Volume 41 ·  Issue 02 ·  2005

After three years of investigation and industry analysis, combined with the development status of China's medical industry, American Aolide Medical Investment Group and the "Chief Think Tank of Hospital Management"-Dean's Decision Research Center plan to invest 1 billion yuan in China within five years to build eight chain eye hospitals, so that more patients with ophthalmic diseases in China can enjoy international medical services. The plan has now been implemented. At present, six hospitals in Guangdong Province are located in six cities: Guangzhou, Zhanjiang, Zhongshan, Meizhou, Shaoguan and Huizhou. The investment targets outside the province are Beijing and Shanghai. At present, the first hospital has settled in Zhanjiang and will open for trial operation at the end of this year, with a business area of 22000m^2. It is the largest ophthalmology hospital in western Guangdong.

In order to improve the level of clinical ophthalmologists and technicians in microcomputer visual field detection and reading, as well as the diagnosis level of glaucoma and various eye diseases, and to promote the in-depth development of ophthalmology, the editorial board of Chinese Journal of Ophthalmology decided to hold a study class on modern microcomputer visual field detection and reading in Shenzhen, Guangdong Province from December 20 to 26, 2005. Visual acuity (visual acuity) and visual field are the two most important aspects of visual function, and the visual field measures visual function outside the macular region.

Since the copyright law of our country was promulgated, it has been paid widespread attention by all circles of society. As a medical scientific and technological journal, the copyright law must be implemented to the letter. Therefore, the relevant requirements of this journal for author's signature and thanks are reiterated as follows.

China Press and Publication News, published on November 19, 2004, published the list of 60 illegal newspapers and periodicals banned for the second time by the General Administration of Press and Publication and the Office of the National Anti-pornography and Anti-illegal Working Group. Adding the first batch of 30 illegal newspapers and periodicals that used overseas issue numbers to engage in illegal publication published on July 13, 2004, the number of illegal newspapers and periodicals banned has reached 90.

Blindness and low vision caused by fundus diseases (such as age-related macular degeneration and hereditary retinopathy) are one of the thorny problems encountered by ophthalmologists at present. Improving the diagnosis and treatment level of fundus diseases depends on the breakthrough of clinical basic research of fundus diseases. At present, some staged achievements have been made in the research of stem cell transplantation, directed development of embryonic stem cells and retinal stem/progenitor cells, microenvironment research and transplantation of retinal pigment epithelial cells and iris pigment epithelial cells, etc. However, in order to solve the still existing problems, it is necessary to give in-depth research on the determination of developmental genes, expression regulation and modification, directed differentiation of stem/progenitor cells and the improvement of microenvironment in host transplantation area. (Chinese Journal of Ophthalmology, 2005, 41:97-99)

Objective to investigate the effect of oxidative stress induced by tert-butyl hydroperoxide (TBH) on the migration of retinal pigment epithelium (RPE) cells. Methods the intracellular oxidation products of human RPE were labeled with Carboxy-H2DCFDA staining; Cell migration was determined using a modified Boyden cavity assay; The expressions of actin, local adhesion kinase and bond protein were observed by immunofluorescence staining, and the expressions of mitogen-activated protein kinase and local adhesion kinase were observed by protein electrophoresis. Results the oxidative reaction products in RPE cells increased after TBH treatment. The effect of TBH on RPE cell migration was bidirectional, that is, low concentration promoted and high concentration inhibited. High concentration of TBH reduced the adhesion of RPE cells, and also reduced the expression of local adhesion kinase and bond protein, while TBH could activate mitogen-activated protein kinase. Conclusion The oxidative stress induced by TBH can both stimulate and inhibit the migration of RPE cells. (Chinese Journal of Ophthalmology, 2005, 41: 100-105)

Objective to investigate the effect of tedelparin on inhibiting the secretion of human hepatocyte growth factor (HGF) and the growth of frozen human retina pigment epithelium (hRPE) cells. Methods RPE cells were frozen at-80℃ for 0, 15 and 60 s, then cultured in vitro (in vitro experimental group) and injected into the vitreous body of normal rabbit eyes (in vivo experimental group). Each experimental group was divided into two subgroups: Tedeparin-treated group (final concentration 25 μ L/ml) and untreated group. Cell culture supernatant and vitreous samples were collected at 3 days and 6 days, and the content of HGF was determined by ELISA, and the proliferation of RPE cells after 48 hours was determined by MTT assay. Results In the experimental group in vitro, compared with the unfrozen group, the level of HGF secretion of frozen RPE cells increased with the prolongation of freezing time (F =27.36, P<0.01), and the level of HGF secretion in the tedeparin intervention group decreased (F =179.50, P<In vivo, the concentration of HGF in the experimental group (rabbit vitreous) increased significantly with the prolongation of freezing time compared with the control group (F =6.24, P<0.01), when vitreous humoral fluid (frozen for 15 s and 60 s, day 6) was added to normal RPE cell culture medium for 48 h, the cell proliferation was stimulated (P<Cell proliferation was significantly weakened in the Tedeparin intervention group (F =44.90, P<Conclusion Freezing can stimulate the high secretion of HGF by RPE cells in vitreous environment in vitro and in vivo, and it is more significant with the increase of freezing time. Tedeparin can reduce the secretion of HGF by RPE cells after freezing and inhibit the growth of RPE cells in growth-promoting environment, and has the effect of preventing PVR.

Objective to investigate the effect and mechanism of sulamine against proliferative vitreoretinopathy (PVR). Methods 10 groups of human retinal pigment epithelium (RPE) cells were cultured in vitro. 5 control groups were added with bFGF at final concentrations of 1, 10, 100, 500 ng/ml and sulamine at 31.25 μ g/ml respectively. In the experimental group, 4 groups were added with bFGF at final concentrations of 1, 10, 100 and 500 ng/ml in addition to sulamine at 31.25 μ g/ml. Another blank group was set up. After 48 h of culture, the absorbance (A) values of each well were measured by MTT assay and enzyme-linked immunoassay to calculate the proliferation rate of cells. The interaction effects of bFGF and sulamine were compared by factorial analysis and the separate effects. Results There was no obvious morphological difference in the cell growth of each group. There was an antagonistic interaction effect between sulamine and bFGF (F =6.73, P<In the control group, compared with the blank group, the A value of all bFGF groups increased, and the maximum A value was the group with 10 ng/ml bFGF concentration; The sulamine group decreased; Conclusion Sulamine can antagonize the effect of bFGF on the proliferation of RPE cells, and its mechanism of inhibiting the proliferation of RPE cells and preventing PVR further includes at least antagonizing the biological effects of growth factors (Chinese Journal of Ophthalmology, 2005, 41:110-113)

Objective to investigate the effects of blocking the production of vascular endothelium growth factor (VEGF) in cultured adult retinal pigment epithelium (RPE) cells on the morphology and growth of RPE cells. Methods the expression plasmid encoding antisense VEGF was introduced into RPE cells by liposome, and then the clones of RPE cells stably transducing antisense VEGF were screened by neomycin (G418). The changes of cell morphology, VEGF production ability and cell markers were observed by inverted microscope, immunofluorescence and immunohistochemical staining, and enzyme-linked immunosorbent (ELISA) technique. Results After blocking the production of VEGF in adult RPE cells continuously, the growth of RPE cells was inhibited, and the secretion of extracellular matrix increased, and the morphology changed, resembling that of nerve cells. After the production of VEGF in RPE cells decreased, the expression of cell markers also changed, and the specific markers of retinal neuron-like cells Thy1.1 and neurofilament protein changed to positive, Conclusion VEGF signaling pathway plays an important role in regulating the transdifferentiation of RPE cells. (Chinese Journal of Ophthalmology, 2005, 41: 114-117)

Objective to investigate the protective effect of transplantation of ciliary neurotrophic factor (CNTF) expressing cells on retinal ganglion cells after optic nerve transection in SD rats. Methods CNTF expression plasmid was transferred to human embryonic lung fibroblasts by liposomes to establish stable and high-level CNTF expression cell lines. Retinal ganglion cells were retrograde labeled with 3% fluorescent gold injection of bilateral dorsolateral geniculate body and superior collicular nucleus. The labeled rats were divided into two groups, and the optic nerve in intraorbital segment was surgically severed 7 days after labeling: one group of left eye without operation as normal control group, and right eye with optic nerve severed as surgical control group; The left eye was injected with PBS as the control group, and the right eye was transplanted with CNTF-expressing cells as the experimental group. The eyeballs were removed at 5, 14, 17, 21 and 28 days after surgery, and the surviving ganglion cells in the retina were observed and counted by fluorescence microscope. Results the number of ganglion cells in the retina decreased by 67.44% 2 weeks after surgery of the optic nerve in the orbital segment. The number of ganglion cells in the retina was significantly higher than that in the control group at 5, 17 and 21 days after transplantation of CNTF-expressing cells<Conclusion Subretinal transplantation of high-level CNTF expressing cells has protective effect on retinal ganglion cells. (Chinese Journal of Ophthalmology, 2005, 41: 119-122)

Objective to investigate the effect of protein kinase c α (PKC α) on the expression of developmental genes (pax-6, slit-2, netrin-1) in mouse embryonic stem cells (ESCs). Methods ES-BALB/c cell lines were cultured in ESCs medium without leukemia inhibitor factor (mLIF) for 4 days to form embryonic bodies (EBs), and then planted in 6-well plates with coverslips and 100 mm diameter petri dishes, respectively. After induction with 5×10-7 mol/L retinoic acid (RA), the types of differentiated cells were identified by neuronal specific antigens NSE and NF-200. The mRNA expressions of PKC α and developmental genes were determined by reverse transcription polymerase chain reaction (RT-PCR) at 1, 3, 5, 7 and 14 days after induction, and the effects of PKC activator phorbol ester (PMA) and PKC inhibitor D-sphingosine on their expressions were observed. Results Immunohistochemistry showed that most cells were positive for NSE and NF-200 on the third day after induction. The expression of PKC α, pax-6 and netrin-1 mRNA was significantly enhanced by PMA, while D-sphingosine had the opposite effect, which significantly decreased their expression, but had no obvious effect on slit-2. Conclusion the developmental genes pax-6 and netrin-1 play an important role in regulating the differentiation of ESCs into neural-like cells, probably through PKC α signaling pathway.

Objective to investigate the efficacy of phacoemulsification combined with trabeculectomy and 5-fluorouracil (5-Fu) in the treatment of glaucoma complicated with cataract. Methods from January 1996 to December 1998, 71 eyes (71 eyes) of primary open-angle glaucoma (POAG) and primary closed-angle glaucoma (PACG) who underwent phacoemulsification combined with trabeculectomy and 5-Fu in Singapore National Eye Center were retrospectively analyzed, except for those who were followed up for less than 6 months. Results the mean intraocular pressure and the mean number of medications were significantly lower than those before operation (P<0.01). The intraocular pressure of patients followed up for 1 to 5 years was significantly lower than that before operation (P<0.01). The complete success rate at 1, 3 and 5 years were 84.2%, 62.7% and 55.3% respectively. Under the condition of complete success, POAG and PACG (P =0.281), the same incision and different incisions (P =0.487) were treated The difference was statistically significant (P =0.02). There was a statistically significant difference in the improvement of postoperative mean visual acuity compared with preoperative mean visual field defect (MD) (P =0.55) and mode standard deviation (PSD) (P =0.64), which indicated that the postoperative visual field remained stable. Endophthalmitis occurred in 1 case 4 days after operation, and intraocular hypotension caused by choroidal leakage and wound leakage in 2 cases in late postoperative period. Conclusion The success rate of phacoemulsification combined with trabeculectomy and intraoperative application of 5-Fu in the treatment of POAG and PACG is high, the operation is safe, and the curative effect is stable after long-term observation. There is no significant difference in the success rate of combined POAG and PACG or the same incision or different incisions. (Chinese Journal of Ophthalmology, 2005, 41: 128-131)

Objective to evaluate the safety of phacoemulsification cataract aspiration intraocular lens implantation in patients with cataract after glaucoma filtration surgery from the aspect of blood-aqueous humor barrier function. Methods 40 cases (46 eyes) of cataract after glaucoma filtration surgery (experimental group) and 60 cases (64 eyes) of senile cataract (control group) underwent phacoemulsification cataract aspiration intraocular lens implantation. The changes of aqueous humor protein concentration were quantitatively measured by laser protein cell detector (LFCM) before and 1, 7, 30 and 90 days after surgery, and compared. Results The mean aqueous humor flash values of the eyes before and 1, 7, 30 and 90 days after phacoemulsification cataract aspiration intraocular lens implantation were (15.12±2.87), (40.24±3.75), (24.33±3.38), (21.18±1.77) and (16.51±1.70), respectively. The differences were statistically significant (P<0.05); In the control group, (6.94±2.34), (26.27±10.21), (13.96±6.44), (9.07±2.67), (7.16±1.89) PC/ms were respectively, and the differences were statistically significant (P<0.05). The two groups were higher at 1, 7 and 30 days after operation than before operation (P<0.05); There was no significant difference between 90 days after operation and before operation (P>0.05). The mean aqueous humor flash values between the two groups before operation and 1, 7, 30 and 90 days after operation were significantly different (P<0.05). The difference of mean aqueous humor flash values between 1 and 30 days after operation and preoperation in the experimental group was higher than that in the control group (P<Conclusion Blood-aqueous humor barrier dysfunction in patients with glaucoma filtration surgery; Phacoemulsification cataract aspiration and intraocular lens implantation is safe in the treatment of cataract patients after glaucoma filtration surgery, but strengthening anti-inflammatory reaction therapy and reducing surgical injury are the key to ensure the safety of surgery. (Chinese Journal of Ophthalmology, 2005, 41:132-135)

Objective to investigate the different characteristics of optic nerve damage in patients with hypertensive primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). Methods the retinal tomography scanner manufactured by Heidelberg Company of Germany was used to quantitatively examine the optic disc parameters and nerve fiber layer in 39 patients with hypertensive POAG (47 eyes) and 32 patients with NTG (38 eyes). The type of retinal nerve fiber layer (RNFL) defect was observed by fundus stereography, and the static quantitative visual field was detected. Results (1) The overall parameters and partitions (except temporal side) of optic disc in NTG group were smaller than those in hypertensive POAG group, while the C/D was greater than that in hypertensive POAG group; The mean RNFL thickness and RNFL area were smaller in infratemporal and supratemporal than in the hypertensive POAG group; The overall disc edge volume was smaller than that of POAG group, and the overall mean cup depth and infratemporal cup area were larger than those of POAG group. The differences between the two groups were statistically significant (P<(2) Types of RNFL defects: diffuse defects accounted for 53.19% and localized defects accounted for 4.26% in hypertensive POAG group; Diffuse defects accounted for 21.05% in NTG group, and localized defects accounted for 55.26% in NTG group. The difference was statistically significant when comparing the composition ratio of RNFL defects between the two groups (P<Conclusion Compared with NTG, POAG with high IOP has larger C/D value, C/D area ratio and narrow disc edge area, and the loss of RNFL is serious. RNFL in patients with high IOP is mainly diffuse defect, while RNFL in patients with NTG is mainly localized defect. The optic nerve damage of the two patients has different characteristics, and the damage mechanism may be different. (Chinese Journal of Ophthalmology, 2005, 41: 136-140)

Objective to investigate the role of interleukin-2 (IL-2) in early intraocular inflammatory reaction induced by iron powder.Methods Twelve New Zealand male white rabbits were randomly divided into control group, intraocular iron powder foreign body group, intraocular iron foreign body + anterior chamber injection of water-soluble interleukin-2 receptor (SIL-2R) group, 8 eyes in each group.At 3, 5, 7 and 10 days after operation, the anterior chamber inflammatory reaction of rabbits in each group was observed, the level of IL-2 in aqueous humor of rabbits in each group was measured, and tissue sections of rabbits in three groups were made, HE staining and iron staining were performed, and the results of each group were compared. Results The postoperative inflammatory reaction of anterior chamber in intraocular iron foreign body + anterior chamber injection of SIL-2R group was significantly lighter than that in intraocular iron powder foreign body group; The content of IL-2 in the anterior aqueous humor was significantly lower in the intralens iron foreign body + anterior chamber injection SIL-2R group than in the intralens iron powder foreign body group (P<0.01); Conclusion IL-2 plays an important role in the early intraocular inflammatory reaction induced by intraocular iron foreign body, and the content of IL-2 in the aqueous anterior chamber is significantly correlated with the intensity of the inflammatory reaction in the anterior chamber. Blocking the effect of IL-2 can reduce the degree of early intraocular inflammatory reaction caused by rust. (Chinese Journal of Ophthalmology, 2005, 41: 141-144)

Retinitis pigmentosa (RP) is a hereditary eye disease causing blindness, and its prevalence is about 1/3500. At present, there is no effective prevention and cure for this disease. This paper summarizes the recent advances in molecular genetics of RP, emphasizing on gene mutations that are valuable for diagnosis and prognosis, and summarizes the new trends of RP gene therapy. (Chinese Journal of Ophthalmology, 2005, 41: 188-192)

A 50-year-old female was admitted to the brain surgery department of our hospital on November 22, 2002 due to headache accompanied by numbness on the right side of the face for half a year, and her condition was aggravated for one month. On the same day, the physical examination showed that the sensation on the right side of the face was reduced, the tongue was extended to the right side, and the sensation and movement of the limbs were normal. The visual acuity of both eyes was 0.4. MRI examination showed that there was a 6.2 cm ×6.0 cm ×5.0 cm space-occupying lesion on the right temporal floor, with low signal in T1WI and moderate signal in T2WI, and obviously enhanced signal. CT scan showed that the right temporal floor was huge meningioma. The admission diagnosis was: huge meningioma on the right temporal floor. In order to understand the blood supply of local tumor, whole brain angiography and embolization of the tumor supply artery were performed under local anesthesia on November 26 of the same year. The right internal carotid artery was intubated from the right femoral artery, and the right internal carotid artery was performed.

The patient was a 71-year-old female who came to the ophthalmology department of our hospital for diagnosis and treatment in June 2001 due to the decrease of visual acuity in her right eye for 3 years. The patient was diagnosed with age-related macular degeneration and vitreous hemorrhage in her left eye in another hospital 11 years ago. She underwent vitrectomy in her left eye in our hospital. Retinal detachment occurred again 1 year after the operation. She underwent extrascleral cerclage in a local hospital, and her visual acuity recovered poorly after operation, and she gradually lost blindness. No abnormalities were found in physical examination.

Congenital macular defect is a congenital abnormality of the fundus that seriously affects the central vision of patients. We admitted one case in 2002, and the report is as follows. The patient was a 29-year-old male who came to our hospital on November 19, 2002 due to poor visual acuity in his left eye since childhood. He had no history of night blindness and trauma in the past, no similar medical history in his family, and his parents were not close relatives, and no abnormalities were found in the whole body examination. Ocular examination showed that the visual acuity was 1.0 in the right eye and 0.04 in the left eye, which could not be corrected. IOP: 16 mm Hg (1 mm Hg =0.133 kPa) in the right eye and 15 mm Hg in the left eye. There was no obvious abnormality in the anterior segment of the left eye, and the color of the fundus papilla was normal with clear boundary after mydriasis. A kind of oval choroidal-retinal defect was seen in the macular area, about 3 PD ×4 PD in size, with more pigment attached to the surface, and several retinal blood vessels crossing it. The defect area sunk for about 3 days, and there were exposed thick choroidal blood vessels in it, with clear edges, and some pigment proliferation and loss (Figure 1).

In recent years, non-penetrating trabeculectomy has been widely used in clinical practice because of its positive curative effect and few postoperative complications. However, extensive posterior elastic membrane detachment after non-penetrating trabeculectomy has not been reported at home and abroad. The author treated one case in 2003, and the report is as follows.

Tumors in the ciliary body are relatively rare, and only a few cases of leiomyoma are reported [1-6]. It is often difficult to diagnose before operation, and most of them are proposed to be diagnosed as malignant melanoma, but only after operation can be diagnosed as benign leiomyoma by histopathological examination. There are very few reports of ciliary angioleiomyoma. The author analyzed a case of ciliary angioleiomyoma diagnosed by histopathology in our hospital to explore the clinical and histopathological characteristics of this tumor.

The patient was a 48-year-old male who came to our hospital on October 13, 2003 due to right exophthalmos for 3 months, tearing with swelling and pain for 1 month. Ocular examination showed that the visual acuity of the right eye was 0.3, which could not be improved by correction. The exophthalmos was 23 mm on the right, 10 mm on the left, and the orbital distance was 100 mm. The upward rotation of the eye movement was limited, the bulbar conjunctiva was congested and edema (Figure 1), the corneal epithelium was punctate-like opacity, the anterior segment was not inflammatory, the lens was clear, and the vitreous body was not opaque. Fundus examination showed that the border of the optic papilla was clear and the color was correct, the omentum was wrinkled, and the reflection of the fovea disappeared. No abnormalities were found in the left eye. CT examination in other hospitals showed space-occupying lesions in the right orbit, anterior cranial fossa and temporal fossa.

With the popularization of laser in situ keratomileusis (LASIK), postoperative complicated infectious keratitis has gradually attracted the attention of clinicians [1, 2]. A case of non-tuberculous mycobacteria (NTM) keratitis after LASIK diagnosed by clinical and laboratory in our hospital is reported as follows.

At present, there are many complications in the clinical application of artificial cornea in ophthalmology. Legeais and Renard [1] believe that if the anterior surface of artificial cornea can be epithelialized, it will be beneficial to the long-term stability of implant. Silica gel is a hydrophobic polymer material, and its hydrophobicity is not conducive to the adhesion and growth of cells. If the surface of artificial cornea is treated to some extent, it will be beneficial to the connection between silica gel artificial cornea and recipient cornea, thus reducing the postoperative complications of artificial cornea. The commonly used methods to change the surface characteristics of materials include low temperature plasma method, surface modification method, chemical modification method and hybrid modification method [2, 3]. We selected acid solution and hydrogen peroxide solution to treat silica gel to some extent, observed the growth of cells, the expression of cytoplasmic and cell membrane proteins in vitro, and then deduced the effects of silica gel on histocompatibility.

povidone-iodine (PI) is a broad-spectrum fungicide against bacteria,virus,fungus and protozoa.5% PI can be used for preoperative preparation of ophthalmology [1-5]. However, it is reported in the literature that the donor cornea can be damaged in the corneal endothelium when kept in 0.1% PI for 5 days [6]; High concentration of PI injected into the anterior chamber of rabbits can lead to corneal endothelial damage [7,8]; 0.01% PI has toxic effects on fibroblasts in vitro, and 0.1% PI can inhibit the growth of fibroblasts [9]. Therefore, we started to observe the potential effects of different concentrations of PI on human corneal endothelial cells cultured in vitro in 2003, in order to provide clinical reference and improve the safety of using PI.

Clinically, it is common to see patients with ocular rust disease caused by iron foreign body entering the eye and failing to be removed in time, which seriously impairs the visual function of patients. It is reported in the literature that the shortest time of iron foreign body entering the eye caused by trauma is 18 days, and the longest time is 8 years, which induces ocular rust disease [1]. This paper collects 22 patients (22 eyes) with ocular rust disease who attended our hospital from January 2001 to February 2002, and the summary report is as follows.

The establishment of the Uveal Disease Diagnosis and Treatment Center of Beijing Chaoyang Hospital affiliated to Capital Medical University and the first Beijing-Tianjin Uveal Disease Academic Symposium were held in Beijing on December 19th, 2004. This is the first ophthalmology professional center in Beijing-Tianjin with uveal disease as its diagnosis and treatment feature, and Professor Lu Hong is the director of the center (Email: luhong62@yahoo.com.cn).