Volume 40 ·  Issue 07 ·  2004

In the 1970s, Machemer [1], the pioneer of modern vitreous surgery, successfully performed the removal of anterior macular hyperplasia membrane in diabetic vitreous hemorrhage patients, which became the beginning of macular surgery.

Retinotomy and retinectomy are an important technique for adjuvant treatment of complex retinal detachment. In 1979, Machemer [1] first proposed and successfully treated a patient with traumatic retinal impaction; In 1981, he introduced retinotomy again in detail, and reported the clinical results of 15 cases of retinotomy. He believed that retinotomy and retinectomy can be used to treat patients with old retinal detachment, retinal shortening, subretinal hyperplasia, rigid edge of giant retinal hole and traumatic retinal impaction.

Objective to study the clinical effects of membrane segmentation and membrane debridement in patients with proliferative diabetic retinopathy (PDR) complicated with fibrovascular membrane.Methods the clinical data of 276 cases (296 eyes) of PDR who underwent vitreous surgery from 1996 to 2000 were retrospectively analyzed.The patients who were followed up for more than 4 months after surgery were strictly selected.The eyes filled with silicone oil must be more than 3 months after silicone oil was removed.All patients had fibrovascular membrane on the retina, 201 eyes had different degrees of vitreous hemorrhage, and 101 eyes had different degrees of traction retinal detachment.During vitreous surgery, 110 eyes were treated with membrane segmentation and 186 eyes with membrane debridement method.The incidence of intraoperative iatrogenic retinal hole, postoperative vitreous hemorrhage and postoperative visual acuity>0.1 in the "membrane segmentation" and "membrane debridement" groups were compared.The efficacy of the eyes with the same filler in the membrane segmentation and membrane debridement groups was compared.Results The sex, age and lesion classification of the two groups were compared, There was no significant difference (P>0.05). The incidence of retinal hole in the membrane segmentation group (35.5%) was lower than that in the membrane clearance group (54.3%), while the postoperative rehemorrhage rate and the improvement rate of postoperative visual acuity were not significantly different between the two surgical methods (P>0.05). Conclusion The risk of retinal hole formation in the membrane segmentation group was less, and the incidence of postoperative bleeding was slightly lower than that in the membrane clearance group; There was no significant difference in the improvement rate of postoperative visual acuity between the two groups (P>0.05). It is suggested that beginners should start with membrane segmentation when performing PDR vitreous surgery. (Chinese Journal of Ophthalmology, 2004, 40: 439-442)

Objective to investigate the relationship between postoperative hiatus healing morphology and visual function recovery in patients with idiopathic macular hole. Methods 36 cases (38 eyes) of idiopathic macular hole healing after one-time surgery were selected and retrospectively analyzed. The healing morphology of the hiatus was observed by coherence optical tomography (OCT), and the photosensitivity, absolute dark spot, mean area of relative dark spot and central visual acuity of the macular area were measured by laser scanning ophthalmoscope (SLO) before and at 1, 3 and 6 months after surgery. Results According to OCT images, the morphology of the hiatus was divided into completely healed (22 eyes), partially healed (10 eyes) and unhealed (6 eyes). Although the central visual acuity and photosensitivity of unhealed eyes were improved compared with those before operation, there was no significant difference between absolute dark spot and relative dark spot (P>0.05); The improvement of visual acuity, photosensitivity and absolute dark spot in completely healed eyes were significantly different from those in partially healed and unhealed eyes (P<0.05). The foveal shape of macula can be completely recovered after operation in stage Ⅱ hiatus eyes. Conclusion The recovery of normal retinal shape in foveal macula is positively correlated with the improvement of visual function after operation (P<0.05). The better the recovery of foveal shape after operation, the higher the improvement of visual function.

Objective to investigate the possibility of differentiation of human embryonic retinal stem cells into retinal terminal cells. Methods Human embryonic retinal stem cells from 16 to 20 weeks were cultured in vitro without serum, induced in vitro with serum and simulated in vivo with eye cup containing retinal pigment epithelium. The expression of surface antigen in stem cells and retinal terminal cells was detected by immunofluorescence, and the expression difference of nestin gene in mRNA level was detected by real-time fluorescence quantitative PCR. Results the retinal stem cells isolated from the neurosensory layer of human embryonic retina could express retinal terminal cell markers PKC α, GFAP, Thy1 under the condition of induction in vitro, and a few cells expressed nestin and MAP2 under the condition of induction in vitro. After induction in the simulated in vivo environment, they not only expressed the above cell markers, but also expressed rhodopsin and syntaxin positively. Conclusion RPE can promote the differentiation of retinal stem cells into rod cells and amacrine cells (Chinese Journal of Ophthalmology, 2004, 40: 448-452)

Objective to compare the effects of different intraocular perfusions on the viability and antioxidant effect of retinal neuroepithelial cells, in order to find the ideal intraocular perfuse.Methods the primary cultured neonatal rat retinal neuroepithelial cells were divided into groups A, B, C, D and E. Group A was the control group, which was serum-containing DMEM/F12 medium, and the other four groups were treated with BSS plus, BSS plus + drugs (tobramycin 16 000 U/L, dexamethasone 16 mg/L and epinephrine hydrochloride 1 mg/L), self-made perfusion and lactate Ringer's solution + drugs, respectively. After incubating the cells for 4, 12, 24 and 48 h, the activity of mitochondrial succinate dehydrogenase, the release rate of lactate dehydrogenase (LDH) and the positive rate of apoptosis were detected in each group. The content of malondialdehyde (MDA), a product of lipid peroxide decomposition, was measured after 4 hours. Results the activity of mitochondrial succinate dehydrogenase in each perfusion group decreased with time, the release rate of LDH and the positive rate of apoptosis increased with time (P<0.05). The effects of different groups on cell viability at the same time point were from small to large: group B, group C, group D and group E. There was no significant difference between group C and group D (P>0.05). In terms of antioxidant effect, the content of MDA in group B, group C and group D was significantly lower than that in group E (P<0.01), and there was no significant difference between the three groups (P>0.05). Conclusion After adding bicarbonate, glucose, oxidized glutathione and tobramycin, epinephrine hydrochloride and dexamethasone to lactate Ringer's solution, the homemade perfusion solution has similar antioxidant and buffering capacity as BSS plus solution, it also provides more energy source and anti-influenza The effect of BSS plus solution on cell viability is similar to that of BSS plus solution added with drug, and the price is cheap, and it has a good prospect for development and application. (Chinese Journal of Ophthalmology, 2004, 40: 453-458)

Objective to investigate the safe dosage of fibrinolytic enzyme and hyaluronidase injected into the vitreous cavity and to evaluate the degree of posterior vitreous detachment.Methods Forty-eight New Zealand white rabbits were randomly divided into six groups, one eye of each rabbit was the experimental eye and the other eye was the control eye.Each experimental eye in each group was injected with different drugs and doses in the posterior 1/3 of the vitreous body before the optic papilla: Group 1: hyaluronidase 20 IU, balanced saline solution (BSS) 0.1 ml; Group 2: Hyaluronidase 30 IU, BSS 0.1 ml; Group 3: Fibrinolytic enzyme 1 IU, BSS 0.1 ml; Group 4: Fibrinolytic enzyme 2 IU, BSS 0.1 ml; Group 5: Fibrinolytic enzyme 3 IU, BSS 0.1 ml; Group 6: Hyaluronidase 20 IU, BSS 0.05 ml, combined with fibrinolytic enzyme 1 IU, BSS 0.05 ml. All control eyes were injected with BSS 0.1 ml. After injection, slit lamp, +90D anterior scope, indirect ophthalmoscope, electroretinogram (ERG), B-ultrasound and coherence optical tomography were examined. After 2 weeks of observation, the eyeball tissue samples were observed by light microscope and scanning electron microscope. Results No intraocular inflammatory reaction and retinal toxicity occurred in the experimental eyes of rabbits in groups 1, 3 and 6; Slight intraocular inflammatory reaction occurred in the experimental eyes of rabbits in groups 2 and 4, and there was no obvious abnormality in retinal tissue structure, but the ERG of the latter showed a reversible decrease; Conclusion Intravitreal injection of hyaluronidase 20 IU and/or plasminolytic enzyme 1 IU is safe, reliable and has no toxic side effects on retina and other intraocular tissues. Combined intravitreal injection of hyaluronidase 20 IU and plasminolytic enzyme 1 IU can induce complete retrovitreal detachment (Chinese Journal of Ophthalmology, 2004,40:459-464)

Objective to investigate the in vivo morphological characteristics of corneal layers in patients with Fuch's corneal endothelial dystrophy by confocal microscopy in China.Methods The central corneas of 19 patients (38 eyes) with Fuch's corneal endothelial dystrophy were examined by confocal microscopy in vivo. They were divided into symptomatic group (19 eyes) and asymptomatic group (19 eyes), and 30 eyes were selected as normal control group. The morphology and density of corneal tissue cells in each layer, as well as the diameter of drop-like verruca and corneal nerve were measured and analyzed by NAVIS software.Results (1) In the symptomatic group: drop-like verruca was observed in the corneal endothelial layer of 19 eyes, with a diameter of 20~60 μ m, and the endothelial cell density was significantly different from that of normal control group (t =18.74, P<0.01); The posterior elastic membrane was thickened in 9 eyes; In 14 eyes, the posterior corneal stromal layer had long strip dark area structure; The corneal stromal reflection was generally enhanced in 19 eyes; The Bowman membrane in 17 eyes had focal hyperreflective areas; The morphology of basal epithelial cells in 19 eyes was roughly normal; Ten eyes showed normal corneal nerve structure; There was no significant difference in the density of posterior and anterior stromal cells compared with the normal control group (t =0.854, 1.173, P =0.38, 0.24). (2) In the asymptomatic group, drop-like verruca was found in the corneal endothelium of 19 eyes, and the number was less than that of the symptomatic group, with a diameter of 15~40 μ m; There was no significant difference in endothelial cell density compared with the normal control group (t =1.998, P =0.053); The difference of endothelial cell density between the symptomatic group and the asymptomatic group was very significant (t =8.352, P<0.01). Conclusion In vivo confocal microscopy is helpful for the diagnosis of Fuch corneal endothelial dystrophy, especially for corneal edema and corneal endothelial endoscopy inability (Chinese Journal of Ophthalmology, 2004, 40: 465-470)

Objective to investigate the effect of corneal orthopedic lens on corneal morphology and aberration of monochromatic light wavefront, and to evaluate the effect of corneal morphology on the optical properties of eyeball. Methods Twenty-five myopic volunteers (50 eyes) were selected. The equivalent spherical degree of refractive error was-1.75~ -4.75D. All eyes were examined by slit lamp microscopy, best corrected visual acuity, corneal topography and monochromatic light wavefront aberration measurement before wearing the lens. The subjects wore the lens at night for at least 7 h, and the lens was examined in the morning 1 d, 1, 2, 4, 8 and 12 weeks after wearing the lens. The number of days and time of wearing the lens were recorded in detail. The slit lamp microscopy, best corrected visual acuity and corneal topography were examined respectively, and the monochromatic light wavefront aberration was measured again after 12 weeks of follow-up. Results The corrected visual acuity before wearing the lens was-0.0628 ± 0.0286 (LogMAR), while the corrected visual acuity after wearing the orthopedic lens for 12 weeks was-0.0120 ± 0.0318 (F =17.821, P<0.001); The Root-Mean-Square RMS (Root-Mean-Square) of the aberration Zernike function of monochromatic light wavefront was (0.5766±0.4771) μ m before wearing the glasses, while the Root-Mean-Square RMS (Root-Mean-Square RMS) of the aberration Zernike function of monochromatic light wavefront was (1.3731±0.8039) μ m after wearing the glasses for 90 days. The difference between the two was significant (F =36.513, P<0.001), the RMS values of the Zernike function values related to each level of aberration increased; The eccentricity of the anterior surface of corneal topography decreases, but the eccentricity of the posterior surface increases. Conclusion the decrease of myopic degree of orthokeratological lens can cause the decrease of visual quality of patients. The increase of aberration of monochromatic light front caused by the change of corneal topography after wearing orthokeratological lens may be one of the main reasons for the decrease of visual quality. (Chinese Journal of Ophthalmology, 2004, 40: 471-473)

Objective to evaluate the effects of phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) on the visual acuity of patients systematically. Methods Medline database and Chinese biomedical literature database were searched, and 9 randomized controlled clinical trial literatures on the clinical efficacy of Phaco and ECCE were meta-analyzed. The risk difference was used to determine the therapeutic effects of Phaco (Phaco group) and ECCE (ECCE group), and the combined risk difference was calculated according to the random effect model. Results There were 1192 patients with cataract in the 9 literatures. The combined risk difference between Phaco group and ECCE group with visual acuity ≥0.5 in the short (postoperative time<1 week) and the long (postoperative time>3 months) was 24% (95% confidence interval 10%-37%) and 20% (95% confidence interval 14%-25%), respectively, with significant differences (P<0.001). The incidence of surgical complications in Phaco group and ECCE group was 36.8% and 62.1%, respectively, with significant differences (P<0.01). Conclusion The visual acuity of patients with Phaco surgery recovered quickly, well and stably Phaco is a kind of vision restoration surgery with better efficacy than ECCE. (Chinese Journal of Ophthalmology, 2004, 40:474-477)

lens epithelial cell (LEC) apoptosis is a common molecular mechanism in all types of cataract except congenital cataract [1], and reactive oxygen species injury is the main cause of LEC apoptosis [2].

Glaucoma is one of the main ocular diseases causing blindness worldwide. There are about 70 million glaucoma patients worldwide, and about 7 million patients are blind in both eyes every year due to glaucoma [1]. According to incomplete statistics, there are 9.4 million glaucoma patients in China alone, of whom 56% are blind in one eye and 19% are blind in both eyes [2]. The epidemiological data of glaucoma investigation show that primary open-angle and closed-angle glaucoma account for the majority of glaucoma patients in China [2-6], and the quality of life of patients is seriously affected with the development of the disease.

Chinese Journal of Ophthalmology was founded on October 1, 1950, sponsored by South China Medical Association, and edited by the editorial board of Chinese Journal of Ophthalmology. The editorial committee is composed of 61 well-known ophthalmologists in China. The current editor-in-chief Zhao Jialiang and the editorial director Zhao Hongmei. The main readers of this journal are ophthalmologists across the country, and it is publicly distributed at home and abroad. China Standard Issue Number: ISSN0412-4081, CN11-2142/R; Postal Code: 2.60; National map code: BM93. "Chinese Journal of Ophthalmology" has always implemented the Party and the State

Chinese Journal of Ophthalmology is a professional academic journal of ophthalmology sponsored by Chinese Medical Association. It focuses on the majority of ophthalmologists, focuses on the leading scientific research achievements and clinical diagnosis and treatment experience in the field of ophthalmology, and reports basic theoretical research that has a guiding role in ophthalmology clinics and is closely integrated with clinical practice. The purpose of this journal is to carry out the principles and policies of the Party and the state on health work, and to carry out the principles of combining theory and practice, popularization and improvement. Reflect the significant progress of clinical and scientific research in ophthalmology in China, and promote

Vitreous surgery in patients with proliferative diabetic retinopathy (PDR) is generally complicated, especially for those patients with insufficient dilatation of pupils, diabetic cataract or intraocular lens. Peripheral vitrectomy and intraocular and extraocular laser treatment are very difficult for these patients. Excessive peripheral pressure during surgery often leads to complications such as lens dislocation or intraocular lens, intraocular pressure instability and intraocular tissue damage.

In the 21st century, the society has entered the information age. It has become an important task in the process of realizing the clinical information management of ophthalmology by using computer network information technology to set up local area network, metropolitan area network or wide area network of all kinds of ophthalmology examination equipment through computer and network hardware equipment, and then developing suitable application software system to realize the information management of ophthalmology image network. After testing and installation in 2001, it has been running stably for more than 3 years.

Acute pancreatitis complicated with fundus changes and visual acuity decrease is rarely seen in clinic.The author treated one case in June 1992 and followed up until February 2004. The follow-up situation of 11 years and 8 months is analyzed and reported as follows.

Expulsive suprachoroidal hemorrhage is a very serious complication of cataract extraction and other intraocular surgery, and improper management can lead to vision loss and eyeball atrophy. Although the incidence of expulsive suprachoroidal hemorrhage has decreased since phacoemulsification cataract aspiration was carried out [1], once it occurs and is improperly managed, it can still cause serious consequences for patients. There are few relevant reports in China [2, 3]. The author has performed phacoemulsification cataract aspiration for many years, and out of 9232 patients in the past 3 years, expulsive suprachoroidal hemorrhage occurred in 5 patients. In order to provide useful data and help for clinical work, the clinical characteristics and management methods of 5 patients are reported as follows.

Recent studies have shown that wearing contact lenses can affect the thickness, shape and function of cornea [1-6]. In China, the fitting of polymethylmethacrylate (PMMA) contact lenses began in the mid-1960s. Although it has been replaced by soft contact lenses and rigid gas permeable contact lenses (RGP), some people still use the original PMMA lenses.

Orbital varices are not uncommon clinically, but bilateral orbital varices are rare [1-3]. One case was recently admitted to our hospital, and the report is as follows.

Allergic eye disease is one of the most common ocular surface diseases, among which allergic conjunctivitis is the most common type. According to statistics, more than 5% of people in the world go to the doctor because of allergic eye disease, and the proportion of allergic conjunctivitis exceeds 50%. In recent years, due to the use of eye cosmetics and the aggravation of air pollution in some areas, the incidence of allergic conjunctivitis has increased further. Therefore, it is of great significance to diagnose allergic conjunctivitis correctly and use drugs rationally.