Volume 40 ·  Issue 03 ·  2004

Ocular surface disease refers to the disease that damages the structure and function of the ocular surface [1], and is the most common ophthalmic disease.Common ocular surface diseases in clinic mainly include: infectious inflammation of the ocular surface (cornea and conjunctiva) (such as bacterial, viral, chlamydia infection [2]), dry eye [3-5], allergic keratoconjunctivitis [6,7] and ocular surface trauma, etc., which are the most common diseases in ophthalmic clinics.Ocular surface injury caused by various ocular surface, anterior and posterior segment surgery has also become common ocular surface diseases.In recent years, due to the emphasis on clinical and basic research of ocular surface diseases, especially the clinical application of new technologies and methods, ophthalmologists have generally improved the diagnosis and treatment level of ocular surface diseases.However, the overall research level of ocular surface diseases in China is uneven and needs to be improved.It is necessary to popularize the concept and knowledge of ocular surface diseases and improve the diagnosis and treatment level of ophthalmologists.

Objective to investigate the indication, surgical principle, clinical efficacy, prevention and management of complications of deep lamellar corneal endothelial transplantation with minikeratome. Methods Six patients with bullous keratopathy were treated with deep lamellar corneal endothelial transplantation with minikeratome. One patient underwent anterior segment vitrectomy plus posterior chamber intraocular lens suture fixation combined with deep lamellar corneal endothelial transplantation, and one patient underwent temporary subprosthetic vitrectomy plus intrabulbar foreign body removal combined with deep lamellar corneal endothelial transplantation. The patients were followed up for 6~9 months. Results The visual acuity of 5 patients was significantly improved. The average postoperative corneal endothelial cell density was (2481 ± 212) cells/mm2, the average corneal central thickness was (549 ± 61) μ m, and the astigmatism was (2.04 ± 1.19) D. There were no serious complications. Conclusion Deep lamellar corneal endothelial transplantation with minikeratome is an optional surgical method for the treatment of bullous keratopathy. Compared with traditional penetrating keratoplasty, this surgical method is expected to be an effective method for corneal endothelial transplantation However, the long-term efficacy still needs to be followed up. (Chinese Journal of Ophthalmology, 2004, 40: 147-150)

Objective to investigate the effect of platelet activating factor (PAF) on corneal wound healing and its molecular biological mechanism by using rabbit deepithelialized cornea model.Methods A circular deepithelialized corneal wound with a median diameter of 7 mm was performed on isolated cornea.The deepithelialized cornea was divided into three groups, namely control, PAF and BN (PAF antagonist) groups.After 48 h of culture, corneal epithelial staining was performed to observe the wound healing status. Rabbit corneal epithelial (RCE) and corneal stromal (RCK) cells were subcultured in vitro.RCE and RCK cells were treated with PAF and/or BN, cultured for 24 h, and RNA was purified. The expression intensities of hepatocyte growth factor (HGF), keratinogenic growth factor (KGF) and epidermal growth factor (EGF) genes in RCK and RCE cells and HGF receptor (HGF-R) genes in RCE cells were detected by RT-PCR and nucleic acid hybridization, respectively. Results PAF (100 nmol/L) significantly inhibited corneal epithelial wound healing. The unhealed area of corneal epithelium in control, PAF and BN groups at 48 h was (6.0 ± 1.5) U, (58.0 ± 7.0) U and (5.0 ± 1.0) U. PAF significantly enhanced the adhesion of RCE cells, and the mean fluorescence photometry of cells per 96-well plate in control, PAF and BN groups was 3696 ± 372, 7908 ± 671 and 3487 ± 324. The results of RT-PCR showed that PAF significantly reduced the expression intensity of HGF mRNA in RCK by 4.1 times, and significantly reduced the expression of HGF-R in RCE cells. The results of PCR were confirmed by nucleic acid hybridization. Conclusion PAF significantly enhanced the adhesion of RCE cells, significantly inhibited the expression intensity of HGF mRNA in corneal stromal cells and HGF-R gene in corneal epithelial cells, and thus inhibited the healing of corneal wound.

Objective to observe the infection efficiency and proliferation-promoting effect of replication-defective recombinant adenovirus vector-mediated acidic fibroblast growth factor (aFGF) on rabbit corneal endothelial cells (RCEC) cultured in vitro.Methods 293A cells were expanded with replication-defective recombinant adenovirus, and the virus titer was measured by TCID50 assay.RCEC was cultured in vitro, and the transient infection efficiency was estimated by recombinant adenovirus (Ad-LacZ) carrying reporter gene (LacZ), and the transient infection efficiency was estimated by dimethylformamide (X-gal) staining.The recombinant adenovirus (Ad-aFGF) containing aFGF was infected with RCEC, and the transcription and protein expression of aFGF were detected by RT-PCR and Western blot, respectively, and the proliferation of transgenic cells was detected by thiazole salt (MTT) assay.The virus titer was 2×108 pfu/ml; Exogenous gene expression could be detected 24 hours after recombinant adenovirus infection in RCEC. When the fold of infection (MOI) value was equal to 20, the infection efficiency of Ad-LacZ was 100%, and Ad-aFGF could promote the proliferation of RCEC (F =217.107,P<Conclusion Exogenous genes mediated by replication-defective recombinant adenovirus vector can be expressed effectively in RCEC, and infection with Ad-aFGF can promote the proliferation of RCEC. (Chinese Journal of Ophthalmology, 2004, 40: 156-159)

Objective to observe the serum specific antibody levels and histopathological changes of New Zealand white rabbits undergoing lamellar keratoplasty at different periods after burn and at different times after burn through animal corneal alkali burn model. Methods Twenty New Zealand white rabbits were randomly divided into five groups: burn group, early transplantation group (i.e. 3-day transplantation group and 7-day transplantation group), middle and late transplantation group (i.e. 2-week transplantation group and 5-week transplantation group). Protein extracts from normal and alkali burned corneas were prepared, and the serum anti-keratin denaturing protein antibody levels in each group were measured by enzyme-linked immunosorbent assay (ELISA). Results the specific antibody was produced by the body after alkali burn, which increased significantly at 2 weeks, reached a peak at 5~6 weeks, and then decreased. At 8 weeks, the antibody was produced significantly when the contralateral cornea was burned again. The antibody increase was not significant in the early transplantation group, but the antibody change trend in the middle and late transplantation group was similar to that in the burn group. Conclusion Early lamellar keratoplasty can block the humoral immune response to corneal denaturing protein after alkali burn. (Chinese Journal of Ophthalmology, 2004,40:160-164)

Objective to investigate the effects of tranilast on the proliferation and migration of ocular Tenon capsule fibroblasts in glaucoma patients in vitro. Methods the tranilast tissues were extracted from glaucoma patients during filtration, and fibroblasts were primarily cultured and subcultured in vitro. The effects of tranilast at different concentrations on the proliferation and migration of fibroblasts cultured in vitro and its relationship with protein kinase C (PKC) expression were studied by MTT assay, cell counting assay, immunohistochemistry plus image analysis and streaking assay, respectively. Results When the concentration varied between 12.5 and 100.0 mg/L, tranilast could significantly inhibit the proliferation of fibroblasts in a dose-dependent manner; Tranilast at 50.0 mg/L and 100.0 mg/L can significantly inhibit the migration of fibroblasts and down-regulate the expression of PKC in cells. Conclusion Tranilast can inhibit the proliferation and migration of fibroblasts, which may be related to the down-regulation of PKC expression in cells. (Chinese Journal of Ophthalmology, 2004, 40: 165-169)

Objective to investigate the effect and complications of optic nerve incision in the treatment of ischemic central retinal vein occlusion. Methods Eight patients with ischemic central retinal vein occlusion were selected. The course of disease was 3~8 months, with an average of 3.6 months. All patients were treated with systemic medication for 3 months. Among them, 3 patients had a history of hypertension and 3 patients suffered from severe cystoid macular edema. All patients underwent fundus photography, fluorescein fundus angiography (FFA) and coherence optical tomography (OCT) before operation. Fundus imaging, FFA and OCT examination were performed at 1 to 3 months after surgery respectively. Results After 3 to 5 months of follow-up, the retinal or macular edema of all patients decreased or resolved within 1 month after surgery. The visual acuity was improved in 6 cases (62.5%). Vitreous hemorrhage occurred in 2 cases 3~4 weeks after operation, and 1 case was secondary to neovascular glaucoma; Conclusion Optic nerve incision can help to resolve intraretinal hemorrhage, exudation and macular edema, and improve visual acuity in some patients. (Chinese Journal of Ophthalmology, 2004, 40: 170-174)

Objective to study the clinical application of combined positive and negative column microscopy in finding mixed astigmatism. Methods 189 patients (340 eyes) with mixed astigmatism were randomly divided into experimental group and control group, and divided into three intervals according to the degree of astigmatism (<3.00 D, 3.00-6.00 D,>6.00 D). Where the astigmatism degree<156 eyes at 3.00 D (76 eyes in the experimental group and 80 eyes in the control group); 132 eyes from 3.00D to 6.00d (68 eyes in the experimental group and 64 eyes in the control group); After cycloplegia, 53 eyes (29 eyes in the test group and 24 eyes in the control group) were examined by combination of positive and negative cylinder lenses, and the conventional spherical or cylinder scope was used as the control. According to the morphological uniformity of neutralizing shadow, the accuracy and difficulty of axial position judgment, the retinographic time and the number of lens combinations, the retinographic results were comprehensively evaluated. The results were divided into three grades, grade I: neutralizing shadow was uniform, axial position was easy to judge, and retinographic time<5 min, the number of lens combinations is 1 or 2; Grade Ⅱ: the neutralization shadow is not uniform, the axial position is not difficult to judge, the retinography time is 5~10 min, the number of lens combinations is 2 or 3; Grade Ⅲ: The neutralization shadow is not uniform, easily disturbed, the axial position is difficult to judge, the retinography time is>10 min, the number of lens combinations is>3. Results Astigmatism<At 3.00 D, there was no significant difference between the test group and the control group (χ 2=0.094, P =0.759). When the astigmatism degree was between 3.00 and 6.00 D, there was a significant difference between the test group and the control group (χ 2=5.546, P =0.019). When the astigmatism degree was>6.00 D, there was a significant difference between the test group and the control group (χ 2=8.509, P =0.004). Conclusion the application of positive and negative column microscopy is an effective, convenient and accurate retinoscopy method for mixed astigmatism with high degree, and it is a good supplement and development of conventional retinoscopy method. (Chinese Journal of Ophthalmology, 2004, 40: 175-177)

Objective to investigate the changes of cyclic adenosine phosphate (cAMP) concentration and protein kinase C (PKC) activity during specific and non-specific phagocytosis of human retinal pigment epithelium (HRPE) cells, and to investigate the role of cAMP and PKC in phagocytosis of HRPE. Methods Normal HRPE cells were incubated with 1×107/ml rod outer segmental disc (ROS) and latex microspheres (LB) at 37℃, and the phagocytosis reaction was terminated at different times (5 min to 48 h). The phagocytosis kinetics of HRPE cells was detected by double fluorescence labeling method. The binding and phagocytosis of HRPE cells to LB and ROS were confirmed by scanning and transmission electron microscopy. The concentration of cAMP and PKC activity of HRPE cells during specific and non-specific phagocytosis at corresponding time points were detected by 125I-cAMP radioimmunoassay and liquid scintillation γ-32P radioactivity assay, respectively. Results During the specific phagocytosis of HRPE cells, ROS bound to the surface of HRPE cells after incubation for 15 min, and the concentration of cAMP began to decrease at this time; The cytoplasmic and membrane PKC activity decreased earlier than that of cAMP, which occurred at 5 min of incubation, but both reached the lowest value at 24 h of incubation. During the process of non-specific phagocytosis, HRPE cells bound to LB at 90 min of incubation, and the cAMP concentration did not change significantly within 12 h of incubation (P>0.05), but the cAMP concentration decreased at 12~48 h; There was no significant difference in cytoplasmic and membrane PKC activity between 5 min and 48 h after incubation (P>0.05). Conclusion cAMP and PKC are very important in maintaining the specific phagocytosis process of HRPE cells, but they do not participate in the direct regulation of non-specific phagocytosis, and the specific phagocytosis process of HRPE cells is accompanied by the decrease of cAMP concentration and PKC activity. (Chinese Journal of Ophthalmology, 2004, 40:178-182)

Objective to study the effects of different time limits of form deprivation on experimental myopia in guinea pigs. Methods Twenty 4-week-old guinea pigs were divided into 4 groups, group Ⅰ was the control, and no treatment was done. Group Ⅱ ~ Ⅳ was covered for 4 weeks, group Ⅱ was covered continuously, and group Ⅲ ~ Ⅳ was covered every day for 1 and 4 hours, respectively. The refractive power and axial length of eyes were measured by retinoscope and A ultrasound before and after the experiment, respectively. Results After 4 weeks, axial myopia occurred in the occluded eyes of group Ⅱ and Ⅲ, and the difference in myopia was significant (P<Compared with the control group, the occluded eyes in group Ⅱ showed-5.49 D myopia, accompanied by a significant increase in the axis of the eyes, while the non-occluded eyes showed a relative hyperopia of +0.76 D. The myopia degree was significantly reduced in those who removed the occlusion regularly every day, and the myopia degree was reduced by 50% in those who removed the occlusion for 1 h, while the myopia degree was not formed in those who removed the occlusion for 4 h. The axial length of the occluded eyes in group Ⅱ was shorter than that in the continuous occlusion group.

Objective to investigate the clinical value of ultrasound biomicroscopy (UBM) in the diagnosis and treatment of lens subluxation.Methods Twenty-nine patients (32 eyes) with lens subluxation due to different causes were collected and examined by UBM before and after phacoemulsification lens aspiration.According to the extent and degree of lens subluxation examined by UBM before operation, different types of capsular tension ring (CTR) were selected and different surgical methods were used to complete the operation. Results 19 eyes with lens subluxation range ≤1/2 quadrant examined by UBM before operation were successfully completed by implanting hookless CTR during operation. After UBM examination, 13 eyes with lens subluxation range>1/2 quadrant were successfully completed by implantation of fixed CTR. After UBM examination, except for one eye with CTR attached to the peripheral iris, the CTR of other eyes were located at the level of the suspensional ligament of the lens; Conclusion UBM examination in patients with lens subluxation before surgery to judge the degree and extent of lens dislocation is helpful to guide the design of surgical plan and improve the curative effect. UBM examination after surgery to observe the position relationship between intraocular implant and intraocular tissue is helpful to judge the curative effect accurately and deal with postoperative complications correctly and timely. (Chinese Journal of Ophthalmology, 2004, 40:186-189)

central serous chorioretinopathy (CSC) is a kind of fundus macular lesion that occurs in young and middle-aged males.At present, the understanding of the pathogenesis of CSC is not uniform.From May 2002 to February 2003, the author measured the plasma catecholamine concentration of CSC patients diagnosed in our outpatient clinic to understand the changes of plasma catecholamine concentration and its relationship with the changes of visual acuity of CSC patients, so as to explore the possible pathogenesis of CSC.

Color Doppler ultrasound can reflect the vascular hemodynamic information objectively and quantitatively by analyzing the pulsed Doppler spectrum of arterial blood flow, and it is a non-invasive detection method. This method has been used in our hospital since 2001 to examine the ocular hemodynamic changes of strabismus patients after surgery, and compared with normal people of the same age, so as to provide reference for clinical work.

senile macular degeneration (SMD) and senile cataract are both important diseases that seriously affect the visual acuity and quality of life of the elderly.As a common senile disease in clinic,SMD may occur in patients with senile cataract.For patients with fundus lesions,the effect and necessity of cataract extraction surgery are still inconclusive.Some literatures report that cataract extraction surgery can promote the occurrence and development of SMD, and the visual acuity of patients may not improve or even decrease further after operation [1-3]; At the same time, a large number of studies have shown that the visual acuity of patients with mild and moderate SMD can be improved after cataract extraction surgery [1]. In order to investigate the efficacy of cataract extraction surgery in patients with severe SMD, we observed the surgical treatment of 35 patients (38 eyes). The results are reported as follows.

Blunt ocular contusion is a common traumatic disease in ophthalmology, which can cause damage to various tissues and structures in the eye, among which the retinal tissue is often damaged first, and the pathogenesis is not very clear. Previous studies have focused on the changes of fundus morphology and blood flow circulation time, but few reports on the changes of blood flow [1, 2]. The author used confocal scanning laser Doppler retinal blood flow analyzer (Heidelberg retina flowmeter, HRF) detection technology produced by Heidelberg Engineer Company of Germany to quantitatively observe and analyze the retinal blood flow perfusion in 31 patients with blunt ocular contusion. The results are reported as follows.

A 13-year-old male was diagnosed with iridocyclitis in another hospital in July 2001 due to red, painful left eye and decreased visual acuity. He was treated with glucocorticoids and antibiotics. After 10 days, empyema was found. B-ultrasound showed vitreous opacity. He was transferred to our hospital for treatment in late July 2001.

A 70-year-old male was admitted to our hospital on October 15, 2001 due to pain in both eyes and vomiting of brown fluid for 2 days. He had no history of similar disease or ulcer in the past. Ocular examination: visual acuity index/1 foot in right eye and index/anterior eye in left eye. Mixed conjunctiva congestion and edema in both eyes, corneal edema, shallow anterior chamber, large pupil, unclear iris texture, partial posterior adhesion of iris at the pupil margin. IOP: 81.78 mm Hg (1 mm Hg =0.133 kPa) in right eye and 94.32 mm Hg in left eye. 82 times/min, the whole abdomen was soft, without tenderness and rebound pain. Laboratory tests: urine routine (-), fecal routine and occult blood in stool (-).

Case 1: A 13-year-old male (proband Ⅲ4) was admitted to hospital on May 15, 2001 due to blurred vision for 10 years and a mass in the upper abdomen for 4 days. The patient had blurred vision and short stature since childhood. When he was in the second grade of primary school, the patient was myopic, and his naked eye visual acuity was 0.5 in the left eye and 0.4 in the right eye. Now he was highly myopic. The patient's intellectual development was normal. When he was taking a bath 4 days ago, his father found that the patient's right upper abdomen was obviously bulged.

A 67-year-old female came to our hospital on June 23, 2001 due to blindness after left eye trauma and pain for more than 30 years, and the pain worsened for 2 months. More than 30 years ago, the patient suffered from eye pain after left eye trauma and visual acuity decreased to blindness, and there was no detailed treatment record. After that, the symptoms of eye pain were repeated, which could be relieved by anti-inflammatory treatment. Clear mind, painful face; Heart, lung and abdomen examinations showed no abnormalities.

A 17-year-old woman came to our hospital on February 25, 2002 due to pain, tearing in her right eye and decreased visual acuity for 1 month. The patient wore an orthokeratoscope to treat myopia for 2 years, and was diagnosed as viral keratitis in another hospital, and was given antiviral therapy, but her condition did not improve significantly. 12 o'clock corneal neuritis changes; Retrocorneal sediment (-), aqueous humor flash (-); The pupil diameter was 6 mm (compound tropicamide mydriasis). The left eye was normal. The right eye was examined with corneal scraping and cultured with bacteria, fungi and amoeba.

The 7th National Conference on Keratopathy and Ocular Surface Diseases of Ophthalmology Branch of Chinese Medical Association, jointly sponsored by the Keratology Group of Ophthalmology Branch of Chinese Medical Association and the Editorial Board of Chinese Journal of Ophthalmology, was held in the beautiful spring city of Kunming on September 16th, 2003. More than 280 ophthalmologists engaged in related specialties from 27 provinces, autonomous regions and municipalities directly under the central government attended. There were 11 special lectures at the conference, 7 special presentations by young scholars, 33 speakers at the conference, 54 speakers at the branch, 77 exhibition boards and 99 topics. The papers at the conference fully reflect the new progress of basic and clinical research in this field in China in the past two years.

keratoconus is a primary corneal degenerative disease characterized by corneal thinning and protrusion resulting in irregular astigmatism. It is often accompanied by varying degrees of visual impairment (Figure 1). It often exists independently, but can also be complicated by many other diseases. It has no inflammatory reaction, does not accompany cell infiltration and neovascularization. It mostly occurs in adolescence, often bilateral, and can occur successively. It is more common in women, and has a certain family genetic tendency. It occurs in all ethnic groups. Foreign scholars have reported [1] that the incidence of this disease is about 0.5‰, but there is still a lack of epidemiological data in China.