Volume 43 ·  Issue 04 ·  2007

The main treatment for corneal blindness is corneal transplantation, but corneal transplantation materials are very scarce in China. Therefore, we should strengthen social propaganda, advocate donation by the whole people, call for organ transplantation legislation, establish organ donation notarization system and standardize the construction of eye bank, etc., so as to obtain more donation materials; We should pay attention to the selection of indications and surgical methods of corneal transplantation, perioperative management, and make full use of various ways of corneal blindness to recover vision, so as to improve the successful rate of surgery and reduce the waste of materials; At the same time, we should speed up the research and development of new corneal materials, especially the research of tissue engineering cornea, so as to alleviate the shortage of corneal transplantation materials as soon as possible.

Refractory corneal ulcer refers to a kind of corneal ulcer that is ineffective with targeted medication, has a long course of disease and is repeatedly prolonged, including various infectious corneal ulcers, aseptic corneal ulcers and bed or graft ulcers after keratoplasty. Whether to continue to take drug treatment, amniotic membrane transplantation, corneal transplantation or conjunctival flap covering for this kind of ulcer has always been the focus and difficult problem in ophthalmology clinics.How to choose the appropriate surgical method, with the least eye damage, the shortest treatment time and the most economical means to cure this kind of corneal ulcer is a difficult problem that ophthalmologists hope to solve.In view of this problem, this article expounds the value of conjunctival flap covering, a traditional surgical method, in the treatment of refractory corneal ulcer.

Fungal keratitis is the most common severe infectious keratopathy in many developing countries, and has become the primary cause of corneal blindness in China.In order to reduce the incidence of this disease,increase the treatment methods and improve the therapeutic effect,ophthalmologists should deeply study its pathogenesis.This paper summarizes and analyzes the research progress of fungal virulence factors and host defense factors in fungal keratitis at home and abroad related to its pathogenesis.

This issue focuses on corneal diseases, and more on the research of corneal transplantation. There are 2~3 million corneal blindness in China, and corneal diseases have become the second main cause of blindness.

In order to further promote mutual understanding and experience exchange between Chinese and American ophthalmology and vision researchers, strengthen substantive cooperation and promote the development of ophthalmology research between China and the United States, the organizing committee of the American Society of Vision and Ophthalmology has decided to hold the second Sino-American Ophthalmology Research Cooperation Seminar at the Conference Center of the Society of Vision and Ophthalmology on May 7, 2007 from 13: 15 to 14: 45 pm during the annual meeting of the Society of Vision and Ophthalmology Research. The conference included reports on epidemiological studies of age-related macular degeneration in Chinese people around the world and how to strengthen cooperation between Chinese and American ophthalmology and vision researchers. The meeting will be chaired by He Shikun, Zhao Jialiang and others. Interested ophthalmologists are welcome to attend.

In order to promote the exchange of the latest progress in ophthalmology at home and abroad, Peking University Ophthalmology Center will hold a forum of famous ophthalmologists of Peking University in Beijing from June 22 to 24, 2007. At that time, renowned experts from home and abroad in cataract, glaucoma, keratopathy, pediatric ophthalmology, eye molding and cosmetology, excimer laser corneal refractive surgery, vitreous-retinal surgery and vitreous-retinal medicine will be invited to give academic lectures and discuss new development trends together.

Ophthalmic diseases can significantly affect the quality of life of patients, and have been paid more and more attention by the society. The rapid development of science and technology has laid the foundation for the continuous renewal of ophthalmic equipment and drugs, and improved the level of clinical diagnosis and treatment.

In recent years, with the continuous development of life science, basic medicine and various high-tech and equipment, the diagnosis and treatment technology of neuroophthalmology has changed with each passing day. If it is confirmed that Chinese LHON is caused by mtDNA 11778 mutation, and early diagnosis can be made by routine blood mtDNA detection; The update of GKP, the advent of frequency doubling perimetry, and the development of visual evoked potential, multifocal electroretinogram, CT and MRI have provided more powerful support for the diagnosis of neuro-ophthalmic diseases; The application of traditional Chinese medicine and nerve growth factor has broken through the bottleneck of treatment in the past and opened up a new way. These new advances in diagnosis and treatment have made many patients not only see the light again.

According to the latest edition of Xinhua Dictionary and Modern Chinese Dictionary, the use specifications of the words "sticky" and "sticky" are as follows: when pronouncing "nián", the word "sticky" is always used, such as mucosa, mucus, slime mold, adhesive, etc.; When pronouncing "zhān", use the word "sticky", such as intestinal adhesion, paste, etc. Regarding the use of the words "Wei" and "Wei", both words mean only and only, but when used in words such as only, only, only, fear, obedience to orders and profit-seeking, the word "Wei" is always used; When used in words such as materialism, idealism, rationalism, nominalism, etc., use the word "only".

Objective to investigate the clinical effects and complications of corneal prosthesis implantation in patients with severe chemical burn caused by corneal opacity. Methods Twenty-eight cases of unilateral eyes of blind patients caused by severe chemical burn were treated in the Department of Ophthalmology of PLA General Hospital from October 2000 to March 2006. Preoperative visual acuity was manual in 14 eyes and light-sensitive in 14 eyes, and the corneal opacity could not be restored by conventional keratoplasty. Among them, 20 eyes had severe alkali burn and 8 eyes had severe acid burn. Artificial corneal prosthesis implantation was divided into two stages: stage I surgery was performed to implant artificial corneal stent into the corneal layer, and the selected eyes underwent corneal surface or interlaminar reinforcement surgery. Three months later, stage II surgery was performed, and the artificial corneal optical part with threads was implanted. Conventional lens, partial iris and anterior vitrectomy were performed, and the outer 1/3 of the upper and lower eyelid margins were permanently sutured. For patients with complete symblepharon adhesion, the corneal surface was covered with upper and lower eyelid skin, only the artificial corneal optical part was exposed. Results The observation period was 3~65 months after stage II surgery, The average visual acuity of 21 of 28 eyes was ≥0.05 (75%) and 2 eyes were ≥1.0. After lens correction, the visual acuity of 11 eyes (39%) was 0.6~1.2; 1 eye (4%) was 0.3~0.5; 5 eyes (18%) was 0.05~0.25; 3 eyes (11%) were manual; 3 eyes (11%) were photosensitive; One eye (4%) had no photosensitivity.The surgical complications included penetration into the anterior chamber during corneal lamellar separation,residual lens cortex,secondary glaucoma,hyperplasia or epithelial covering on the anterior surface of the lens column,deposits on the posterior wall of the lens column,corneal lysis,endophthalmitis,and retinal detachment.Conclusion Corneal prosthesis is an effective method to restore vision in patients with severe corneal scar and vascularization of binocular.This surgical procedure combined with autologous conjunctiva covering,autologous periosteum transplantation and partial suture of palpebral fissure,etc. is beneficial to the long-term survival of artificial cornea.Regular postoperative review and active prevention of complications are effective means to maintain vision.

Objective to investigate the clinical characteristics of disease classification, age and sex distribution of children with corneal transplantation in Shanghai. Methods The clinical data of 121 children (122 eyes) who underwent corneal transplantation in 4 hospitals in Shanghai from January 2003 to January 2006 were retrospectively analyzed by multi-center cooperation. The children were all under 17 years old. The data of primary disease, age and sex were analyzed by SPSS 13.0 statistical software. Results Among the 121 children (122 eyes), there were 27 cases (22.3%) of traumatic corneal scar, 24 cases (19.8%) of leukoplakia after keratitis, 14 cases (11.6%) of congenital corneal opacity, 13 cases (10.7%) of keratoconus, 11 cases (9.1%) of corneal ulcer, 6 cases (5.0%) of graft rejection, 6 cases (5.0%) of band corneal degeneration, 6 cases (5.0%) of chemical injury, 5 cases (4.1%) of thermal burn, 5 cases (4.1%) of dermoid tumor and 4 cases (3.3%) of congenital hereditary corneal endothelial dystrophy The median was 11 years old. Penetrating keratoplasty was the main surgery in 95 cases (78.5%); 19 patients (15.7%) underwent lamellar keratoplasty; Penetrating keratoplasty was performed in 7 cases (5.8%). Conclusion Traumatic corneal scar and post-keratitis leukoplakia are the main causes of corneal transplantation in children.

Objective to investigate the ultrastructural changes and mechanisms of chronic dysfunctional graft after penetrating keratoplasty. Methods in the chronic failure of corneal graft (CCAD) group, 12 corneal graft (12 patients) failed due to CCAD after penetrating keratoplasty (PK); The mean interval between two PK surgeries was 69 months in 12 patients, 10 patients had one or more immune rejection after the initial PK surgery, and 2 patients had no immune rejection. In the normal control group, five corneal grafts provided by Shandong Eye Bank were used as normal donors.The corneal grafts of the two groups were examined by histopathology,transmission electron microscopy and scanning electron microscopy, and comprehensively analyzed in combination with the patient's medical histories.Results the corneal epithelial layer in the CCAD group was thinner than that in the normal control group, and large vacuoles were formed, the fibers in the corneal stromal layer were disordered, and there was no obvious inflammatory cell infiltration; Abnormal gaps and fibroproliferation were observed between the posterior elastic layer and corneal endothelial cells; The corneal endothelial layer was atrophied and thinned, the cells were deformed, the nuclear chromatin was condensed, and the inflammatory cells adhered to the corneal endothelial cells occasionally. Conclusion the characteristic ultrastructural changes of CCAD graft are atrophy of endothelial cells and fibroproliferation of non-inflammatory cells. Chronic subclinical antigen-dependent and non-antigen-dependent factors may jointly participate in the occurrence of CCAD, and immune rejection may induce and promote the occurrence and development of CCAD.

Objective to investigate the efficacy of ciliary body photocoagulation (ECP) under direct endoscope and its effect on the survival of corneal graft in patients with intraocular pressure increased after penetrating keratoplasty (PKP) and uncontrolled by medication. Methods Twenty-six patients (26 eyes) were selected as controls and treated with transcleral semiconductor laser ciliary body photocoagulation (TCP) (TCP group). Visual acuity, intraocular pressure, graft transparency, endothelial cell density and anterior chamber response were observed before and after operation. Ciliary process and chamber angle were examined by ultrasound biopsy microscope (UBM), and postoperative complications were noted. Results In ECP group, intraocular pressure was lower than that in 13 cases (38.2%) and 23 cases (67.7%) The intraocular pressure was lower than 21 mm Hg in 10 cases (38.5%) and 8 cases (30.8%) in TCP group at 3 and 6 months after operation, respectively. There was no significant difference in intraocular pressure control rate between the two groups at 3 months (x2=0.0003, P =0.986), but there was significant difference at 6 months (x2=8.024, P =0.005). The postoperative endothelial cell density of ECP group and TCP group was (1013±170) and (847±136) /mm2, respectively, and the difference was statistically significant (t = -0.009, P =0.033). There were 9 cases (26.5%) and 21 cases (80.8%) of reactive iritis in ECP group and TCP group, respectively, and the difference between the two groups was statistically significant (x2=17.376, P =0.001). Conclusion The long-term curative effect of ECP on reducing intraocular pressure in patients with glaucoma after PKP is better than that of TCP. The damage to endothelial cells of corneal graft and the degree of uveitis caused by ECP is milder than that of TCP, which is relatively higher than that of TCP

Objective to investigate the clinical manifestations, diagnosis and treatment of congenital extraocular muscle fibrosis (CFEOM) families. Methods the clinical characteristics of congenital extraocular muscle fibrosis (CFEOM) families were retrospectively summarized and analyzed, including genetic characteristics, gender, age, clinical manifestations and surgical conditions. Results the congenital extraocular muscle fibrosis family had autosomal dominant genetic characteristics, CFEOM-1 type. The common clinical manifestations of 14 patients were both eyes located in the lower oblique position, unable to turn up to the midline, and ptosis in both eyes. The differences were vertical eye position, horizontal eye position and eye movement restriction. Some patients were accompanied by pupil abnormalities, abnormal innervation and juvenile gray hair. According to the eyelid and eye position, frontal muscle suspension, levator palpebral muscle shortening, rectus retrogression or rectus muscle suspension were feasible for correction. Conclusion Congenital extraocular muscle fibrosis patients are rare in clinic. This family of congenital extraocular muscle fibrosis has phenotypic heterogeneity, accompanied by pupil abnormalities, abnormal innervation and hair abnormalities, It has not been reported in previous literature. Fully grasping clinical characteristics and combining genetic analysis is the basis for making a correct diagnosis, and also provides a basis for further research on the pathogenesis of this disease.

Objective to evaluate the accuracy, stability and predictability of iris recognition technique applied to excimer laser in situ keratomileusis (LASIK) in the treatment of myopic astigmatism.Methods 97 patients (183 eyes) with myopic astigmatism treated by iris recognition guided LASIK were divided into 3 groups according to the preoperative cylinder power: 79 eyes in group 1 (-0.50~ -1.00 D), 70 eyes in group 2 (-1.25~ -2.00 D) and 34 eyes in group 3 (-2.25~4.00 D); The iris data and wavefront aberration data were collected before and after dilatation, and ate files were formed after iris recognition. The data were combined with ote files generated by Orbscan corneal topography system to design surgical plan and form tls files, which were imported into excimer laser system. The laser identified the iris of the eyes in the recumbent position again, determined the pupil center offset and eyeball rotation angle, and compensated for it during treatment. The eye movement was monitored by three-dimensional eye tracking system during operation. The visual acuity, astigmatism and axial changes at different periods before and after operation were observed. Results The total offset of the pupil center during operation was X-axis direction (O.41 ± 98.90) μ m, Y-axis direction (109.15±141.35) μ m, eyeball rotation deviation angle 0.83°±3.40°, which were compensated during surgery. 183 eyes (100.0%) with naked eye visual acuity ≥0.5 and 169 eyes (92.3%) with visual acuity ≥1.0 at 6 months after surgery, the astigmatism decreased from (-1.54±0.65) D before surgery to (-0.26±0.25) D at 6 months after surgery. The overall astigmatism of samples at each time point after surgery was analyzed by one-way analysis of variance, and the differences were statistically significant (F =5.74, P<0.01). SNK test was used for pairwise comparison between each group, and the differences were statistically significant (P<0.05) when comparing 1 week with 1, 3 and 6 months after surgery; There was no significant difference between 1, 3 and 6 months after surgery (P =0.88). At 6 months after surgery, 45 eyes (24.6%) decreased in conformal astigmatism, 31 eyes (16.6%) decreased in reverse astigmatism, 38 eyes (21.0%) increased in oblique astigmatism, and 69 eyes (37.8%) became astigmatism-free eyes at 6 months after surgery. Conclusion Iris recognition-guided LASIK is one of the accurate, advanced and effective methods for treating astigmatism in myopia.

Methods 98 patients (98 eyes) were randomly divided into two groups, 51 (51 eyes) in the experimental group and 47 (47 eyes) in the control group, who received wavefront-guided LASIK and traditional LASIK respectively. The changes of contrast sensitivity, subjective assessment and aberration of the experimental group and the control group before and after operation were observed. Results The experimental group was better than the control group in the evaluation of the changes of halo, night vision, glare and night driving discomfort compared with the preoperative changes (P<0.05); The contrast sensitivity between the two groups was different in each frequency band after operation, but it was more obvious in the middle and low frequency bands under dark vision; The difference of postoperative aberration between the two groups is statistically significant, and its influence on subjective assessment and contrast sensitivity is concentrated in the low and middle frequency bands under night vision and dark vision, among which the influence of defocus and spherical aberration is the most obvious, and the influence of vertical coma on subjective assessment and contrast sensitivity is opposite to that of defocus and spherical aberration. Conclusion Wavefront-guided LASIK is superior to traditional LASIK group in postoperative contrast sensitivity and subjective assessment, which is mainly related to the fact that the former greatly reduces postoperative defocus and spherical aberration, and vertical coma can partially neutralize their influence on visual quality.

Objective to study the safety and effectiveness of iris clip phakic intraocular lens (ICPIOL) in the treatment of high myopia. Methods Thirteen patients (25 eyes) with high myopia were implanted with ICPIOL with equivalent spherical power (SE) (-15.63±3.51) d. The visual acuity, refractive state, intraocular pressure, cornea, anterior chamber, pupil, ICPIOL, lens and fundus were observed before and after the operation for 1 year. The results showed that the naked eye visual acuity (UCVA), best corrected visual acuity (BCVA) and SE were significantly improved at 1 d, 7 d and 1, 3, 6 and 12 months after the operation. BCVA did not decrease, 95.24% increased by ≥2 lines, 4.76% increased by 1 line; The refractive status of all eyes was stable at ± 2.00 D, 71.43% of them were at ± 0.50 D and 85.71% were at ± 1.00 D. There was no significant loss of corneal endothelial cells at 1 year after operation, except that 7 eyes had mild iris depigmentation during iris fixation with ICPIOL, and 1 eye had main incision leakage after re-suturing on the second day after operation, no other complications occurred. Conclusion ICPIOL is safe and effective in the treatment of high myopia within 1 year after operation.

Objective to investigate the prognosis and risk factors of vitreous body surgery in traumatic eyes without photosensitivity. Methods From February 1999 to August 2004, 577 patients (599 eyes) who underwent vitreous body surgery with mechanical ocular trauma were registered by Peking University Eye Center, Peking University Third Hospital and Wenzhou Medical College Ophthalmology Hospital from February 1999 to August 2004. Among them, 38 patients (38 eyes) underwent vitreous body surgery with traumatic eyesensitivity, including 32 eyes (84.2%) with open eye injury and 6 eyes (15.8%) with closed eye injury. The patients who underwent first-stage enucleation were not followed up, and the other patients were followed up for more than 6 months, with an average of 7.2 months. The clinical data of all patients were filled in a pre-designed form, and the determination of each parameter strictly followed the standards stipulated in the protocol. The risk factors of poor prognosis in traumatic eyes and the risk factors of traumatic eyesensitivity without photosensitivity were analyzed by Logistic statistics. Results 14 eyes (36.8%) received anatomical and functional repair, 3 eyes (7.9%) received anatomical repair, 9 eyes (23.7%) underwent enucleation, the other 4 eyes had low intraocular pressure, 7 eyes had silicon The visual acuity was improved in 21 eyes (55.3%) after operation. Among them, 3 eyes had visual acuity increased to 0.2, 2 eyes had visual acuity increased to 0.02, 3 eyes had finger counting and 3 eyes had manual movement, 10 eyes had recovered photosensitivity, and 8 eyes (21.1%) still had no photosensitivity. The results of Logistic regression analysis showed that the risk factors of poor prognosis in traumatic eyes were traumatic absence of photosensitivity, relative afferent pupil disorder (RAPD), massive suprachoroidal hemorrhage (MSCH), closed funnel retinal detachment, ciliary body damage, early ophthalmic atrophy, iris prolapse and absence of iris, lens expulsion, scleral wound>10 mm and eyeball rupture. The above factors (except traumatic absence of photosensitivity, iris prolapse and absence of iris) were also the risk factors of absence of photosensitivity after trauma. Usually, more than two risk factors coexist in the same traumatic eye. Conclusion The prognosis of traumatic absence of photosensitivity is poor, However, nearly 45% of traumatic eyes can obtain anatomical and functional repair or anatomical repair through vitreous surgery. Traumatic absence of photosensitivity is attributed to comprehensive risk factors. MSCH, severe retinal tissue damage and extensive ciliary body damage are the main indications of poor prognosis in traumatic eyes.

Objective to observe the clinical efficacy of vitrectomy with silicone oil filling combined with phacoemulsification cataract extraction and intraocular lens implantation in the treatment of proliferative diabetic retinopathy. Methods According to the principle of patient voluntary, 53 cases (57 eyes) of proliferative diabetic retinopathy stage VI were divided into combined surgery group and vitreous surgery group. 33 cases (33 eyes) in combined surgery group and 20 cases (24 eyes) in simple vitreous surgery group. The combined surgery group underwent vitreoretinal surgery, silicone oil filling, phacoemulsification cataract extraction and folding intraocular lens implantation, while the simple vitreous surgery group underwent vitreoretinal surgery and silicone oil filling. There were 20 eyes with complete retinal reduction in the vitreous operation group, and the rate of retinal reduction was 83.3%, and the difference between the two groups was not statistically significant (P =0.626). Iris neovascularization occurred in one eye (3.0%) in the combined operation group, and in two eyes (8.3%) in the simple vitreous operation group, both occurred in patients with unretinal reduction, and the difference between the two groups was not statistically significant (P =0.775). Conclusion Vitreoretinal surgery combined with phacoemulsification and cataract extraction and intraocular lens implantation is safe and effective in the treatment of proliferative diabetic retinopathy, and combined surgery can avoid repeated cataract surgery.

A 72-year-old female was admitted to hospital on April 27, 2006 due to redness, swelling and pain in her right eye, visual acuity decrease with headache for 2 months, and recurrence for 1 d. The patient developed redness, swelling and pain in her right eye, visual acuity decrease with headache without obvious trigger 2 months ago, and was admitted to hospital for "acute angle closure glaucoma: acute attack of right eye".

On August 11, 2004, a 5-year-old male presented with acute abdominal pain for 6 h. Physical examination showed somnolence, shortness of breath, pale complexion, cyanotic lips, damp and cold upper limbs, patterned skin, body temperature up to 40.6℃, heart rate 137 beats/min, low and dull heart sounds, blood pressure 30/10 mm Hg (1 mm Hg =0.133 kPa), slight tenderness in the left lower abdomen.

A 43-year-old male was admitted to our hospital on June 3, 2005 due to progressive decrease of visual acuity in his right eye for 2 years, accompanied by exophthalmos for 2 months. No abnormalities were found in physical examination.

Clinically, Nocardia keratitis after laser in situ keratomileusis (LASIK) is rarely reported [1]. in May 2005, a patient with Nocardia keratitis after LASIK was admitted to our hospital.

Dry eye syndrome is the most common complication after laser in situ keratomileusis (LASIK), which occurs for many reasons, mainly because all nerves except the pedicle of the corneal flap are severed during the operation, which leads to decreased corneal sensation and affects tear secretion.

The main function of the suspensory ligament of lens is to maintain the normal position of the lens and perform refractive adjustment. It is the only tangible tissue connecting the lens and the eyeball wall. The suspensory ligament migrates on the surface of the lens capsule and constitutes the lamellar layer of the suspensory ligament on the surface of the capsule. The capsule is an important barrier to maintain the stability of the environment in the lens. Whether the aging, degeneration and disconnection of the suspensory ligament will affect the structure of the lens capsule and then affect its function is not reported at present.

The patient was a 49-year-old female who came to our hospital on January 28, 2004 due to a sharp decrease in visual acuity in her left eye for 1 week. The patient had undergone allogeneic kidney transplantation in our hospital on August 21, 2003 due to chronic renal failure. After the operation, she was treated with immunosuppressants. The cumulative dosage was about 31 000 mg of cyclocytin A, about 8400 mg of azathioprine, about 2500 mg of prednisone and 30 mg of rapamycin.