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AIM: To evaluate the effects of panretinal photocoagulation (PRP) compared with PRP plus intravitreal bevacizumab (IVB) in patients with high-risk proliferative diabetic retinopathy (PDR) according to the Early Treatment Diabetic Retinopathy Study criteria. METHODS: The data were collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. After treated with standard PRP, the eyes were randomly assigned to receive only PRP (PRP group) or PRP plus intravitreal injection of 1.25 mg of bevacizumab (PRP-Plus group). Patients underwent complete ophthalmic evaluation, including best corrected visual acuity (BCVA), intraocular pressure (IOP), and new vessel size in fluorescein angiography (FA) and optical coherence tomography for the assessment of central subfield macular thickness (CSMT) at baseline and at weeks 12 (±2), 16 (±2), 24 (±2) and 48 (±2). Main outcome measures also included vitreous clear-up time and neovascularization on the disc (NVD) regression time. Adverse events associated with intravitreal injection were investigated. RESULTS: Thirty consecutive patients (n=36 eyes) completed the 48-week follow-up. There was no significant difference between the PRP and PRP-Plus groups with respect to age, gender, type or duration of diabetes, area of fluorescein leakage from active neovascularizations (NVs), BCVA or CSMT at baseline. The mean vitreous clear-up time was 12.1±3.4wk after PRP and 8.4±3.5wk after PRP combined with IVB. The mean time interval from treatment to complete NVD regression on FA examination was 15.2±3.5wk in PRP group and 12.5±3.1wk in PRP-Plus group. No significant difference in CSMT was observed between the groups throughout the study period. However, the total area of actively leaking NVs was significantly reduced in the PRP-Plus group compared with the PRP group (P<0.05). Patients received an average of 1.3 injections (range: 1-2). Ten eyes (27.8%) underwent 2 injections. Two eyes had ocular complication of PDR progression to dense vitreous hemorrhage (VH). No major adverse events were identified. CONCLUSION: The adjunctive use of IVB with PRP is associated with a greater reduction in the area of active leaking NVs than PRP alone in patients with high-risk PDR. Short-term results suggest combined IVB and PRP achieved rapid clearance of VH and regression of retinal NV in the treatment of high-risk PDR. Further studies are needed to determine the effect of repeated intravitreal bevacizumab injections and the proper number of bevacizumab injections as an adjuvant.

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Posterior capsular opacification (PCO), the main complication of cataract surgery, is mainly caused by the proliferation, migration, and epithelial-mesenchymal transition (EMT) of the residual lens epithelial cells (LECs).Vitamin C was reported to reduce the risk of forming a cataract. However, there has been no study showing the association between vitamin C and PCO. In this study, we found that vitamin C could inhibit the migration and proliferation of human lens epithelial cells. We also found that vitamin C could increase the proline hydroxylation of HIF-1α and reduce the activity of HIF-1α. Moreover, vitamin C could not inhibit the activity of proline-mutant HIF-1α (402/564). Overexpression of wild-type HIF-1α or proline-mutant HIF-1α was found to increase the proliferation and migration of human lens epithelial cells. Differently, vitamin C could inhibit the proliferation and migration in wild-type HIF-1α-overexpressing lens epithelial cells but not the proline-mutant HIF-1α-overexpressing cells. Additionally, vitamin C was also found to inhibit the expression of EMT transcription factors TWIST. We then found that vitamin C could repress the EMT phenotypes induced by the overexpression of wild-type HIF-1α but not the proline-mutant HIF-1α. These results provide evidence that vitamin C plays a role in the repression of proliferation, migration, and EMT of human lens epithelial cells by destabilizing HIF-1α.

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AIM: Age-related macular degeneration (AMD) is the leading cause of blindness in the developed world and complement factor H (CFH) polymorphism has been found to associate with the AMD. To investigate whether the Y402H variant in CFH is associated with AMD in Chinese populations, a systematic review and meta-analysis were performed to estimate the magnitude of the gene effect and the possible mode of action. METHODS: A meta-analysis was performed using data available from ten case-control studies assessing association between the CFH Y402H polymorphism and AMD in Chinese populations involving 1538 AMD. Data extraction and study quality assessment were performed in duplicate. Summary odds ratios (ORs) and 95% confidence intervals (CIs) an allele contrast and genotype contrast were estimated using fixed- effects models. The Q-statistic test was used to assess heterogeneity, and Funnel plot was used to evaluate publication bias. RESULTS: Seven of ten case-control studies were neovascular AMD, and few studies came from west and north of China. There was strong evidence for association between CFH and AMD in Chinese population, with those having risk allele C 2.35 times more likely to have AMD than subjects with T allele. Evidence of publication bias was not observed in our meta-analysis. CONCLUSION: [corrected] This meta-analysis summarizes the strong evidence for an association between CFH and AMD in Chinese and indicates each C allele increasing the odds of AMD by 2.33-fold.But more evidences about the relation between CFH polymorphism and different type of Chinese AMD from various district were needed.

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AIM: To analyze the clinical characteristics, incidence and risk of retinal detachment (RD) after cataract surgery and posterior chamber intraocular lens implantation in high myopic patients. METHODS: The medical records of 146 high myopic patients (232 eyes) who underwent cataract surgery and posterior chamber intraocular lens implantation were studied retrospectively. The development of RD was followed up over a 3-year period, and its characteristics were determined. All of the eyes received a comprehensive ophthalmological examination, including best-corrected visual acuity measurements, a dilated fundus examination and axial length measured by A-scan ultrasonography. RESULTS: RD developed in 15 eyes of 15 patients. All the 15 eyes needed vitreo-retinal surgery. The mean interval between cataract surgery and the development of RD was 10 +/- 9 months (range 0.5-32 months). The visual results of the eyes after anatomical successful vitreo-retinal surgery ranged from finger count/10 cm to 0.06. 80% (12/15) of the eyes had a worse vision after the surgery than that before cataract surgery. Posterior capsular tear were associated significantly with RD (P < 0.01). Approximately 60% (9/15) of retinal detachment was attributable to posterior capsule tear during cataract surgery. CONCLUSION: Incidence of RD in high myopic patients after cataract surgery was 6.4%. RD was the potentially serious complication and tended to develop more frequently in eyes with posterior capsular rupture during cataract surgery. It is crucial to examine retinal status after cataract surgery and to have a close follow-up to prevent retinal complications, especially for patients with posterior capsular disruption.

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OBJECTIVE: With the rabbit iris pigment epithelial cells (IPECs), which were containing the NT4-NAP fusion gene, taken as the substituting secreting cells producing the neuropeptide NAP, the effect of neuropeptide NAP on the growth status of retinal neuroepithelial cells of rabbit was examined and explored. METHODS: The iris pigment epithelial cells and retinal neuroepithelial cells of rabbit were cultured; rAAV-GFP and rAAV-NAP (containing NT4-NAP fusion gene) were constructed; the rabbit IPECs were infected with rAAV-GFP and rAAV-NAP; the infections of viruses were detected by GFP fluorescence expression; the supernatant of culture from rabbit IPECs with NAP was collected and added into the culture medium of rabbit retinal neuroepithelial cells, and the growth state of retinal neuroepithelial cell was observed. RESULTS: Compared to control cells, the rabbit IPECs could express the GFP fluorescence. The rabbit retinal neuroepithelial cells with NAP supernatant could survive more, and the survival cells showed longer and stronger axons. On 14's day of cell culture, the mean axon length of NAP group was (14. 6+/-1. 1) microm, while that of control group was only (3. 1+/-0. 6) mircom. Obviously, a significant difference existed between two groups (P<0. 05). CONCLUSION: The rabbit IPECs with NT4-NAP fusion gene can secrete NAP, and the NAP can promise the growth of rabbit retinal

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OBJECTIVE: To investigate the effect of infection with adeno-associated virus (AAV) vector containing NT4-NAP fusion gene on photoprotection of rabbit iris pigment epithelium cells (IPECs). METHODS: rAAV-GFP and rAAV-NAP (containing NT4-NAP fusion gene) were constructed; rabbit IPECs were cultured and infected with rAAV-GFP and rAAV-NAP; transfection of viruses was detected by GFP fluorescence expression; NAP protect rabbit iris pigment epithelium from light stimulation was evaluated by MTT and flow cytometry. RESULTS: Rabbit IPECs expressed the GFP fluorescence; comparing with control cells, IPECs transfected with rAAV-NAP remained normal proliferation and showed lower apoptosis percentage after ultra-violet stimulation. CONCLUSION: rAAV-NAP constructed in the study can infect rabbit IPECs, and NAP may protect rabbit IPECs from ultra-violet damage.

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PURPOSE: To determine whether triamcinolone acetonide (TA ) staining facilitates posterior hyaloid removal in patients undergoing pars plana vitrectomy (PPV) for retinal disease. METHODS: A triamcinolone acetonide(TA)-assisted vitrectomy was performed on patients with the following disease: proliferative diabetic retinopathy (5 eyes), central retinal vein occlusion (5 eyes), macuar hole (3 eyes), and epiretinal membrane (2 eyes). Eyes without apparent preoperative posterior vitreous detachment were enrolled in this study. After a core PPV, TA aqueous suspension (40 mg/ml) was injected into the mid vitreous cavity to visualize the posterior hyaloid, thus allowing a complete posterior hyaloid separation and removal. The visual acuity, intraocular pressure (IOP), tamponade, corneal pathology, after-cataract, vitreous hemorrhage, and necessity for reoperation were thereafter examined for at least 3 months after surgery. RESULTS: In all patients, the vitreous body was clearly seen by means of triamcinolone during surgery, and complete removal of posterior hyaloid was facilitated and confirmed. Retina was attached in 14 of 15 eyes, and vision acuity was improved in 9 of 15 eyes. Two eyes showed transient postoperative IOP elevation, 2 eyes had after cataract formation and l eye had cataract progression. Vitreous hemorrhage occurred in 1 eye. No eye had corneal pathology. CONCLUSION: Triamcinolone improved the visibility of the hyaloid and the safety of surgical procedures during PPV. No obvious adverse effect due to toxicity of TA accrued in TA-assisted PPV.

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OBJECTIVE: To determine the effect of Y27632, a specific inhibitor of p160 Rho-associated coiled-coil forming protein kinase (ROCK), on experimental rabbit PVR. METHODS: Cultured rabbit retinal pigment epithelial cells were used in the experiments. The effects of Y27632 on RPE alpha-SMA (smooth muscle actin) stress fiber formation were studied by immuno-fluorescent staining. An in vitro type I collagen gel contraction assay and MTT assay were used to detect the effect of Y27632 on RPE cell contractile force and proliferation. Cultured 6 th passage rabbit RPE cells were injected intravitreally to induce the PVR model and then followed injection of 50 micromol/L of Y27632. The presence of tractional retinal detachment (TRD) was assessed to evaluate the effect of this agent in vivo. Electroretinography and histological studies were performed after intravitreal injection of Y27632 into untreated eyes to evaluate toxicity. RESULTS: The results showed that Y27632 disrupted SMA stress fiber formation in the cultured RPE cells and impaired contractile force generated by RPE cells (t = 16.212, P < 0.01). Development of TRD was significantly reduced (P < 0.01) with 50 micromol/L of Y27632. No obvious histological or retinal functional damage was found in the Y27632-treated group. CONCLUSION: p160 ROCK specific inhibitor Y27632 decreased contractile force generated by RPE cells and attenuated PVR without significant side effect in rabbit. This reagent could be potential therapeutically method in the treatment of PVR.

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PURPOSE: To report ophthalmologic and angiographic features of choroidal metastases from carcinoid tumor and analyze their common clinical manifestation. METHODS: Ophthalmologic examinations and fundus fluorescein angiography (FFA) were performed in 30 patients suffered from carcinoid tumor, and four patients diagnosed of breast cancer (2 cases), lung cancer (1 case) and maxillary sinus cancer (1 case) were confirmed with choroidal metastases. RESULTS: Choroidal metastases were found as the initial manifestations of the malignant tumors on 2 patients whose initial and chief complaints were decreasing vision, their fundus lesions were mainly presented in the posterior pole and FFA showed high density of fluorescence of the lesions. CONCLUSIONS: This study indicated choroidal metastasis might be the first sign of metastases for patients with cancer. For patients with unknown metastasic cancers, examinations of the choroids may be useful for diagnosis and prognosis.

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