Volume 42 ·  Issue 02 ·  2006

Retinal degenerative diseases include many common ophthalmic diseases (such as retinitis pigmentosa, age-related macular degeneration, etc.), which seriously affect the visual acuity of patients. Apoptosis of retinal cells is an important pathological feature of these diseases. In recent years, some gratifying progress has been made in preventing retinal cell apoptosis, but how to explore new ways to prevent and treat retinal degenerative diseases from the perspective of anti-apoptosis is still the focus of basic research in ophthalmology.

Glaucoma is the second ocular disease causing blindness in the world, and its etiology has not been completely understood. At present, the effective treatment is to reduce intraocular pressure, because intraocular pressure is the most dangerous factor leading to visual field loss in glaucoma patients, and once diagnosed, it needs long-term treatment.

Objective to investigate how the regenerated optic nerve of mice with high expression of Bcl-2 can grow into normal target tissues in the brain after optic nerve injury. Methods C57Bl/6J wild mice and Bcl-2 transgenic mice were injured by clamping of the optic nerve in their left eyes at 3 days after birth. The contralateral eyeball was removed immediately, and the mice were sacrificed at 4 days after injury. The optic nerve and brain tissue were sectioned to evaluate the regeneration of the optic nerve. After optic nerve injury, an antegrade marker-fluorescent cholera toxin B (CTB-F) was injected intravitreal to label the axons of retinal ganglion cells, and the regenerated axons were revealed by immunofluorescence staining with anti-growth-associated protein 43 antibody on the optic nerve sections. Results the optic nerve of C57Bl/6J mice could not regenerate after injury, while the optic nerve of Bcl-2 transgenic mice actively regenerated for a long distance, but the regenerated optic nerve axons could not enter the normal visual paths on both sides, but grew into the white matter of the forebrain The optic nerve axons can regenerate and grow into the brain, but the regenerated optic nerve axons lose the guidance in the visual path and cannot grow into the target tissues in the bilateral midbrain, but form ectopic nerve distribution in the forebrain.

Objective to investigate the feasibility of flow cytometry, immunofluorescence and 3H-Thymidine analysis to identify the properties and proliferation of rat embryonic retinal precursor cells in vitro. Methods the quantitative and morphological properties of retinal precursor cells derived from 19 d embryonic rat retina were identified by flow cytometry and immunofluorescence. The cell proliferation was studied by 3H-Thymidine analysis, morphological observation and statistical analysis in vitro in serum-free medium. Results The results of flow cytometry analysis of primary retinal precursor cells isolated from the full-thickness retina of embryonic rats showed that 22.23% of the cells showed positive expression of neuroepithelial stem cell protein (Nestin), 16.04% of the cells showed positive expression of Sox-2, 19.66% of the cells showed positive expression of calcium binding protein, Other markers of terminal retinal cells (glial fibrillary acidic protein, CD90, rhodopsin, C-reactive protein, presynaptic membrane array protein) were very slightly positive or negative. Immunofluorescence results showed that most cells and spheres (>90%) were positive for Nestin. After 6 days of culture, flow cytometry analysis showed that 43.36% cells were positive for Nestin, and immunofluorescence showed that Nestin and glial fibrillary acidic protein were positive for Nestin. The primary retinal precursor cells proliferated well at the initial stage of 3H-Thymidine analysis, morphological observation and statistical analysis for 4 consecutive days. Conclusion Flow cytometry, immunofluorescence and immunological techniques such as 3H-Thymidine can well identify the properties and proliferation of retinal precursor cells. Rat embryonic primary retinal precursor cells showed the characteristics of neural stem cells. According to different detection methods, the positive results were different.

Objective to evaluate the effect of liposome-mediated endostatin (ES) gene transfer on hypoxia-induced retinal neovascularization in mice and to investigate the feasibility of gene transfer to inhibit retinal neovascularization. Methods to prepare cationic liposomes and PCDNA3-ES complexes. 1 week old C57Bl/6N mice were placed in an oxygen chamber with (75±2) % oxygen concentration for 5 days and returned to the normal environment to induce retinal neovascularization model. On the day that the mice left the oxygen chamber, 2 μ L of liposome PCDNA3-ES complex was injected into the vitreous cavity of ES injected mice; The control group was injected with equal amount of liposome blank carrier complex; The mice in the blank control group were injected with equal amount of PBS, and the expression of ES protein in retina was detected by ES antibody immunohistochemistry; Five days after returning to normal environment, the distribution of retinal neovascularization was observed by retinal patch under vascular perfusion with fluorescent labeled dextran; The number of vascular endothelial cells breaking through the inner limiting membrane of retina was compared by histological sections; Results Immunohistochemical examination showed that ES expression began to occur 24 hours after ES injection in vitreous cavity, mainly in retinal nerve fiber layer cells, and the expression was maintained at least 2 weeks. The neovascular buds and fluorescence leakage were observed at the edge of the non-perfusion area in the blank control group, while the neovascular buds were significantly reduced in the ES injection group; Histological examination showed that the number of cells breaking through the inner limiting membrane of the retina in the ES injection group decreased compared with the other two groups, and the difference was statistically significant; Conclusion Liposome-mediated endostatin gene transfer by intravitreal injection can inhibit hypoxia-induced retinal neovascularization in mice to a certain extent, and has no obvious toxic or side effects on the retina.

Methods Human umbilical vein endothelial cells (HUVEC) were cultured in vitro to construct PcDNA3.1+ HESR-1 recombinant plasmid and pSIREN + HESR-1 plasmid for RNA interference. The two plasmids were transfected into HUVEC with liposomes, and the transfected blank plasmids were used as controls. The expression of HESR-1 was highly expressed and downregulated in HUVEC, respectively. The expression of vascular endothelial growth factor 2 receptor (KDR), activin receptor-like kinase 1 (ALK-1) and angiogenic factor 1 (Ang-1) was detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunoblotting. Results the expression of HESR-1 in HUVEC was downregulated and the expression of ALK-1 and Ang-1 was upregulated. When HESR-1 gene is suppressed, the expression of KDR is up-regulated, and the expression of ALK-1 and Ang-1 is down-regulated. Conclusion HESR-1 gene can regulate the expression of KDR, ALK-1 and Ang-1 in HUVEC, and plays a key role in the formation and maintenance of blood vessels.

Objective to study the changes of cytoskeleton of cultured human retinal pigment epithelial cells (RPE) subjected to mechanical traction force.Methods the collagen-coated magnetic bead suspension was added to cultured human RPE cells and incubated, and the unbound magnetic beads were washed.After the pretreatment with cytochalasin D (0.05 mmol/L, 25 min) for 0, 4, 8, 12 and 24 h, the actin and vimentin in the cells were stained by immunofluorescence double label staining.Results the morphology and the polarity of the microfilaments of human RPE cells changed after mechanical traction for 4 h, the arrangement of actin microfilaments was consistent with the direction of the force.The expression of cytoskeleton microfilaments mainly occurred around the nucleus and around the magnetic beads gathering.However, the above changes occurred in the cells pretreated with cytochalasin D at 8 h. Conclusion Mechanical traction can cause the changes of the cytoskeleton distribution of human RPE, which can make it exhibit some biological characteristics of muscle cells, which may promote the cell migration and proliferation.

Objective to investigate the feasibility of transplantation of human embryonic lung (HFL) fibroblasts expressing ciliary neurotrophic factor (CNTF) into the subretinal space of RCS rats with hereditary retinal degeneration. Methods the expression plasmid encoding CNTF was transferred into HFL fibroblasts by liposomes, MTX and ELISA were used to screen the high-level CNTF-expressing cells. 5 μ L of HFL fibroblasts containing 1×105 high-level CNTF-expressing cells were injected into the subretinal space of the right eye of 4-5 weeks old RCS rats via 1 mm after the limbus under direct surgical microscope, and the left eye was injected without surgery or PBS as control. The apoptosis of extraretinal granular layer photoreceptors was significantly less than that of the control eyes, and the accumulation of disc fragments between photoreceptors and retinal pigment epithelium was also less. The morphology of host retinal pigment epithelium cells was well preserved, and phagosomes were observed. Conclusion the transplantation of HFL fibroblasts modified by CNTF gene in subretinal space can delay the degeneration of retinal photoreceptors in RCS rats.

Objective to investigate the changes of mitochondrial reactive oxygen species production in bovine retinal microvascular endothelial cells and pericytes cultured under high glucose conditions, and the causes and effects of such changes. Methods Bovine retinal microvascular endothelial cells and pericytes were cultured by selective culture method. The changes of mitochondrial reactive oxygen species production in endothelial cells and pericytes at different glucose concentrations were detected by confocal microscope. At the same time, the changes of mitochondrial membrane potential and cell mortality were detected by flow cytometry, and the expressions of manganese superoxide dismutase and catenin (UCP) 1,2,3 and the changes at different glucose concentrations were detected by RT-PCR. Results (1) With the increase of glucose concentration in culture medium, the production of mitochondrial reactive oxygen species in endothelial cells and pericytes increased. (2) With the increase of glucose concentration in culture medium, the mitochondrial membrane potential and cell mortality of endothelial cells increased gradually, but the pericytes did not. (3) In cultured retinal microvascular endothelial cells and pericytes, The mRNA of UCP1,2 was detected by RT-PCR, but not UCP3.The expression levels of UCP1,2 and manganese superoxide dismutase changed with the change of glucose concentration in the medium. Conclusion High glucose can induce the production of reactive oxygen species in mitochondria of cultured retinal microvascular endothelial cells and pericytes. There is feedback regulation between the increase of reactive oxygen species in endothelial cells and the increase of mitochondrial membrane potential; Compensatory increases in the expression of UCP1, 2 and manganese superoxide dismutase regulated the production of reactive oxygen species under high glucose condition, but when the glucose concentration reached a certain degree, the compensatory mechanism disappeared; The different characteristics of endothelial cells and pericytes under high glucose conditions indicate that they play different roles in the occurrence of diabetic retinopathy.

Objective to investigate the clinical changes of near zero parallax, cross parallax and non-cross parallax in patients with intermittent exotropia before and after surgery. Methods 100 patients with intermittent exotropia were divided into 4 groups. The near zero parallax, cross parallax and non-cross parallax before and after surgery were detected by stereoscopic vision examination chart, and the far fusion range and far stereoscopic vision were measured by homoscopic machine. The examination results were analyzed and compared. Results Among all patients, there were no near zero parallax and non-cross parallax coexisting with cross parallax and non-cross parallax coexisting with cross parallax, and there were no cross parallax and non-cross parallax independent before and after surgery.<There was no significant difference in the range of distal fusion between the four groups before and after surgery (P>0.05). There was significant difference in the range of distal stereoscopy between the four groups after surgery (P<Conclusion (1) Stereoscopic acuity of near-zero parallax, stereoscopic perception of crossover parallax and non-crossover parallax in patients with intermittent exotropia is not perfect, and the order of damage is non-crossover parallax, crossover parallax and near-zero parallax, and the order of reconstruction is reversed. (2) Stereoscopic perception of non-crossover parallax is seriously impaired or disappeared, which should also be regarded as a surgical indication for intermittent exotropia, and surgical treatment should be carried out immediately to facilitate the reconstruction of binocular visual function.

Objective to investigate the effectiveness, safety and predictability of Phakic anterior chamber intraocular lens (PAC-IOL) implantation in the correction of ultra-high myopia. Methods 15 patients (29 eyes) with ultra-high myopia were implanted with Phakic 6H2 PAC-IOL. The visual acuity, diopter, intraocular pressure, corneal endothelial cell count, lens position, contrast sensitivity, glare sensitivity, surgical complications and poor vision symptoms were observed after operation. Results 79.3% (23/29) of patients with naked eye visual acuity ≥0.5 at 3 months and 82.6% (24/29) at 6 months were observed. The best corrected visual acuity of the patients was ≥0.8 in 69.0% (20/29) at 3 months and 69.0% (20/29) at 6 months after surgery. The visual acuity of the naked eye and the best corrected visual acuity were significantly higher than those before surgery, and the difference was statistically significant (P<At 3 months postoperatively, 70.0% (20/29) of patients had two or more lines of improvement in naked eye visual acuity compared with the best corrected visual acuity before operation, and 72.4% (21/29) at 6 months postoperatively. The median diopter at 3 and 6 months postoperatively was-1.00d, which was significantly lower than that before operation, and the difference was statistically significant (P<There were no significant differences in intraocular pressure and corneal endothelial cell count at 3 and 6 months postoperatively compared with those before surgery (P>0.05). PAC-IOL maintained an effective safe distance from corneal endothelium and lens, and the elastic haptics were located at the anterior chamber angle. At 6 months postoperatively, the contrast sensitivity and glare sensitivity of each frequency band were significantly improved compared with those before surgery, and the differences were statistically significant (P<0.05). The inflammatory reactant deposition on the surface of PAC-IOL was observed in 3 eyes at 3 months and 2 eyes at 6 months after operation; The pupil of one eye was slightly oval; PAC-IOL rotation occurred in 8 eyes, 3 cases (5 eyes) complained of glare at night, and the other patients had no obvious discomfort, and the degree of satisfaction was high.Conclusion PAC-IOL implantation has good effectiveness, safety and predictability in the correction of ultra-high myopia, and it is an effective intraocular refractive surgery to supplement the insufficiency of corneal refractive surgery, but its long-term effect needs to be further observed.

Objective to investigate the effects of broadband scleral cerclage on the volume of eyeball and vitreous cavity and three-dimensional diameter of retinal detachment. Methods From July 2002 to December 2003, 26 patients with rhegmatogenous retinal detachment who underwent broadband scleral cerclage were successfully operated by ophthalmic ultrasound, corneal topography and magnetic resonance imaging (MRI) to detect the relevant indexes of eyeball. In 13 patients (13 eyes), the size and volume of eyeball and vitreous cavity were measured by MRI continuous thin-slice rapid scanning technique and layer superposition technique before and 1 week after operation. Results After the reduction by broadband scleral cerclage, the volume of eyeball in 13 eyes with retinal detachment was decreased by MRI (1.72 ± 0.49) ml (t =12.68, P<0.01), the volume of vitreous cavity decreased (1.73 ± 0.46) ml compared with that before operation (t =20.13, P<0.01); Anterior chamber volume increased (0.01 ± 0.04) ml (t =0.51, P =0.62); The horizontal diameter and vertical diameter of the deepest part of the cerclage band depression were (7.84±1.86) mm smaller than that of the pre-cerclage site 2.5 mm after the equator (t =15.20, P<0.01), (7.70±2.79) mm (t =9.96, P<0.01). The circumference of the deepest part of the cerclage band depression was significantly smaller than that before operation (t =13.18, P<0.01), the shortening amount was (24.42±6.68) mm, the shortening ratio was (33.11±8.69) %, and the mean height of the cerclage ridge was (3.80±0.58) mm; The mean ridge width was 3.82±0.60) mm on the temporal side and 3.51±0.76) mm on the nasal side, and the mean anterior and posterior diameter of the eyeball was only shortened (0.22±0.79) mm (t =1.01, P =0.33). Conclusion The effect of scleral cerclage on the vitreous cavity volume and three-dimensional diameter of the eyeball was measured and analyzed intuitively by using MRI biological measurement technique, which can provide reference data for the correlation study of optimal quantitative anatomical reduction and visual function recovery in scleral cerclage.

In order to reflect the innovative scientific research achievements and clinical experience of ophthalmology in China as soon as possible, this journal has opened up a "fast track" to publish excellent academic papers in 2002, simplifying the procedure from review to official publication of papers, and shortening the publication cycle. In view of the increasing number of authors applying for the "fast track" at present, the editorial board of this journal has supplemented and improved the specific conditions for applying for the "fast track" on the basis of the operation of some time ago, and reiterated the relevant regulations of the "fast track" once again, so that academic papers with innovative content can be published as soon as possible.

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.

1. Statistical research design: The name and main practices of statistical research design should be explained. Such as survey design (divided into prospective, retrospective or cross-sectional survey studies); Experimental design (specific design types should be explained, such as self-pairing design, group design, cross design, factorial design, orthogonal design, etc.); Clinical trial design (should explain what phase of clinical trial it belongs to, what blinding measures are adopted, etc.). The main approach should be outlined around the four basic principles (randomization, control, duplication and equilibrium), especially how to control the interference and influence of important non-experimental factors.

Practical Ophthalmology Diagnosis is a large-scale reference book of Chinese ophthalmology, which contains many materials that are difficult to find in Chinese and foreign books at present, paving the way for China's ophthalmology to integrate with international standards. The author, Shi Dianxiong, has worked in the Department of Ophthalmology of Shanghai Medical College and Chongqing Medical College for nearly 30 years, and then worked in the Kresge Institute of Ophthalmology of wayne State University School of Medicine in the United States for 20 years. He wrote this book based on his many years of clinical and teaching experience.

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.

The purpose of surgical treatment of idiopathic macular hole is to close the hole and improve the visual acuity of patients. Although there is still controversy, most scholars believe that the peeling of internal limiting membrane (ILM) of retina can improve the closure rate of macular hole and the prognostic visual acuity of patients. However, since Morris et al. [1] began to apply ILM technique to surgical treatment of macular hole in 1994, it has been a very difficult technique to completely and thoroughly peel it. The difficulties are mainly that ILM is not easy to distinguish, the edge is not easy to see clearly, it is easy to damage other tissues of retina, and the extent of peeling is not easy to determine.

Clinically, for patients with leukoplakia in one eye, the transparent cornea of the contralateral blind eye can be exchanged and transplanted with leukoplakia cornea as a donor to restore vision. Usually, the transparent cornea of the blind eye is drilled and then the allogeneic corneal graft is temporarily sutured into the graft hole to prevent the contents of the eye from overflowing. However, when the allogeneic cornea is lacking, the autologous corneal exchange and transplantation is limited. Since August 1999, we have used temporary artificial cornea made of plastic sheet to replace allogeneic corneal graft, and achieved good clinical results.

The child was a female, born on June 25, 2004, with a gestational age of 40+6 weeks and a birth weight of 3600 g. Because her parents found that the child had "no vision in both eyes for 1 month", she went to the ophthalmology department of our hospital on November 1, 2004. After birth, the child appeared patchy peeling and dark red papules all over the body (except the face), and several impetigo on the right upper arm. Scattered blisters appeared on the chest, abdomen and limbs 2 days after birth, which gradually developed into reticular skin pigment spots.

A 41-year-old laser engineer was seen in our department on Nov. 25, 2004 due to laser beam burn on his left eye. One hour before admission, the left eye was burned by the laser beam reflected from the surface of black photographic paper without wearing protective goggles when debugging a high energy neodymium-yttrium, aluminum, garnet (Nd:YAG) laser. At that time, the fixation distance was 20 cm, the laser energy was 400 mJ, the energy of the reflected beam was about 1% of the total output energy, the spot diameter was 8 mm, the wavelength was 1064 nm, the frequency was 1 Hz, and the pulse width was 10 ns.

A 42-year-old female was admitted to the Department of Ophthalmology of our hospital on December 15, 2004 due to a tumor in her left eye accompanied by eye pain, headache and vision loss for 2 weeks. Two weeks ago, the patient developed swelling and pain in her left eye without inducement, accompanied by headache and vomiting. When washing her face, she looked in the mirror and found a small black tumor at the edge of her pupil, with a rough surface and rapid growth.

The histological type of orbital non-Hodgkin's lymphoma (NHL) is mostly B-cell lymphoma. We present two cases of orbital T-cell lymphoma with clinical manifestations similar to cellulitis.

The patient was a 47-year-old male who came to the ophthalmology department of our hospital on January 4, 1998 due to photophobia, lacrimation and blurred vision in his left eye for more than 2 months. Physical examination showed no abnormalities in the whole body examination, and the patient had no signs of cough or abnormal chest. Ocular examination showed that the visual acuity of the right eye was 1.2 and that of the left eye was 0.2. The conjunctiva of the left eye was ciliary congested, the cornea was clear, the aqueous humor flashed (+), the brown floating particles in the anterior chamber were visible, and the dusty turbidity in the vitreous body was visible. The patient was diagnosed as "uveitis of the left eye".

A 50-year-old male was admitted to the Department of Ophthalmology of our hospital on December 21, 2000 because of progressive exophthalmos in his right eye for 1 year. Twenty-three years ago, the patient had undergone intraorbital tumor resection in an external hospital because of "intraorbital tumor" in his right eye. Five years ago, he undergone intraorbital tumor resection in an external hospital because of right exophthalmos. The surgical procedure and pathological examination were unknown. The patient reported that he had no history of trauma and no similar diseases in his family.