| ObjectiveTo evaluate the expression of erythropoietin receptor(EpoR) in epiretinal membranes of proliferative diabetic retinopathy(PDR) and non-diabetic patients,and to analyse quantitatively levels of EpoR in epiretinal membranes and relationship with vision prognosis of PDR, to demonstrate the mechanism of EpoR in PDR.Methods1. Retrospective series of clinical case studies. There ara36epiretinal membranes removed during vitreoretinal surgery between June2011and August2012. For age-matched subjects without diabetes, we collected12retinal vein occlusion(RVO) patients. All patients were divided into two group:PDR group (24cases)and RVO group(12cases). The membranes peeled and removed from retina were fixed in4%paraformaldehyde and paraffin-embedded tissue sections were made for immunohistochemistry after informed consent was obtained. Hematoxylin-Eosin(HE) staining and light microscopy were used to observed the morphological changes of the epiretinal membranes; immunohistochemistry staining was used to demonstrate the masculine staining of the EpoR in epiretinal membranes.2. Analyze the vision acuity(VA) of pre-and post-vitreoretinal surgery in PDR, all PDR patients were divided into two group according the VA:improved group and unchanged or declined group. The Image-Pro Plus6.0software was used to analyze the masculine expression of the membranes and then calculate the integrated optic density(IOD), the results of IOD amoug the two groups were compared by statistical software.3. The results were input the SPSS16.0statistical software. Independent-samples and paired-sample were tested by t test after normality and homogeneity of variance tested, and Pearson correlations were calculated between variables. P<0.05(two-sided) was regarded as the standard of statistical significance. Results1. The clinical results of two groups.There were24eyes of18patients in PDR group, including8eyes of6male patients and16eyes of12female patients; the RVO group consisted of12eyes of10patients which comprised of5eyes of4male and7eyes of female. The mean ege of PDR group was55.2±5.1years, and RVO group was52.7±8.0years, the difference wasn’t statistically significant(t=1.02,P=0.26).2. The results of HE staining and immunohistochemistry staining of membranesHE staining demonstrated that the membranes of PDR group consisted of a variety of endothelial cells forming a microvascular cavity with red blood cells and the strama was edematous and fibrous. The immunohistochemistry staining demonstrated that membranes and cytoplasmic immunoreactivity for EpoR was detected in endothelial cells and some stromal cells in all PDR patients. In PDR group, the expression of EpoR was stronger in active epiretinal membranes, and in RVO group the staining of endothelial cells was not clear compared with PDR group. There might exist positive correlation between IOD and visual prognosis (r=0.514, P=0.010).The IOD of the two groups was statistically significant(P=0.006), and the expression level of PDR was higher than RVO.3.Relationship between the visual prognosis of PDR with the IOD of EpoRThe postoperative follow-up was10.6months. Postoperatively, BCVA improved in16eyes(66.7%), remained unchanged in5eyes(20.8%) and declined in3eyes(12.5%). The IOD between improved group and unchanged or declined group was statistically significant(P=0.039), and the level of unchanged or declined group was higher than the improved group. Conclusion1. The expression of EpoR was detected in PDR epiretinal membranes, and mainly detected in the membranous and cytoplasmic of endothelial cells. Epo-EpoR pathway maybe play an important role in the pathogenesis of PDR.2.The improved level of EpoR in epiretinal membranes maybe affect on the visual prognosis of PDR, which can be indicated innovative treatment target on pathogenesis of PDR. |
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