Volume 40 ·  Issue 04 ·  2004

retinoblastoma (RB) is the most common intraocular malignant tumor in infants and young children, and its incidence has been on the rise in recent years. RB has attracted widespread attention from the medical community for its unique genetic regularity, multidirectional differentiation potential and high degeneration rate [1-18]. In the past, the "secondary mutation theory" and the discovery of RB susceptibility genes and the theory of anti-cancer genes about RB still have great influence in the field of biology. Clinical and basic research on RB in China has always been one of the key research topics in ophthalmology. In the past 15 years, there are 11 research topics on RB alone funded by the National Natural Science Foundation of China. Its research not only proved the abnormality of RB gene at the chromosomal and molecular levels [3-7], but also established multiple RB tumor cell lines [8,9], prepared RB monoclonal antibodies and carried out experimental research on immune guidance and gene therapy of RB [10-12]; More importantly, many scientific research teams focusing on RB research have been formed in China. In the past 20 years, 531 RB-related articles have been published in various domestic journals, including 314 clinical studies (59.13%) and 217 basic studies (40.87%), which are extensive and deep in content.

Objective to study the pathological types and clinical characteristics of lacrimal gland epithelial tumors. Methods 273 paraffin sections of 261 patients with pathological diagnosis of lacrimal gland epithelial tumors were collected and analyzed in combination with the histopathological and clinical data of patients, to investigate the pathological characteristics and clinical manifestations of different types of lacrimal gland epithelial tumors. Results the proportions of various types of lacrimal gland epithelial tumors were pleomorphic adenoma (mixed tumors) (62.3%), lacrimal cystadenocarcinoma (22.3%), pleomorphic adenocarcinoma (8.8%) and lacrimal adenocarcinoma (4.0%) in order from high to low. 12 cases had postoperative recurrence, and the total recurrence rate was 4.6%; 4 cases died, the mortality rate was 1.5%. Conclusion the mortality rate of lacrimal gland epithelial tumor is low, but the recurrence rate is high. The treatment, medication and postoperative management should be decided according to clinical data and pathological diagnosis, and surgery should be the main treatment. (Chinese Journal of Ophthalmology, 2004, 40: 220-224)

Objective to establish a novel nude mouse model of orthotopic transplantation of human retinoblastoma (RB) cells by using green fluorescent protein (GFP) gene, and to investigate the growth and metastasis characteristics of RB. Methods the eukaryotic expression plasmid pEGFP-N1 of GFP was transferred into human RB cells (HXO-RB44) by liposome, and the clones stably expressing GFP were screened by neomycin, fluorescence microscope and flow cytometry. 30 (60 eyes) nude mice were injected into the subretinal space of each eye with 2 μ L of RB cell suspension with cell density (4.5~5.5) ×108 cells/ml. The histopathological manifestations of transplanted tumors were similar to those of human RB tumors; Immunohistochemical staining showed positive expression of GFP in tumor cells. Conclusion The RB transplantation model established by human RB cells labeled with GFP gene transplantation into subretinal space in nude mice provides a new tool for studying the growth and metastasis of RB tumors in natural state. (Chinese Journal of Ophthalmology, 2004, 40:225-228)

Objective to investigate the specific killing effect of retinoblastoma (RB) antigen-sensitized dendritic cell (DC) vaccine on RB cell line SO-RB50 in vitro, SO as to provide a new idea for further research on the treatment of RB. Methods the protein antigen of RB cells was used to shock mature DC from healthy subjects (normal control group) and RB patients (patient group) in vitro, and it was mixed with autologous T cells to induce specific cytotoxic T lymphocytes (CTL) against SO-RB50. The killing rate of CTL on SO-RB50 and Raji cells and the killing rate between normal controls and RB patients were compared by thiazole blue (MTT). Results The cytotoxic effect of CTL on SO-RB50 and Raji cells, normal controls and RB patients increased with the increase of effect-target ratio, and the killing effect on SO-RB50 cells was stronger than that of Raji cells with corresponding effect-target ratio (P<0.01 Compared with the normal control group, the specific killing effects of CTL on SO-RB50 cells were significantly stronger than those of RB patients (P<0.01); However, the non-specific killing effect of CTL on Raji cells was similar to that of normal control group and RB patients group, but there was no significant difference between the two (P>0.05). Conclusion CTL specific for SO-RB50 cells can be induced by using RB antigen-loaded DC, and this method may have potential clinical application value in the treatment of RB. (Chinese Journal of Ophthalmology, 2004, 40:229-233)

Objective to investigate the expression of telomerase gene (hTR) and telomerase catalytic subunit gene (hTRT) in retinoblastoma (RB) tissue specimens, and to study the relationship between telomerase and proliferation and differentiation of RB. Methods The expression of hTR and hTRT in 37 RB and 2 normal tissue specimens was detected by in situ hybridization. The proliferating cell nuclear antigen (PCNA) in the specimens was immunohistochemically stained and quantified as the tumor proliferation index; The results showed that the positive expression of hTR and hTRT in RB samples was 83.8% and 89.2%, respectively, and the expression in two normal retinal tissues was negative. The expression levels of hTR and hTRT were significantly different from the different proliferation and differentiation degrees of RB (all P<0.05). The more serious the invasion of optic nerve by RB, the worse the differentiation degree, the stronger the expression of hTR and hTRT. In addition, there was a certain correlation between the telomerase hTR and hTRT indexes of RB. Conclusion The high expression of telomerase gene hTR and catalytic subunit gene hTRT in RB can be used as novel markers to judge the malignancy and degree of RB. hTR and hTRT are closely related to the differentiation type of RB and the invasion of optic nerve, which provides a theoretical basis for telomerase expression level to reflect the differentiation degree and proliferation ability of RB. The existence of telomerase in RB provides a new idea for opening up a new clinical treatment method, that is, to achieve the therapeutic goal by inhibiting telomerase activity of RB cells. (

Objective to investigate the effect of phacoemulsification cataract aspiration by bursting combined with high vacuum mode.Methods 819 cases (954 eyes) of cataract patients with lens hardness>grade Ⅲ were randomly divided into continuous group, pulse group and bursting group. The phacoemulsification cataract aspiration by temporal transparent corneal tunnel incision was performed. The actual ultrasound energy and time, visual acuity and corneal endothelial cell density were recorded in the three groups, and the occurrence of surgical complications were observed. Results the actual ultrasound energy used in the continuous group, pulse group and blasting group were 25.36%±6.65%, 19.54%±3.50% and 6.27%±1.27%, respectively; The ultrasound time was (222±30) s, (186±41) s and (36±6) s, respectively; Compared with the ultrasound energy and time used in the three groups, the difference was very significant (P =0.005,0.0001). The visual acuity of the three groups improved after operation, but the difference was not significant between the continuous group and the pulse group (P =0.062); Compared with the burst group, the difference was significant (P =0.002). The loss rate of corneal endothelial cells in the burst group was significantly lower than that in the continuous group and the pulse group (P =0.005, 0.001). The corneal edema (+ + +) in the continuous group was more than that in the pulse group and the burst group.Conclusion The use of burst combined with high vacuum mode for phacoemulsification cataract aspiration can significantly reduce the ultrasound energy and time, reduce the loss rate of corneal endothelial cells, and reduce the early corneal edema after operation, which is worthy of popularization. (Chinese Journal of Ophthalmology, 2004, 40: 239-242)

Objective to investigate the clinical significance of subjective and objective rotation examination and to investigate the effect of inferior oblique muscle weakening on the rotation of eyeball.Methods 20 patients (40 eyes) with inferior oblique muscle hyperfunction were treated with lower oblique muscle amputation or partial resection of both eyes, and the subjective rotation degree of the operated eyes was examined by double Markov rod test (DMRT) before operation, 1 week after operation and 2 months after operation; Fundus imaging was performed in 15 patients (30 eyes) before and 1 week after surgery, and the degree of macular-papilla angle was measured by drawing software, and the objective degree of rotation of the eyes was recorded. Results 9 patients with primary inferior oblique muscle hyperfunction were all negative for DMRT before surgery, and 1 patient had subjective internal rotation of 5.0° 2 months after surgery; Among the 11 patients with secondary hyperactivity of inferior oblique muscle, 4 patients had external rotation of 2.5° ~5.0° before DMRT, and 11 patients had no subjective rotation degree at 2 months after operation. The average objective rotation degree of left and right eye of all patients was 14.92°±4.51° and 16.83°±6.39° before operation, respectively, and decreased by 10.54°±3.75° and 13.07°±3.38° 1 week after inferior oblique muscle weakening operation, respectively; The difference of objective rotation degree before and after surgery in both eyes was very significant (P<0.01). Conclusion the results of subjective and objective rotation examination in patients with primary or early secondary inferior oblique hyperfunction were inconsistent. There are complicated compensatory mechanisms for the changes of subjective rotation status after operation; There is still inconsistency between subjective and objective rotation states. (Chinese Journal of Ophthalmology, 2004, 40:243-246)

Objective to investigate the effect and technique of Moria M2 double-motor rotary knife for corneal flaps.Methods Moria M2 double-motor rotary knife was used to make corneal flaps in 409 patients (806 eyes) who underwent excimer laser in situ keratomileusis (LASIK).<250 mm Hg (1 mm Hg =0.133 kPa), the termination ring was set at 8.0 position, and the suction ring was selected according to the corneal curvature table.Results All the corneal flaps were successfully made at one time, no broken flap, thin flap or unreached flap, the pedicle size was moderate, the flap was flipped freely, and the reduction was easy.There were no knife stuck, halfway pause or stopping and walking phenomenon.The corneal flap edge was neat, no serrated change, and the corneal stromal bed was smooth.3 eyes (0.37%) had free flap during operation; There was "island phenomenon", that is, the corneal stromal bed had irregular bulge, which was isolated in sheet or strip shape in 2 eyes (0.25%); Three eyes (0.37%) had empty knife phenomenon. Conclusion Moria M2 double motor rotary knife was effective in making corneal flap without serious complications. Intraoperative complications could be avoided by selecting suction ring according to corneal curvature, inserting the blade correctly and checking the blade before operation. (Chinese Journal of Ophthalmology, 2004,40:247-249)

Objective to investigate the changes of blood flow in primary open-angle glaucoma (POAG) and its sensitivity and specificity as a diagnostic index.Methods 100 cases (100 eyes) of POAG were selected, 50 male and 50 female, and all of them were measured in one ocule.The diagnostic criteria of POAG were as follows: (1) The intraocular pressure value was>25 mm Hg (1 mm Hg =0.133 kPa) measured at three different times, and the chamber angle was open when the intraocular pressure increased; (2) 24-h intraocular pressure difference>8 mm Hg; (3) Typical glaucomatous papillary changes; (4) Typical glaucomatous visual field defects. 50 cases (50 eyes) of normal controls were male and female. The selection conditions were as follows: (1) Same sex; (2) the age difference is less than 5 years; (3) Refractive error, the difference of refractive power<±2.00 DS. Pulsatile ocular blood flow (POBF) was used to measure pulsatile ocular blood flow, IOP PA, pulse rate (PR), maximum IOP, minimum IOP, mean IOP [(Max-Iop + Min-IOP) /mean IOP 2 times (Ave-IOP)]. The paired t-test was used to compare the measured values between glaucoma group and normal control group, and the correlation between the changes of Ave-IOP, the mean and standard deviation of visual field detection and the changes of POBF was analyzed; The specificity and sensitivity of POBF values were calculated as diagnostic indexes.Results the non-study factors were comparable between POAG group and normal control group.The POBF values were (9.72±3.47) μ L/s in POAG group and (12.04±4.68) μ L/s in normal control group; The POBF, PV, PA and Ave-IOP values of POAG patients were all lower than those of normal controls, and the differences were significant (P<0.05). There was no correlation between the mean and standard deviation of visual field detection and POBF values (r =0.224, P =0.219). Taking the POBF value of glaucoma>10.75 μ L/s as the boundary point between normal and abnormal, the specificity detection value was 0.623 and the sensitivity detection value was 0.422. Conclusion Abnormal blood supply and vascular autoregulation function are one of the causes of POAG patients; The crossover range of POBF reference values between POAG patients and normal subjects is large, but it can provide an index of blood flow changes in the cardiac cycle, and more information can be obtained than simply measuring intraocular pressure. (Chinese Journal of Ophthalmology, 2004, 40: 250-253)

Objective to observe the effects of tranilast on the expression of transforming growth factor-β 2 (TGF-β 2) in human trabecular cells cultured in vitro.Methods the 3rd to 5th generation human trabecular cells cultured in vitro were treated with 0.0 (control group), 12.5, 25.0 and 50.0 mg/L tranilast for 48 h, and then the effects of tranilast on the expression of TGF-β 2 in human trabecular cells cultured in vitro were observed by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR), with human glyceraldehyde-3-phosphate dehydrogenase (G3PDH) as an internal reference. Results the pixel ratios of TGF-β 2/G3PDH in the 12.5, 25.0 and 50.0 mg/L tranilast treated groups were 1.85±0.35, 1.66±0.42 and 1.16±0.24, respectively, and the differences were very significant compared with the ratio of 3.82±0.56 in the control group (q′ =10.77, 11.80, 14.54; P<0.01); At the same time, the ratio of TGF-β 2/G3PDH decreased with the increase of tranilast concentration, showing an obvious dose-effect relationship. Conclusion Tranilast can significantly inhibit the expression of TGF-β 2 in trabecular cells. The therapeutic mechanism of tranilast in primary open-angle glaucoma can be investigated from the pathogenetic approach. (Chinese Journal of Ophthalmology, 2004, 40: 254-257)

Methods Eight healthy rhesus monkeys aged 2~3 months were treated with excimer laser corneal refractive surgery (PRK) in one eye, which resulted in 3.00 D relative myopia or hyperopia defocus (4 monkeys each); The corneal epithelium was completely healed within 3 days after surgery, and the cornea remained transparent during the observation period. The experimental eyes showed compensatory growth, and the growth rate of vitreous cavity changed with different refractive status after surgery. The growth rate of vitreous cavity was faster than that of control eyes (t =3.656, P =0.0354). The growth rate of vitreous cavity was slower than that of the control eyes (t =3.576, P =0.0374). Conclusion the optical defocus induced by PRK can regulate the growth of vitreous cavity and emmetrophosis process of young monkeys, indicating that the emmetrophosis process of young monkeys is regulated by visual feedback, suggesting that the optical correction of infant refractive error should be cautious in clinic.The animal model of optical defocus induced by PRK can be used in the study of visual science. (Chinese Journal of Ophthalmology, 2004, 40: 258-261)

all-trans retinoic acid (AT-RA) can inhibit the proliferation of tumor cells and achieve the goal of treating tumor [1, 2]. We used AT-RA to inhibit the proliferation of Retinoblastoma (RB) strains in order to explore a new way of treating tumor.

Hyperthermia has always been a hot topic in tumor treatment, and its safety and effectiveness have been widely confirmed. Clinical findings show that some tumor patients experience fever reaction, their tumor body can gradually resolve, which suggests that high fever can stimulate the immune response of human body, causing vascular sclerosis, necrosis and absorption of tumor body [1].

The 4th National Ophthalmology Academic Conference of Chinese Medical Association for Young and Middle-aged Ophthalmology was held in Southwest Eye Hospital of Chongqing Third Military Medical University from October 17th to 19th, 2003. Chairman Professor Zhao Jialiang, Vice Chairman Professor Li Ziliang, Standing Committee Members Zhao Kanxing, He Shouzhi, Xu Jie, Wang Jing, Wang Jingzhao, Chu Renyuan, Sun Naixue, Xu Jie, Li Xiaoxin, Youth Committee Members Yang Peizeng, Sun Xinghuai, Sun Xuguang, Ren Zeqin, Xing Yiqiao, Zheng Yuezhong, Zhang Junjun, Qu Jia and Liu Xipu attended the conference. Ophthalmologists and scholars from Britain, the United States, Brazil and other countries were also invited to attend the conference; Nearly 500 delegates from 28 provinces and cities all over the country attended the conference. A total of 932 papers were included in the compilation of papers of the conference, involving 18 tertiary disciplines of ophthalmology.

1. Statistical research design: The name and main practices of statistical research design should be explained. Such as survey design (divided into prospective, retrospective or cross-sectional survey studies); Experimental design (specific design types should be explained, such as self-pairing design, group design, cross design, factorial design, orthogonal design, etc.); Clinical trial design (should explain what phase of clinical trial it belongs to, what kind of blinding measures are adopted, etc.). The main approach should be outlined around the four basic principles (repetition, randomization, control and equilibrium), especially how to control the interference and influence of important non-experimental factors.

The Clinical Department of Beijing Tongren Eye Center of Capital Medical University undertook eight national continuing medical education projects in 2004.

In order to improve the research level of optometry in China and promote the in-depth development of ophthalmology, the editorial board of Chinese Journal of Ophthalmology decided to hold a special academic seminar on optometry in Qingdao, Shandong Province from June 26 to 30, 2004. At that time, well-known experts and academic leaders engaged in optometry research in China will be invited to give special lectures, and ophthalmologists from all over the country are welcome to sign up enthusiastically.

The child, Jiang, 4 years old and 6 months old, was seen in March 2002 because of poor visual acuity in both eyes. The child was the third child and the first child, and had a full-term cesarean section with preservation of fetus. The mother had no abnormalities such as fever, allergy, poisoning and medication during pregnancy. The father had no abnormalities in both eyes, and the mother had high myopia (right eye-7.50 D, left eye-8.00 D). Visual acuity examination: the distance vision was 0.1 in both eyes; the near vision was 0.25 in the right eye and 0.2 in the left eye; the intraocular pressure was 12 mm Hg in the right eye (1 mm Hg =0.133 kPa) and 16 mm Hg in the left eye. The axial length of the eye was 16.00 mm in the right eye and 16.72 mm in the left eye; Corneal diopter: 51.00 D in the right eye and 52.00 D in the left eye; Corneal diameter: 9 mm in the right eye, 10 mm in the left eye. There was no abnormality in the external eye, the cornea and lens were transparent, and there was no obvious abnormality in shape. The pupil was perfectly round, 2.5 mm in diameter, sensitive to light reflection, and the fundus: the optic papilla was small, red in color, a small amount of pigment in the macular area, and the central reflection was not obvious.

The patient was a 24-year-old female who complained of postural exophthalmos in her right eye for 7 years, and recently had frequent eye pain and headache. She was admitted to hospital on March 4, 2002 with right orbital varices. Ocular examination showed that the visual acuity was 0.5 in the right eye, 1.0 in the correction and 1.5 in the left eye. The right eyeball was invaginated, the exophthalmos in the right eye was 11 mm, the left eye was 13 mm, and the orbital distance was 100 mm. After lowering the head, the exophthalmos of the right eye was 16 mm, the exophthalmos of the left eye was 13 mm, and the eyeball was slightly moved upward (Figure 1).

Pseudoxanthoma elasticum is also known as Groenblad-Strandberg-Touraine syndrome. The author found a patient with this disease in utero due to skin lesions, abortion and fetal death, and it is reported as follows.

Subconjunctival injection of antibiotics is one of the conventional therapies for preventing and treating intraocular infections. However, in recent years, there are more literature reports about toxic retinopathy caused by mistaken injection of antibiotics into the eye, mainly gentamicin, amikamycin and tobramycin, which basically belong to aminoglycoside antibiotics [1-3]. In recent years, the author treated a case of toxic retinopathy caused by mistaken injection of lincomycin into the bulb, but there is no literature report yet.

evidence-based ophthalmology (EBO) is a research hotspot in the field of international ophthalmology in recent years. It is the product of the combination of evidence-based medicine (EBM) and modern ophthalmology. It was first proposed by Minckler in 1999 [1]. The core of EBO is to responsibly and clearly use the best available evidence to determine the treatment of each patient. The goal of EBO is to combine the latest research results with clinical practice. According to the current research status at home and abroad, the process of developing EBO can be summarized as follows: (1) Forming evidence for systematic reviews (SR); (2) SR and meta-analysis were performed; (3) According to the SR results, the current clinical diagnosis and treatment principles of ophthalmology were adjusted; (4) Use EBO evidence and new clinical diagnosis and treatment principles to guide the clinical work of ophthalmology.