Volume 42 ·  Issue 11 ·  2006

In recent years, some foreign glaucoma experts have proposed a new classification system to classify patients with anterior chamber angle closure or risk factors into anatomical narrow anterior chamber angle, primary anterior chamber angle closure (PAC) and primary angle closure glaucoma (PACG), which is quite different from the traditional PACG classification adopted for a long time in China. We should not exclude this classification system, nor should we accept it completely without analysis, but should analyze it carefully and absorb the essence, so as to put forward our views on the classification and diagnostic criteria of PACG. (Chinese Journal of Ophthalmology, 2006, 42: 961-963)

The academic debate about the classification and diagnostic criteria of primary angle-closure glaucoma is one of the focus issues in the research field of glaucoma in China recently. The reasons are all due to the different conclusions of academic colleagues who hold different viewpoints, different methods and different understandings on the same problem. The author expounds his personal views on the focus of academic debate about the classification and diagnostic criteria of primary angle-closure glaucoma, the possible ways to solve the problem and the promotion and enlightenment of this academic debate to the development of the discipline, in order to exchange and discuss with fellow ophthalmologists. (Chinese Journal of Ophthalmology, 2006, 42: 964-966)

Objective to investigate the mechanism of ultraviolet-induced DNA damage repair in human lens epithelial cells (LEC) and the antagonistic effect of antioxidants on DNA damage.Methods Human LEC cultured with ultraviolet irradiation doses of 0.0 (control group) and 2.5, 5.0, 7.5, 10.0 mJ/cm2 (experimental groups 1-4) were used to analyze the degree of DNA single strand break (SSB) and self-repair after receiving 10.0 mJ/cm2 ultraviolet irradiation in human LEC, and the effects of different concentrations of antioxidants vitamin C (VitC), taurine, superoxide dismutase (SOD) and epigallocatechin gallate (EGCG) on the degree of DNA damage before and after 10.0 mJ/cm2 ultraviolet irradiation in human LEC. Results The degree of DNA SSB in the control group and the four experimental groups showed an upward trend, and the difference between the five groups was statistically significant (F =17.259, P<0.01); After DNA SSB induced by 10.0 mJ/cm2 UV, the half-repair time of human LEC was 60 min; Before ultraviolet irradiation, the antioxidants taurine, SOD and EGCG were added, and the difference between the experimental group and the control group was statistically significant (F values were 6.591, 13.542 and 4.626, respectively, P<0.01), while the difference between the control group and the experimental group was not statistically significant (F =1.451, P>0.05); After ultraviolet irradiation, the antioxidants VitC, taurine, SOD and EGCG were added, and the differences between the experimental group and the control group were statistically significant (F values were 6.571, 4.810, 6.824 and 9.182, P<0.01). The effects of 4 kinds of antioxidants added before UV irradiation were statistically significant (F =8.870, P<0.01), but the effects of 4 kinds of antioxidants added after UV irradiation were not statistically significant (F =0.101, P>0.05). Conclusion The degree of damage of human LEC DNA was linear with UV dose; Exogenous VitC, taurine, SOD and EGCG had antagonistic effects on the damage of human LEC DNA induced by ultraviolet irradiation. The effects of adding antioxidants before ultraviolet irradiation from strong to weak were SOD, EGCG, taurine and VitC, while the effects of adding four antioxidants after ultraviolet irradiation were not statistically significant. SOD and EGCG were highly effective antioxidants. (Chinese Journal of Ophthalmology, 2006, 42: 1002-1007)

Objective to investigate the protective effect of neurotrophin-4 (NT4) -neuroshort peptide (NAP) on rabbit iris pigment epithelial cells (IPECs). Methods Rabbit IPECs were isolated and cultured, and the fusion gene of neuroshort peptide NAP and neurotrophic factor NT4 was constructed by asymmetric complementary primer/template method, and recombinant adeno-associated virus (rAAV) -green fluorescent protein (GFP) and rAAV-NAP were constructed. The rabbit IPECs cultured in vitro were transfected with this method, and the virus transfection was detected by fluorescence expression. The rabbit IPECs cultured in vitro were injured by ultraviolet light, and the protective effect of NAP on rabbit IPECs was detected by MTT assay and flow cytometry. Results the rabbit IPECs transfected with rAAV-GFP expressed obvious GFP fluorescence. Compared with the control cells, the proliferation of rabbit IPECs transfected with rAAV-NAP was normal after ultraviolet light damage, and the apoptosis rate was decreased. Conclusion the rAAV-NAP constructed in this study can effectively transfect rabbit IPECs cultured in vitro, and NAP has photoprotective effect on rabbit IPECs. (Chinese Journal of Ophthalmology, 2006, 42: 1008-1012)

Objective to observe the structural changes of sieve plate after radial optic nerve incision (RON) in live cat eyes, and to explore the therapeutic mechanism and safety of RON. Methods A total of 20 healthy adult cats were divided into 1 normal group and 4 experimental groups. The anatomical data of the normal group were measured. Both eyes of each experimental group were subjected to RON, and samples were taken at 1, 15, 30 and 90 days after operation, respectively. The left and right eyes were randomly subjected to special staining of optic papilla tissue sections and scanning electron microscopy examination.Results The distance between the temporal flat part of normal cat eyes and the limbus was 6.8~8.6 mm, the thickness of the ball wall of the posterior pole was (0.78 ± 0.06) mm, and the diameter of the optic papilla was (1.30 ± 0.11) mm. On 15 d, the incision was in the shape of "jujube nucleus", the widest part was located in the scleral ring, and glial cells proliferated; At 30 d, collagen fibers proliferated along the incision edge in a ring shape, and the mesh pores showed long fissures; The scar tissue completely filled the sieve plate and scleral incision after 90 days. Conclusion the scleral ring around the optic head can be cut sharply without damaging the retinal large vessels, and the incision tends to widen gradually at the scleral ring. (Chinese Journal of Ophthalmology, 2006, 42: 1013-1016)

Objective to investigate the eukaryotic expression of ciliary neurotrophic factor (CNTF) gene in wild-type and truncated mice and its expression and significance in ARPE-19 cells. Methods the full-length coding sequence of mouse CNTF was amplified by reverse transcription polymerase chain reaction (RT-PCR), and the complementary DNA (cDNA) coding sequence of truncated CNTF was obtained by site-directed mutagenesis in vitro. The two sequences were cloned into pTracer-CMV eukaryotic expression vector, transfected into ARPE-19 cells, and the expression of two kinds of CNTF was detected by immunoblotting. Results PCR successfully amplified wild-type and truncated CNTF genes, and DNA sequence analysis confirmed that the CNTF sequences in the two eukaryotic expression vectors were consistent with the target sequence in Gene Bank. After transfection of two recombinant eukaryotic expression plasmids into ARPE-19 cells, the results of immunoblot confirmed that CNTF was expressed in the supernatant of ARPE-19 cells. The results of MTT detection showed that CNTF could not promote the proliferation of ARPE-19 cells, and the apoptosis analysis by flow cytometry suggested that CNTF could inhibit the apoptosis of ARPE-19 cells induced by deserum culture to some extent. Conclusion The eukaryotic expression of wild-type and truncated CNTF genes in ARPE-19 cell lines laid the foundation for Gene therapy of retinitis pigmentosa. (Chinese Journal of Ophthalmology, 2006, 42: 1017-1022)

Objective to investigate the mechanism and effect of oral bear bile powder reaching the corresponding target tissues through the blood-eye barrier. Methods 56 rabbits were randomly divided into 8 control groups and 48 administration groups according to the method of random number table. The administration group was randomly divided into 6 subgroups, 8 in each subgroup. The rabbits were given 100 mg/kg body weight of bear bile powder on fasting for 12 h by gavage, and 2 ml of blood was collected from the rabbits' ear margin vein at 0.5, 1.0, 2.0, 4.0, 6.0 and 8.0 h after gavage, respectively. The aqueous humor was taken from the left eye and the vitreous body was taken from the right eye. The experimental method of the control group was the same as that of the administration group, and the treatment time was recorded as 0 h. The concentration of tauroursodeoxycholic acid (TUDCA) in bear bile powder in blood, aqueous humor and vitreous body was determined by high performance liquid chromatography (HPLC). Results The concentration of TUDCA in blood, aqueous humor and vitreous body was accurately measured by HPLC, and the concentration in blood was (999.1±17.2) ~ (1300.6±78.2) μ g/ml; The concentration in aqueous humor was (12.7±1.4) ~ (47.8±4.7) μ g/ml; The concentrations of TUDCA in blood, aqueous humor and vitreous were (10.8±2.9) ~ (57.9±7.9) μ g/ml. The concentrations of TUDCA in blood, aqueous humor and vitreous were statistically significant compared with those in the control group at each time point (P<0.01). The difference between the concentration of TUDCA in aqueous humor and vitreous body at different time points was not statistically significant (P>0.05). Conclusion Oral bear bile powder can reach the corresponding target tissues through the blood-eye barrier, and the concentration in aqueous humor and vitreous body is significantly less than that in blood, and the ability to enter aqueous humor and vitreous body is similar. (Chinese Journal of Ophthalmology, 2006, 42: 1023-1025)

Objective to investigate the frequency of peripapillary atrophy (PPA), choroidal and retinal atrophy in patients with glaucoma.Methods 43 cases (43 eyes) of primary glaucoma were selected, including 16 cases (16 eyes) of chronic angle closure glaucoma, 27 cases (27 eyes) of open angle glaucoma, and 33 cases (33 eyes) of normal control group.Fluorescein fundus angiography and indocyanide green fundus angiography (ICGA) were performed simultaneously in patients with Heidelberg retinal angiography (HRA), and the characteristics of ICGA of PPA α band and β band were determined by fluorescein fundus angiography. Results ICGA of PPA α band showed normal filling and weakened filling. ICGA of PPA β band showed no filling of choroidal vessels or only filling of large choroidal vessels. The frequency of PPA α band was 87.5% in chronic angle closure glaucoma group, 100.0% in open angle glaucoma group, and 84.8% in control group. The difference was not statistically significant (χ 2=4.339, The difference was statistically significant (χ 2=19.915, P =0.000). The frequency of ICGA filling attenuation in PPA α band was 66.7% in the open angle glaucoma group, 53.8% in the chronic angle closure glaucoma group and 32.1% in the control group, and the difference was statistically significant (χ 2=6.648, P =0.036). Conclusion The frequency of PPA β band choroidal blood supply deficiency was highest in the open angle glaucoma group, followed by the chronic angle closure glaucoma group. There was no statistically significant difference in the frequency of PPA α band occurrence between the groups, but the PPA α band in the open angle and chronic angle closure glaucoma groups showed more attenuation of choroidal blood vessel filling, which may be a precursor of PPA β band enlargement. (Chinese Journal of Ophthalmology, 2006, 42: 967-971)

Objective to investigate the effect of AccuMap multifocal visual evoked potential objective visual field detection on the visual field detection results of glaucoma and the correlation between it and Humphrey automatic visual field detection results. Methods to observe and compare the results of AccuMap and Humphrey visual field detection before and after cataract surgery in patients with primary glaucoma accompanied by moderate lens opacity. The same experienced ophthalmologist observed and recorded the opacity degree of lens before surgery (using LOCS Ⅲ standard). The results met the inclusion criteria and completed the observation in 22 cases. (1) The mean amplitude of AccuMap visual field detection was (308.0±96.6) nV before surgery and (382.6±146.7) nV after surgery. The mean amplitude difference between preoperative and postoperative was statistically significant (P =0.01). The mean visual field damage severity index (ASI) was 90.0±54.8 before surgery and 48.6±42.4 after surgery, which was significantly lower than the preoperative ASI (P<0.001). There was no significant change before and after surgery in incubation period . (3) The results of Humphrey perimetry: the mean deviation (MD) was-12.2±7.8 before operation and-9.6±8.8 after operation, and the difference between postoperative and preoperative MD was statistically significant (P<0.001); However, the pattern standard deviation (PSD) was 6.5±3.2 before operation and 6.3±4.0 after operation, and the difference was not statistically significant (P =0.748). (4) Comparison of ASI and MD: ASI was correlated with MD before and after operation, respectively (Pearson correlation analysis, P =0.013 before operation, P<0.001 after operation); The changes of ASI and MD after and before operation were also correlated (Pearson correlation analysis, P =0.017). Conclusion AccuMap visual field detection showed that lens opacity affected the visual field detection results of glaucoma patients, and the amplitude was more obviously affected. Compared with Humphrey visual field detection results, ASI and MD detected by AccuMap were correlated (Chinese Journal of Ophthalmology, 2006, 42: 972-976)

Objective to observe the effect of interleukin-1 α (IL-1 α) on the phagocytic function of human trabecular cells (HTM) cultured in vitro.Methods Human trabecular tissues were collected and cultured in vitro.Human trabecular cells passed through 3~5 generations were added with different concentrations of IL-1 α in DMEM-F12 medium, and the changes of phagocytic function of human trabecular cells were observed by inverted phase contrast microscope, light microscope and electron microscope.Results The number of latex microspheres phagocyted by trabecular cells was correlated with the concentration of IL-1 α (F =3.603, P =0.046) and the action time (F =15.846, P =0.005) (F =18.069, P =0.000). Conclusion IL-1 α can directly damage the phagocytic function of human trabecular cells cultured in vitro, and its phagocytic degree is correlated with the action time and concentration of IL-1 α. (Chinese Journal of Ophthalmology, 2006, 42: 977-979)

Objective to investigate the feasibility of using filtration surgery to establish the scar model of conjunctival filtration vesicles in rats. Methods 35 healthy adult SD rats were selected as experimental animals, and unilateral ocular filtration surgery was performed under general anesthesia. The formation of conjunctival filtration vesicles and the anterior segment reaction were observed after surgery. Three rats were sacrificed at 5 time points at 1, 3 days, 1, 2 and 4 weeks after operation, their eyeballs were removed, fixed with 10% formalin routinely, sectioned, and HE stained to observe their pathological changes, and the contralateral eyes were used as normal controls.Results All rats had conjunctival filtration vesicles formed at 7 days after operation; The conjunctival filtration vesicles disappeared at 8 days after operation, and the longest conjunctival filtration vesicles lasted for 21 days. Histopathological observation showed that the subconjunctival tissue was loose and edema at 1 day after operation, with obvious vasodilatation and congestion, and more neutrophil infiltration; Three days after operation, the subconjunctival tissue was vasodilated and congested. Besides neutrophil infiltration, mononuclear macrophage infiltration was also observed, and the connective tissue was loose and edema was reduced. At 7 days after operation, the degree of vasodilatation and congestion was reduced compared with that at 3 days after operation, and there were more fibroblasts proliferating. The nucleus of fibroblasts was oval and cytoplasm was abundant, and a small amount of loose collagen fibers were formed around fibroblasts; At 2 weeks after operation, the number of fibroblasts decreased compared with that at 1 week after operation, the cells became slender, the two ends of the nucleus became sharp, and the surrounding collagen fibers were denser than that at 1 week after operation; At 4 weeks after operation, most of the blood vessels in subconjunctival tissues were closed, the cellular components were significantly reduced, the fibroblasts evolved into fibroblasts, the nucleus became slender, and a large number of collagen fibers were deposited around them, showing scar-like changes. Conclusion It is feasible to establish a scar model of conjunctival filtering vesicles on rat eyes by filtration surgery, and its pathological changes are a process of wound repair. The establishment of this model not only provides a new research method for the prevention and treatment of conjunctival filtering vesicles scar after glaucoma surgery, but also provides a new research method for the prevention and treatment of conjunctival scar caused by other causes. (Chinese Journal of Ophthalmology, 2006, 42: 980-984)

Objective to compare the results of Pentacam three-dimensional anterior segment analysis and diagnosis system and A-type ultrasonic keratometer in the measurement of corneal thickness at the center of the pupil in normal subjects and myopic patients, so as to provide evidence for clinical use.Firstly, Pentacam system was examined three times in succession in 50 eyes of normal subjects to evaluate the repeatability of corneal thickness measurement.Then, 217 patients (433 eyes) with refractive errors who intended to undergo excimer laser in situ keratomileusis (LASIK) and 63 patients (126 eyes) who were more than 6 months after LASIK were selected to measure the corneal thickness by Pentacam system and A-ultrasound, respectively.Results There was no significant difference in the repeated measurement results of corneal thickness at the center of the pupil in 50 normal eyes (P>0.05), which indicated that the repeatability of Pentacam system was very good. Among the results of corneal thickness measurement, the central corneal thickness measured by A-ultrasound and Pentacam system were (537.26±31.61) and (538.08±32.72) μ m before operation, and (464.21±41.04) μ m after operation, respectively There was no statistically significant difference between the two measurement methods before and after surgery (P>0.05), and there was a close linear correlation between the two measurement results (P<0.001). The difference between the two measurement results before surgery was 95.38% within 20 μ m. The thinnest point of cornea was mostly located within 1 mm from the periphery of the corneal apex, slightly inferior to the temporal. Conclusion The measurement of corneal thickness before and after LASIK with Pentacam 3D anterior segment analysis and diagnosis system is accurate, comprehensive and convenient, and has good clinical application value. (Chinese Journal of Ophthalmology, 2006, 42: 985-988)

Based on objective evidence, evidence-based medicine makes clinical treatment decision-making scientific, which is a major change in clinical medical model. Its purpose is to seek the best and most reliable diagnosis and treatment plan according to evidence, so as to improve the treatment effect and prolong the life span of patients. However, the prolongation of life span does not mean the improvement of quality of life, and clinical practice must take into account the feelings and wishes of patients. Value-based medicine is based on the best evidence of evidence-based medicine, combines it with the quality of life of patients and the economic cost of treatment to the maximum extent, and uses the method of utility analysis to quantify the "quality" of quality of life. This new medical model will provide a better tool for the whole society to evaluate treatment plan, can provide patients with higher quality medical services, and at the same time reduce the economic burden of society to the maximum extent. (Chinese Journal of Ophthalmology, 2006, 42: 1042-1046)

The first national "Taofen Publishing Newcomer Award" jointly selected by China Publishers Association and Taofen Foundation has been announced. You Suning, editor-in-chief of Chinese Medical Association Magazine, won the "Taofen Publishing Newcomer Award" as the only representative of China's sci-tech journals. On April 25, 2006, the award ceremony of "Tao Fen Publishing Newcomer Award" was held in Beijing. Ji Bingxuan, Executive Vice Minister of the Central Propaganda Department, Long Xinmin, Director of the General Administration of Press and Publication, Yu Yongzhan, Liu Binjie, Shi Feng and Wu Shulin, Deputy Directors, presented awards to the 20 winners of the first "Taofen Publishing Newcomer Award", encouraging them to continue to make new contributions to publishing reform and publishing prosperity.

Dry eye refers to a type of disease in which the tear film is instable and the eye surface is damaged due to the abnormality of tear quantity or quality, thus leading to ocular discomfort symptoms. According to the scope and degree of ocular involvement, the symptoms of patients are different, mainly including foreign body sensation, burning sensation, itching sensation, red eyes, photophobia and blurred vision [1]. Clinically, the traditional method of treating dry eye syndrome is mainly to passively increase tears (such as artificial tears and ocular lubricants for alternative therapy) [2,3], while cyclosporine A anti-inflammatory therapy [4], puncticular embolism [5,6], submandibular gland transplantation and corneal epithelial stem cell transplantation have certain curative effects, but there are also shortcomings. The ideal method of treating dry eye syndrome should be non-invasive and can promote the active secretion of tears by the lacrimal gland, and acupuncture in traditional Chinese medicine meets this requirement. At present, international attention has been paid to the research of acupuncture in the treatment of dry eye syndrome, but there are few clinical reports [7-13]. In order to explore the clinical efficacy and safety of acupuncture in the treatment of patients with dry eye syndrome, We observed 44 patients with dry eye from October 2004 to January 2005.

Because the bioavailability of ophthalmic antibiotics decreases due to the flow of tear fluid and the barrier effect of corneal epithelium, the effective therapeutic concentration of antibiotics may not be obtained by using ophthalmic fluid drops [1]. By improving the drug delivery system, the contact time of antibacterial drugs with corneal tissue can be prolonged, and the intraocular permeability of drugs can be improved [2, 3].

Case 1: A 25-year-old male was diagnosed with intraocular tumor due to right eye discomfort at the age of 3, and underwent two ciliary body cryooperation.After operation, the visual acuity did not improve, and gradually lost, and the cornea became white.Because the right eye affected the appearance, the patient came to our hospital in January 2002 to request right eyeball enucleation.The patient's parents had no history of tuberous sclerosis or neurofibroma.

Case 1: A 36-year-old female came to our hospital on August 24, 1998 due to transient cloud sensation in her left eye for 1 week. Eye examination: The visual acuity of both eyes was 1.0 by logarithmic visual acuity chart. The cornea was transparent, the posterior corneal deposition (-), the refractive interstitial was clear, and the bilateral pupils were equally large and round, and they were sensitive to light. There was a pigmented mass on the surface of the iris at 6 o'clock below the anterior chamber of the left eye. When the patient changed the position of the head, the mass in the anterior chamber floated. When the head was tilted to the left, the mass could move to the temporal anterior chamber, and when the head was tilted to the right, the mass moved to the nasal anterior chamber. No obvious abnormalities were found in the fundus examination. There was no history of trauma or surgery in both eyes.

A 43-year-old woman came to our hospital on December 12, 2003 due to repeated tearing and exophthalmos in her right eye. One month ago, she had uninduced tearing in her right eye, and gradually appeared exophthalmos, bulbar conjunctiva was congested, ocular abduction was mildly limited, and her visual acuity gradually declined. A movable mass of about 2 cm ×2 cm was palpable in the lateral orbital margin, but no diagnosis and treatment were made.

Castleman's disease, also known as giant lymphadenopathy and vascular follicular lymphoproliferation, is a chronic lymph node proliferative disease, which is relatively rare in clinic and rarely involves the eye. The earliest case of Castleman's disease involving the eye was reported by Gittinger [1], and only Luo Qingli et al. [2] reported 4 cases of lacrimal gland Castleman's disease with submandibular gland involvement in China. One case of Castleman's disease involving the inferior rectus muscle was admitted to our hospital, and the report is as follows.

The patient was a 28-year-old male who came to our hospital on June 25, 2005 due to pain in both eyes accompanied by fog vision for 2 years, and the symptoms aggravated after strenuous exercise. He was examined in the local hospital and found that the intraocular pressure increased significantly after exercise. There was no abnormality in the whole body examination, and the laboratory examinations were all normal. Tiny pigmented particles were deposited behind the cornea in both eyes, the anterior chamber was deep, the angle of the chamber was open, and the trabecular meshwork was pigmented (+ +); There were no abnormalities in both eyes, C/D of optic disc: 0.8 in the right eye and 0.6 in the left eye. IOP: 29 mmHg (1 mmHg =0.133 kPa) in the right eye and 26 mmHg in the left eye.

Among the existing intraocular pressure lowering drugs, only about 25% ~50% of patients can achieve the target intraocular pressure by using a single drug for glaucoma. If the intraocular pressure cannot be controlled satisfactorily by using a certain drug, we will choose dressing change, drug addition, laser and surgical methods for treatment. Generally, drugs with different mechanisms of action or stronger intraocular pressure lowering effect can be selected, and the intraocular pressure control after dressing change can be observed in due course. More factors need to be considered in the combination treatment of two or more drugs, such as the synergistic effect and safety of combination medication, the convenience and compliance of patients' medication. The author emphasizes on the collocation, selection principle and precautions of combination medication from the aspects of intraocular pressure lowering effect and side effects, so as to communicate with fellow ophthalmologists.

History of initial diagnosis (main contents) History of eye. Systemic history. Family history. Review patient-related medical records.