Volume 43 ·  Issue 03 ·  2007

choroidal neovascularization (CNV) of various causes is one of the most common causes of central vision loss in patients. In recent years, the international ophthalmology community has made great progress in the treatment of CNV. The ophthalmology community in China has followed the development trend abroad and introduced the latest technology of CNV treatment in time, which has made the research of CNV treatment in China develop rapidly. However, compared with the research level abroad, there is still a big gap in China, especially it is necessary to base on innovative research and improve the level of clinical application research, so that the research of CNV treatment in China can catch up with the advanced level in the world as soon as possible.

Repeated therapy of photodynamic therapy is carried out throughout the treatment of submacular choroidal neovascularization (CNV). Therefore, it is necessary to elaborate the necessity of repeated therapy, the indication of repeated therapy and termination therapy, the time interval and safety of repeated therapy, and put forward personal opinions on the unclear and controversial points, in order to provide reference for scientific research on repeated therapy.

Objective to investigate the efficacy and safety of photodynamic therapy (PDT) with verteporfin as photosensitizer in the treatment of age-related macular degeneration (AMD) complicated with typical choroidal neovascularization (CNV) in the macular fovea.Methods A multicenter, open, uncontrolled phase III clinical trial was conducted.The subjects were AMD patients with typical CNV in the macular fovea.The observation period was 24 weeks.The re-examination was performed at the end of 12 and 24 weeks after the first treatment. If CNV recurrence was found at 12 weeks after the first treatment, the photodynamic therapy was repeated. The changes of fundus lesions and visual acuity before and after treatment were compared.All adverse reactions during treatment and follow-up.Results A total of 32 patients were enrolled, and 31 patients (31 eyes) met the selection criterion.In the 24-week observation, 38.7% of the treated eyes had visual acuity increased by more than 5 letters, and 83.9% had visual acuity increased or decreased by less than 15 letters. 61.3% had leakage, but it was limited to the original lesion area; 25.8% had progressive leakage. 24 weeks after the first treatment, the size of the lesion and atrophic area around the lesion, and the maximum straight line distance of the whole lesion area were slightly enlarged compared with those before treatment, but the differences were not statistically significant (P =0.65, 0.31, 0.12). This indicated that the lesion of the affected eye was basically stable and no significant enlargement was observed during the 24 weeks after the treatment, and no significant enlargement of the lesion scar was found after PDT treatment. In the whole clinical trial, 11 cases (34.4%) had adverse events, of which 7 cases (21.9%) were mild adverse events, 3 cases (9.4%) were moderate adverse events, and 1 case (3.1%) was severe adverse events. 24 weeks after PDT treatment, there were no obvious abnormalities in hematuria routine and electrocardiogram examination. Conclusion PDT with verteporfin as photosensitizer has good efficacy in the treatment of submacular foveal CNV in AMD patients, which can reduce CNV leakage, delay visual decline, and the incidence of drug-related adverse events is low. Therefore, PDT with verteporfin as photosensitizer can treat typical CNV secondary to AMD

Objective to investigate the causes of retinal pigment epithelium (RPE) injury after photodynamic therapy (PDT) for idiopathic choroidal neovascularization (CNV). Methods 43 cases (45 eyes) of idiopathic CNV treated with PDT were retrospectively analyzed. 25 cases (27 eyes) of pathological myopia complicated with CNV with similar CNV membrane size were used as controls. Fluorescein fundus angiography images were analyzed 4 weeks after treatment to determine the fluorescence of pigment epithelium around the lesion, and the cause of recurrence of CNV patients 8~12 weeks after treatment was investigated. Results After the initial treatment, 21 eyes of idiopathic CNV had RPE changes in PDT light area, and 1 eye was added after the second treatment. The incidence of RPE changes was about 48.9%, while only 2 eyes of pathological myopia group had RPE changes after PDT treatment. During the follow-up period, 4 patients with idiopathic CNV had CNV enlarged significantly after PDT treatment. The age of onset of idiopathic CNV was younger, and the two patients with pathological myopia showed RPE changes after treatment, one was 37 years old and the other was 15 years old. Conclusion RPE injury appeared around the lesions of idiopathic CNV patients after PDT treatment, which suggested that young patients were prone to excessive reaction after treatment.

Objective to investigate the effect of hematomethyl ether photodynamic therapy (PDT), a new photosensitizer made in China, on choroidal melanoma in rabbits. Methods 46 eyes of New Zealand white rabbits were selected to establish choroidal melanoma model. Cyclosporin A was injected daily to inhibit immune response, and the tumor growth was observed by indirect ophthalmoscope and B-ultrasound. When the tumor was 1.5-4.6 mm thick, 46 eyes (46 eyes) were divided into two groups. 41 eyes in the experimental group were intravenously given hematomethyl ether 10 mg/kg body weight, and 3 hours later, they were irradiated with 630 nm helium-neon laser with laser energy of 60-150 J/cm2. 5 eyes in the control group, of which 1 eye was blank control, 2 eyes were hematomethyl ether control, and 2 eyes were laser irradiation control. After PDT treatment, the tumor changes were observed by indirect ophthalmoscope, B-ultrasound and color fundus photography for 4-5 weeks. 16 eyes in the experimental group were sacrificed at 24 h and 1 week after laser irradiation, respectively, and eyeballs were extracted for pathological examination to observe the curative effect. Results In the experimental group, when the laser energy was ≥70 J/cm2, Its thickness is obviously reduced; In the control group, the tumor increased rapidly within 2~3 weeks, even filling the whole vitreous cavity. Conclusion Photodynamic therapy with hematoxymethyl ether, a domestic photosensitizer, has certain therapeutic effect on choroidal melanoma.

Objective to investigate the factors affecting the prognosis of visual acuity in patients with indirect optic nerve injury, and to evaluate the clinical effects of simple drug therapy (mainly glucocorticoid, supplemented by conventional drugs such as energy mixture, neurotrophy, dehydration and vascular microcirculation improvement) and combination therapy (optic nerve decompression plus the above drugs). Methods The clinical data of 186 patients with indirect optic nerve injury were retrospectively studied, and the factors affecting the prognosis of visual acuity were analyzed, and the clinical effects of drug therapy and combination therapy were compared. Results Among 186 patients, 67 cases (36.02%) had improved visual acuity, 51 cases recovered central visual acuity, and the final visual acuity after treatment was better than that after injury (P<0.01). The improvement rate of visual acuity in 136 eyes without light sensing was only 25.74%, which was 42.26% lower than that in eyes with residual visual acuity (P<0.01). The difference of efficacy between combination therapy and drug therapy alone was statistically significant (P<0.01). Logistic regression analysis showed that surgical therapy was significant for the improvement of visual acuity in eyes with residual visual acuity after injury (P<0.01), and coma after injury affected optic nerve Optic canal fracture, craniocerebral injury, high age and delay in the first improvement of visual acuity are all the risk factors affecting the prognosis of visual acuity, while timely surgical treatment after optic nerve injury is a beneficial measure to protect visual acuity, and the residual visual acuity after injury is positively correlated with the final visual acuity and the recovery value of visual acuity, respectively. Conclusion Visual acuity, coma, optic canal fracture, craniocerebral injury, high age and delay in the first improvement of visual acuity are all the risk factors affecting the prognosis of visual acuity in patients with indirect optic nerve injury, and the residual visual acuity after injury is directly related to the prognosis of visual acuity; Optic canal decompression is beneficial to the prognosis of residual eyes after injury, and the effect of combined therapy is better than that of simple drug therapy.

Objective to investigate the distribution characteristics of nestin-positive cells in the ciliary body-retina of adult eyes.Methods Eight fresh dead healthy adult eyeballs and three infant eyeballs were provided by Guangdong Eye Bank. The expression of nestin-positive cells in the ciliary body and retina was detected by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). The ultrastructure and distribution characteristics of nestin-positive cells were observed by transmission electron microscopy. The expression of nestin gene mRNA in ciliary body and retina was detected by RT-PCR, and the expression level in ciliary body was higher than that in retina; Transmission electron microscopy showed that there were some neural stem cells with large and round nuclei, obvious nucleoli and naive organelles in ciliary body and retina, which were located near the basement membrane of ciliary body pigment epithelium and between the inner and outer nuclear layers of retina. Conclusion There were some nestin positive cells with neural stem cells in adult ciliary body-retina, mainly distributed in ciliary body pigment epithelium and inner nuclear layer of retina.

Objective to investigate the clinical efficacy of corneal surface lens surgery (EP) combined with stage Ⅱ excimer laser keratectomy (PRK) in the treatment of keratoconus completion stage.Methods (1) Criteria for inclusion: ①EP inclusion criteria: patients with keratoconus completion stage, no scar in the central corneal region, optimal corrected visual acuity (BCVA) ≤0.3, corneal curvature ≤60.0 D; ② The inclusion criteria of stage Ⅱ PRK: astigmatism change<0.5 D within 3 months after corneal suture removal, age>18 years, and no other ocular diseases. (2) Surgical treatment: the patients who entered the inclusion criteria of surgery were routinely performed EP in stage Ⅰ and PRK in stage Ⅱ. (3) Postoperative follow-up: the postoperative graft status was observed, and the visual acuity, astigmatism change and complications were recorded. Results Eight patients (10 eyes) received stage Ⅰ EP combined with stage Ⅱ PRK, and the average follow-up time was 40.6 (30-94) months. (1) Visual acuity: BCVA of 10 eyes was>0.3 from 12 to 18 months after EP (before PRK with total corneal suture removal), among which 1 eye was 0.3-0.5, and 9 eyes were ≥0.5; After more than 12 months after PRK, BCVA of 10 eyes was ≥0.5, and BCVA of 5 eyes reached 1.0. (2) Corneal astigmatism: The mean corneal astigmatism was (7.3 ± 1.8) D before EP, (3.8 ± 1.6) D after 12~18 months after EP, and (1.6 ± 0.9) D after more than 24 months after PRK. (3) Graft status: All grafts were transparent after EP, and no immune rejection occurred. After PRK, one eye had grade 0.5 nebulous opacity under corneal epithelium, and no recurrence of keratoconus was observed. (4) Postoperative complications and management: 1 case (1 eye) had secondary glaucoma on the day after EP, and the anterior chamber disappeared, which was relieved after anterior chamber reconstruction in emergency department; One patient (1 eye) had large wrinkles in the implant bed after EP surgery, and one patient (1 eye) had loose sutures within 3 months after EP surgery, which was relieved after re-suturing the graft. Conclusion Stage Ⅰ EP combined with stage Ⅱ PRK may be an effective method for treating the completion of keratoconus, and the visual acuity after PRK is stable for a long time.

Objective to locate the pathogenic genes of pathological myopia in Chinese population.Methods A family of 12 patients (7 patients) with pathological myopia agreed to participate in the study after being informed by the researcher.DNA was extracted from the venous blood of each family member.330 pairs of highly heterozygous microsatellite DNA primers covering the whole genome were selected and genomic scanning was performed; Under the condition of autosomal dominant inheritance, gene frequency 0.0133 and penetrance 100%, two-point Linkage analysis was performed by Linkage software, and multi-point Linkage analysis was performed by Genehunter software.The genetic distance between marker loci was determined according to Genethon Linkage map.Based on the principle of lowest recombination rate, haplotype was constructed by Cyrillic software.Results Two-point Linkage analysis showed that there were loci closely linked to pathological myopia on the long arm of chromosome 15. When the recombination rate was 0, the maximum log dominance score (LOD) value of 1.76 appeared at D15S1010, D15S1007 and D15S1042 loci; Multi-point linkage analysis also supported the existence of linkage in this region, with a maximum NPL value of 5.16. Haplotype analysis restricted this myopic locus to about 12 cM between D15S1019 and D15S146 on 15q12-13. No clear linkage evidence was found in the known myopia-related loci, including 18p11.31, 12q21-23, 7q36, 17q21-22, 4q22-q27, 2q37.1, 15q15-21, 12q13.11-13.2, 6p21.3, 1q21-31, 1p21 and 21q22.3. Conclusion There may be a new myopia gene locus in 15q12-13. There are at least 94 known genes in this region, so it is necessary to sequence this region to find the pathogenic genes. The discovery of this new gene locus also confirmed the strong genetic heterogeneity in pathological myopia.

Objective to develop a quality of life scale for children with congenital cataract in both eyes aged 8~15 years, and evaluate the validity, reliability and responsiveness of the scale. Methods According to the definition of children's quality of life, covering important indexes related to visual impairment, a 23-item quality of life scale for children with congenital cataract in both eyes was compiled. The scale was used to investigate 18 children with normal vision and 76 children with congenital cataract in both eyes aged 8~15 years. The valid items of the scale were screened by dispersion degree method, correlation coefficient method, factor analysis method, discrimination analysis method, Cronbach coefficient method and test-retest reliability method, and the validity, reliability and responsiveness of the scale were evaluated after screening. The correlation coefficients of content validity of each item and each sub-item were greater than 0.6 (P<0.05). The differences between the total scores of normal children and cataract children and cataract children before and after operation were statistically significant (P =0.000). The correlation coefficient of test-retest reliability was 0.895 (P =0.000). The Cronbach A reliability coefficients of the four sub-items of this scale were 0.822, 0.922, 0.797 and 0.794, respectively. The statistic of effect scale was 1.141. Conclusion The scale of 20 items after screening meets the technical requirements of validity, reliability and responsiveness of the quality of life scale, and can be applied to the clinical study of quality of life of children aged 8~15 years with congenital cataract in both eyes.

Objective to investigate the etiology and clinical characteristics of suppurative keratitis. Methods 1054 inpatients with suppurative keratitis diagnosed and treated in Shandong Ophthalmology Institute and Qingdao Eye Hospital from January 1999 to December 2004 were retrospectively analyzed. Results Fungal keratitis accounted for the highest proportion of suppurative keratitis (61.9%), with middle-aged patients aged 41-50 (27.3%) and farmers (82.9%) being the most common. Corneal injury was the most common risk factor. The positive rate of direct microscopic examination with potassium hydroxide was 88.7%, while the positive rate of bacterial keratitis with gram staining was only 43.4%. Among the isolated fungi, Fusarium accounted for 73.3%, followed by Aspergillus (12.1%). Among the isolated bacterial pathogens, Pseudomonas aeruginosa was the majority (35.7%), Followed by Staphylococcus epidermidis (22.5%). Conclusion Fungal keratitis is the most common in severe suppurative keratitis and shows a trend of increasing year by year. Direct microscopic examination with potassium hydroxide wet film is a rapid, simple and effective tool for the diagnosis of fungal keratitis.

Objective to study the culture of corneal epithelial and stromal cells in vitro by using the principles of cell biology and engineering, to simulate the living environment of epithelial and stromal cells interaction, and to understand the interaction law between corneal epithelial cells and stromal cells. Methods the primary culture and two-dimensional plane culture of rabbit corneal epithelial cells and stromal cells were carried out in vitro, respectively, and the model of epithelial cells and stromal cells co-culture was made by special culture device, so as to achieve the purpose that the two kinds of cell bodies are not mixed, but their secreted components can permeate and interact with each other, so as to better observe the growth state of each cell. The growth curves of corneal epithelial cells and stromal cells and their growth curves in the interaction model were drawn. The changes of epithelial cells intercellular communication were observed by laser confocal microscope in the separate culture and three-dimensional co-culture models. Results the doubling time of corneal epithelial cells was 3.45 d, The doubling time of co-cultured epithelial cells was 3.30 d, the doubling time of corneal stromal cells was 2.11 d, and the doubling time of co-cultured stromal cells was 2.32 d. The growth of co-cultured epithelial cells was statistically significant compared with that of cultured epithelial cells alone (P<0.01), and the growth of co-cultured stromal cells was statistically significant compared with that of cultured stromal cells alone (P<0.01). The intercellular communication of corneal epithelial cells co-cultured with corneal stromal cells was significantly higher than that of cultured stromal cells alone, and the difference was statistically significant (U =2.691, P<0.05). The intercellular communication between epithelial cells and stromal cells was enhanced.

In the 2006 annual conference of ophthalmology, the number of papers on fundus disease research once again ranked among the top, and various topics of fundus disease are still the hot topics of attention and discussion by the majority of ophthalmologists. The abstracts of papers released at this conference and some literatures on fundus disease published this year all show the hot contents of fundus disease research in China, involving epidemiological investigation, clinical diagnosis and treatment, and related basic research. These reports not only reflect the key problems and difficult problems in the research field of fundus disease in China, but also fully demonstrate the progress of fundus disease related research in China.

In the past year, clinical and experimental immunological research in ophthalmology in China has developed rapidly, and related fields include uveitis, rejection after corneal transplantation and other immune-related ophthalmopathies. Some studies have approached the international level.

In recent years, the clinical and basic research of glaucoma in China has made great progress, which has aroused the attention and appreciation of international counterparts. However, when we examine the current situation of glaucoma research in China and European and American countries with a calm and objective attitude, we suddenly find that there are differences in the development track. In addition, due to the extremely unreasonable allocation of medical resources in China, the different popularization of glaucoma diagnosis and treatment skills, the lack of popularization of glaucoma knowledge and the increasingly strong "profit-seeking" in the medical field, the research of glaucoma in China has mixed happiness and sorrows, forming a particularly unique Chinese landscape.

The "Neuroophthalmology Study Class" jointly organized by Wu Jieping Medical Foundation and the Department of Ophthalmology of the People's Liberation Army General Hospital will be held by the General Hospital of the Chinese People's Liberation Army in Beijing from May 11 to May 13, 2007. The class will invite well-known domestic experts and young and middle-aged doctors to teach. Main content: (1) Basic knowledge of neuro-ophthalmology; (2) a visual field detection method; (3) The basic examination method of neuro-ophthalmology; (4) Common neuroophthalmological diseases: intracranial venous sinus thrombosis and papilledema, internal carotid artery stenosis and related eye diseases, sella turcica lesions and ophthalmological manifestations, diabetic optic neuropathy, diagnosis and treatment of optic neuritis, the relationship between paracentric vision and optic neuritis, ischemic optic neuropathy, new views on diagnosis and treatment of traumatic optic neuropathy, Leber optic neuropathy, retinal artery occlusion, optic chiasm disease, and orbital diseases with neuroophthalmological significance;

Approved by China Association for Science and Technology and the Ministry of Science and Technology, the "7th International (Shanghai) Academic Conference on Ophthalmology and Optometry", co-sponsored by Ophthalmology Branch of Chinese Medical Association in six provinces and one city in East China, and co-sponsored by Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, School of Optometry of Wenzhou Medical College and China International Science and Technology Conference Center, will be held at Shanghai Everbright Convention and Exhibition Center International Hotel (No.66 Caobao Road, Xuhui District, Shanghai) from April 12 to 15, 2007. Experts, scholars and well-known manufacturers in the fields of ophthalmology and optometry from the United States, European countries, South Korea, Japan, India and other countries in China will be invited to attend this conference.

Actinomycetal keratitis is a rare infectious keratitis, and the detection rate in infectious keratitis is less than 1% [1]. Because its cause and clinical manifestation are often similar to fungal infection, it is easy to be misdiagnosed as fungal keratitis and delay the treatment. In January 2006, we treated a patient who was misdiagnosed as "fungal keratitis", and it was confirmed as actinomycetal keratitis by laboratory examination.

The patient was a 26-year-old male who came to our hospital on September 28, 2005 due to the decrease of visual acuity in his left eye and visual object deformation for 1 year. The patient had a history of hypertension and had undergone double adrenal pheochromocytoma resection when he was a child.

The patient was a 92-year-old male who came to our hospital on June 20, 2005 due to the gradual decline of visual acuity in his left eye for 6 years. Ocular examination showed that the visual acuity of his left eye was 0.1, the lens density was high, and a large number of dense yellow-white drusen with diameter>125 μ m was seen in the posterior pole of the fundus (Quintessence Picture 1), and a huge liquid drusen with diameter>500 μ m was formed. The fluorescein fundus angiography of his left eye showed that the drusen showed high fluorescence, but no obvious fluorescein leakage (Quintessence Picture 2). The drusen showed low fluorescence in the indocyanide green fundus angiography (Quintessence Picture 3). According to the diagnostic recommendations of the American Age-Related Ophthalmology Research Group, this case was diagnosed as age-related macular degeneration (mid-stage).

Visual loss caused by age-related macular degeneration (AMD) has become one of the main eye diseases causing blindness in Europe and America. With the aging of the population in China, the number of patients with AMD is increasing gradually, and the formation of choroidal neovascularization (CNV) is the main pathological change in AMD.

This issue introduces another form of type A multiple-choice questions, namely, case abstract best-choice questions. In this type of questions, the question stem is a simple case abstract or background introduction, with necessary figures, tables, photos and other relevant materials attached. There are 5 alternative answers, of which only one is the best choice, and the rest are interference options (A2 type questions). Some questions have a special standard negative word (no, no, can't, except, except, wrong, irrelevant, etc.) in the question stem. Sometimes, several related questions share one question stem. These questions are mostly related to etiology, pathogenesis, diagnosis, differential diagnosis, treatment, etc. The series of related questions belong to A3 type questions when 2 or 3, and those with more than 3 belong to A4 type questions.