Evaluation of clinical efficacy and safety on phacoemulsification combined with gonioscopy-assisted angle plasty for primary angle-closure glaucoma with cataract / 中华实验眼科杂志

Objective:To evaluate the efficacy and safety of phacoemulsification combined with gonioscopy-assisted angle plasty (Phaco-GAAP) for primary angle closure glaucoma (PACG) with cataract.Methods:A case series study was carried out.Twenty-five eyes of 22 patients with PACG and cataract were enrolled in Beijing Tongren Hospital from April 2022 to August 2022.All of the patients received Phaco-GAAP surgery.During the operation, viscoelastic-assisted goniosynechialysis was performed at first, followed by a secondary angle plasty for residual peripheral anterior synechiae (PAS) based on the quantified assessment by gonioscopy, and the extent of PAS was recorded intraoperatively.The operated eyes were followed at 1 day, 1 week, 1 month and 3 months after surgery to evaluate intraocular pressure (IOP), PAS range, the number of anti-glaucoma drugs application, operation-related complications, and success rate.The qualified success rate was defined as medicine-controlled IOP ≤21 mmHg after surgery, and complete success rate was defined as IOP ≤21 mmHg without any anti-glaucoma medication.This study complied with the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital (TRECKY2021-136). Written informed consent was obtained from each patient prior to entering the research cohort.Results:The extent of PAS was [270(225, 360)°], [165(110, 215)°] and [100(35, 175)°] at preoperation, first and secondary angle plasty, respectively, showing a significant difference among them ( χ2 =40.742, P<0.001). The PAS range was significantly reduced at first angle plasty in comparison with preoperation and was significantly reduced at secondary angle plasty in comparison with at first angle plasty (both at P<0.001), and the proportion of the angle PAS range ≥180° decreased from 48% to 24% after second angle plasty.In 13 eyes finished gonioscopy, the PAS range was [240(195, 305)°], [60(25, 182.5)°], [170(120, 275)°]and [180(140, 280)°]at preoperation, at the end of operation, postoperative 1 month and 3 months, respectively, with a significant difference ( χ2 =23.631, P<0.001). The PAS range was significantly smaller at postoperative 1 month, 3 months than that at preoperation (both at P=0.004) and larger than that at the end of operation ( P=0.011, P=0.003). The IOP was (40.19±17.23), (15.80±7.98), (13.89±5.09), (12.80±3.79) and(13.24±2.78) mmHg before operation and 1 day, 1 week, 1 month and 3 months after operation, respectively, showing a significant difference ( F=44.031, P<0.001), and the IOP was significantly reduced after operation (all at P<0.001). The PAS range at the end of operation was positively correlated with preoperation ( rs=0.409, P=0.042). The complete and qualified success rates were 95.8%, 95.8% for postoperative 1 month, 95.8% and 100% for postoperative 3 months, respectively.The primary complication was intraoperative anterior chamber angle hemorrhage, with an incidence of 68%. Conclusions:Phaco-GAAP can intraoperatively quantify PAS range and guide secondary angle plasty, therefore, it is an effective and safe surgical intervention for PACG with cataract.

Intraocular pressure distribution and reference interval of high-altitude eye health screening population from Xining, Qinghai / 中华实验眼科杂志

Objective:To investigate the distribution of intraocular pressure (IOP) in high-altitude population aged 18 years and over in Xining, Qinghai and establish the reference interval (RI) of IOP.Methods:A cross-sectional study was conducted in Xining, Qinghai Province at 2.271 km above sea level from September 2019 to May 2020.Ophthalmic examinations and IOP measurement were conducted among subjects from Physical Examination Center of Qinghai Provincial People's Hospital.The subjects who had been living in Xining without leaving for three months were enrolled.Ophthalmic examinations included vision examination, IOP measurement, slit-lamp microscopy, fundus photography, anterior and posterior segment optical coherence tomography.IOP was measured using Goldmann applanation tonometry under local anesthesia.Subjects with factors that could cause significant changes in IOP and affect the accuracy of IOP measurement, and those who were unable to receive IOP measurement were excluded.Subjects were grouped according to sex, age and ethnicity, and the distribution and RI of IOP were compared among all groups.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2017-024). Written informed consent was obtained from each subject.Results:A total of 6 120 subjects (6 120 eyes) aged 18-90 years old were enrolled, including 2 850 males and 3 270 females with average age of (45.54±13.85) years.The average IOP of high-altitude population in Xining, Qinghai Province was (14.32±1.93) mmHg (1 mmHg=0.133 kPa), with the RI of 10.54-18.10 mmHg.The average IOP was (14.42±1.98) mmHg in male with the RI of 10.54-18.30 mmHg, (14.23±1.88) mmHg in female with the RI of 10.55-17.91 mmHg.The IOP of male was higher than that of female ( t=3.71, P<0.001). The IOP of Han, Tibetan, Hui and other nationalities were (14.38±1.91), (13.93±2.06), (14.21±1.87), (13.94±1.95) mmHg, respectively, with a statistically significant overall difference ( F=6.73, P<0.001). The IOP of Han nationality was significantly higher than that of Tibetan, Hui and other nationalities, and the differences were statistically significant (all at P<0.05). Conclusions:RI of IOP in high-altitude population from Xining, Qinghai is lower compared with normal altitude area.

Research on real-world study of tafluprost in glaucoma and ocular hypertension / 中华实验眼科杂志

Medication treatment is the most common measure for lowering intraocular pressure in glaucoma, and prostaglandin analogues have been unanimously recommended as the first choice for the treatment of glaucoma in multiple guidelines or consensus.Real-world studies (RWS) are observational studies in which diverse data are obtained in clinical environment, community or home settings to evaluate the real impact of some treatment on patients’ health.RWS have shown that tafluprost has a good effect on lowering intraocular pressure in patients with primary open angle glaucoma, ocular hypertension, normal tension glaucoma and other types of glaucoma, and it has mild ocular adverse effects in monotherapy for treatment-naive patients, alternative therapy and combination therapy.However, there are limiting factors for RWS such as the absence of the control group, and further studies are needed to evaluate the drug efficacy.In this article, the RWS of patients with different types of glaucoma and high intraocular pressure treated by tafluprost and the efficacy of tafluprost under different treatment modes as well as the safety of tafluprost and medication compliance in RWS were reviewed, so as to provide certain guidance for the practical clinical application of tafluprost.

Generation of a chimeric plasmin-resistant VEGF165/VEGF183 (132-158) protein and its comparative activity.

Vascular endothelial growth factor-A (VEGF) is a potentially ideal angiogenic agent in tissue repair, however, various side effects still limit its application in clinical practice. If VEGF could be localized and activated in a specific region, its side effects would be minimized. A VEGF variant was designed by fusing the peptide VEGF183 (132-158), which contains plasmin and matrix metalloproteinases (MMPs ) cleavage sites, as well as extracellular matrix (ECM) binding sequences to the COOH-terminus of plasmin-resistant VEGF165 (designated as VEGF192). These were then expressed in Pichia pastoris and mouse breast cancer EMT-6 cells. Its stimulation of dermal vessel permeability in rats, mitogenic activity in cultured human umbilical vein endothelial cells (HUVECs), affinity for ECM, as well as its half-life in rats were compared with those of VEGF165. The results show that VEGF192 has weaker vessel permeabilization activity and mitogenic activity for HUVECs only at lower concentrations. It also has a longer half-life and a higher ECM-binding affinity compared with those of VEGF165. However, the plasmin-cleaved VEGF192 could stimulate HUVEC proliferation in a dose-dependent manner. Different functional peptide combinations should have potential applications for VEGF modifications and VEGF192 might be used in tissue engineering and the treatment of ischemia-related diseases.

Immunization with P277 induces vascular leak syndrome in C57BL/6 mice via endothelial damage.

Accumulating evidence established a positive association of anti-heat shock protein 60 (HSP60) autoantibodies and the presence of atherosclerosis. However, whether anti-P277 (HSP60 437-460) autoantibodies may lead to the pathological increase in vascular permeability, a vascular leak syndrome (VLS), is unknown. In the present study, anti-P277 immunity was effectively induced in C57BL/6 mice, causing a marked increase in VLS in both normal mice and those bearing melanoma as well. Further analysis of the pathological role of anti-P277 immunity revealed that the B-cell epitopes located in P277 played a causal role in the development of VLS. Moreover, studies on endothelial cells (ECs) showed that the anti-P277 antibodies could cross-react with HSP60, highly expressed in both normal and stressed ECs, and mediate damage to cells in the presence of complement. These data suggested that humoral immune response induced by anti-P277 immunity mediates EC damage and induces VLS. These negative effects may cast shadows on P277, used as a peptide vaccine.

Construction, expression, purification and immunology effect of an anti-atherosclerosis chimeric enzyme vaccine in Escherichia coli.

In order to prevent atherosclerosis, a chimeric enzyme vaccine of AnsB-TTP-PADRE-CETPC was successfully constructed, expressed and purified to immunize New Zealand white rabbits for inducing high titers of anti-CETP antibodies to improve lipid abnormality. The protein was expressed as soluble protein in Escherichia coli and purified by anion exchange column and Sephadex G-100 size-exclusion chromatography. After immunizing rabbits with the purified protein, high titer anti-CETP antibodies were induced and lasted more than nineteen weeks in vivo; High density lipoprotein cholesterol (HDL-C) content in the serum was elevated to 61% while decreased low density lipoprotein cholesterol (LDL-C) to 37.2% compared with control rabbits in the presence of Al(OH) (3).