Volume 41 ·  Issue 11 ·  2005

With the rapid development of modern ophthalmology and optometry, people have put forward higher requirements for visual quality. The application of optometry knowledge and research results in various fields of ophthalmology will definitely have an impact on improving people's visual quality, which is also one of the main work directions of the majority of ophthalmologists in China in the future. This paper discusses the combination of optometry and ophthalmology from four aspects: fundus disease, cataract, ocular surface disease and glaucoma, aiming to provide evidence for the future research direction of ophthalmologists. (Chinese Journal of Ophthalmology, 2005, 41: 961-962)

This paper introduces the characteristics of video terminal (VDT) and the ocular manifestations of patients with VDT syndrome. The research on the effects of VDT on the eye involves various aspects such as visual function, visual development and ocular surface characteristics. This kind of research is still in the preliminary stage. Only by attaching importance and deep research can we provide active and effective prevention and treatment methods for clinic. (Chinese Journal of Ophthalmology, 2005, 41: 963-965)

Objective to investigate the efficacy and safety of lamellar keratoplasty assisted by microkeratome in the treatment of recurrent granular corneal dystrophy after phototherapeutic keratectomy. Methods Seven patients (9 eyes) with recurrent granular corneal dystrophy after phototherapeutic keratectomy were selected. Corneal grafts and implantation beds of certain thickness were made on donor and recipient with microkeratome. The donor grafts were aligned and covered on the implantation beds of recipient, and the sutures were removed at 4~6 weeks after operation with 4~8 stitches intermittently. Visual acuity, corneal transparency, corneal thickness and corneal topography were examined at different times before and after operation. Results During the follow-up period of (18.9 ± 4.1) months, there was no obvious opacity and serious complication in all the grafts. The visual acuity of patients after operation improved to different degrees, among which the best corrected visual acuity of 7 eyes was greater than or equal to 0.5, and the visual acuity of 2 eyes reached 0.8. After 12 months, the refractive power of cornea increased on average (2.34 ± 0.93) D (P<0.01), the average decrease in astigmatism was (0.91±0.98) D (P<The mean corneal thickness before operation was (477.4±26.9) μ m, and the mean corneal thickness at the end of follow-up was (507.8±23.4) μ m (P<Conclusion Microkeratome-assisted lamellar keratoplasty is a safe and effective treatment for recurrent granular corneal dystrophy after phototherapeutic keratectomy. (Chinese Journal of Ophthalmology, 2005, 41: 1000-1004)

Objective to investigate the clinical effect of amniotic membrane transplantation in conjunctival sac reconstruction in patients with conjunctival sac stenosis.Methods 23 patients with conjunctival sac stenosis were treated with prosthetic seat implantation and conjunctival sac reconstruction.During the operation, the inferior dome was fixed in the periosteum of the inferior orbital wall by embedding thread method, and the amniotic membrane was preserved and transplanted in the conjunctival defect area, and the upper and lower eyelid margins were sutured in mattress. The eyelids were opened every week and stained with fluorescein test paper to observe the growth of conjunctival epithelium. Among the 10 eyes with second degree conjunctival sac stenosis, 8 were cured and 2 were improved; Among the 9 patients with degree III conjunctival sac stenosis, 3 eyes were cured, 3 eyes were improved, and the remaining 3 eyes were ineffective. Among them, 1 eye underwent conjunctival sac plasty again half a year later. The 21 patients who completed the treatment had no complications such as exposure of prosthetic eye seat, infection and symblepharon adhesion, and the mobility and appearance of the eye seat were satisfactory. Conclusion It is safe and feasible to implant the eye seat simultaneously with preserved amniotic membrane for degree I and II conjunctival sac stenosis.

Objective to investigate the clinical efficacy of penetrating keratoplasty in the treatment of perforated fungal corneal ulcer.Methods 40 cases (40 eyes) of perforated fungal corneal ulcer underwent penetrating keratoplasty in Qingdao Eye Hospital from 1994 to 2003 were followed up for 6 to 24 months. The postoperative changes of visual acuity and complications such as fungal recurrence,graft rejection,secondary glaucoma,complicated cataract.Results Among the 40 patients, 39 cases (97.5%) successfully preserved their eyeballs, and 38 cases (95.0%) improved their visual acuity to varying degrees.After penetrating keratoplasty, 4 cases (10.0%) had fungal recurrence, of which 3 cases were cured with drugs, and 1 case was removed due to fungal endophthalmitis that could not be controlled by drugs; The graft rejection occurred in 15 patients (37.5%), of whom 12 patients were treated with anti-rejection therapy and 3 patients underwent second penetrating keratoplasty because of ineffective drug therapy. Ulcer occurred in 3 cases (7.5%), of which 2 cases were cured, and 1 case underwent secondary penetrating keratoplasty due to corneal endothelial decompensation; 5 cases (12.5%) had secondary glaucoma, and intraocular pressure was successfully controlled; Conclusion Penetrating keratoplasty is an effective surgical method for the treatment of perforated fungal corneal ulcer and the main means to save eyeball and vision. (Chinese Journal of Ophthalmology, 2005, 41: 1009-1013)

Objective to investigate the molecular markers of human corneal epithelial stem cells. Methods Human cornea and limbus were examined histologically to analyze the anatomical structure of the limbus. Immunohistochemical staining was performed on human corneal sections and whole corneal tissues to detect the undifferentiated markers of central cornea and limbus, such as nucleoprotein p63, breast cancer resistance protein (ABCG2, BCRP1), enolase α, integrin α 6, α 9 and β 1, epidermal growth factor receptor (EGFR), cytokeratin 19 (CK19), 14 (CK14) and transferrin receptor (CD71). The mRNA of middle corneal and limbus epithelial cells were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and in situ hybridization to detect the expression of related genes. Results Transverse sections of limbus showed that the limbus epithelial cells were arranged in papilla radial shape, corresponding to the Vogt palisade environment. The results of laser scanning confocal microscopy and RT-PCR showed that p63, ABCG2, integrin α 9 protein and mRNA were expressed in the limbus. In situ hybridization showed that p63 was expressed only in the limbus basal cells. Conclusion the limbus epithelium is arranged in the radial pattern of the papilla, and the limbus stem cell population has complex markers: p63 is expressed in the nucleus, ABCG2 is expressed in the cytoplasm, and integrin α 9 is expressed in the membrane.

Objective to study the pathogenic genes and their related phenotypic characteristics in a large family of autosomal dominant retinitis pigmentosa (ADRP). Methods A new splice site mutation (IVS5-1G→A) was found in intron 5-1 of PRPF-31 gene on chromosome 19. The symptomatic patients in the family were all diagnosed before 10 years old, and the disease progressed rapidly and severely, showing type I diffuse retinitis pigmentosa (RP). Goldmann visual field examination showed that patients over 30 years old had a large range of dynamic visual field defects, some patients only had temporal island, and the static visual field threshold could not be detected. mERG detection showed that the amplitudes of A and b waves in binocular darkopia were extremely decreased and low and flat, showing extinguishing type; Multifocal electroretinogram showed a significant decrease in the reactive density of both eyes in the macular area and its surrounding retina; Fluorescein fundus angiography showed atrophy of pigment epithelium around the fovea, showing "bull eye" appearance. Among the 7 asymptomatic patients, 1 case was confirmed to be mild RP by mERG, psychophysical and molecular genetic examination, and the other case was a heterozygous carrier of the disease gene.Conclusion The mutation of intron 5-1 splice site of PRPF-31 gene (IVS5-1G→A) is a new mutation site of ADRP. The phenotype of ADRP caused by this mutation is mainly type Ⅰ diffuse RP, and there are variable expressions with incomplete gene and different expression degrees. (Chinese Journal of Ophthalmology, 2005, 41: 1020-1026)

Objective to investigate the feasibility of transfecting human hair division-associated enhancer 1 (HESR-1) gene into retinal vascular endothelial cells in vitro and remodeling retinal neovascularization. Methods HESR-1 was cloned into pcDNA 3.1+ vector to form pcDNA 3.1+ HESR-1 recombinant plasmid. Human retinal vascular endothelial cells were primarily cultured. In the experiment, 10 ng vascular endothelial growth factor (VEGF) was added to stimulate the growth of endothelial cells and simulate the activation state of neovascular endothelial cells in vivo. The recombinant plasmid of pcDNA 3.1+ HESR-1 was transfected into cultured cells with liposomes. The expression rate of vascular endothelial growth factor (VEGF) receptor 2 (KDR) and tight junction protein (OCLUDIN) was detected by immunohistochemistry. The regulatory effect of HESR-1 on OCLUDIN expression was analyzed by immunoblotting. The retinal vascular model was established in vitro to detect the effect of HESR-1 on vascular permeability. Results HESR-1 gene was successfully transfected into vascular endothelial cells, and the positive rate of KDR expression was detected Enhancing the expression of occludin, reducing vascular leakage and remodeling retinal neovascularization; It can provide new ideas and methods for the treatment of retinal neovascularization. (Chinese Journal of Ophthalmology, 2005, 41: 1027-1032)

Objective to investigate the effects of excimer laser in situ keratomileusis (LASIK) and excimer laser sub-epithelial keratomileusis (LASEK) on ocular wavefront aberrations. Methods Eighteen myopic patients (18 eyes) who were treated by LASIK or LASEK were randomly selected and examined by WFA-1000 subjective wavefront aberrations before and 10 days, 1 and 3 months after operation. The Zernik coefficients of 1 to 35 items were calculated by Matlab 5.3 software, and the root mean square (RMS) of each higher order (3~7 order) and total higher order aberrations were calculated. The statistical software SPSS 10.0 was used to analyze the variance between groups and compare the results by pairs.Results All patients' naked eye visual acuity reached or exceeded the best corrected visual acuity before operation at 3 months after operation, and there were no complications that harmed the visual acuity. The high-order and total high-order aberrations increased at 10 days after LASIK compared with those before operation, decreased significantly at 1 month, and increased slightly at 3 months after LASEK. The wavefront aberrations gradually decreased with time after LASEK, and all the high-order aberrations were smaller than those before operation at 1 month except for the third-order aberrations, and all the high-order aberrations were smaller than those before operation at 3 months after LASEK. Conclusion Early postoperative aberration of ocular wavefront increases, but decreases gradually with the passage of time, and there is no statistically significant difference between 1 and 3 months postoperatively and preoperatively. Compared with LASIK, the increase of ocular wavefront aberration after LASEK is smaller (Chinese Journal of Ophthalmology, 2005, 41: 966-971)

Objective to compare the recovery of corneal sensation after excimer laser in situ keratomileusis (LASIK) and excimer laser sub-epithelial keratomileusis (LASEK). Methods Fifty-nine patients (59 eyes) underwent LASIK or LASEK for correction of myopia in our hospital, including 20 eyes with low and moderate myopia, 30 eyes with high myopia, and 9 eyes with low and moderate myopia. The corneal central perception was measured before operation, 2 weeks, 1, 3 and 6 months after operation, and the correlation was tested with the cutting depth. Results the corneal perception decreased after LASIK and LASEK, but the decrease was more obvious after LASIK. At each observation time point, the corneal perception after LASEK was better than that at 2 weeks, 1 month and 3 months after LASIK (P<Corneal perception did not recover at 6 months after LASIK for low and moderate myopia (P =0.023); The corneal perception was recovered at 3 months after LASEK (P>0.05), and the corneal perception was basically recovered at 6 months after LASEK for high myopia (P>0.05). There was a correlation between corneal perception and cutting depth at 1, 3 and 6 months after LASEK (r =0.419, 0.433, 0.413; P<There was no correlation between corneal perception and cutting depth at each time point after LASIK (P>0.05). Conclusion the recovery of corneal perception after LASEK is faster than that after LASIK, and the recovery of corneal perception after LASEK is related to cutting depth. (Chinese Journal of Ophthalmology, 2005, 41: 972-976)

Objective to investigate the reasons for painlessness after excimer laser subkeratomileusis (LASEK) and micro keratome excimer laser subkeratomileusis (Epi-LASIK) and the methods of protecting the corneal epithelial flaps.Methods 285 patients (285 eyes) with LASEK and 39 patients (39 eyes) with Epi-LASIK were selected for statistical analysis.Excimer lasers included Mel 80, lasersight LSX, NIDEK EC5000 and VISX 4star excimer instrument, VISKEGA AOV and Bausch & Lomb 217Z excimer laser.The operation was performed by the same surgeon.EPI-LASIK was performed with 12-point base as the corneal epithelial flap.LASEK was infiltrated with 20% ethanol for 10~20 s. Results Postoperative pain was observed: 269 cases (91.23%) in LASEK group and 36 cases (92.31%) in Epi-LASIK group were basically painless and could open their eyes naturally 2 days after surgery. The painless ratio was higher in LASEK group and Epi-LASIK group, but the difference was not statistically significant. 10 cases (3.51%) in LASEK group delayed lens removal at the latest 11 days, and 2 cases (5.13%) in Epi-LASIK group delayed lens removal at the latest 10 days. The main reason for delayed lens removal in both groups was corneal epithelial edema. Conclusion More than 92% of LASEK and Epi-LASIK eyes in this study had no pain and irritation after surgery, and the effective visual acuity recovered rapidly, which was close to LASIK. When corneal epithelial flap healed delayed, it was safe and effective to delay contact lens removal. (Chinese Journal of Ophthalmology, 2005, 41: 977-980)

Objective to investigate the efficacy of excimer laser subkeratomileusis (LASEK) in the treatment of residual myopia and astigmatism after excimer laser in situ keratomileusis (LASIK). Methods Thirty-four patients (66 eyes) with residual myopia and astigmatism after LASIK were followed up from April 2000 to January 2004. The postoperative symptoms, healing time of corneal epithelial flap, visual acuity, diopter, wavefront aberration and formation of haze under corneal epithelium were observed. The average follow-up time was 13.2 months. Results The average equivalent spherical lens of 34 patients (66 eyes) was (-3.20 ± 0.32) d. All patients completed the operation at one time. The peripheral part of the epithelial flap was broken in 3 eyes, and the rest was intact. The epithelial flap was basically transparent in 55 eyes and 11 eyes had mild edema. The average time of taking the lens was (3.35 ± 0.49) d. Three months after surgery, 56 eyes (85%) had diopters between ±0.50 D, 64 eyes (97%) had diopters between ±1.00 D. The best corrected visual acuity of 3 eyes improved by 1 line and 2 eyes improved by 2 lines compared with that before surgery, and there was no decline in the best corrected visual acuity. The higher order aberrations increased at 3 months after surgery compared with that before surgery. 10 eyes (15%) had haze grade 0.5, and 2 eyes (3%) had haze grade 1 at 3 months after surgery. Conclusion LASEK has good predictability, definite efficacy, safety and reliability in the treatment of residual myopia and astigmatism after LASIK.

Recent studies have shown that the occurrence and development of myopia is closely related to the remodeling of scleral extracellular matrix (ECM), and the increased activity of matrix metalloproteinases (MMPs) is the most important enzyme system that regulates the dynamic balance of scleral ECM, and its activity is significantly related to the development of myopia. The research progress of scleral ECM and MMPs in the development of myopia is reviewed.

Presbyopia is a physiological aging phenomenon, which makes near reading gradually difficult due to the decrease of age-related adjustment amplitude. At present, the mainstream methods of presbyopia correction are wearing monofocal frame glasses, bifocal frame glasses and gradual multifocal glasses. At present, all surgical methods for presbyopia have not brought lasting real physiological improvement. This paper reviews the current status and development trend of various surgical methods for presbyopia correction (including monofocal method, corneal method, scleral method and lens method). (Chinese Journal of Ophthalmology, 2005, 41: 1050-1052)

In recent years, the clinical efficacy of radial optic nerve incision has attracted the attention of ophthalmologists. Although it has not been widely used in ophthalmology, it is true that the fundus condition of some patients has improved obviously after this operation. Therefore, it is necessary to summarize the case selection criteria, operation methods, use of knives, clinical effect and treatment mechanism of radial optic nerve incision, so as to improve the clinical efficacy of this operation. (Chinese Journal of Ophthalmology, 2005, 41: 1053-1056)

The CD-ROM "Ophthalmic Surgery (Part 1 and Part 2)" produced by Beijing Tongren Ophthalmology Center of Capital Medical University and published by China Medical Electronic Audio and Video Press has been published.

Oride Medical Investment Group is a large-scale professional medical investment group jointly invested by Oride Medical Investment Group and Hengyu Wanjia Group in the United States, and supported by Margaret International Medical Foundation and Dean's Decision Research Center. Since 2004, the Group has implemented the "108 Plan", which plans to invest RMB 1 billion in China within five years to build eight large-scale modern intelligent eye chain hospitals integrating medical treatment, scientific research, health care and academic exchanges.

In order to improve the level of microcomputer visual field detection and reading for clinical ophthalmologists and technicians, as well as the diagnosis level of glaucoma and various eye diseases, and promote the in-depth development of ophthalmology, a modern microcomputer visual field detection and reading class sponsored by the editorial board of Chinese Journal of Ophthalmology of Chinese Medical Association and co-organized by Ophthalmology Branch of Shenzhen Medical Association and Shenzhen Eye Hospital will be held in Shenzhen, Guangdong Province from December 15 to 20, 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.

The Ophthalmology Center of Peking University People's Hospital undertakes a number of national continuing education projects of the Ministry of Health, and offers various ophthalmology professional study classes all the year round. The contents of the study classes are hereby notified as follows (Table 1). Ophthalmologists are welcome to sign up enthusiastically.

Approved by China Association of Science and Technology, the 6th International (Shanghai) Ophthalmology Conference and the 6th International (Shanghai) Optometry Conference will be held in Shanghai Exhibition Center from April 14th to 17th, 2006, jointly sponsored by Ophthalmology Branch of Shanghai Medical Association, Ophthalmology Branch of Six Medical Associations in East China, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, Optometry College of Wenzhou Medical College and China International Science and Technology Conference Center.

In order to better implement the journal policy of combining theory and practice, improvement and popularization, and further improve the clinical diagnosis and treatment ability and academic level of ophthalmologists, the editorial board of Chinese Journal of Ophthalmology continued to open the column "Continuing Education Garden" in 2005, inviting experts with deep academic attainments and rich clinical experience in the field of ophthalmology to give lectures. Published contents: corneal disease, cataract, glaucoma, fundus disease, orbital disease, eye plastic surgery, eye tumor, strabismus and amblyopia, etc. Focus on a special topic each time, with 5 questions for thinking at the end of the article and an answer sheet accompanying the publication.

central retinal vein occlusion (CRVO) is a blinding retinal vascular disease that often occurs in middle-aged and elderly people, and the clinical treatment is difficult and the efficacy is poor.Equipcak et al. [1] reported that radial optic neurotomy (RON) was performed on the basis of vitreous surgery, and the retinal bleeding was cleared, the dilated veins were relieved and the visual acuity was improved in 8/11 (73%) patients after surgery.

With the increasing number of acquired immunodeficiency syndrome (AIDS) patients in the world, it is very important to understand the various opportunistic infections of human immunodeficiency virus (HIV) infected patients, and then diagnose AIDS patients, and carry out targeted prevention and treatment. The author discovered cytomegalovirus (CMV) retinitis in our ophthalmology clinic in November 2003 and April 2004 respectively, and finally confirmed that 2 patients were AIDS patients. The patients were diagnosed as "central serous retinitis" and "uveitis" in the local hospital, and received general treatment for 1 to several months. The diagnosis, follow-up and staged treatment process of transfer to infectious disease hospital are reported as follows.

The patient was a 36-year-old male who came to our hospital for sudden blurred vision in his left eye for 3 days. Before 3 days, there was no obvious trigger for sudden visual decline in his left eye, and there were no accompanying symptoms such as redness, eye pain, headache and nausea. He was in good health and had no history of hypertension or diabetes. No abnormalities were found in the physical examination. Eye examination: visual acuity in the right eye was 1.2, and visual acuity in the left eye was 0.01 (uncorrectable). The anterior segment and fundus of the right eye were normal. The cornea of the left eye was transparent, the anterior chamber was clear, the pupil was round, about 3.0 mm in diameter, and the light response was (+), the lens was transparent, the fundus papilla was congested and edematous, the boundary was blurred, the arteries were thin, the veins were highly distorted and dilated, showing sausage shape, and a large number of flaky and flame-like bleeding in the retina, with gray-white cotton wool spots in between. There was a tongue-shaped milky white edema band in the retina above the temporal, and the light reflection in the fovea of the macula disappeared (Figure 1).

Acute fungal infections caused by mucormycosis are divided into nasal-ocular-cerebral type (also called nasal-cerebral type), pulmonary type, gastrointestinal type, skin type and central type according to the infection site, among which nasal-ocular-cerebral type is the most common [1]. The disease is often misdiagnosed and cannot be effectively treated, and the mortality rate is extremely high. Many patients are diagnosed only at the end of life or after death. Because the disease has obvious characteristic ocular manifestations in the early stage of disease and during the development of disease, patients often make the first diagnosis or visit the ophthalmology department, so it is helpful for early diagnosis. Since 1984, 3 patients with nasal-ocular-cerebral mucormycosis have been diagnosed in our hospital, and the diagnosis and treatment situation are summarized.

Optic nerve sheath meningioma is a common optic nerve tumor in clinic, but it is rare to occur bilaterally with intracranial spread. The report is as follows. 　　

A 49-year-old woman came to our hospital on December 30, 2003 due to repeated fatigue, palpitations for 1 year and diplopia for 2 days. One year ago, the patient showed symptoms such as heat sensitivity, hyperhidrosis, palpitations combined with hand shaking without obvious inducement. She was diagnosed as hyperthyroidism due to the serum free triiodothyronine concentration of 19.30 pmol/L, free thyroxine concentration of 77.20 pmol/L and high sensitivity thyroid stimulating hormone concentration of 0.10 mU/L.

A 26-year-old male was admitted to the hospital on November 12, 2002 with "right corneal lamellar laceration" due to eye pain, tearing and blurred vision after being stabbed by a screwdriver in his right eye. The previous patient underwent binocular excimer laser in situ keratomileusis due to myopia on September 12, 1997. The naked visual acuity of his right eye before operation was 0.06, the corrected visual acuity was 1.0, the myopic diopter was-6.00 D, and the corneal thickness was 161 μ m. The naked eye visual acuity after operation was 1.0. The whole body examination was normal in this visit.

Age-related macular degeneration (AMD) is the first ocular disease causing blindness in people over 65 years of age in the United States and other western countries, and it is a fundus disease funded by scientific research fund management institutions such as the National Institute of Health (NIH) in the United States. The journal Science published on April 15, 2005 published three articles on the basic research of AMD genetics.