Volume 43 ·  Issue 10 ·  2007

Pterygium surgery has been widely carried out in hospitals at all levels in China, and remarkable achievements have been made, but the results of surgery are mixed. This article reviews the current situation and existing problems of pterygium surgery in China, as well as standardizing surgical methods and techniques, reducing postoperative recurrence rate, etc.

Pterygium is a common and frequent ocular surface disease in China, and the mechanism of pathogenesis and recurrence is still not completely clear, and there is a lack of standardized surgical and drug treatment.The main cause of pterygium is environmental stimulation (ultraviolet), the important mechanism is the destruction of limbal epithelial barrier, and the basic pathology is conjunctival degeneration and hyperplasia.This paper synthesizes various factors related to the pathogenesis of pterygium, shows the mechanism diagram and puts forward some problems worthy of further discussion and in-depth research, and recommends the primary surgery to choose resection plus autologous conjunctiva transplantation, or resection plus amniotic membrane transplantation, or autologous conjunctiva transplantation with limbal epithelium.

Objective to investigate the mechanism and role of vascular mimicry in the pathogenesis of pterygium. Methods The morphology of 218 pterygium specimens resected by surgery was observed under light microscope. Among them, 97 cases were treated with immunohistochemistry, immunohistochemistry (primary antibody was CD34, laminin and vascular endothelial growth factor) combined with periodic acid-Schiff (PAS) histochemical double-label staining, i.e., primary antibody was incubated at 37℃ for 60 min, secondary antibody was incubated at 37℃ for 30 min, horseradish peroxidase chromogenic agent developed, 0.5% periodate oxidated for 10 min, Schiffs solution stained in the dark for 20 min, Mayer hematoxylin counterstained for 3 min, dipped in running water, and sealed with neutral gum. Results 97 cases of 218 pterygium tissues showed vascular mimicry changes, which showed tubular type and reticular matrix type. The mesh interval of vascular mimicry area was stained purple red by PAS staining. CD34 immunohistochemistry combined with PAS histochemistry double-label staining showed that the scaffold protrusions and cells in the mesh area were CD34 positive, Laminin immunohistochemistry combined with PAS histochemistry double-label staining showed that vascular endothelial cells and vascular wall expressed laminin, but the cells in the tube-like area had no obvious positive reaction. Vascular endothelial growth factor immunohistochemistry combined with PAS histochemistry double-label staining showed that fibroblast-like cells in the reticular area showed positive reaction, and the mesh interval and extracellular matrix PAS stained purple red. Conclusion Vascular mimicry exists in pterygium tissue, and vascular mimicry is one of its blood supply routes.

Objective to investigate the pathological relationship between pterygium and cornea sclera and its postoperative recurrence and visual acuity changes under surgical microscope. Methods 41 cases (46 eyes) of primary pterygium exceeding the pupil margin were selected, and the pathological relationship between pterygium tissue and cornea was observed by various methods under surgical microscope. The head of pterygium was divided into three parts: top of head, loose part and adhesive part; The top of the head is a dense, hard translucent tissue at the top of the pterygium head, which adheres tightly to the cornea; The adhesive part is a band-like area parallel to the corneal limbus before the anterior boundary of the corneal sclera limbus, which is closely adhered to the cornea; The loose part is the pterygium tissue between the top of the head and the adhesive part, which is easily separated from the cornea; The neck and body of pterygium were easily separated from corneoscleral limbs and sclera.The data of the head and its three divisions of pterygium were measureed.Extensive degenerative bulbar fasciectomy and autologous conjunctival flap transplantation were performed. The follow-up time was 12.0~50.2 months, with a median of 22.4 months. The changes of visual acuity and postoperative recurrence were observed before and after operation. Results the total length of the head of pterygium was (6.3±0.4) mm, and the length of the top of the head was about (1.7±0.4) mm; The adhesive portion is about (0.9 ± 0.1) mm long; The length of the loose part was about (3.6±0.4) mm. The naked eye visual acuity before operation was exponential/anterior to 0.7, with a median of 0.3, and the naked eye visual acuity at 1 month after operation was exponential/anterior to 1.5, with a median of 0.7 (rank sum test u =5.435, P<0.01). 5 cases (5 eyes) had postoperative recurrence, with a recurrence rate of 11% (5/46). Conclusion The pathological relationship between primary pterygium and corneoscleral is regular, which provides an objective basis for the selection of microsurgical methods for pterygium; The method of extensive degeneration bulbar fasciectomy combined with autologous conjunctival flap transplantation showed low recurrence rate and significant improvement of visual acuity.

Objective to investigate the expression of cyclooxygenase 2 (COX-2) in pterygium and the related inhibitory effect of its selective inhibitor nimesulide.Methods Pterygium tissue and control normal conjunctival tissue samples were taken from patients who underwent surgical treatment in the Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, and the expression of COX-2 in the tissues was detected by immunohistochemistry. Primary cultured human pterygium fibroblasts (HPF) were identified and treated with basic fibroblast growth factor (bFGF) at concentrations of 0, 1, 10 and 100 ng/ml for 24 h. The expression of COX-2 protein in HPF was detected by Western-blot method. The concentrations of 0, 25, 50, 100 and 200 μ mol/L nimesulide were applied to HPF for 24, 48, 72 and 96 h, respectively. The effects of different concentrations of nimesulide on the proliferation of HPF at different times were detected by tetrazolazole blue reduction (MTT) assay. Results the immunohistochemical results showed that the positive expression rate of COX-2 in pterygium tissue was 70%. Western blot assay showed that the expression of COX-2 protein in HPF was positive under different concentrations of bFGF, and the expression was dose-dependent. MTT test confirmed that nimesulide inhibited the proliferation of fibroblasts dose-dependently and time-dependently, and the concentration of 50 μ mol/L started to inhibit it significantly after 24 hours (P<0.05). Conclusion bFGF can stimulate the proliferation of HPF and induce the upregulation of COX-2 expression in pterygium, which may be involved in the formation of pterygium; The proliferation of HPF was significantly inhibited by nimesulide, a selective COX-2 inhibitor.

Objective to investigate the pathogenic genes of Chinese Meesmann corneal dystrophy families. Methods A family with three generations of corneal dystrophy was diagnosed with detailed clinical genetics, and the genetic pattern and characteristics were determined. Then, the members of the family, including patients and normal people, were examined with detailed ophthalmology, blood samples were obtained, and genomic DNA was extracted. The markers D17S800, D17S930, D12S390 and D12S96 surrounding the known genes KRT12 and KRT3 were scanned respectively, and then the linkage analysis was performed to calculate the maximum log dominance score. The polymerase chain reaction (PCR) amplification products of all exons of the known genes in the linked region were directly sequenced. Results the genetic pattern of corneal dystrophy in this family was autosomal dominant inheritance, and the clinical diagnosis was Meesmann corneal dystrophy. The linked chromosomal microsatellite markers were D17S800 and D17S930, with a score of 2.41 (θ =0.00), which were linked to KRT12 gene. After sequencing all 8 exons, it was found that the mutation of 419 base of exon 1 (T419A) of this gene was found, and the encoded leucine mutation was histidine (L132H). Conclusion The mutation of KRT12 gene (T419A, L132H) may be the molecular basis of the pathogenesis of Meesmann corneal dystrophy in this Chinese family.

Objective to investigate the clinical effect of intravitreal injection of bevacizumab (Avastin) in the treatment of wet age-related macular degeneration (ARMD). Methods A single-center non-randomized controlled clinical study was performed. Five patients with ARMD who were diagnosed with subfoveal choroidal neovascularization (CNV) by fluorescein fundus angiography (FFA) and coherence optical tomography (OCT) were collected. The best corrected visual acuity of the affected eyes was less than 0.1, and there were no systemic or local contraindications for surgery. The visual acuity, intraocular pressure, FFA and OCT of the affected eyes were recorded before and after surgery by intravitreal injection of bevacizumab at 1.5 mg (0.06 ml). The follow-up time was 4~6 months. Results There were no intraocular or systemic adverse reactions in all patients. One patient had transient intraocular pressure increase on the third day after surgery, and the symptoms were controlled after local intraocular pressure lowering drugs. One patient had a visual acuity increase from 0.1 to 0.4 at 1 week after surgery, and 4 patients had a visual acuity increase of 1~6 lines at 2 months after surgery, including 3 patients at 4 months after surgery Conclusion Intravitreous injection of bevacizumab in the treatment of wet ARMD is safe and has few side effects. It can improve the visual function of patients, reduce macular edema and CNV leakage. It is expected that it will be a new method for the treatment of ARMD, but a multi-center large sample clinical randomized controlled study is needed.

Objective to investigate the development of cataract surgery in Qingdao Eye Hospital in the past 10 years and the changes of eye disease prevention and treatment consciousness and quality of life of urban residents and suburban farmers in Qingdao.Methods Retrospectively investigate the age, lens hardness, occupation, preoperative and postoperative visual acuity, surgical methods and main surgical complications of patients who underwent surgical treatment for age-related cataract in Qingdao Eye Hospital in 1994, 1999 and 2004, and compare the changes of various indexes in different years to understand the changes and significance of various indexes in the past 10 years. Results In 1994, 338 cases underwent age-related cataract surgery, including 34 cases (10.06%) in suburban farmers in Qingdao; 36 cases (10.65%) underwent phacoemulsification cataract aspiration; The patients under 60 years old, 60-69 years old, 70-79 years old and over 80 years old accounted for 12.34%, 33.14%, 33.43% and 21.01%, respectively; 11.83%, 27.51% and 60.66% of patients with nuclear stiffness of grade Ⅲ and beneath grade Ⅲ, grade Ⅳ and grade Ⅴ, respectively. The main complication of operation was anterior chamber inflammatory reaction (16.86%). In 1999, 460 cases of age-related cataract surgery were performed, including 95 cases (20.65%) in suburban farmers; 180 cases (39.13%) underwent phacoemulsification cataract aspiration; The patients under 60 years old, 60-69 years old, 70-79 years old and over 80 years old accounted for 14.13%, 35.22%, 31.96% and 18.70%, respectively; In 2004, 499 patients underwent age-related cataract surgery, including 112 cases (22.44%) in suburban farmers; 396 cases (79.36%) underwent phacoemulsification cataract aspiration; The patients under 60 years old, 60-69 years old, 70-79 years old and over 80 years old accounted for 19.44%, 36.47%, 30.66% and 13.43%, respectively; The major surgical complications were corneal edema (6.41%) and posterior lens capsule rupture (6.21%). Conclusion The results of this survey show that the number of age-related cataract patients undergoing surgical treatment in our hospital has increased year by year in the past 10 years, and the proportion of suburban farmers has increased significantly. The age of patients undergoing surgical treatment has been younger, and the proportion of patients with hard core and overmature cataract and visual acuity significantly affected has decreased year by year. At the same time, the technique of phacoemulsification of cataract has become increasingly popular and mature, which reflects that with the rapid development of national economy, the continuous progress of various social undertakings and the improvement of the overall quality of the whole people in Qingdao in the past 10 years, the people's medical and health level has improved, and the consciousness of self-protection and eye health care has increased.

Objective to investigate the effect of interleukin-2 (IL-2) on apoptosis of lens epithelial cells during non-infectious early intraocular inflammatory response. Methods New Zealand male white rabbits were randomly divided into control group, experimental group (intraocular iron powder foreign body group) and experimental control group (intraocular iron powder foreign body group + anterior chamber injection water-soluble IL-2 receptor group), 8 eyes in each group. The anterior chamber inflammatory response of rabbits in each group was observed at 3, 5, 7 and 10 days after operation, and the level of IL-2 in the anterior chamber of each group was measured. Tissue sections of rabbits in three groups were made, and information transduction and transcription activator (STAT) 1, STAT3 staining and TUNEL staining were performed. Results Compared with the experimental control group, the anterior chamber inflammatory response in the experimental group was obvious after operation, and the level of IL-2 in the anterior chamber was significantly increased. The STAT3 staining in the experimental group was strong positive and TUNEL staining was weak positive. Conclusion Lens epithelial cells can undergo apoptosis in the early stage of non-infectious inflammatory reaction. IL-2, as an acute inflammatory reaction factor, activates STAT3 to protect lens epithelial cells from apoptosis and alleviate the damage of tissue inflammatory reaction.

Objective to investigate the histocompatibility of xenogeneic (porcine) acellular dermal matrix (Xeno-ADM) implanted into rabbit eyelids. Methods 38 healthy New Zealand white rabbits were randomly divided into experimental group and control group. The 5 mm ×4 mm full-thickness tarsal plate of lower eyelid was removed, and Xeno-ADM and allogeneic sclera were implanted respectively. The general conditions were observed. At 1, 2, 4, 6, 8, 12 and 16 weeks after operation, the junction of the graft was taken, and the histological changes were observed under HE staining light microscope. At the same time, the concentrations of interleukin-2 (IL-2) and interleukin-6 (IL-6) were detected by radioimmunoassay in centrifuged serum and supernatant of graft tissue homogenate. Results After Xeno-ADM implanted into rabbit eyelids, the inflammatory reaction was mild, the vascularization and new collagen growth were fast, and the graft and normal tissue were well compatible. The mean width and height of palpebral fissure were measured in all animals (n =10) at 16 weeks after operation. There was no significant difference between the experimental group, the control group and the normal group (P>0.05). The changes of IL-2 and IL-6 in the graft tissue homogenate were as follows: the concentration of IL-2 in the experimental group was 0.292 81 mg/L at 6 weeks, IL-6 was 118.258 ng/L at 8 weeks, IL-2 in the control group was 0.277 99 ng/ml at 8 weeks, and IL-6 was 255.871 pg/ml at 8 weeks), which decreased to a very low level at 12 weeks, but rose at 16 weeks. The concentration of IL-2 in the control group reached the second peak (IL-2 was 1.363 41 ng/ml, IL-6 was 622.863 pg/ml), which was significantly higher than the first peak. The changes of IL-2 and IL-6 in peripheral blood showed a fluctuating increasing trend, with a significant peak at 4 to 8 weeks after implantation, and it was similar to the changes of inflammatory reaction in the implantation area; Using repeated measures analysis of variance, it was found that the effects of treatment factors and time factors on serum IL-2 and IL-6 levels in the two groups were not statistically significant (P>0.05). Conclusion Xeno-ADM has good histocompatibility after implantation into eyelid of rabbits, and high levels of IL-2 and IL-6 can be detected locally and systemically. Compared with allogeneic sclera, the dynamic changes of IL-2 and IL-6 are not statistically significant.

Objective to investigate the expression of stromal cell-derived factor (SDF-1) in the retina of diabetic animal models. Methods 34 healthy adult male Wistar rats were randomly divided into 3 groups: control group (CON, n =8), 2 months (DM2M, n =14) and 3 months (DM3M, n =12). Streptozotocin (STZ) was injected intraperitoneally to prepare diabetic animal models. Retinal anti-SDF-1 immunohistochemical staining was performed in each group, and the integrated absorbance per unit retinal area (IOD/AOI) was measured by microscopic observation and semi-quantitative image analysis. The co-expression of SDF-1 and hypoxia-inducible factor (HIF-1) in diabetic retina was studied by immunofluorescence tissue staining double label.Fluorescence real-time quantitative RT-PCR was used to determine the contents of SDF-1 mRNA in the retinal neuroepithelium of DM2M group (n =4) and CON group (n =2). After β-actin correction, t-test was used to compare between groups.Results The expression of SDF-1 in the retinal neuroepithelium of rats in each group was found in immunohistochemical sections, and the difference between the normal control group and the diabetic group was statistically significant (z = -3.359, P<0.001). The double expression of SDF-1 and HIF-1 was found in some inner retinal cells. Real-time quantitative RT-PCR confirmed that the contents of SDF-1 mRNA in the retinal neuroepithelium of diabetic rats were increased compared with the control group (t =2.33, P<0.05). Conclusion Experimental diabetes mellitus can increase the expression of SDF-1 in the retinal neuroepithelium, and its expression may be related to the transcription factor HIF-1.

Objective to investigate the effect of 1% lidocaine without preservative on rabbit lens epithelial cells (LECs), and to provide experimental evidence for seeking effective drugs to remove epithelium and prevent capsular opacity during cataract surgery. Methods Twenty-nine rabbits (58 eyes) were collected and divided into three groups: control group without drug treatment, BSS group with BSS for 1 min, lidocaine group with lidocaine for 1 min, then trypanosome blue-alizarin red staining, microscopic photography, observation of LECs activity and counting of dead cells; The histopathological changes of LECs in rabbits were observed by HE staining and transmission electron microscopy.Trypanosome blue-alizarin red staining and dead cell count in 15 rabbits (30 eyes): 5 rabbits (10 eyes) in control group, 5 rabbits (10 eyes) in BSS group and 5 rabbits (10 eyes) in lidocaine group; Nine rabbits (18 eyes) were stained with HE: 1 rabbit (2 eyes) in the control group, 4 rabbits (8 eyes) in the BSS group and 4 rabbits (8 eyes) in the lidocaine group; Transmission electron microscopy was performed on 5 rabbits (10 eyes), including 1 rabbit (2 eyes) in the control group, 2 rabbits (4 eyes) in the BSS group and 2 rabbits (4 eyes) in the lidocaine group. Results the mortality rate of epithelial cells in the anterior lens capsule and the epithelial cells in the equatorial capsule in the control group was (1.51±0.39) %; In the BSS group, the mortality rate of epithelial cells in the anterior capsule of lens was (1.78 ± 0.50) %, and the mortality rate of epithelial cells in the equatorial capsule was (1.77 ± 0.47) %; The mortality rate of anterior capsule epithelial cells in lidocaine group was (13.01±4.67) %, and the mortality rate of equatorial capsule epithelial cells was (9.59±3.35) %. The cell mortality rate in lidocaine group was significantly higher than that in control group and BSS group (P<0.05). HE staining showed that LECs in control group and BSS group were still attached to the capsule, but no obvious pathological changes were observed. Some cells in lidocaine group had gaps between the capsule and the capsule, and the cells were vacuolated and degenerated. Under transmission electron microscope, the connection between cells and capsule was intact in control group and BSS group. Some cells in lidocaine group and the connection between cells and capsule were destroyed, and the cells were shed more and arranged loosely. The cell membrane collapsed, a large number of vacuoles formed in cytoplasm, and the cell structure was destroyed. Conclusion 1% lidocaine without preservative can release the connection between LECs and between cells and lens capsule in rabbits, and can lead to degeneration and death of LECs.

Epidermal growth factor and its receptor family are important regulatory factors of cell growth and differentiation.It has been proved that the members of the epidermal growth factor family can be expressed continuously in tears, and its receptor can be expressed in ocular surface epithelium.It is of great significance to maintain the integrity of ocular surface and promote the wound healing of corneal tissues.The role of epidermal growth factor and its receptor family in ocular surface wound healing is reviewed.

Choroidal neovascularization (CNV) caused by multiple etiologies is one of the most common causes of central vision loss in patients. In recent years, photodynamic therapy (PDT) has been mainly used for the treatment of subfoveal CNV. Recently, drugs aiming at neovascularization and inflammatory reaction process of CNV lesions have been applied in clinic. The future development trend may be the combination of multiple therapeutic mechanisms in order to obtain the maximum efficacy and reduce complications.

With the establishment of the Health Management Branch of Chinese Medical Association, the Chinese Journal of Health Management will be launched in October 2007. So far, there is a new member in the family of Chinese Medical Association series magazines. She will become a good mentor and friend of workers and health managers engaged in health management. Health management is an emerging interdisciplinary, interdisciplinary, comprehensive and applied discipline. It involves many disciplines such as preventive medicine, clinical medicine, nutrition, kinesiology and traditional Chinese medicine, and its main research scope is the maintenance and promotion of health and chronic diseases and their outcomes. China urgently needs a platform to demonstrate the theoretical research level of Chinese health management and exchange practical experience, and the founding of China Health Management Journal can just promote this exchange and promote the development of China's health management.

In response to the clinical, scientific research and teaching needs of ophthalmologists, version 5.0 (CD database) of ophthalmic electronic tools produced by Beijing Zhitong Blueprint Medical Information Technology Co., Ltd. and published by Tsinghua Tongfang CD-ROM Electronic Publishing House is now officially released by Beijing Zhitong Blueprint Medical Information Technology Co., Ltd.

Jointly sponsored by the Department of Ophthalmology of Peking Union Medical College Hospital and the Chinese Journal of Ophthalmology of Chinese Medical Association, the "2007 National Study Class on Clinical and Basic Progress in Neuroophthalmology" was successfully held in Beijing from August 11 to 15, 2007. More than 100 ophthalmologists from all provinces, municipalities and autonomous regions across the country participated in the study. Professor Lao Yuanyuan, the founder of China's neuroophthalmology, delivered a warm speech at the opening ceremony, encouraging the students to work diligently to promote the development of China's neuroophthalmology. This class was co-chaired by Professor Zhong Yong of the Department of Ophthalmology of Peking Union Medical College Hospital and Director Huang Yibin of the editorial department of Chinese Journal of Ophthalmology.

The 2007 American Academy of Ophthalmology/International Refractive Surgery Association Conference and the 9th Academic Conference of the Cataract Group and the 2007 Refractive Group of the Ophthalmology Branch of the Chinese Medical Association jointly organized by the American Academy of Ophthalmology, the Ophthalmology Branch of the Chinese Medical Association and the Asia Pacific Society of Cataract Refractive Surgery were held in Beijing International Convention Center from May 25 to 27, 2007. The conference was co-chaired by Ronald R. Krueger of the American Academy of Ophthalmology and Professor Zhao Jialiang of China. More than 600 ophthalmologists from all over the world attended the conference. The topic of the conference was surgical treatment of cataract and refractive surgery.

deep lamellar keratoplasty (DLKP) is a newly developed procedure in recent years, which was first reported by Melles et al. [1].

Gap junction is a specific cell membrane structure, which directly connects the cytoplasm of adjacent cells, regulates the bidirectional flow of ions, metabolites and small molecules with relative molecular mass less than 1000 between adjacent cells [1-2], and regulates cell proliferation, differentiation and regeneration [3].

The recovery of visual function after cataract surgery is one of the problems that need attention after cataract surgery. Multifocal intraocular lens (IOL) is widely concerned because it can improve the distance and near vision at the same time. Good distance and near vision is accompanied by the recovery of other visual functions. At present, there are few studies on the changes of stereoscopic function after multifocal IOL implantation.

Corneoscleral laceration accounts for a large proportion of ocular trauma, but corneoscleral laceration with tissue defect is rare, and the wound is difficult to treat. In April 2006, we treated a patient who repaired the tissue defect of adjacent corneoscleral limbus with inverted in situ lamellar scleral flap, and achieved good curative effect.

The patient was a 6-year-old male whose right eye was whitening for 3 years and aggravated for 1 year. He came to our hospital on April 28, 2007. The patient had been scratched by nails in his right eye 3 years ago, and he had photophobia and tears. After drug treatment, the symptoms were relieved, and no corneal abnormalities were found. Half a year later, white spots appeared on the cornea, but there was no other discomfort except visual acuity decrease. He had been dripping anti-infection and corneal repair eye fluid for a long time; In the past six months, the white spots have gradually become larger.

Erosive corneal ulcer is a kind of chronic progressive corneal ulcer with painful sensation. The exact cause is unknown. Both humoral and cellular immune responses are involved in the pathological process of the disease.