF treatment alone, TCM combination therapy led to improved BCVA and reduced CMT. However, most of the included literature is small-sample, single-center, single-blind RCTs with an overall low quality.
الملخص
AIM: To compare the clinical efficacy of conbercept and aflibercept in the treatment of wet age-related macular degeneration(wARMD)based on 4 consecutive intravitreal injections.METHODS: The clinical data of 108 patients(108 eyes)who were diagnosed as wARMD and treated with intravitreal injection at our hospital from January 2019 to January 2021 were retrospectively analyzed. They were divided into conbercept group(54 cases, 54 eyes)and aflibercept group(54 cases, 54 eyes)according to the different injectable drugs. All patients received intravitreal injection once a month, with four consecutive injections. Follow up for 12mo to observe best corrected visual acuity(BCVA), central macular thickness(CMT), complications and recurrence before and after injection.RESULTS: BCVA and CMT of patients in the two groups at 1, 2, 5 and 8mo after injection had no between-group differences(P&#x003E;0.05), but both were significantly improved compared with those before injection(P&#x003C;0.05). By the end of follow-up, conjunctival hemorrhage occurred in 2 eyes of the conbercept group at the early stage, and increased intraocular pressure and conjunctival hemorrhage occurred respectively in 2 eyes of the aflibercept group. There were no serious complications related to drug injection such as retinal detachment, complicated cataract, endophthalmitis and retinal pigment epithelial tear in the two groups, and there was no difference in the recurrence rate between the two groups(7% vs. 6%, P=1.000).CONCLUSION: On the basis of continuous 4 times of intravitreal injection, both conbercept and aflibercept are safe and effective in the treatment of wARMD, and the efficacy is even.
الملخص
With the increasing aging population, the incidence of wet age-related macular degeneration(wARMD)is gradually rising. The formation of neovascularization leads to recurrent hemorrhage in the macular region, which is one of the main causes of blindness in the elderly. Currently, the primary clinical treatment for wARMD is intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs. However, there are still some patients who have poor or no response to anti-VEGF drugs, resulting in suboptimal or ineffective clinical outcomes. Analyzing the specific influencing factors will be beneficial in guiding clinical decision-making. This article reviews the impact of factors such as advanced age, treatment duration, number of injections, characteristics of neovascular lesions, macular structure, intraocular cytokine levels, and genetics on the response to anti-VEGF therapy. In addition, recent studies have found that pericytes, as cellular components of microvascular walls, can influence the sensitivity to anti-VEGF therapy. This review summarizes the current research on the mechanisms of pericytes in poor or non-response to anti-VEGF therapy and discusses targeted strategies focusing on pericytes.
الملخص
Conbercept is a novel anti-vascular endothelial growth factor drug independently developed by China. Since it was approved for clinical application by the State Food and Drug Administration of China in 2013, conbercept has shown reliable safety and efficacy in the treatment of ocular neovascular diseases such as wet age-related macular degeneration, choroidal neovascularization and macular edema. For different diseases, the treatment strategies of conbercept are different. This article mainly reviews the application progress of conbercept in ocular neovascularization related diseases including wet age-related macular degeneration, diabetic macular edema, pathologic myopia choroidal neovascularization, neovascular glaucoma, retinopathy of prematurity and corneal neovascularization, and summarizes and explores the indications, administration scheme and therapeutic effect of conbercept. It is expected that the indications of conbercept will be wider and the administration scheme will be more given, and the usage of conbercept will bring new ideas for the treatment of ocular neovascular diseases.
الملخص
@#AIM: To evaluate the diagnostic value of optical coherence tomography angiography(OCTA)in detecting the choroidal neovascularization(CNV)of wet age-related macular degeneration(wARMD).<p>METHODS: PubMed, Embase, Web of science, Cochrane library, CNKI, Wanfang, CBM and VIP databases were searched from inception to October 27, 2020 in diagnosing CNV of wARMD by OCTA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by QUADAS-2 standard. Meta-analysis was performed by Meta-Disc 1.4 and Stata 16.0 softwares.<p>RESULTS: A total of 11 studies involving 995 eyes were included. The results of Meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic ratio, the AUC of sROC and the positive post-test probability were 0.88 \〖95%<i>CI </i>(0.83, 0.92)\〗, 0.95 \〖95%<i>CI </i>(0.85, 0.99)\〗, 18.45 \〖95%<i>CI </i>(5.36, 63.52)\〗, 0.12 \〖95%<i>CI </i>(0.08, 0.18)\〗, 152.73 \〖95%<i>CI </i>(36.39, 641.05)\〗, 0.95 \〖95%<i>CI </i>(0.92, 0.96)\〗 and 0.96 respectively.<p>CONCLUSION: OCTA has significant diagnostic value for CNV of wARMD, especially for patients with early wARMD.
الملخص
@#Wet age-related macular degeneration is a severe and blinding disease with progressive central visual impairment, accounting for about 10%-15% of age-related macular degeneration. In recent years, with the deepening understanding of its pathogenesis, especially the discovery of anti-VEGF family, the clinical popularization of new drugs has brought benefits to patients. However, this treatment mode requires frequent intraocular injection, and many patients must continue to use it indefinitely to preserve their vision. Gene therapy can provide long-term stable anti-VEGF activity, which has become a new hotspot of research. Several methods of gene therapy are summarized as follows.
الملخص
@#AIM: To observe the clinical characteristics and influence factors of different responses in patients with wet age-related macular degeneration(wARMD)treated with intravitreal conbercept.<p>METHODS: A total of 62 eyes(56 patients)with wet age-related macular degeneration who received intravitreal Conbercept injections(3+PRN)in our hospital from January to September 2018 were retrospectively analyzed. The best-corrected visual acuity(BCVA)and optical coherence tomography(OCT)were performed before and after treatment. Responses were evaluated and grouped according to BCVA after the last injection. 33 cases of 35 eyes with BCVA improvement ≥5 letters were included in the response group. 23 cases with 27 eyes were included in the non-response group. Before and after treatment, BCVA, central retinal thickness(CRT)and related data of the two groups were analyzed.<p>RESULTS: One month after 3 injections, BCVA in the response group increased from 41.83±7.92 letters at baseline to 52.52±10.61 letters(<i>t</i>= -6.883, <i>P</i>=0.02), and BCVA increased from 43.65 ± 10.42 letters at baseline to 44.18 ± 8.47 letters in the non-response group(<i>t</i>=0.471, <i>P</i>=0.684).CRT of the two groups after treatment decreased from the baseline(<i>F</i>=31.47, 27.28, all <i>P</i><0.01). Six months after 3 injections, the proportion of patients with the integrity of the macular fovea ellipsoid in response group(69%)was more than that in the non-responsive group(7%), and the proportion of patients with subretinal fluid(86%)was higher than that without SRF in the response group(44%), the proportion of patients with intraretinal fluid(31%)in the response group was lower than that in the non-response group(81%)(all <i>P</i><0.05), but there was no difference in the proportion of patients with pigment epithelial detachment between the two groups(77% <i>vs</i> 59%, <i>P</i>> 0.05).<p>CONCLUSION: Intravitreal injections of conbercept can effectively reduce the subretinal fluid and retinal fluid in patients with wet age-related macular degeneration, and improve the patient's visual acuity. Patients with the integrity of the outer layer of the retina(especially the ellipsoidal zone)and SRF responded well after treatment, while patients with IRF responded poorly after treatment.
الملخص
@#AIM: To observe the changes of selected area of choroidal neovascularization(CSA)and flow area of choroidal neovascularization(CFA)before and after the treatment of anti-vascular endothelial growth factor(VEGF)by optical coherence tomography angiography(OCTA), and to explore the advantages of OCTA in the treatment and prognosis of wet age-related macular degeneration(wAMD). <p>METHODS: A retrospective analysis was performed on 22 patients(27 eyes)who were diagnosed with wARMD and received the first anti-VEGF drug treatment and subsequent treatment in the Department of Ophthalmology of our hospital from 2018-02 to 2019-07. All patients were treated with anti-VEGF drugs according to the 3+prn regimen. The best corrected visual acuity(BCVA),macular foveal retinal thickness(CMT), CSA, and CFA were compared before and after treatment. We analyzed the correlation between BCVA(LogMAR)and CMT, CSA, CFA by Pearson correlation analysis. <p>RESULTS: After 3mo of the treatment, the mean LogMAR BCVA(0.512±0.367), CMT(223.271±17.795μm),CSA(0.085±0.113mm2)and CFA(0.015±0.008mm2)were significantly lower than those before treatment(<i>P</i><0.05). The results of correlation analysis showed that the post- BCVA was positively correlated with pre-CMT, post-CMT, pre-CSA, post-CSA, pre-CFA and post-CFA(<i>P</i><0.05).<p>CONCLUSION: OCTA can directly display and quantify the changes of CSA and CFA before and after anti-VEGF treatment of wAMD, and provide a reference for the evaluation of wAMD treatment effects.
الملخص
@#Age-related macular degeneration(ARMD)is one of the main causes which lead to irreversible blindness. Wet ARMD, which is featured by choroidal neovascularization(CNV), takes up 90% in ARMD related blind patients. With the increasing population of aged people in China, wet ARMD has become a severe social and medical issues. Currently, management aiming at wet ARMD is the applications of anti-VEGF agents. Anti-VEGF drugs not only postpone the development of CNV, but also preserve the visual function, improve the prognosis, and reduce the incidence of blindness. However, we still need to focus on the non-response during treatment, long-term maintenance, drug resistance, adverse reactions, and economic effectiveness. Here we review the recent clinical medications on wet ARMD.
الملخص
@#AIM: To observe the changes of selected area of choroidal neovascularization(CSA)and flow area of choroidal neovascularization(CFA)before and after the treatment of anti-vascular endothelial growth factor(VEGF)by optical coherence tomography angiography(OCTA), and to explore the advantages of OCTA in the treatment and prognosis of wet age-related macular degeneration(wAMD). <p>METHODS: A retrospective analysis was performed on 22 patients(27 eyes)who were diagnosed with wARMD and received the first anti-VEGF drug treatment and subsequent treatment in the Department of Ophthalmology of our hospital from 2018-02 to 2019-07. All patients were treated with anti-VEGF drugs according to the 3+prn regimen. The best corrected visual acuity(BCVA),macular foveal retinal thickness(CMT), CSA, and CFA were compared before and after treatment. We analyzed the correlation between BCVA(LogMAR)and CMT, CSA, CFA by Pearson correlation analysis. <p>RESULTS: After 3mo of the treatment, the mean LogMAR BCVA(0.512±0.367), CMT(223.271±17.795μm),CSA(0.085±0.113mm2)and CFA(0.015±0.008mm2)were significantly lower than those before treatment(<i>P</i><0.05). The results of correlation analysis showed that the post- BCVA was positively correlated with pre-CMT, post-CMT, pre-CSA, post-CSA, pre-CFA and post-CFA(<i>P</i><0.05).<p>CONCLUSION: OCTA can directly display and quantify the changes of CSA and CFA before and after anti-VEGF treatment of wAMD, and provide a reference for the evaluation of wAMD treatment effects.
الملخص
Age-related macular degeneration (AMD) is the primary cause of the blindness among the population aged more than 50 years old.The prevalence of AMD increases with age growing.Wet AMD is the main cause of the visual impairment in over 90％ of AMD patients,which is characterized by formation of choroidal neovascularization.It takes the hypersecretion of vascular endothelial growth factor (VEGF) as a mechanism,leading to vision loss and blindness finally.Targeted anti-VEGF therapy for angiogensis,like ranibizumab and aflibercept can reduce the rate of blindness greatly in AMD patients.It has become the front-line therapy in clinical.However,there still exist some problems.Some patients do not respond to the treatment or their eyesight cannot sustain after long-term treatment.In addition,repeated injection increases the risk of complications and economic burden.In order to further increase their quality of life and improve long-term outcome in patients with wet AMD,a steady flow of new therapy has emerged,such as function towards the same or different targets of antiangiogenesis to enhance the effect by combination therapy,improving or simplifying the mode of administration,inhibiting VEGFR tyrosine protein kinase,etc.This paper reviewed the research progress of anti-VEGF for the therapy in wet AMD.
الملخص
Objective To investigate the application value of deep learning optical coherence tomography ( OCT) on wet age-related macular degeneration ( wAMD) assisted diagnosis. Methods Weakly supervised deep learning algorithms was applied on the premise that only disease or not can be provided as a marker. The OCT image automatically assisted in the diagnosis of diseased areas of wAMD,and thermograms were applied to provide a basis for doctors to detect disease areas. Based on the deep learning of weak supervision,a new network algorithm structure was proposed for detecting disease area in ophthalmic OCT images. At the same time, thermograms were adopted to improve the accuracy of the lesion map,which is the location of the lesion area. This study followed the Declaration of Helsinki. This study protocol was approved by Ethic Committee of Ningbo Eye Hospital ( No. 2018-YJ05 ) . Written informed consent was obtained from each subject before entering study cohort. Results Resnet-based deep learning algorithm gave a diagnostic accuracy rate of 94. 9％ for the disease, which was much higher than that of AlexNet 85. 3％,VGG 88. 7％, and Google-Net 89. 2％. The thermograms with different colors provided a more convenient auxiliary diagnosis basis for doctors. Conclusions Compared with the original classification network,which needs disease area markers as empirical knowledge, deep learning algorithm model not only provides better results in the classification of retinal diseases,but also marks potential disease areas. The lesion area provides a basis for judging the area of the lesion for the diagnosis of wAMD.
الملخص
Age.related macular degeneration ( AMD ) is the primary cause of the blindness among the population aged more than 50 years old. The prevalence of AMD increases with age growing. Wet AMD is the main cause of the visual impairment in over 90％ of AMD patients, which is characterized by formation of choroidal neovascularization. It takes the hypersecretion of vascular endothelial growth factor ( VEGF) as a mechanism,leading to vision loss and blindness finally. Targeted anti.VEGF therapy for angiogensis,like ranibizumab and aflibercept can reduce the rate of blindness greatly in AMD patients. It has become the front.line therapy in clinical. However,there still exist some problems. Some patients do not respond to the treatment or their eyesight cannot sustain after long.term treatment. In addition,repeated injection increases the risk of complications and economic burden. In order to further increase their quality of life and improve long.term outcome in patients with wet AMD,a steady flow of new therapy has emerged, such as function towards the same or different targets of antiangiogenesis to enhance the effect by combination therapy,improving or simplifying the mode of administration,inhibiting VEGFR tyrosine protein kinase, etc. This paper reviewed the research progress of anti.VEGF for the therapy in wet AMD.
الملخص
@#AIM:To investigate the effect of intravitreal injection of anti-vascular endothelial growth factor(VEGF)on choroidal thickness and posterior ciliary artery blood flow in patients with wet age-related macular degeneration(ARMD). <p>METHODS:A total of 93 wet ARMD patients enrolled into the ophthalmology department in our hospital from September 2014 to December 2016 were selected into our study. The patients were treated with anti-VEGF vitreous injection for 3mo. The central retinal thickness(CRT), subfoveal choroidal thickness(SFCT), best corrected visual acuity(BCVA, LogMAR), choroidal neovascularization(CNV)and parameters of ciliary arterial blood flow \〖systolic peak flow velocity(PSV), end-diastolic blood flow velocity(EDV)and mean blood velocity(mV), resistance index(RI)/pulse index(PI)\〗 before treatment(T0), 1mo after treated(T1), 2mo after treated(T2), 3mo after treated(T3)were recorded and compared. All patients had been followed for 18mo, and side-effect were recorded. <p>RESULTS: All wet ARMD patients had successfully completed intravitreal anti-VEGF injection. Compared with before treatment, BCVA, CRT, SFCT, and CNV had gradually decreased(<i>F</i>=72.738, 32.333, 7.305 and 957.450, <i>P</i><0.05)after treatment. BCVA, CRT, SFCT and CNV: T3<T2<T1<T0(<i>P</i><0.05). There had no significant difference in PSV, EDV and mV before and after treatment(<i>F</i>=2.619, 1.942, 0.820, <i>P</i>>0.05). Compared with before treatment, RI index had gradually decreased(<i>F</i>=25.451, <i>P</i><0.05)and PI index had gradually increased(<i>F</i>=8.660, <i>P</i><0.05)after treatment. PI: T3>T2≈T1>T0; RI: T3≈T2<T1≈T0(≈ means approximately equal to). All patients were followed up for a period of 18 to 29mo. The BCVA of 93 patients was 0.26-0.42(mean 0.32±0.06). There were no serious complications such as cataract and retinal detachment. Three cases had subconjunctival hemorrhage, 1 eye intraocular pressure increased, 1 eye corneal edema, 2 eyes appearance of foreign body sensation, all given symptomatic treatment or self-improvement.<p>CONCLUSION: Intravitreal injection of anti-VEGF can effectively reduce choroidal thickness and increase ciliary posterior arterial perfusion, with a good long-term effect and less risk.
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AIM: To investigate the relationship between high temperature essential factor A-1(HTRA1) polymorphism and genetic susceptibility of wet age-related macular degeneration (AMD) in Han population. METHODS: Totally 201 patients of wet AMD in Han population were selected from May 2014 to January 2017 in our hospital as disease group,and 201 healthy persons of Han were selected as health group. Blood samples of peripheral vein were collected and genomic DNA was extracted. HTRA1 polymorphism loci were detected,and the rs11200638 and rs2248799 loci of HTRA1 gene were detected by Sequenom mass spectrometry platform. Then the relationship between HTRA1 polymorphism and genetic susceptibility of wet AMD were analyzed. RESULTS: The grade distributions of the genotype of the rs11200638 and rs2248799 loci in the two groups subjects had significant differences (P<0.01), and the frequencies of AA and TT in the disease group were respectively 51.2% and 57.7%,of which the health group were respectively 20. 9% and 28. 4%, and the former were significantly higher than the latter, with significant differences (P<0.01). The frequencies of risk allele A of rs11200638 loci and risk allele T of rs2248799 loci in the disease group were respectively 69.7% and 73.6%, of which the health group respectively were 45. 8% and 52 5%, and the former were significantly higher than the latter, with significant differences (P<0. 01). The OR values of rs11200638 genotype AA and AG were respectively 5.36 and 3.45,which were the risk factors of wet AMD (P < 0. 01). The OR values of rs2248799 genotype TT and TC were respectively 2.36 and 1.98, which were the risk factors of wet AMD (P<0.01). CONCLUSION: The rs11200638 and rs2248799 polymorphisms of HTRA1 gene are associated with the incidence of wet AMD,and the genotype AA and TT are closely related to the risk of wet AMD in Han population, of which the higher frequencies can increase the risk of wet AMD.