Volume 40 ·  Issue 06 ·  2004

Along with the increasing requirements for quality of life, many people are sensitive to the slight change of eyeball position. At the same time, the rapid development of medical imaging has significantly improved the discovery rate of orbital diseases. On the whole, the level of diagnosis and treatment of orbital diseases in China has been significantly improved, but we should also see that due to the complexity and particularity of orbital diseases, as well as the irregularity or blindness in the current treatment, the complications and recurrence rate of orbital diseases after operation have increased, and even the probability of malignant tumor has increased, and the best time of treatment has been lost. Therefore, it is very necessary to discuss some common problems in the diagnosis and treatment of orbital diseases to popularize and improve the diagnosis and treatment level of orbital diseases.

Objective to investigate the diagnostic value of ultrasound (standardized A/B ultrasound) and CT in orbital vascular tumors and malformations.Methods the clinical data and ultrasound (98 cases) and CT scan (108 cases) of 108 patients with orbital vascular lesions were collected and analyzed retrospectively. Among them, 94 cases were confirmed by surgery and pathology.54 cases were cavernous hemangioma,26 cases were varice,13 cases were venous hemangioma,5 cases were infantile hemangioma,6 cases were lymphangioma,4 cases were other tumors.Results The tumor showing rate of ultrasound was 98% (96/98), the false negative rate was 2% (2/98), and the qualitative diagnosis rate was 93% (91/98). The tumor showing rate of CT scan was 100% (108/108), and the qualitative diagnosis rate was 92% (99/108). Conclusion The combined application of ultrasound and CT scan is very important to judge the nature, extent, location and surgical approach of orbital vascular tumors and malformations. (Chinese Journal of Ophthalmology, 2004, 40: 364-367)

Objective to observe the clinical manifestations of patients with thyroid-related ophthalmopathy (TAO) and the influence of thyroid function and anti-hyperthyroidism (hyperthyroidism) treatment on the occurrence and development of TAO.Methods The clinical data of 339 patients (597 eyes) with TAO admitted from 1994 to 2001 were retrospectively analyzed.Results TAO patients mostly occurred in middle-aged people over 40 years old (70.5%), with no obvious gender difference; Exophthalmos and diplopia were the main reasons for consultation, and more than 70% of patients had ocular signs and involvement of extraocular muscles; Among the 339 patients, 93 had normal thyroid function; There were 246 cases of abnormal thyroid function (hyperthyroidism or hypothyroidism). There were significantly more TAOV and VI patients with abnormal thyroid function than those with normal thyroid function. 39.3% of patients developed ophthalmopathy after 131I anti-hyperthyroidism treatment, 15.6% of patients developed ophthalmopathy after oral anti-hyperthyroidism drugs, and 14.0% of patients developed ophthalmopathy after subtotal thyroidectomy. All patients' ocular lesions appeared after hyperthyroidism was controlled, and most patients were due to hypothyroidism. Rapid and excessive anti-hyperthyroidism therapy may adversely affect TAO; Timely and appropriate treatment can improve the therapeutic effect. (Chinese Journal of Ophthalmology, 2004, 40:368-372)

Objective to evaluate the effect of free forearm flap on orbital absence and orbital atresia secondary to retinoblastoma.Methods Sixteen patients with severe orbital or orbital fossa deformity.Among them, 7 patients underwent orbital absence and radiotherapy due to retinoblastoma.The free forearm flap with radial artery and cephalic vein was used to anastomose the radial artery and facial artery, and the cephalic vein and external jugular vein by microsurgical technique.The orbital absence and orbital atresia were corrected.Results All the 16 patients with free forearm flap orbitoplasty survived and were followed up for 0.5~5.0 years.The appearance of the patients was satisfactory and the prosthetic eyes were well fitted.Conclusion Intraorbital transplantation of free forearm flap is one of the good methods to repair severe orbital fossa deformity. (Chinese Journal of Ophthalmology, 2004,40:373-376)

Objective to investigate the effect and safety of Medpor high density porous polyethylene biomaterial for filling and reconstruction of orbital margin depression. Methods the prognosis of 16 patients who underwent Medpor high density porous polyethylene biomaterial for filling and reconstruction of orbital margin depression was followed up. Results 16 patients who underwent filling and reconstruction of orbital margin depression with Medpor obtained satisfactory results. The follow-up was 1~4 years, with an average of 2.4 years, and no complications such as implant prolapse, displacement and resorption were observed. Conclusion Medpor is a good bone replacement material, which is obviously superior to autologous tissue and other artificial materials. (Chinese Journal of Ophthalmology, 2004, 40: 377-379)

Objective to analyze the effect and complications of surgical treatment of exophthalmia caused by craniofacial dysplasia. Methods Three different surgical methods were selected for patients of different ages: total frontal bone fragment osteotomy and frontal orbital band advancement surgery were selected for patients aged 1~3 years old; The patients aged 4~15 years were treated with Le Fort's type Ⅲ craniofacial osteotomy and bone distraction osteogenesis; The patients over 16 years old were treated with Le Fort's type Ⅲ craniofacial osteotomy, which immediately moved the skull or middle facial skeleton at the time of osteotomy. Results All 18 patients achieved good therapeutic results. The exophthalmos decreased by 7.7 mm on average, the anterior and posterior depth of the anterior skull base increased by 8.2 mm on average, the inferior edge of the orbit advanced by 7.8 mm on average, and the angle between the skull base and the maxilla increased by 9 ° on average, indicating that the exophthalmos and facial appearance after operation were close to those of normal peers. Conclusion The best method for the treatment of exophthalmos caused by craniofacial dysplasia is to move forward immediately after craniofacial osteotomy, or to move forward gradually with bone traction after osteotomy to increase the volume of the orbit.

Objective to investigate the role of multifocal intraocular lens (MIOL) in the treatment of cataract. Methods During small incision phacoemulsification cataract aspiration, 30 patients (36 eyes) with cataract were implanted with MIOL (experimental group) and 32 patients (40 eyes) with cataract were implanted with monofocal intraocular lens (SIOL) (control group). The postoperative visual acuity, focal depth, corneal astigmatism, contrast sensitivity and glare sensitivity, surgical complications and poor vision symptoms of the patients were observed. The follow-up time was 6.0~18.0 months. Results The naked eye myopia ≥0.5 at 6 months after operation accounted for 80.6% (29/36) in the experimental group and 25.0% (10/40) in the control group, and the difference between the two groups was significant (P<0.05); In the range of +1.00~ -1.00D, 97.2% (35/36) of the experimental group and 97.5% (39/40) of the control group had visual acuity ≥0.5, and there was no significant difference (P>0.05); In the adjustment range of-1.50 D and-2.50~ -3.50 D, the corneal astigmatism in the test group [97.2% (35/36), 88.9% (32/36)] with visual acuity ≥0.5 was significantly higher than that in the control group [0.0% (0/40), 0.0% (0/40)] (P<0.05). In the operated eyes with visual acuity ≥0.5, the focal length depth was 4.50 D in the test group and 2.00 D in the control group. There was no significant difference in corneal astigmatism between the two groups at 1 week, 1 month, 3 months and 6 months after operation (P>0.05). The contrast sensitivity and glare sensitivity in the low frequency band were significantly lower in the test group (28.49±6.45 and 16.97±4.40) than those in the control group (36.20±7.45 and 24.05±6.08), and the difference was significant (P<0.05). The contrast sensitivity and glare sensitivity in the middle and high frequency bands were not significantly different between the two groups (P>0.05). Only 2 (5.6%) patients with MIOL implantation complained of glare at night, and the other patients had no obvious discomfort, and the degree of satisfaction was high.Conclusion MIOL implantation is safe and effective in the treatment of cataract; MIOL has obvious advantages in providing patients with good visual acuity (Chinese Journal of Ophthalmology, 2004, 40:385-388)

Objective to identify the 18S rDNA (Rns) genotype of Acanthamoeba keratitis isolates. Methods Twenty-six strains of Acanthamoeba keratitis were isolated and cultured. The whole genome DNA of the strains was extracted, and partial 18S rDNA sequences were amplified by polymerase chain reaction (PCR) with Acanthamoeba specific primers. After the amplified products were sequenced, the detected sequences were analyzed by molecular biology software Clustal X and MEGA2, and compared with the existing sequences in the gene bank. The genotype characteristics of Rns of Acanthamoeba strains preserved in Beijing Ophthalmology Institute and the genotype similarities and differences with other countries and regions were analyzed. Results Among the 26 strains of Acanthamoeba corneal infection isolated and preserved, 25 (96%) belonged to Rns T4 genotype and 1 (4%) belonged to Rns T3 genotype. Conclusion According to the characteristics of Rns genotype, most of Acanthamoeba corneal infection strains belonged to T4 genotype, and some strains belonged to T3 genotype. The results of this classification were similar to those in foreign countries.

Objective to investigate the distribution and expression of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in cornea after corneal infection with herpes simplex virus type Ⅰ (HSV-1). Methods HSV-1 (KOS strain) was inoculated into corneas of BALB/c mice to induce herpes simplex keratitis (HSK). The expressions of MMP-2, -8, -9 and TIMP-1, -2 in corneal tissues were detected by immunohistochemistry and Western blot, and the enzyme activity of MMPs was detected by Zymography. Results The expressions of MMP-2, -9 and TIMP-1, -2 in infected eyes were increased on the second day after infection compared with those in uninfected eyes, and the expressions were mainly located in superficial stromal layer and inflammatory cells under epithelium. Necrotizing keratitis and corneal ulcer were observed on the 14th and 28th day after infection, and the expressions of MMP-2, -9 and TIMP-1, -2 were significantly increased in corneal stromal and infiltrating inflammatory cells, especially in the ulcer. There were a large number of MMP-8 positive stained neutrophils in the ulcer area. After corneal infection with HSV-1, the activity of gelatinase (MMP-2, -9) and collagenase (MMP-8) were enhanced. Conclusion After HSV-1 corneal infection, MMPs secreted by corneal cells and infiltrating inflammatory cells may play an important role in promoting the formation of epithelial keratitis and ulcer. The interaction between MMPs and TIMPs may play an important role in regulating the necrotic lesions of HSK. (Chinese Journal of Ophthalmology, 2004, 40:395-399)

Objective to investigate the protective effect of electrical stimulation of cerebellar parietal nucleus on retinal ischemia-reperfusion injury in rats.Methods Rats were randomly divided into ischemia-reperfusion group,electrical stimulation group and sham operation group.The morphological changes of retina were observed; The expression of inducible nitric oxide synthase (iNOS) in retina was observed by NADPH diaphorase histochemical staining (NADPH-NDP); Results (1) The thickness of inner retinal layer (including inner nucleus layer, inner plexus layer, ganglion cells), nerve fiber layer and inner limiting membrane increased in the ischemia-reperfusion group, especially the thickness of inner plexus layer was significantly higher than that in the sham operation group (t =3.680, P<0.01); There was no significant difference in the internal retinal thickness between the electrical stimulation group and the sham operation group (t =1.064, P>0.05); (2) Obvious changes of chromatin density and nuclear fragmentation in the ischemia-reperfusion group were observed by light microscopy, while only a small amount of nuclear condensation and fragmentation were observed in the electric stimulation group; (3) The number of iNOS-positive ganglion cells in the electrical stimulation group was significantly lower than that in the ischemia-reperfusion group (t =3.326, P<0.01); (4) The number of apoptotic retinal cells in the electrical stimulation group was significantly lower than that in the ischemia-reperfusion group (t =4.038, P<0.01). Conclusion Electrical stimulation of the cerebellar parietal nucleus in rats has a protective effect on the retinal tissue injury caused by ischemia-reperfusion. (Chinese Journal of Ophthalmology, 2004, 40: 400-403)

Objective to investigate the expression and significance of pigment epithelium-derived factor (PEDF) in choroidal neovascularization (CNV) induced by laser in BN rats. Methods Thirty BN rats in 5 groups were treated with monocular retinal krypton laser photocoagulation to induce choroidal neovascularization. The eyeballs were removed at 3 days, 1, 2, 3 and 4 weeks after photocoagulation, respectively. Pathological examination and immunohistochemical examination of factor VIII-related antigen (FⅧR:Ag) were performed in the photocoagulation area to observe the formation of CNV. The expression and changes of PEDF and PEDF mRNA during the formation of CNV were detected by immunohistochemistry and in situ hybridization. Results Pathological examination and FⅧR:Ag immunohistochemical examination showed that CNV started to form at 1 week after photocoagulation and reached its peak at 3~4 weeks. PEDF mRNA and PEDF were expressed in retinal ganglion cells, some cells in the inner nucleus layer and retinal pigment epithelium in normal BN rats. The positive expression of PEDF was significantly higher on the near-choroidal side of the spot than on the inside of the spot. From 3 days to 4 weeks after photocoagulation, the density of PEDF mRNA and PEDF positive staining in the spot increased gradually (P<0.05), and the density of PEDF mRNA and PEDF positive staining decreased gradually (P<0.05). The negative correlation between PEDF and the positive staining density of PEDF and PEDF was negative (r = -0.84, P<0.05). Conclusion The negative correlation between the formation of CNV and the expression of PEDF suggests that the insufficient expression of PEDF may be one of the main causes of CNV formation and proliferation. (Chinese Journal of Ophthalmology, 2004, 40: 404-408)

In recent years, the examination and diagnosis methods of central serous chorioretinopathy (mesoplasma) have been increasing continuously. Among them, retinal thickness analyzer (RTA) has been widely used in ophthalmology clinic because it can quickly scan the posterior pole retina, thus obtaining objective and quantitative retinal thickness [1,2]. Since 2001, the author has applied RTA to detect the macular retinal thickness of 38 patients with mesoplasma, aiming to explore the diagnostic value of RTA in mesoplasma.

posterior capsule opacification (PCO) is one of the most common complications after cataract extraction. It is mainly caused by the proliferation, migration, metaplasia of residual 1ens epithelial cells (LECs) and postoperative inflammatory reaction [1]. Intracapsular injection of hyaluronidase (HS) combined with capsule polishing in 44 rabbit eyes proved that it can effectively reduce the occurrence of PCO and is safe for intraocular application.

When corneal inflammatory or mechanical injury occurs, corneal stromal cells proliferate into corneal fibroblasts, which play an extremely important role in the repair of corneal injury. This process involves the involvement of a series of complex cytokines, and the mechanism of which has not been completely elucidated. connective tissue growth factor (CTGF) is a newly discovered polypeptide growth factor, which is the main regulator of tissue repair and regeneration in wound.

diabetic retinopathy (DR) is one of the most common and serious microvascular complications of diabetes mellitus (DM). Its incidence rate increases with the development of DM. The incidence rate of DR is 44.4% within 5 years, 56% after 7 years [1, 2], and can reach 80% after 15 years. It is predicted that there will be 25 million DR patients in the United States and 300 million DR patients in the world by 2030 [3]. The pathogenesis of DR is still unclear, and there is still a lack of effective prevention and treatment methods for DR. The changes of microvascular structure are mostly observed by ophthalmoscope or fundus fluorescein angiography. In recent years, with the widespread application of retinal microvascular digestion and spreading technology [4], there are more and more experimental studies on DR at home and abroad, and most animal models are mainly rats. There are few reports of dynamic observation of DR-like lesions in rats for 6~8 months in China, and there are few reports of dynamic observation of DR-like lesions in rats for 1 year.

Transciliary vitrectomy has been used in ophthalmology since 1970s, which has significantly improved the cure rate of posterior segment diseases and saved the visual acuity of patients to the greatest extent. Because of the great interference of vitrectomy on the intraocular structure, bleeding of surgical wound and traction effect on vitreoretina, corresponding surgical complications can occur [1-4]. Therefore, choosing appropriate surgical instruments and smaller scleral incision can not only reduce surgical trauma, but also make scleral wound autistic, thus improving the success rate of surgery and shortening the recovery time of postoperative visual function. In 2002, the author initially applied 25-gauge transconjunctival sutureless vitrectomy (TSV25) system (product of Bausch & Lomb, USA) to treat 13 patients with simple vitreoretinopathy, in order to explore the surgical indications, complications and clinical application value of this system.

A 15-year-old male came to our hospital in April 2000. He complained of developmental deformity in his left eye at birth, no "black eyeball", and the eyeball was replaced by a meat-like mass, which could move and grow slowly with the development of the body. His mother had a history of syncope during pregnancy. The family genetic history was denied. No abnormalities were found in the whole body examination. Ocular examination: visual acuity of right eye 1.5, no abnormalities were found in both internal and external eyes; There was no sense of light in the left eye, normal eyelid development, narrow conjunctival sac, and cornea was replaced by a dermoid mass. The mass was about 12 mm ×12 mm ×5 mm in size, partially protruding outside the palpebral fissure, and there was hair growth on it (Figure 1). The mass continued with the bulbar conjunctiva with obvious boundary. The cornea, iris and lens could not be detected, the intraocular pressure was low, and the palpation of the mass showed a cystic sensation. CT examination showed that the volume of the left eyeball was significantly smaller than that of the contralateral side, a low-density shadow (flesh shadow) was seen in the front of the eye, the vitreous body was opaque with calcified plaques, and there was a semi-annular high-density calcified shadow in the back of the eye ring, and the shape of the extraocular muscle and optic nerve was normal (Figure 2).

A 51-year-old female was admitted to the hospital on March 25, 2002 with acute attack of acute angle-closure glaucoma in her right eye due to redness and pain in her right eye accompanied by acute visual acuity decrease for 1 d. Ocular examination showed that the far visual acuity of her right eye was 0.06, the near visual acuity was J1, and the visual acuity of her left eye was 1.2. IOP was 60.0 mm Hg (1 mm Hg =0.133 kPa) in her right eye and 12.0 mm Hg in her left eye.The conjunctiva of her right eye was mixed congested (+ + +), the cornea was nebulous edema (+ +) and pigmented KP (+ +); The depth of the central axis of the anterior chamber was 1. 5 cm, the peripheral anterior chamber disappeared, Tyndall sign (+); The pupil diameter was 4 mm, and the light response disappeared; The lens was transparent and the surface was pigmented. The gonioscopy could not be performed due to corneal edema. The left eye conjunctiva was not congested and the cornea was transparent. Anterior chamber gonioscopy: NⅡ ~ NⅢ, functional trabeculae can be seen in more than two quadrants under dynamic.

Lens ectopia refers to the deviation of the lens from its normal position in the center of the visual axis, including total ectopia and semi-ectopia. This sign can appear alone, such as traumatic lens ectopia and congenital lens ectopia, or it can be a part of systemic lesions, such as Marfan's syndrome. The clinical manifestations of simple lens ectopia are different from Marfan's syndrome, except for ocular abnormalities, there are no skeletal and cardiovascular abnormalities; The difference between simple lens ectopia and congenital lens ectopia is that the former has no abnormal lens position at birth. There is no family report of this disease in China so far. When we diagnosed and treated a child case, we found a family of simple lens ectopia, and the report is as follows.

Non-penetrating trabecular surgery combined with SK sodium hyaluronate gel (gel) implantation in the treatment of open-angle glaucoma has the advantages of fewer complications and safer operation. Our hospital has carried out this operation in 35 cases since 1998, with good surgical results and no serious complications. However, in recent years, the author found that 3 patients had conjunctival autolysis and SK gel rejection after SKgel implantation. The diagnosis and treatment are reported as follows.

Patients with severe blunt eyeball contusion may have many complications, such as complete rupture of the suspensory ligament of the lens, which leads to glaucoma secondary to the dislodgement of the lens into the vitreous cavity, vitreous hemorrhage, retinal concussion, retinal hole and retinal detachment, which seriously affect the visual function, so timely surgical treatment is needed. In 2001, the author treated 2 patients with glaucoma secondary to the dislodgement of the lens into the vitreous cavity caused by ocular trauma, and achieved good results by vitrectomy, removal of dislocated lens and combined anterior chamber intraocular lens implantation.

In 1967, Kelman first performed phacoemulsification cataract aspiration in two patients with cataract, and published<Through the unremitting efforts of ophthalmologists for more than 30 years, phacoemulsification equipment and operation technology have been changed and improved day by day. However, although the surgical trauma is gradually reduced, it is difficult to completely avoid the damage to ocular tissues such as cornea, iris, trabecular meshwork and retina caused by surgery. Therefore, clinicians must clearly understand and recognize all kinds of damage to ocular tissues caused by surgery, in order to further improve the technology and equipment and continuously improve the surgical efficacy.