Yanrong Jiang

Apelin in plasma and vitreous and in fibrovascular retinal membranes of patients with proliferative diabetic retinopathy.

PURPOSE Apelin is an endogenous ligand for the angiotensin-1-like receptor APJ. Because apelin has been reported to regulate angiogenesis, the authors searched for associations between apelin and proliferative diabetic retinopathy. METHODS The study included 55 patients undergoing vitrectomy for proliferative diabetic retinopathy (study group) and 34 patients undergoing vitrectomy for idiopathic preretinal membranes or macular hole (control group). Using enzyme-linked immunosorbent assay, the authors measured the concentrations of apelin and vascular endothelial growth factor (VEGF) in the vitreous and plasma. The expression of apelin and angiotensin-1-like receptor APJ in the excised membranes was examined by fluorescence immunostaining and semiquantitative reverse transcription polymerase chain reaction. RESULTS Vitreous concentrations of apelin were significantly higher in the study group than in the control group (P = 0.005), whereas plasma concentrations of apelin did not vary significantly (P = 0.66). The vitreous concentrations (P < 0.001) and the plasma concentrations (P = 0.03) of VEGF were significantly higher in the study group than in the control group. Neither the vitreous concentrations of apelin and VEGF (P = 0.47) nor the plasma concentrations of apelin and VEGF (P = 0.19) were significantly associated with each other. In the fibrovascular membranes of the study group, colocalization of the endothelial markers CD31 with the markers for apelin and colocalization of the endothelial markers CD31 and APJ was observed. Expression of apelin mRNA (P = 0.03), APJ mRNA (P = 0.02), and VEGF mRNA (P < 0.01) was significantly higher in fibrovascular proliferative diabetic retinopathy membranes than in idiopathic epiretinal membranes. CONCLUSIONS The apelin/APJ system may be involved in retinal neovascularization during the development of proliferative diabetic retinopathy.

Vascular Endothelial Growth Factor in Plasma and Vitreous Fluid of Patients with Proliferative Diabetic Retinopathy Patients after Intravitreal Injection of Bevacizumab

PURPOSE To investigate plasma and vitreous vascular endothelial growth factor (VEGF) levels after intravitreal bevacizumab (IVB) injection into eyes with proliferative diabetic retinopathy (PDR). DESIGN Retrospective, interventional, nonrandomized, comparative study. METHODS Fifty-six eyes of 56 patients with PDR and 13 eyes of 13 patients with nondiabetic ocular diseases were enrolled. Analysis included evaluation of basic clinical conditions and measurement of vitreous and plasma VEGF concentrations using enzyme-linked immunosorbent assays. RESULTS PDR eyes without IVB had the highest vitreous VEGF levels; the levels were significant compared with those in the recent IVB group (previous injection within 1 week), the prolonged IVB group (injection more than 1 week previously), and the nondiabetic control group (P = .001, P = .035, P < .001, respectively). The vitreous VEGF level in the recent IVB group was higher than that in prolonged IVB group (P = .035). PDR eyes without IVB had the highest plasma VEGF level, and the level was significant compared with those in the recent IVB group, the prolonged IVB group, and the nondiabetic control group (P < .001, P = .003, P < .001, respectively). The plasma VEGF level in the recent IVB group was lower than that in the prolonged IVB group (P = .003). The vitreous VEGF level was associated significantly with the plasma VEGF level (P = .002). CONCLUSIONS Vitreous and plasma VEGF levels were increased markedly in patients with PDR. VEGF concentrations in vitreous and plasma were decreased significantly after IVB into PDR eyes, and the effect lasted from 4.4 ± 2.2 days to 34.8 ± 33.7 days after injection.

Differences in aqueous concentrations of cytokines in macular edema secondary to branch and central retinal vein occlusion.

Purpose This study investigates the differential aqueous concentrations of interleukin 6, 8, 1β (IL-6, IL-8, IL-1β, respectively), serum amyloid A (SAA), transforming growth factor (TGF)-β, basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) in eyes with macular edema as a result of a branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Principal Findings Significantly higher concentrations of IL-6, IL-8, IL-1β, TGF-β, bFGF, SAA, and VEGF were found in the aqueous humor of CRVO and BRVO patients than in the aqueous humor of control patients. A significant correlation was observed between the concentration of bFGF and the inner central macular thickness (CMT) of BRVO patients (r = 0.688; P = 0.02). A significant correlation was observed between the concentration of SAA and both the full and outer CMT of the ischemic group (r = 0.545 and 0.683, respectively; P = 0.04 and 0.01, respectively). In the non-ischemic group, the level of IL-6 was significantly associated with inner CMT (r = 0.560; P = 0.03). The full and outer CMT was significantly reduced in CRVO patients when compared with BRVO patients (P = 0.02 and 0.02, respectively) after injection of intravitreal bevacizumab (IVB) at 4 weeks. Significance Serum amyloid A as a major protein involved in the acute and chronic stages of inflammation, and IL-6 and bFGF were significantly associated with the extent of macular edema in patients with RVO. Besides VEGF, other inflammatory cytokines and angiogenesic factors may be associated with RVO. This finding may have implications for the medical treatment of RVO.

The role of apelin in the retina of diabetic rats.

Purpose Apelin is a novel adipocytokine participating in diabetes, but its role in diabetic retinopathy (DR) is unknown. Our study aimed to investigate the effect of apelin on the proliferative potential in DR along with its antagonist inhibitory effects. Principal Findings Strong staining of apelin, co-localized with glial fibrillary acidic protein (GFAP) and vascular endothelial growth factor (VEGF) was observed in the retina of diabetic rats. Apelin, GFAP, and VEGF mRNA and protein levels were significantly increased in the sample’s retinas. Moreover, exogenous apelin promoted retinal Müller cell proliferation in vivo. Simultaneously, apelin induced GFAP and VEGF expression. F13A markedly reduced retinal gliosis caused by diabetes. Furthermore, F13A suppressed both GFAP and VEGF expression in vivo. Significance Our results strongly suggest that apelin is associated with the development of DR and contributes to changes in the retinas of diabetic rats. Apelin induced promotion of cell proliferation lends support to the possibility that apelin may play a role in the progression of DR to a proliferative phase. This possible role deserves further investigation, which may offer new perspectives in the early prevention and treatment of DR.

Traumatic choriodialysis treated by intraocular fibrin glue

horiodialysis has been definedas a condition in which thechoroid is detached from the scleraand additionally shows a limbus par-allel rupture just behind the ciliarybody (Bordeianu 1984). Given thatthe management of this conditionhas been described only rarely(Bordeianu 1984), this article pre-sents a patient with traumatic chori-odialysis.A 38-year-old man had suffered anopen-globe injury with a rupture ofthe sclera in his only remaining eye,the left (Kuhn et al. 1996). His righteye was phthitic with no light percep-tion because of an accident 30 yearsago. The scleral rupture of the left eyehad been closed at the same day ofthe accident. Two weeks after theaccident and after the primary closureof the scleral rupture, postoperativevision was questionable light percep-tion. Intraocular pressure was closeto 0 mmHg. Slit-lamp examinationshowed corneal striae and a severehyphaema that prevented any oph-thalmoscopic examination. Sonogra-phy revealed a funnel-shaped totalretinal detachment and a subretinalsonographic signal emerging from theocular wall and extending into thecentre of the vitreous cavity (Fig. 1).A pars plana vitrectomy was car-ried out, during which the choroidwas found to be ruptured anddetached (Fig. 2). Relaxing retinoto-mies were performed, and epiretinaland subretinal membranes wereremoved so that the retina wasrelieved from tractional forces. How-ever, the detached choroid could notbe mobilized and could not be reat-tached to the inner surface of thesclera, either by intraocular perfluro-carbon liquid or by scleral buckling. Afibrin glue for medical use (TianXiuCo., Guangzhou, China) was theninjected into the suprachoroidal spacebetween the detached choroid andthe sclera after an air-fluid exchangewas performed to prevent the gluefrom overflowing from the supracho-roidal space into the main vitreouscavity (Coleman et al. 1988; Silveret al. 1995). Five minutes later, whenthe fibrin clot started to form, sili-cone oil was injected into the vitre-ous cavity to attach the retina and toindirectly press the choroid againstthe sclera. A circumferential periph-eral retinal endolaser coagulation wasperformed to keep the edge of the ret-inal tear attached to the retinal pig-ment epithelium. After surgery, theretina was attached. The anteriorchamber was filled with aqueoushumour. At 1 month and 6 monthsafter surgery, visual acuity was0.10 and intraocular pressure was8 mmHg. With the intraocular silicone