Volume 43 ·  Issue 09 ·  2007

Primary glaucoma is one of the severe irreversible ocular diseases causing blindness. Early diagnosis and intervention are the key measures to prevent the severe loss of visual function in patients with glaucoma. In recent years, important progress has been made in the basic and clinical research of primary glaucoma, such as the understanding of the classification of primary angle closure glaucoma (PACG), the understanding of the risk factors of PACG, the management of PACG, the understanding of the changes of the optic head in primary open angle glaucoma (POAG), and the concept of target intraocular pressure in the treatment of primary glaucoma, etc., all of which are beneficial to the early diagnosis and intervention of primary glaucoma. Strengthening the continuing education of ophthalmologists in early diagnosis and intervention of glaucoma, popularizing the knowledge of glaucoma prevention and treatment to the public, and early screening of primary glaucoma through public health will make a large number of patients with primary glaucoma get early diagnosis and intervention, thus reducing the blindness rate of glaucoma.

Positive family history is one of the main risk factors for glaucoma, suggesting that gene defects play an important role in the pathogenesis of glaucoma.The progress of genetic research provides more basis for elucidating the pathogenesis of glaucoma.The prerequisite for understanding and studying the genetic factors related to diseases is to have sufficient genetic resources related to diseases.Based on the utilization of glaucoma genetic resources abroad, many genes or loci related to primary glaucoma have been identified. China has the richest disease population resources in the world.However, there are still many problems in the collection, preservation and utilization of disease genetic resources in China, including the lack of strict operating norms, the lack of active participation of clinicians, the inability of basic medicine and clinical personnel to cooperate and participate together, the inability to fully utilize disease resources, the outflow of genetic resources, etc. We should face these problems squarely. At present, Reasonable exploitation and utilization of genetic resources in China is an urgent task. (Chinese Journal of Ophthalmology, 2007, 43: 772-774)

Glaucoma is a chronic optic neurodegenerative disease characterized by progressive loss of retinal ganglion cells and its axons and accompanied by decreased visual field sensitivity. With the deepening of immunological research in recent years, the role of immune system regulation in the protection of glaucomatous optic nerve has attracted more and more attention of researchers. When the body's immune system is abnormally regulated, autoimmune response and stress-mediated immune response will also lead to degenerative changes of optic nerve. A comprehensive and systematic understanding of the role of immune system in glaucomatous optic neuropathy is of important guiding significance for establishing effective optic nerve protection strategies. Therefore, it is necessary to review the role of immune system in glaucomatous optic neuropathy. (Chinese Journal of Ophthalmology, 2007, 43: 858-861)

Objective to study the prevalence of primary angle closure glaucoma (PACG) and its related influencing factors in the rural population of Changchun City, Jilin Province. Methods From September 2004 to February 2005, a total of 1139 people aged 40 and above in two natural villages of Qijia Township, Shuangyang District, Changchun City were investigated for glaucoma. The on-site examination items included routine visual acuity, slit lamp microscope, peripheral anterior chamber depth, intraocular pressure and fundus examination. The prevalence of glaucoma was 2.5% in 29 cases diagnosed with PACG, and the prevalence of glaucoma increased with age. The prevalence of glaucoma was 1.5% in males and 3.5% in females; The prevalence of glaucoma in females was significantly higher than that in males.The percentage of shallow anterior chamber in females was significantly higher than that in males.The percentage of shallow anterior chamber in females was significantly higher than that in males.The prevalence of PACG in people with family history of glaucoma was higher than that in people without family history of glaucoma.Conclusion The prevalence of PACG in Shuangyang District of Changchun City was higher, and its prevalence was related to the gender, age, family history and peripheral anterior chamber depth of patients (Chinese Journal of Ophthalmology, 2007, 43: 775-778)

Objective to investigate the gene mutation of primary congenital glaucoma (PCG) in Han nationality in Hubei Province and lay a foundation for gene diagnosis. Methods Genetic analysis of 47 unrelated PCG children and 100 healthy normal children was performed. Genomic DNA of peripheral leukocytes was prepared from 4 ml peripheral venous blood. Exons 2 and 3 of CYP1B1 gene were amplified by polymerase chain reaction (PCR) with reference to the primer sequences reported in the literature. After the products were identified by agarose gel electrophoresis, the genes of the children and controls were analyzed by single strand conformational polymorphism (SSCP), denaturing high performance liquid chromatography (DHPLC) and DNA sequence analysis. Results 7 PCG children showed a point mutation of the first base C→T of the 385 codon of exon 3 of CYP1B1 gene, resulting in the corresponding leucine conversion to phenylalanine (L385F). Conclusion There is a mutation in exon 3 of CYP1B1 gene in Han PCG patients in Hubei, which is located in the important functional region of P450 protein, and may be a pathological mutation. It is of great significance to investigate the pathogenesis of PCG by studying the mutation of CYP1B1 gene and searching for other pathogenic genes in Han PCG patients

Objective to study the frequency and size difference of parapapapillary choroidal atrophy (PPA) in patients with primary open-angle glaucoma with monocular visual field defects. Methods the incidence and size difference of PPA in 40 patients with primary open-angle glaucoma with monocular visual field defects were measured by computer image analysis system. The diopter (equivalent spherical lens) of all enrolled patients was between-3.00 and +3.00D. Results the cup area and cup-to-disc area ratio of eyes with visual field defects were greater than those of eyes with normal visual field, and the difference was statistically significant (cup area: t =5.332, P<0.01; cup-to-disc area ratio: t =5.126, P<0.01). The α area of eyes with visual field defects was slightly larger than that of eyes with normal visual field, and the difference was statistically significant (t =3.02, P =0.0045). There was no statistically significant difference in β area between the two eyes (S =13.5, P =0.426); The incidence of α and β regions was consistent in both eyes (α regions: χ 2=0.00, P =1.000; β regions: χ 2=1.2857, P =0.2568). Conclusion After excluding patients with moderate and high myopia above-3.00D, the presence or absence of α and β regions and the size of β regions in primary open-angle glaucoma with monocular visual field defects could not reflect the difference of visual field defects between the two eyes well. (Chinese Journal of Ophthalmology, 2007, 43: 784-787)

Objective to investigate the clinical manifestation and therapeutic effect of choroidal osteoma Methods 12 patients (18 eyes) with choroidal osteoma, including 5 males and 7 females; 8 right eyes and 10 left eyes. All patients underwent routine ocular examination, including optimal corrected visual acuity, intraocular pressure, visual field, anterior segment and fundus examination. Special examination: color fundus photography, fluorescein fundus angiography (FFA) and/or indocyanide green fundus angiography (ICGA), B-ultrasound, CT, visual field and electrophysiological examination. The patients were treated as follows: (1) Taking anti-infective drugs and vitamin drugs, clinical follow-up observation. (2) Taking multi-wavelength krypton laser photocoagulation therapy. (3) TTT, the number of treatments was 1~5 times, and the interval between two treatments was 1 month. All patients were scheduled for regular follow-up, with a follow-up period of 1 to 26 years, with a median of 2.5 years. Results (1) A total of 6 patients (8 eyes) were treated with drugs and regular follow-up. During the follow-up, it was found that choroidal osteoma increased slowly, the growth edge was pseudopodic, and the tumor body increased. The longest follow-up time was 1 case, and the tumor resolved spontaneously after 26 years of follow-up. (2) Two cases (4 eyes) were treated with laser photocoagulation Photocoagulated pigment spots appeared on the edge of choroidal osteoma after operation. Two eyes still had a little serous exudation and superficial retinal detachment in myopic papilla and macula, and one eye had macular hemorrhage. FFA examination showed the formation of choroidal neovascularization (CNV), and the condition of 2 patients improved after TTT supplementation therapy. (3) Four cases (6 eyes) were treated with TTT alone, and one case (1 eye) had macular hemorrhage. FFA and ICGA examination showed CNV leakage, which improved after TTT treatment; In one case (2 eyes), the serous exudation at the tumor was reduced after TTT treatment, and there was blue-gray pigment and thin organized scar hyperplasia. Conclusion Choroidal osteoma grew slowly during the natural course of the disease, with pseudopod-like edge. Laser photocoagulation has certain effect. TTT can be used alone or as an adjunct to the deficiency of laser photocoagulation, especially for eyes with subfoveal CNV. (Chinese Journal of Ophthalmology, 2007, 43: 788-792)

Objective to compare the clinical characteristics of Leber hereditary optic neuropathy (LHON) and optic neuritis (ON). Methods the clinical data of 55 patients with LHON and 48 patients with ON were collected and compared with the laboratory results of cerebrospinal fluid and cranial magnetic resonance (MRI). ON was 21 cases. The onset age of LHON was early, the median was 16 years; The onset age of ON was later, the median was 30 years, and the visual acuity decreased for more than 2 weeks, LHON was 42 cases, and ON was 10 cases. LHON was uniphasic course in 53 cases, and ON was 30 cases; The visual impairment of patients with LHON was severe, most of which ranged from index to 0.1. Both eyes were involved at the same time and the visual acuity was close to each other. Very few patients were accompanied by blinking pain, 3 cases of LHON and 26 cases of ON. The changes of fundus were not easy to distinguish between the two groups. The genetic history of maternal family was common, and the detection rate of LHON was 50.0% (25/50), and that of ON was 4.1% (2/48). The percentage of visual field examination showed that the affected eyes had central dark spots, 26/39 of LHON and 12/35 of ON. Some patients with LHON and ON showed inflammatory demyelinating-like changes by visual evoked potential, cerebrospinal fluid and cranial magnetic resonance examination. Genetic examination can confirm the vast majority of patients with LHON. Conclusion LHON has outstanding clinical features, but most of them overlap with ON, and a few patients with typical clinical manifestations of LHON have negative genetic examination results. (Chinese Journal of Ophthalmology, 2007, 43: 793-797)

Objective to investigate the changes of contrast sensitivity and aberration after phacoemulsification cataract extraction in both eyes after implantation of different intraocular lenses (IOL). Methods Sixty-three patients with age-related cataract in our hospital from April to August 2005 were selected. Under the premise of informed consent, SA60AT IOL was implanted in one eye and Tecnis Z9001 IOL was implanted in the other eye after phacoemulsification cataract extraction in both eyes. Computer and comprehensive optometry were performed 1 and 3 months after operation, and the best corrected visual acuity, contrast sensitivity under glare and no glare conditions, corneal aberration, and the total aberration of the eye at 4 and 6 mm pupil diameter were detected respectively. Results There was no significant difference in best corrected visual acuity between all patients 1 and 3 months after operation (P>O.05). There were no significant differences in spherical aberration, coma and root mean square of total corneal aberration between the two groups (P>0.05). The contrast sensitivity of eyes implanted with Z9001 IOL at 1 and 3 months postoperatively was higher than that of eyes implanted with SA60AT IOL at spatial frequencies of 3, 6, 12 and 18 c/d (P<0.05). Comparing Zernike polynomial C12, RMS4 and RMSh at 1 and 3 months postoperatively, the eyes implanted with Z9001 IOL were smaller than those implanted with SA60AT IOL at 4 and 6 mm pupil diameter (P<0.05). Conclusion Tecnis Z9001 can improve the higher-order aberration, especially spherical aberration, and improve functional visual acuity compared with SA60AT IOL

Objective to investigate and understand the epidemiological changes of blindness and low vision in Medog County, Tibet Autonomous Region. Methods Six administrative villages were selected as the survey sites by using the principle of random cluster sampling. The epidemiological survey of blindness and low vision was conducted in the whole county according to the standard of blindness and low vision established by World Health Organization. Results Among 821 people, 735 were examined, and the examination rate was 89.52%. 19 were blind in both eyes, and the blindness rate was 2.59% (1.72% men and 3.40% women). The prevalence rate of low vision was 4.35% in 32 patients (4.02% in males and 4.67% in females). The prevalence rate of blind and low vision patients ≥40 years old was significantly higher. The eye diseases causing blindness were cataract (42.11%), corneal disease (21.05%) and glaucoma (15.79%). Conclusion Cataract is the first eye disease causing blindness and low vision in Medog County, Tibet Autonomous Region. Therefore, surgical treatment of cataract is still the primary task of prevention and treatment of blindness in the future. (Chinese Journal of Ophthalmology, 2007, 43: 803-805)

Objective to investigate the clinical effect and characteristics of a new type of retrograde lacrimal duct catheterization. Methods Patients with nasolacrimal duct obstruction and chronic dacryocystitis treated in outpatient clinic were selected, and the lacrimal duct drainage tube was placed into the lacrimal duct from the lower opening of the nasolacrimal duct under local anesthesia with a lacrimal duct probe guide needle. During postoperative treatment, the position, cleanliness, characteristics of epiphora and lacrimal sac secretion and drainage and discharge of the drainage tube were observed, and the tube was extubated after 2~4 weeks. According to the length of follow-up time after treatment, the group was divided into groups: (1) Group A: 521 patients (613 eyes) treated for more than 3 years in the Department of Ophthalmology of Shenzhen Hospital of Traditional Chinese Medicine from May 1997 to December 2001 were counted as the long-term treatment effect observation group; (2) Group B: 381 patients (411 eyes) treated in Shenzhen Eye Hospital for 0.5 to 1.5 years from October 2003 to October 2005, and 5 patients (6 eyes) treated in the ophthalmology department of Shunyi District Hospital in Beijing in the same period, a total of 386 patients (417 eyes), were counted as the observation group of recent treatment effect. The cure rate between the two groups was compared by chi-square test. Results the lacrimal duct irrigation was generally unobstructed about 1 week after operation; The symptoms of epiphora were eliminated in 2~3 weeks; The cure rate was 92.3% (23/26). The cure rate was 84.5% in group A and 88.2% in group B. There was no statistically significant difference in the cure rate between the two groups (P>0.05). Surgery and anesthesia can lead to short-term diplopia and discomfort without complication. Conclusion The new retrograde lacrimal duct catheterization is safe and convenient, basically non-invasive, and has good prognosis. It can be used as a method for treating nasolacrimal duct obstruction and chronic dacryocystitis.

Objective to investigate the killing mechanism of lentivirus-mediated thymidine kinase gene/propoxyguanosine system (HSV-tk/GCV) on human lens epithelial cells (LECs). Methods Lentivirus-infected cells co-expressing HSV-tk gene and enhanced green fluorescent protein (EGFP) reporter gene were used as the experimental group, and lentivirus-infected cells only expressing EGFP and normal cells were used as the control group. The transfection efficiency of HSV-tk was detected by flow cytometry, the gene expression in LECs was detected by fluorescence microscopy, genomic PCR and RT-PCR, and the killing effect of this system on LECs was observed by DNA ladder and electron microscopy. The concentration time dependence and bystander effect of HSV-tk/GCV system were detected. Results HSV-tk was integrated into LECs and highly expressed. GCV at 10~25 μ g/ml could induce apoptosis or necrosis of HSV-tk transfected cells, and the effect was enhanced with the increase of GCV concentration and prolongation of action time, and there was obvious bystander effect And the bystander effect significantly enhanced the killing effect of HSV-tk/GCV system. The lentiviral vector co-expressed by HSV-tk and EGFP could transfect LECs efficiently and stably (Chinese Journal of Ophthalmology, 2007, 43: 810-816)

Objective to investigate the role of gelatinase including matrix metalloproteinase (MMP) 2 and MMP-9 in the pathological changes of fungal keratitis in rabbits. Methods Eighty New Zealand white rabbits were randomly divided into four groups, 20 in each group, of which three groups were experimental groups. The right eye of the rabbits was injected with 100 μ l of suspension of Fusarium solani, Aspergillus fumigatus and Candida albicans respectively; The other group was the control group. The right eye of rabbits was injected with equal amount of normal saline. The sources of MMP-2 and MMP-9 were observed by immunohistochemistry, and their activities were detected by gelatin zymogram. The infiltration of inflammatory cells, the degradation of corneal extracellular matrix (ECMs) and the growth pattern and invasion depth of fungal hyphae in the cornea were observed by histopathology. Results MMP-2 was mainly produced by corneal stromal cells, and its activity was detected at 5 days after fungal infection, and its activity increased at 8 days. MMP-9 was mainly derived from neutrophils, and its activity was detected at 1 day after inoculation, and its activity increased at 3 days, and then gradually decreased. 3 days after Fusarium solani infection, there were scattered neutrophils in the cornea, superficial ECMs were degraded, and hyphae grew parallel to corneal stromal fibers. 3 days after Aspergillus fumigatus and Candida albicans infection, a large number of neutrophils were observed in the cornea, and the surrounding ECMs degraded significantly, and hyphae showed vertical growth. 8 days after inoculation, inflammatory cells and hyphae in the cornea infected by Fusarium solani and Candida albicans were clearly observed Conclusion the activity of gelatinase produced by Fusarium solani, Aspergillus fumigatus and Candida albicans was significantly different after infection of rabbit cornea. Gelatinase plays an important role in the degradation of corneal ECMs; With the degree of ECMs degradation, the pathological changes of hyphae growth pattern and invasion depth in cornea were different. (Chinese Journal of Ophthalmology, 2007, 43: 817-822)

Since Schermer et al. [1] discovered that limbal stem cells were located in the Vogt palisade at the base of the limbus in 1986, there have been many new therapies for the treatment of limbal stem cell loss and corneal epithelial lesions, among which the in vitro culture of limbal epithelial cells is more effective for the treatment of these diseases. At present, most scholars have adopted tissue block method to culture limbal epithelial cells in vitro, but it is still controversial whether stem cells can migrate from tissue block in culture line.

At present, most of the researches on retinal function are at the level of morphology and genome. These studies cannot reflect the regulation of gene transcription, the changes of protein expression level and the post-translational modification of protein, and the intracellular mRNA level and protein abundance are not completely consistent. Therefore, it is particularly important to study the retinal function at the level of protein.

With the application of anterior chamber intraocular lenses (AC IOL), especially AC IOL with angle support, it becomes more and more important to accurately measure the anterior chamber diameter and implant the appropriate size AC IOL. Using ultrasound biomicroscopy (UBM), the whole anterior segment structure can be included in the image and the anterior chamber diameter can be accurately measured.

Hypertensive chorioretinopathy is more common in patients with acute hypertension. 4 cases diagnosed and treated in ophthalmology department of our hospital are reported as follows. 1. Clinical data From October 2002 to December 2005, 4 patients with hypertensive chorioretinopathy were diagnosed and treated in the ophthalmology department of our hospital, including 1 male and 3 female; Age 16-66 years old; One case was binocular, and three cases were monocular.

The patient was a 19-year-old male with poor visual acuity in both eyes and night blindness since childhood. He came to the ophthalmology department of our hospital on August 2, 2005. The patient was born naturally at the second term, and his mother had no history of disease during pregnancy. The parents were not close relatives, and his sister and other members did not have the same disease. There was no history of similar ophthalmology in the family. No abnormalities were found in the whole body examination. The eye examination showed that the visual acuity of the right eye was 0.06 and the left eye was 0.1, both of which could not be corrected.

Corneal endothelial transplantation has been gradually used in the treatment of bullous keratopathy, and has achieved good clinical results [1-3]. At present, the widely accepted surgical method is to tear off the posterior elastic layer and endothelium of the lesion, and then implant the donor corneal endothelial slice with a thickness of less than 100 μ m, and attach it to the posterior surface by injecting air in the anterior chamber. This method is called Descemet stripping automated endothelial Keratoplastic (DSAEK).

The patient was a 10-year-old male who came to our hospital on March 25, 2005 because he found a subcutaneous mass in the lacrimal sac area of his left eye with epiphora for 1 month. He was diagnosed as "dacryocystitis" in another hospital, but the treatment with "penicillin" was ineffective. He denied the history of epiphora and nasal congestion, trauma, fever, cough, headache, vomiting and consciousness disorder, and denied the history of long-term use of antibiotics, glucocorticoids and immunosuppressants.

Patients with lacrimal canalicular actinomycosis are rare in clinical practice, and it is easy to cause misdiagnosis or misdiagnosis. A patient diagnosed and treated in our hospital is reported as follows.

Case analysis question is a series-type indefinite multiple-choice question which simulates clinical conditions in the qualification examination of intermediate and senior professional titles. Its emphasis is to examine the skills, thinking mode, comprehensive application of knowledge and ability of analyzing and solving problems in clinical work. The contents of the test question can involve the whole course of the patient, including emergency admission, examination, diagnosis, progress of the disease course, treatment, prognosis, etc., or only some links in the whole course of the disease.