Volume 40 ·  Issue 05 ·  2004

Combined cataract surgery refers to the combined operation of other parts of the eyeball while cataract extraction surgery. In the past, the combined cataract surgery has poor curative effect because of complicated operation, large injury and many surgical complications. In recent years, with the improvement of ophthalmic surgical equipment and microsurgical technology, the methods of combined cataract surgery are continuously enriched, the curative effect is obviously improved, and some triple or multiple surgery has also obtained satisfactory curative effect. Therefore, it is of great significance to correctly understand and master combined cataract surgery in clinical work.

Objective to evaluate the safety and efficacy of phacoemulsification and folding intraocular lens (IOL) implantation combined with viscoelastic tubule dilatation (V-P). Methods The clinical data of 28 patients (30 eyes) who underwent V-P surgery due to cataract combined with primary open-angle glaucoma (V-P group) were collected. The visual acuity, intraocular pressure and the occurrence of surgical complications of the patients were summarized and analyzed, and compared with 27 patients (28 eyes) who underwent phacoemulsification and folding IOL implantation combined with trabeculectomy (T-P group). The postoperative follow-up time was 6 months. Results At 6 months postoperatively, the mean intraocular pressure in V-P group was (14.65±2.70) mm Hg (1 mm Hg =0.133 kPa), which was 10.33 mm Hg lower than that before surgery, and the difference was significant (P =0.000); The percentage of eyes with optimal corrected visual acuity ≥0.5 in the V-P group was 62.1% (18/29), 71.4% (20/28) and 80.0% (24/30) respectively, compared with the T-P group, there was no significant difference (P =0.621, 0.702, 0.893). The intraoperative complications in the V-P group included Descemet membrane puncture and Schlemm canal puncture (2 eyes each), transient intraocular pressure increase (4 eyes) 24 h after operation, and no other serious complications. The postoperative complications in the T-P group included obvious anterior chamber inflammatory reaction (6 eyes), small amount of anterior chamber hemorrhage and choroidal detachment (1 eye each). Conclusion V-P operation has good curative effect and few complications, and can safely and effectively treat cataract complicated with primary open angle glaucoma. (Chinese Journal of Ophthalmology, 2004, 40: 291-294)

Objective to observe the clinical effect of phacoemulsification cataract aspiration and intraocular lens implantation combined with trabeculectomy, and compare the differences between two different surgical procedures. Methods 35 patients (40 eyes) with open-angle or chronic angle closure glaucoma combined with cataract underwent phacoemulsification cataract aspiration and intraocular lens implantation combined with trabeculectomy by single incision (15 eyes in single incision group) or double incision (25 eyes in double incision group), respectively. The visual acuity and intraocular pressure before and after the operation were recorded and compared, and the formation of filtering vesicles and the occurrence of complications were observed. The follow-up time was 12 months. Results The mean intraocular pressure of 35 cases (40 eyes) was significantly lower at 12 months after operation [(14.35±3.03) mm Hg (1 mm Hg =0.133 kPa)] than that before operation [(35.76±4.39) mm Hg] (P<0.001). There was no significant difference between the mean intraocular pressure between the two groups before and 1 week, 1 month, 3 months, 6 months and 12 months after operation (P>0.05). There was no significant difference (P>0.05). There was no significant difference between 17 eyes in the single incision group and 22 eyes in the double incision group (P>0.05). There was no serious complication after surgery. Conclusion Phacoemulsification and cataract aspiration and intraocular lens implantation combined with trabeculectomy are safe, effective and convenient for the treatment of glaucoma complicated with cataract, and there is no significant difference in the short-term efficacy between single incision and double incision. (Chinese Journal of Ophthalmology, 2004, 40:295-298)

Objective to investigate the feasibility of anterior and posterior capsulorhexis combined with anterior segment vitrectomy and intraocular lens implantation in the treatment of cataract in infants<2 years old. Methods Twenty-two cases (27 eyes) of cataract children aged 8-24 months were treated with cataract extraction, anterior and posterior capsulorhexis combined with anterior segment vitrectomy and intraocular lens implantation, and the intraoperative and postoperative conditions were observed. The average follow-up time was 12 months. Results the operation was successfully completed. Conclusion Cataract extraction, anterior and posterior capsulorhexis combined with anterior vitrectomy and intraocular lens implantation can effectively maintain the transparency of the visual axis, restore the normal anatomical structure of the eye, and significantly reduce the occurrence of complications. The improvement of visual function needs long-term observation. (Chinese Journal of Ophthalmology, 2004, 40:299-301)

Objective to investigate the surgical technique, feasibility and curative effect of phacoemulsification for cataract aspiration with both hands. Methods 131 cases (132 eyes) of senile cataract were treated with phacoemulsification with both hands. Transparent corneal tunnel incision was performed on the temporal side with an external opening length of 1.4 mm, an internal opening length of 1.2 mm and a tunnel length of 1.0 mm. A titanium metal emulsified needle with 0.9 mm outer diameter with silicone cannula removed was extended from the incision, and a perfusion lens nucleus splitter was extended from the 1.2 mm ×1.0 mm auxiliary incision. The lens nucleus was aspirated with both hands with phacoemulsification by rapid lens nucleus splitting technique. The lens cortex was aspirated with a bihanded cortical injection and aspiration instrument. The intraoperative phacoemulsification time, postoperative visual acuity and surgical complications were observed. Results The mean intraoperative phacoemulsification time was (0.75±0.64) min. At 1 d, 1 week and 1 month after surgery, 55.30%, 87.12% and 90.15% had unaided visual acuity ≥0.5, respectively, and 90.91% and 77.27% had optimal corrected visual acuity ≥0.5 and 0.8 at 1 month after surgery, respectively. All patients had stable anterior chamber during surgery, and no incision thermal injury. Other intraoperative complications included: posterior lens capsule rupture in 1 case (0.76%) and mild iris injury in 3 cases (2.27%). Conclusion Micro-incision phacoemulsification with both hands can safely and effectively remove cataract through incision<1.5 mm, and the surgical effect is good. (Chinese Journal of Ophthalmology, 2004, 40:302-305)

Objective to investigate the ultrastructure of autosomal dominant congenital cataract (ADCC) with special phenotype and cluster-like opacity of the lens, and to locate the related candidate genes of the disease. Methods the data of a family of ADCC with special phenotype were collected, and the eye examination was performed on the family members; The ultrastructural changes of lens cells were observed under optical microscope and transmission electron microscope; Linkage analysis of ADCC-related candidate genes was carried out by selecting multiple microsatellite loci near γ-lens protein genes. Results Under light microscope, the lens fibroblasts of ADCC patients with special phenotype lost their normal arrangement and irregular refraction, and focal degenerative changes such as grid-like changes, mucoid degeneration and crystal-like substance precipitation were observed. The results of linkage analysis showed that the ADCC disease-related candidate genes in this family were linked to microsatellite loci D2S2208, D2S2382 and D2S164, and the maximum LOD was 3.34. Conclusion the specific pathological changes of ADCC with specific phenotype concentrated in lens fibroblasts, and the disease-related candidate gene was most likely γ-lens protein gene. (Chinese Journal of Ophthalmology, 2004, 40:306-310)

Objective to investigate the role of peroxynitroso anion (ONOO-) in the formation of cataract in diabetic rats and the antagonistic effect of puerarin. Methods 72 healthy Sprague-Dawley (SD) male rats were divided into control group, streptozotocin (STZ) group and treatment group. STZ was used to make diabetic models in STZ group and treatment group. The rats in treatment group were intraperitoneally injected with puerarin. The morphology of lens epithelial cells (LEC) was observed under light microscope; At the same time, the number and percentage of apoptotic cells in LEC, as well as the fluorescence intensity and number of ONOO-marker-nitrotyrosine (NT) positive cells were detected by flow cytometry; The expression of NT protein in the lens was detected by immunoblotting. Results At 20, 40 and 60 days of experiment, the lens of the control group was transparent, the lens of the treatment group was only mildly opaque, and the lens of the STZ group was obvious and gradually aggravated; Under light microscope, there was no change in the morphology of LEC in the control group, only slight change in the treatment group, and obvious change in the STZ group. At 20, 40 and 60 days of experiment, the number and percentage of apoptotic cells were significantly different between the treatment group and the STZ group and the control group (P<0.05). The fluorescence intensity and quantity of NT-positive cells were significantly different between the treatment group and the STZ group and the control group, and between the treatment group and the STZ group (P<0.05). The changes of LEC apoptosis in the treatment group and STZ group were basically the same as the changes of fluorescence intensity and number of NT positive cells. At 20, 40 and 60 days of experiment, NT protein expression levels were significantly different between the treatment group and STZ group and the control group, and between the treatment group and STZ group (P<0.001). Conclusion ONOO-mediates the formation of diabetic cataract in rats, which is one of the factors that cannot be ignored in the mechanism of cataract oxidative stress injury. Puerarin has antioxidant effect, which is effective for the treatment of early diabetic cataract in rats. (Chinese Journal of Ophthalmology, 2004, 40: 311-316)

Objective to investigate the expression of adrenomedullin (ADM) and its receptor (ADMR) in the epiretinal membrane of proliferative vitreoretinopathy (PVR). Methods 10 consecutive cases diagnosed with rhegmatogenous retinal detachment combined with PVR underwent vitreous surgery in our ophthalmology institute from July to November 2001. The mRNA expression of ADM and ADMR in the epiretinal membrane of proliferative vitreoretinopathy (PVR) were observed by in situ hybridization. Results 7 cases of ADM and ADMR mRNA were positive in the epiretinal membrane of proliferative vitreoretinopathy (PVR). The intracellular distribution of positive cells was uneven, some cells were mainly positive in cytoplasm, and some cells were positive in the nucleus. Conclusion ADM and ADMR were expressed in the epiretinal membrane of PVR.

Objective to investigate the feasibility of liposome-mediated endostatin (ES) gene transfer to inhibit the proliferation of vascular endothelial cells and the effect of ES gene transfer on the proliferation of vascular endothelial cells. Methods the cationic liposome-mediated expression vector PCDNA3-ES was used to transfect COS-7 cells, and the expression of ES protein in the transfected cells and their supernatant was detected by immunodot hybridization. Human umbilical vein vascular endothelial cells (ECV-304 cells) were transfected with liposome-mediated PCDNA3-ES, and the expression of ES protein was observed by immunohistochemical staining; Thiazole blue staining (MTT) was used to observe the effect of liposome-mediated ES gene transfer and inhibiting the proliferation of ECV-304 cells; The effect of ES gene transfection on cell proliferation cycle was detected by flow cytometry. Results there were obvious spots in COS-7 cells transfected with recombinant plasmid and its supernatant, but no spots appeared in cells transfected with vector plasmid; Liposome-mediated ES gene was successfully transfected into ECV-304 cells, and the expression of ES protein reached its peak 2 days after transfection; ES gene transfer could significantly inhibit the proliferation of vascular endothelial cells, and the difference between the transfected and non-transfected groups at the same observation time was very significant (P<0.01); Conclusion Liposome-mediated ES gene can successfully transfect vascular endothelial cells with secretion and expression of ES protein, thus specifically inhibiting the proliferation of vascular endothelial cells. (Chinese Journal of Ophthalmology, 2004, 40:321-325)

Objective to study the therapeutic effect of calcium channel antagonist nimodipine on proliferative retinopathy and its interaction with vascular endothelial growth factor (VEGF). Methods to establish a model of proliferative retinopathy in SD rats induced by high concentration of oxygen. Different doses of nimodipine were injected retrobulbar and intraperitoneally respectively. The eyeballs of young rats were taken for ordinary pathological section and immunohistochemical examination to detect the number of retinal neovascular bud endothelial cells and the expression of VEGF respectively. Results the number of retinal neovascular bud endothelial cells and the expression of VEGF in the untreated group were significantly increased compared with the normal control group (P<0.01), while the number of retinal neovascular bud endothelial cells and the expression of VEGF in the large and medium dose groups were significantly decreased compared with the untreated group (P<0.01) Conclusion VEGF can increase extracellular calcium influx and promote cell proliferation by activating cell membrane calcium channels, while calcium channel antagonist nimodipine can inhibit the occurrence of proliferative lesions by inhibiting calcium influx. Nimodipine can inhibit VEGF expression to some extent.

Objective to investigate the feasibility and safety of seamless optical lamellar keratoplasty with microkeratome combined with fibrin adhesive.Methods Twenty-four healthy purebred New Zealand white rabbits were randomly divided into two groups.The graft and implantation bed were made with microkeratome. Group I was treated with commercial fibrin bioadhesive Tisseel, and Group II was treated without fibrin bioadhesive.The corneal transparency and rejection were observed by slit lamp microscope at 3 days, 2 weeks, 1 month and 3 months postoperative.The changes of corneal refractive state were detected by automatic optometric keratometry, and the corneal wound healing response was observed in vivo by confocal microscope.At the same time, the corneal specimens were taken for routine hematoxylin-eosin (HE) observation, and the new collagen fibers were observed by fluorescence microscope.Results The grafts in 11 eyes (92%) of Tisseel group were in place, and all grafts in the group without fibrin bioadhesive were detached.The cornea in Tisseel group was completely transparent at 1 month after operation; Confocal microscopy showed that the number of stromal cells near the interlayers of the graft bed decreased, but the number and morphology of stromal cells and endothelial cells did not change after the operation. HE staining showed that the eosinophilic staining band without fixed morphology appeared between the layers at 3 days after operation, and disappeared after 1 month. Fluorescence microscopy showed that there was no obvious new collagen fibers after operation by DTAF staining. Conclusion Seamless optical lamellar keratoplasty with microkeratome combined with fibrin adhesive is simple and safe, the wound healing reaction of cornea after operation is slight, and fibrin adhesive does not affect the optical properties of cornea.

In order to improve the biocompatibility of intraocular lens, scholars at home and abroad are continuously exploring new methods for surface treatment of intraocular lens. On the basis of the successful grafting of α-allyl glucoside to the surface of polymethylmethacrylate (PMMA) intraocular lens [1], we explored the effects of hydrophilic treatment of intraocular lens on macrophage adhesion and NO synthesis, in order to lay a foundation for clinical popularization and application of this technology.

diabetic retinopathy (DR) is a disease with neovascularization as the main pathological change. At present, it has been recognized that this neovascularization is related to growth factors. The author's previous research results also proved that DR is related to vascular endothelial growth factor [1] (VEGF) and basic-fibroblast growth factor [2] (bFGF), but the relationship between growth factors and vascular lesions has not been reported. The authors used streptozocin (STZ) -induced diabetic rat model to study the relationship between bFGF and retinal vascular ultrastructure. The analysis report is as follows.

There are many kinds of pathogenic bacteria in fungal keratitis, the common ones are Fusarium, Aspergillus, Candida, etc. [1]. Different fungi have different biological characteristics and pathogenic mechanisms. Fungi can cause severe corneal ulcer through mechanical damage, toxicity and strong enzyme system, often leading to complications such as corneal perforation and endophthalmitis [1]; In China, Fusarium and Aspergillus infections account for the majority [2].

herpes simplex virus (HSV) is mainly HSV-Ⅰ in ocular infection, and its main biological characteristic is that it can form latent infection. At present, it is recognized that HSV-Ⅰ can be latent in the corneal tissue of herpes simplex keratitis (HSK) at rest. Aiming at the presence of HSV-Ⅰ in normal cornea, scholars at home and abroad have used polymerase chain reaction (PCR) in recent years to detect the presence of HSV-Ⅰ DNA in normal cornea [1-3]. In this study, three methods were used to detect HSV-Ⅰ in normal corneal epithelial cells.

Since Ridley invented intraocular lens (IOL) implantation in 1949, the development of cataract extraction combined with IOL implantation has become one of the main achievements in modern ophthalmology [1].

In recent years, erbium-yttrium aluminum garnet laser emulsification cataract aspiration has been gradually popularized in clinical practice abroad [1]. This operation has been carried out in our hospital since September 2000, and has achieved good results. The results are reported as follows.

Retinal tears are often accompanied by vitreous hemorrhage, and when subretinal effusion does not occur in the early stage, it is often easy to miss the diagnosis and delay the treatment in clinic.Therefore, the author made a comprehensive analysis of the clinical manifestations of patients with retinal tear hole and the characteristics of B-ultrasound images of anterior and posterior valves of retinal tear hole, aiming at exploring the diagnostic value of B-ultrasound in retinal tear.

True microphthalmia is a rare blinding eye disease. Most patients develop glaucoma in middle age, and simple intraocular surgery often leads to complications such as choroidal detachment. There are no reports of sclerectomy in domestic literature [1-4]. We used lamellar sclerectomy combined with surgery to treat a patient with true microphthalmia, and the analysis of the treatment effect is reported as follows.

Bilateral retinal arteritis with multiple neoplastic arterial dilatation is a rare fundus disease, and the cause of the disease is unknown at present. A case admitted to our hospital is reported as follows.

Case 1 male, 22 years old, underwent laser epithelial keratomileusis (LASEK) in our hospital on September 2, 2002 due to binocular myopia.

neodymium yttium aluminum garnet (Nd:YAG) laser cataract aspiration is a new technique in cataract aspiration by laser emulsification using Dodick laser emulsifier approved by the US Food and Drug Administration (FDA) in 2000. Compared with traditional phacoemulsification cataract aspiration, it has the advantages of smaller incision, less energy, less heat production, accurate laser action during operation, flexible operation and fast postoperative vision recovery, which provides an effective surgical basis for recovering adjustable intraocular lens in cataract patients in the future.