Volume 41 ·  Issue 10 ·  2005

Since the birth of molecular biotechnology and its gradual application in the field of ophthalmology in the 1970s, the research of ophthalmology has undergone revolutionary changes and made remarkable achievements, and its influence has exceeded the field of ophthalmology. For example, the "tumor suppressor gene" was first discovered in the research of retinoblastoma by molecular biotechnology, and the key evidence for the "secondary mutation hypothesis" of tumor formation was provided; In the study of retinal degeneration, the application of molecular biotechnology to locate and clone dozens of pathogenic genes has revealed the complexity of the etiology and pathogenesis of the disease. Although the application of molecular biotechnology in the basic research of ophthalmology has begun in China, it still lags behind abroad in the effective use of this technology to explore the etiology and development mechanism of the disease at the molecular level. In recent years, the theories and technologies of genomics, proteomics, epigenetics, model biology, bioinformatics and systems biology have developed rapidly. The correct use and integration of these new technologies can not only provide more effective means for our research work, but also have a profound influence on the development of ophthalmology in China.

Orbital malignant lymphoma is a common clinical orbital tumor, with different malignant degrees and clinical manifestations, different treatment methods and prognosis due to different types. Therefore, the classification of orbital malignant lymphoma has important clinical significance. However, the classification of orbital malignant lymphoma is rather disordered at present. On the basis of collecting relevant data at home and abroad, combining with many years of clinical experience and experience, and under the guidance of histopathologists, we put forward preliminary opinions on the classification and treatment methods of orbital malignant lymphoma for reference and discussion by ophthalmologists.

Objective to investigate the incidence, clinical characteristics, histopathological characteristics and classification of lymphoproliferative lesions of ocular adnexal. Methods 116 paraffin sections were collected from 112 patients with lymphoproliferative lesions of ocular adnexal diagnosed by histopathology. The clinical data were analyzed and summarized. The histopathological characteristics were further analyzed, and the diagnosis was reclassified according to the classification program of lymphoid and hematological tissue tumors of World Health Organization in 2001. Results The patients were aged 8~80 years, with an average of 49 years, and the course of disease was 20 days to 22 years, with an average of 22 months. 16 patients (14.3%) had both eyes. The common clinical manifestations were exophthalmos and localized mass (69 cases, accounting for 61.6%). Histopathological examination showed reactive lymphocyte proliferation in 11 cases (9.8%), atypical lymphocyte proliferation in 10 cases (8.9%), and lymphoma in 91 cases (81.3%). Among them, mucosa-associated tissue type marginal zone B cell lymphoma in 74 cases (accounting for 81.3%). Conclusion B-cell lymphoma in the marginal zone of mucosal associated tissue is the most common in ocular adnexal lymphoproliferative lesions, and it occurs in middle-aged and elderly people. The clinical manifestation is chronic and persistent, and the onset is not uncommon in both eyes.

Objective to study the clinical characteristics and histopathological types of lacrimal gland space-occupying lesions.Methods 151 cases of lacrimal gland space-occupying lesion diagnosed by histopathology in our hospital from 1996 to 2003 were collected, and their clinical manifestations, tissue origin, histopathological characteristics and prognosis were retrospectively summarized and analyzed.Results Among 151 cases of lacrimal gland space-occupying lesion, 103 cases (68.2%) were epithelial tumors, 69 cases were benign, 63 cases (41.7%) were pleomorphic adenoma, 3 cases (2.0%) were myoepithelioma, 2 cases (1.3%) were lacrimal duct cyst, and 1 case (0.7%) was basal cell adenoma. There were 34 malignant cases, 15 cases (9.9%) of adenoid cystic carcinoma, 14 cases (9.3%) of malignant pleomorphic adenoma, 4 cases (2.6%) of adenocarcinoma, 1 case (0.7%) of metastatic carcinoid carcinoma, 48 cases (31.7%) of non-epithelial lesions of lacrimal gland, the most common cases were 17 cases (11.3%) of mucosal associated lymphoid tissue (MALT) lymphoma, 12 cases (7.9%) of inflammatory pseudotumor, 7 cases (4.6%) of benign lymphoepitheliopathy, respectively.

Objective to investigate the clinical effect of transpupillary thermotherapy in the treatment of localized choroidal hemangioma. Methods 10 patients (10 eyes) with localized choroidal hemangioma were diagnosed by fundus examination and fluorescein fundus angiography, aged 16-48 years, with an average age of 34 years. Transpupillary thermotherapy was used to irradiate the lesion area with 810 infrared laser continuously with 1-5 spots with a spot diameter of 3.0 mm, completely covering the tumor. The laser power was 800-1200 mW, the irradiation time was 60 s, or prolonged by 10-20 s. Follow-up was 1-3 months after operation. The treatment could be repeated 1-3 times according to the need of the disease. The follow-up period of patients was 3-36 months, with an average of 14 months. 4 patients were treated for the first time; Results At the end of the diagnosis, there was 1 case of choroidal hemangioma, the lesion was located in the central macular area, there was still fluid under the retina, and there was a red light transmission area in the fundus, which needed to be continued treatment. The subretinal effusion completely resolved in the remaining 9 cases. Fluorescein fundus angiography and indocyanine green choroidal angiography showed that there was no strong fluorescence in the tumor area, and visual acuity improved. After six months to two years of follow-up, the patient's condition was stable, and no postoperative complications or sequelae occurred. Conclusion the clinical effect of transpupillary thermotherapy in the treatment of localized choroidal hemangioma is positive, and good results can be obtained whether it is the first choice treatment alone or used to supplement the shortcomings of previous photocoagulation therapy.

Objective to investigate the inhibitory effect of arsenic trioxide (ATO) on the growth of human choroidal melanoma cell line OCM-1 and its mechanism.Methods the growth of OCM-1 cells treated with ATO was determined by thiazole blue colorimetric assay; The rate of necrosis and apoptosis was observed by flow cytometry; The morphological changes of cells were observed by transmission electron microscopy, and the activity of glutathione peroxidase in cells was measured; The potential changes of mitochondrial membrane were detected by laser confocal microscope. Results ATO could inhibit the growth of OCM-1 cells in a certain concentration range (P<The median inhibition rate (IC50) of ATO on OCM-1 cells within 24 h was 16.8 μ mol/L. The rate of cell necrosis induced by different concentrations of ATO was higher than that of apoptosis. Morphological changes such as necrosis and apoptosis were observed in OCM-1 cells under electron microscope. The activity of glutathione peroxidase in OCM-1 cells decreased after ATO (P<0.05); The mitochondrial membrane potential of cells decreased, which was related to the action time and ATO concentration (P<Conclusion ATO can inhibit the growth of OCM-1 cells by decreasing the activity of glutathione peroxidase in cells, decreasing the mitochondrial membrane potential, resulting in energy synthesis obstacle, and finally leading to cell necrosis and apoptosis.

Objective to investigate the effect of vitreous cavity filling with chitosan on intraocular tissue structure and intraocular pressure of retina, ciliary body, crystalline lens, cornea etc. Methods Twelve healthy rabbits were selected, right eye as the experimental group and left eye as the control group. After vitrectomy, medical chitosan (experimental group) and sodium hyaluronate (control group) were injected into the vitreous cavity. Slit lamp microscope and ophthalmoscope were performed regularly before and after operation, and intraocular pressure was measured. Results the filling in vitreous cavity remained transparent, the retina was flat, and there was no retinal detachment and hyperplasia. There was no significant difference in intraocular pressure between the experimental group and the control group at each time point (P>0.05). The results of light microscopy and transmission electron microscopy showed that there was no significant difference in microscopic appearance between the experimental group and the control group, and there was no abnormality in cornea, ciliary body, lens and retina. Conclusion Chitosan filling the vitreous cavity has no obvious effect on ocular tissue structure and does not cause intraocular pressure fluctuation.

Objective to explore the feasibility of early light stimulation as a method for inducing myopia in animals and the similarities and differences of ultrastructure of different experimental myopia. Methods 12-day-old C57BL/6J pure line mice were sutured and the suture was removed after feeding for 7 days. 4-day-old mice were artificially opened and fed for 10 days until the eyelid was opened naturally. Untreated mice of the same age were set up as the control group. After the myopia was confirmed by optometry, the eyeballs were extracted, measured and examined by light and electron microscope.Results Compared with the control eyes, the relative myopia of-7.63 d was induced in the sutured eyelid group, and the axis of the eyes was longer than that of the left eye (0.06 ± 0.03) mm, and the difference in eyeball weight was not statistically significant. The relative myopia of-9.83 d was induced in the early light stimulation group, and the axis of the eyes was shorter than that of the left eye (0.04 ± 0.04) mm, and the eyeball weight was reduced by-0.0004 g on average. Conclusion Premature light stimulation can be used as a convenient and effective method to establish animal myopia model. Compared with the control eyes, the eyes with premature eyelid opening have shorter axis and lighter eye weight, and the mechanism of inducing myopia is different from that of axial myopia induced by form deprivation.

Objective to investigate the therapeutic effect and mechanism of inhibitory effect of eukaryotic expression plasmid encoding soluble vascular endothelial cell membrane receptor sFlk-1 and ExTek on the growth of retinoblastoma (RB) transplanted tumors by electroporation. (1) In vitro experiment: After 24 h transfection of human embryonic kidney 293 cells with cationic liposome-mediated plasmid pCI-sFlk-1, the cell culture medium was collected, mixed with RPMI-1640 medium at the ratio of 1:1, 2:1 and 3:1, respectively, supplemented with fetal bovine serum to 10%, RB cells were cultured and the cell growth curve was drawn. (2) In vivo experiment: 1×107 human RB cells (HXO-Rb44) were inoculated subcutaneously into the right hind leg of 40 nude mice to establish RB transplanted tumor model. In the treatment group, the electroporation-mediated expression plasmid pCI-sFlk-1 (15 μ g) and pCI-ExTek (15 μ g) were combined into the tumor The tumor growth curve was drawn and the tumor inhibition rate was calculated. The microvessel density and the expression of vascular endothelial growth factor (VEGF) and its receptor Flk-1 in the treatment group and the control group were determined by immunohistochemical staining with anti-smooth muscle actin antibody. Results sFlk-1 had no obvious inhibitory effect on the growth of RB cells cultured in vitro, but the combined application of sFlk-1 and ExTek could significantly inhibit the growth of RB transplanted tumors in vivo, and the tumor inhibition rate was 80.04%. The mean microvessel density in the treatment group was (26.69±2.95) /200 times visual field, which was significantly lower than that in the control group (44.51±6.11) /200 times visual field, and the difference between the two groups was statistically significant (P<Although there was no significant difference in VEGF staining intensity between the two groups, the staining intensity of Flk-1 in the treatment group was higher than that in the control group. Conclusion Electroporation mediates the introduction of expression plasmids encoding soluble vascular endothelial cell membrane receptor sFlk-1 and ExTek into RB tumors, which can significantly inhibit tumor growth, and its mechanism of action is to inhibit tumor angiogenesis.

Objective to investigate the expression of differential genes in cornea after alkali burn in rats, clone the target gene fragments and understand their homology, and detect whether new genes are produced, so as to elucidate the molecular biological basis of denatured protein production after alkali burn in rats. Methods Corneal RNA was extracted by guanidine isothiocyanate method 3 days and 2 weeks after alkali burn in rats, and double-stranded cDNA was synthesized. Two kinds of anchor primers and 12 kinds of random primers were used as templates to clone, identify, sequence and analyze the homology of the target genes by reverse transcription polymerase chain reaction (DDRT-PCR) with 24 different primer combinations. Results Under the same PCR reaction conditions, compared with the normal cornea after 2 weeks of alkali burn, a differential band with molecular weight of 630 bp was produced in the cornea after 2 weeks of alkali burn. The Gene was cloned and sequenced, and compared with Gene Bank, it was found that the Gene was partially homologous to the subunits Ⅰ, Ⅱ and Ⅲ of rat mitochondrial cytochrome C oxidase. Conclusion The differential Gene was produced in the cornea after 2 weeks of alkali burn, which was partially homologous to the subunits Ⅰ, Ⅱ and Ⅲ of rat mitochondrial cytochrome C oxidase.

Objective to investigate the sensitivity (Sen), specificity (Spe) and prognostic factors of visual acuity in the detection of macular edema caused by retinal vein occlusion by optical coherence tomography (OCT). Methods 90 cases (91 eyes) of retinal vein occlusion were detected by OCT and fluorescein fundus angiography (FFA), including 54 males and 36 females; The age ranged from 20 to 74 years, with an average of (57.8±13.8) years; 45 right eyes and 46 left eyes (1 case was binocular); Fifty-four eyes with central retinal vein occlusion, nine eyes with hemilateral vein occlusion and 28 eyes with branch vein occlusion were observed for 1 to 46 months, with an average of 6.1 months. The sensitivity and specificity of OCT and FFA were compared. The retinal thickness in the central macular area of 55 other healthy eyes was measured for comparison and analysis. Results (1) The morphology of macular edema was observed under OCT scan. 71 eyes (78.0%) had cystoid macular edema, 14 eyes (15.4%) had retinal neuroepithelial effusion, and 1 eye (1.1%) had macular lamellar hole. The minimum vesicle height of cystoid macular edema was 94 μ m, the maximum was 1317 μ m, with an average of (668.18 ± 245.58) μ m. The minimum retinal thickness in the central macular area of 54 contralateral healthy eyes was 110 μ m, the maximum was 236 μ m, with an average of (154.09 ± 21.85) μ m. The maximum retinal neuroepithelial effusion was 1377 μ m, even exceeding the height that can be detected by OCT. (2) The sensitivity and specificity of OCT in detecting cystoid macular edema were 98.6% The sensitivity and specificity of FFA were 86.1% and 100.0%. (3) Prognosis of visual acuity in patients with cystoid macular edema: 60 cases (61 eyes) with cystoid macular edema were followed up for more than 3 months. The difference of visual acuity before and after treatment was statistically significant in patients with macular edema caused by branch vein occlusion (P<There was no significant difference in visual acuity between patients with central venous occlusion and hemilateral venous occlusion before and after treatment (P>0.05). The factors affecting the prognosis of visual acuity of patients were the duration of the disease, whether there was blood accumulation in the central macular area, the severity of the disease, etc<The difference of visual acuity before and after treatment was statistically significant in patients at 3 months (P<Conclusion OCT is a safe, reliable and repeatable technique for detecting macular edema caused by retinal vein occlusion. It is a new non-invasive and repeatable technique. However, the prognosis of visual acuity in patients with cystoid macular edema is poor, so OCT should be promoted vigorously for early detection and treatment, so as to improve the visual acuity of patients.

Objective to study the ocular characteristics of patients with multiple peripheral neuropathy-organ enlargement-endocrine disorder-M proteinemia-cutaneous lesion syndrome (POEMS) and to explore its mechanism.Methods the clinical manifestations, ocular characteristics and intracranial pressure of 15 patients with POEMS syndrome diagnosed from 1984 to 2004 were retrospectively analyzed.Results Among 15 cases (30 eyes), 3 cases had mild visual acuity decrease in both eyes; 7 cases of early mild papilledema in both eyes; Five cases of complete papilledema, of which 4 cases (5 eyes) had small patches of hemorrhage at the edge of the papilla or near the retina, 11 cases had at least one cerebrospinal fluid pressure measurement, and 7 cases of papilledema were accompanied by increased intracranial pressure.Conclusion the main ocular manifestation of POEMS syndrome patients is binocular papilledema, the incidence rate is about 80.0%, and most of the patients with papilledema are accompanied by increased intracranial pressure.

DNA quantitative pathological examination is one of the important contents of quantitative pathological research, which is to analyze the histopathological structure or intracellular DNA content by using cytochemical quantitative analysis technique. As an objective indicator of tumor biological behavior, the quantitative determination results of DNA content in tumor cells are of great significance for judging precancerous lesions and borderline tumors, diagnosing benign and malignant tumors and their malignant degree, and judging the prognosis of patients.

Dry eye is a common ocular surface disease, and aqueous dry eye is a common clinical subtype. aqueous dry eye can be divided into two types: Sj (o) gren's syndrome (SS) and non-Sj (o) gren's aqueous tear deficiency (NSTD) dry eye [1]. It was found that the corneal perception of dry eye patients has obvious changes [2, 3], indicating that the function of their nerves has changed. However, there are few studies on whether the corneal nerves of dry eye patients have morphological changes, and the research results are inconsistent [4, 5]. Therefore, we used confocal microscopy to study the corneal nerves of 11 patients with SS and 27 patients with NSTD, and compared them with 35 normal human corneas. The results are reported as follows.

Corneal neovascularization is a common pathological process in many corneal lesions, which not only seriously affects visual acuity, but also is the first high-risk factor leading to corneal transplant rejection [1,2]. endostatin was extracted from rat hemangioendothelioma by O'Reilly et al. in 1997. It is a C-terminal enzymatic fragment of collagen VXⅢ with a molecular weight of 2×104 [3]. In vitro and in vivo experimental studies have shown that endostatin is a highly potential neovascularization inhibitory drug [4,5]. Lin et al. [6] reported that endostatin is expressed in normal human corneal tissue and participates in maintaining normal corneal avascularization [6]. The purpose of this experiment was to observe the inhibitory effect of different doses of endostatin on neovascularization after alkali burn in rats by exogenous administration of endostatin.

Ni Chu and Guo Bingkuan [1] reported the histopathological analysis of 1471 patients with ocular surface tumors, of which 981 (66.7%) were benign tumors, including 17 types; There were 490 cases (33.3%) of malignant tumors, including 12 types, including 1 case of conjunctival mucoepidermoid carcinoma, accounting for 0.2% of malignant tumors on the surface of the eyeball. Patients with pigmented mucoepidermoid carcinoma are even rarer. A patient with pigmented mucoepidermoid carcinoma with clinical manifestations similar to conjunctival melanoma was admitted to our hospital, and the report is as follows.

A 53-year-old male came to our hospital on September 5, 2003 due to left exophthalmos complicated with diplopia for nearly 2 years. In January 2002, he developed left exophthalmos complicated with diplopia without obvious trigger. Thyroid function examinations were performed many times in the local hospital, and there was no obvious abnormality. CT examination showed solitary space-occupying nodular lesion in left orbit, and the diagnosis was inflammatory pseudotumor. Oral prednisone and intravenous cyclophosphamide were ineffective for more than 1 year, and the above symptoms gradually worsened.

The patient was a 48-year-old male with gradually growing black spot in the right conjunctiva and foreign body sensation for 2 months. He came to our hospital on November 9, 1998. When the patient was 1 year old, after mild lime burn in his right eye, there was a needle-shaped black spot in the bulbar conjunctiva, which was not diagnosed and treated. Two months ago, the black spot of the bulbar conjunctiva grew gradually, and was diagnosed as malignant melanoma of the right conjunctiva in an external hospital. All of them recommended orbital contents removal.

pathologic myopia (PM) usually refers to a type of high myopia with myopia degree above-8.00 D combined with a series of degenerative changes in the posterior pole retina, and causing visual impairment. It is more common in Asian adults, accounting for about 9% of the myopia population, and is also the main cause of blindness in young people [1]. Recently, we clinically diagnosed and treated 3 patients with pathologic myopia with paramacular foveal telangiectasia.

The 18-year-old male was admitted to our hospital on July 22, 2004 due to the decrease of visual acuity in the right eye for 1 month and the decrease of visual acuity in the left eye for 10 days. He had a history of upper respiratory tract infection before the onset of the disease.

Ophthalmopathology, as an important branch of histopathology research, is a basic subject of ophthalmology that studies the etiology, occurrence and development rule of ophthalmology diseases and the changes of ocular tissue morphology, tissue metabolism and function in the process of ocular diseases. Its purpose is to reveal and explore the mechanism and essence of ocular diseases, provide necessary theoretical basis for the diagnosis and treatment of ophthalmology diseases, and is the bridge between basic medicine and clinical medicine, which can promote and promote the development and progress of clinical ophthalmology. As ophthalmologists, they should fully recognize the importance of ophthalmopathology, understand, familiarize themselves with and master the basic knowledge of ophthalmopathology, so as to broaden the knowledge field and improve the level of clinical comprehensive diagnosis and treatment.