Volume 43 ·  Issue 11 ·  2007

Our investigation found that the lower limit of 5% visual acuity reference value of healthy children aged 3~6 years is lower than 0.70. The corrected visual acuity is lower than 0.9 as the diagnostic criterion for amblyopia is too high for young children, and some young children with developing visual acuity are diagnosed as amblyopia, resulting in the misdiagnosis and mistreatment of millions of children. If the influence of young children's age is not correctly considered, the referral rate and false positive rate can increase, and the cost of screening and the financial burden of parents can be increased. Therefore, it is suggested that different visual acuity standards should be adopted for children of different age groups when diagnosing amblyopia.

In order to conduct scientific research, the choice of subject is very important. How to choose a subject well, the author's experience is to do a good theme, two essentials, three kinds of thinking and four measures. One theme is innovation. The source of innovation comes from association, and association is based on extensive knowledge and good summarization. The two essentials are practical essentials and nail essentials. The three kinds of thinking are associative thinking, logical thinking and reverse thinking. The four measures are reading measure, practice measure, consultation measure and negative measure.

Objective to evaluate the effectiveness, safety and stability of posterior chamber intraocular lens implantation in phakic eyes in the correction of high myopia. Methods 113 patients (216 eyes) with high myopia from January 1997 to December 2005, with an average age of 30 years, were treated with peribulbar anesthesia and topical anesthesia and implanted with posterior chamber intraocular lens (15 cases of ICL V2, ICL V4, STAAR, USA) through a 3.2 mm clear corneal incision. The follow-up contents included naked eye visual acuity, best corrected visual acuity, corneal topography, diopter, slit lamp microscopy, intraocular pressure, corneal endothelial count, etc. The equivalent spherical diopter was (17.78 ± 3.88) d before operation. The refractive status was observed after 18.2 months of follow-up, and the postoperative complications were observed after 24.3 months of follow-up. Results All operations were successful, and the naked eye visual acuity of all patients was significantly improved. The equivalent spherical diopter was (-1.00 ± 1.40) d at the last follow-up, which was the same as expected There were 165 eyes (76.4%) within ±0.50 D, 151 eyes (77.8%) with preoperative diopter less than-20.00 D, 145 eyes (96.0%) with diopter less than ±1.00 D and 128 eyes (84.8%) with diopter less than ±0.50 D. There was no significant difference in diopter during the follow-up period (P>0.05), 168 eyes (77.8%) with optimal corrected visual acuity increased by 1 line or more, 4 eyes (1.85%) with 1 line decreased, 4 eyes (1.85%) with pupillary block glaucoma requiring surgical treatment, 3 eyes (1.39%) with anterior subcapsular opacity, all underwent intraocular lens extraction, extraction and intraocular lens implantation, and the optimal corrected visual acuity did not decrease after surgery. Conclusion Posterior chamber intraocular lens implantation in phakic eyes is effective, safe and stable in correcting high myopia.

Objective to investigate the etiology, prognosis and prognostic factors of penetrating keratoplasty (PKP) in children. Methods A total of 236 cases (257 eyes), aged less than 14 years (3 months to 14 years), who underwent PKP or PKP combined with other operations due to corneal abnormalities for various reasons, were treated in Qingdao Eye Hospital of Shandong Institute of Ophthalmology from June 1994 to June 2004. A total of 266 times of PKP were followed up from 6 months to 9 years and 5 months, with an average of (21 ± 13) months. The etiology of PKP in children, the results of postoperative follow-up observation and the factors affecting the prognosis of PKP were retrospectively analyzed. Results The etiology of PKP in children was congenital, developmental and genetic corneal diseases (99 eyes, 38.5%), corneal diseases related to corneal trauma (82 eyes, 31.9%) and corneal diseases related to keratitis (76 eyes, 29.6%) The transparency rate of PKP alone corneal grafts was 71.5% (138/193), and that of PKP combined with other operations was 71.2% (52/73). There was no significant difference between the two (x2=0.002, P =0.965); The transparency rate of corneal graft was 50% (24/48) in binocular surgery and 76.1% (166/218) in monocular surgery, and the difference between them was statistically significant (x2=13.178, P =0.000). In 9 cases (12 eyes), the transparency rate of corneal graft was 38.1% (8/21) after 21 repeated PKP, and the difference between the transparency rate of corneal graft after one PKP (74.3%, 182/245) was statistically significant (x2=12.413, P =0.000). Conclusion Congenital, developmental and genetic corneal diseases are the main causes of PKP in children; The prognosis of surgery is influenced by many factors, such as the etiology of surgery, the age of onset, whether to combine vitreous surgery and whether to operate binocular surgery.

Objective to investigate the expression and new mutations of Bcl-10 gene in ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma, atypical lymphoid tissue hyperplasia and lymphoid tissue reactive hyperplasia in Chinese population.Methods Fresh frozen tissue samples of 31 patients from ophthalmology department of Changzheng Hospital affiliated to Second Military Medical University were collected, including 23 cases of ocular adnexal MALT lymphoma, 4 cases of atypical lymphoid tissue hyperplasia and 4 cases of lymphoid tissue reactive hyperplasia.Bcl-10 gene was obtained by molecular biology methods.DNA sequencing by dideoxysanger method and Blast analysis were performed to obtain the mutant bases.At the same time, immunohistochemical detection and immunofluorescence localization were performed, and the co-localization of Bcl-10 and NF-κ B was detected by laser confocal microscopy.Results Among 31 cases, 14 cases of ocular adnexal MALT lymphoma were detected with Bcl-10 gene expression, and new gene mutations were found in 10 of them. In 4 cases of atypical lymphoid tissue hyperplasia and 4 cases of lymphoid tissue reactive hyperplasia, The abnormal expression of Bcl-10 gene was found in 14 cases of MALT lymphoma by immunohistochemistry (60.8%), of which 6 cases had moderate intensity nuclear expression, 8 cases had weak to moderate intensity cytoplasmic expression, 2 cases had abnormal expression of Bcl-10 in the cytoplasm of dysplasia, and 1 case had abnormal expression of Bcl-10 in the cytoplasm of reactive hyperplasia. Immunofluorescence mapping showed that the response factor I κ α of NF-κ B was diffusely expressed in 20 cases of MALT lymphoma, of which 14 cases had co-expression of Bcl-10 and I κ α. Conclusion Bcl-10 gene has a new mutation in the ocular adnexal MALT lymphoma in China, and the detected gene mutation distribution is consistent with the pathological diagnosis. The sensitivity of gene detection is higher than that of pathological diagnosis, and it can judge the stage and nature of the lesion without morphological changes and other indicators for differentiation, which can be used as one of the sensitive indicators for early diagnosis.

Objective to investigate the uptake of lipofuscin fluorescent group N-subretinyl-N-retinyl ethanolamine (A2E) by adult retinal pigment epithelium (hRPE) cells and the role of A2E in blue light damage of hRPE cells. Methods A2E was synthesized in vitro by mixing all-trans retinal and ethanolamine. hRPE cells were cultured in vitro. A2E was added to hRPE cell culture medium, and the concentration of A2E was 25, 50 and 100 μ mol/L, respectively. The hRPE cells were irradiated with blue light (450 nm) for 20 min, the light intensity was 70 mW/mm, the cell viability was detected by CCK-8, and the cell apoptosis was detected by Hoechst 33342 fluorescein staining and flow cytometry. Results 53.8 mg of A2E was produced by mixing all-trans retinal (100.0 mg) and ethanolamine (9.5 mg). Autofluorescence could be detected in hRPE cells phagocytosing A2E, which mainly distributed around the nucleus. After blue light irradiation, the viability of hRPE cells containing A2E decreased, and the degree of decrease increased with the increase of A2E concentration. After blue light irradiation, the cell viability of hRPE cells without A2E did not decrease significantly. After blue light irradiation, the nucleus of hRPE cells containing A2E showed dense stained fragment fluorescence, and the characteristic sub-diploid peak of apoptotic cells was detected by flow cytometry. When 25 μ mol/L A2E was added, the apoptosis rates of hRPE cells were (12.11 ± 2.32) %, (31.21 ± 3.72) %, (64.23 ± 3.53) % and (58.71 ± 3.48) % at 12, 24, 36 and 48 h after light irradiation, respectively. The apoptosis rates of hRPE cells receiving only light without A2E and without light (with or without A2E) were less than 5% at each time point after light irradiation. Conclusion During the process of blue light damage of hRPE cells, light irradiation alone would not cause obvious cell damage or apoptosis

Objective to investigate the effect of hypoxia-inducible factor-1 α (HIF-1 α) on the expression of vascular endothelial growth factor (VEGF) in human retinal pigment epithelium (hRPE) cells under hypoxic conditions. Methods Small hairpin loop RNA (shRNA), one of the targets of HIF-1 α mRNA sequence, was synthesized by in vitro transcription method, and the hypoxic environment of RPE cells was simulated by chemical hypoxia inducer CoCl2. RNA interference was performed on HIF-1 α in hRPE cells under hypoxic conditions. The expression of HIF-1 α and VEGF mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR), and the levels of HIF-1 α and VEGF protein were detected by immunoblotting. The silencing effect of HIF-1 α gene and the inhibition of VEGF expression were observed in normal group, hypoxic group and negative transfection group as controls. Results After transfection of specific shRNA of HIF-1 α mRNA, the results of RT-PCR showed that the silencing effect of HIF-1 α gene in hRPE cells under hypoxic conditions was 77.1%, and the expression of VEGF mRNA was high The results of immunoblotting showed that the levels of HIF-1 α and VEGF protein were significantly reduced. Conclusion the shRNA targeting HIF-1 α mRNA can effectively silence HIF-1 α gene and inhibit the upregulation of VEGF by hypoxia.

Objective to investigate the inhibitory effect of pSuperH1-SIHIF-1 α eukaryotic expression vector on the expression of hypoxia-inducible factor-1 α (HIF-1 α) and the difference of vascular endothelial growth factor (VEGF) expression induced by this vector under normal oxygen and hypoxic environment.Methods pSuperH1-SIHIF-1 α eukaryotic expression vector was constructed, and pSuperH1-SIHIF-1 α stable transfected cell line was established.The cell line with the highest inhibitory efficiency of HIF-1 α mRNA was screened by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR), and then cultured with control cells under normal oxygen (20% O2) and hypoxic environment (1% O2). The inhibitory effect of pSuperH1-SIHIF-1 α on HIF-1 α and VEGF expression was detected by semi-quantitative RT-PCR, immunoblotting and ELISA under normal oxygen and hypoxic environment.Results pSuperH1-SIHIF-1 α significantly inhibited the expression of HIF-1 α and VEGF mRNA and protein under hypoxic environment.In normal oxygen environment, pSuperH1-SIHIF-1 α significantly inhibited the expression of HIF-1 α and VEGF mRNA and protein PSuperH1-SIHIF-1 α may provide a new pathway for gene therapy of retinal neovascularization.

Objective to investigate the changes of binocular vision before and after surgery in patients with intermittent exotropia, so as to provide evidence for choosing a reasonable operation time.Methods 171 patients with intermittent exotropia were divided into two groups according to the age of surgery,<9 years old group 1 and ≥9 years old group 2. The distant and near binocular vision before and after surgery were examined and analyzed and compared.Results The reconstruction rate of normal near binocular vision after surgery was 40.0% in group 1 and 63.8% in group 2 (P =0.002); However, the reconstruction rate of group 1 and group 2 after operation was 53.1% and 23.8% (P =0.032), and the reconstruction rate of distant binocular vision after operation was 98.2% in group 1 and 81.9% in group 2 (P =0.027), 96.4% in group 1 and 84.5% in group 2 (P =0.024), 81.8% in group 1 and 73.3% in group 2 (P =0.844); Logistic correlation test showed that the prognosis of surgery was correlated with the near binocular vision before operation and the age of onset (P<0.01). Conclusion Surgical treatment was very effective in reconstructing the distant and near binocular vision in both groups. The age of onset had some influence on the formation and recovery of binocular vision after operation. Therefore, the children with onset age earlier than 4 years old should be operated as soon as possible, and the patients with intermittent exotropia who have crossed the sensitive stage of visual development after 4 years old should be operated as soon as possible within 9 years old to improve the reconstruction of normal distant binocular vision.

Objective to investigate the new surgical method and effect of medial and lateral rectus retrogression combined with Y-shaped separation in the treatment of Duane regression syndrome.Methods Eight patients with Duane regression syndrome were treated by surgery. Among the 7 patients with forward Duane regression syndrome, 6 patients underwent medial and lateral rectus retrogression combined with Y-shaped separation, and 1 case underwent lateral rectus retrogression combined with Y-shaped separation; A patient with reverse Duane retroglobular syndrome was followed up for 1~12 months, and the changes of eye position, eye movement and compensatory head position were observed. Results the compensatory head position, rapid upward or downward rotation disappeared; Regression of eyeball and decrease of palpebral fissure were improved; Conclusion Internal and external rectus retrogression combined with Y-shaped separation can effectively treat Duane regression syndrome, and achieve the goal of correcting strabismus, correcting head position and eliminating regression.

Objective to establish a three-dimensional model of rectus trochlea in human eyes by digitalization and visualization. Methods the sequential coronal tissue sections of the whole orbit stained by Masson were taken by digital camera and input into the computer one by one. The three-dimensional model of rectus trochlea system, eyeball, four rectus muscles and orbital wall were reconstructed by using 3D-Doctor software by positioning and segmenting the images. At the same time, the rectus trochlea and related tissue structures were measured and analyzed by 3D-Doctor software. Results The three-dimensional model of rectus trochlea in human eyes visually showed the three-dimensional relationship between rectus trochlea system and eyeball, rectus muscle and orbital wall. The three-dimensional model can rotate around any axis, which is convenient for multi-angle observation. The reconstructed three-dimensional structure can be selectively demonstrated, so as to eliminate interference and lock the target observation. The measurement results show that the length of each rectus trochlea is 4.6~5.8 mm, and the distance from the beginning to the corneoscleral limbus is 13.8~18.0 mm, among which the medial rectus trochlea is the widest and thickest, The ratio of the thickness of the medial rectus trochlea to the corresponding muscle thickness can reach up to 1.11. Conclusion the three-dimensional rectus trochlea model provides a visual image for clinicians to understand the structure of the rectus trochlea in human eyes; It provides three-dimensional anatomical basis for the imaging study of rectus trochlea, and the measurement data of rectus trochlea and related tissue structure will help to establish a three-dimensional visualization database of rectus trochlea in human eye.

Objective to investigate the relationship between strabismus surgery volume and correction effect in patients with thyroid-related ophthalmopathy (TAO). Methods All cases of strabismus correction surgery in patients with thyroid-related ophthalmopathy diagnosed and treated by the author in Sun Yat-sen Ophthalmology Center of Sun Yat-sen University from January 1999 to March 2006 were retrospectively analyzed. Results A total of 30 cases (32 eyes) of TAO patients needed surgical correction due to strabismus, including 19 males and 11 females; The mean age was 49.4 years; Among the 32 eyes, 10 eyes underwent inferior rectus retrogression, 10 eyes underwent superior rectus retrogression, 6 eyes underwent medial rectus retrogression, 3 eyes underwent superior rectus tendinotomy, 2 eyes underwent inferior rectus retrogression combined with medial rectus retrogression, and 1 eye underwent superior rectus retrogression combined with medial rectus retrogression. Of the 32 eyes, 30 eyes were completely corrected, and the postoperative orthopedic rate was 93.75%. The average correction amount per millimeter was (3.93±1.67) °/mm in 28 eyes of 29 eyes who underwent rectus retrogression. The minimum correction amount of superior rectus was (2.63±0.83) °/mm, the maximum correction amount of medial rectus was (5.33±1.46) °/mm, and the correction amount of inferior rectus was (4.11±1.55) °/mm. For strabismus ≤15°, the correction amount was (2.30±1.09) °/mm; For the strabismus degree of 16° ~30°, the correction amount was (3.56±0.79) °/mm; The correction amount of strabismus is (6.02±1.01) °/mm in patients with strabismus>30°. Conclusion the unit correction amount of strabismus in TAO patients is greater than that of other types of strabismus; With the increase of strabismus, the amount of correction per millimeter increased, but the quantitative quality of surgery was still poor, and it was difficult to predict the surgical effect.

Retinal neovascularization (RNV) is one of the most important causes of blindness at present, and there is no specific cure so far. Pigment epithelium-derived factor (PEDF) is a newly discovered effective natural inhibitor of intraocular neovascularization, which plays an important role in regulating the formation and development of neovascularization. The results show that the application of recombinant PEDF protein or intraocular gene transfer of PEDF can significantly inhibit the formation of RNV, which opens up a new way for the treatment of retinal neovascular diseases such as diabetic retinopathy, retinopathy of premature infants and central retinal vein occlusion. Therefore, it is necessary to review the biological situation of PEDF, the characteristics and mechanism of its inhibitory effect on neovascularization and its application prospect in the prevention and treatment of retinal neovascularization.

Nanotechnology is the product of the combination of modern science and advanced engineering technology, which involves almost all the existing scientific and technological fields. The main applications in ophthalmology field include using nanotechnology to observe and analyze the tissue morphology, structure, physiology and pathological phenomena of the eye; Using the targeting, sustained release and controlled release properties of nano-drug carriers, they have been successfully applied to the clinical treatment and laboratory research of various ophthalmic diseases; Nano-biomaterials have good prospects in tissue repair and prosthesis fabrication; Using nanotechnology to assist in diagnosis, as a gene therapy carrier, etc.

central serous chorioretinopathy (CSC) is a common fundus disease in healthy young and middle-aged people. The clinical manifestations of patients are visual decrease, vision deformation and darkening, and idiopathic macular serous neuroepithelial detachment is the characteristic.

Lacrimal canaliculus rupture is a common ocular trauma. In order to reconstruct its tear-conducting function, the conventional treatment is lacrimal canaliculus anastomosis. Clinically, due to the different location and degree of trauma, it is sometimes difficult to find the nasal end of the lacrimal canaliculus during the operation, and lacrimal canaliculus anastomosis can not be performed directly. Since 1998, 18 patients (18 eyes) who did not find the nasal end of the lower lacrimal canaliculus were treated with superior canaliculus transplantation and lower canaliculus anastomosis, and the results were satisfactory.

Case 1: A 21-year-old male was diagnosed in our hospital for the first time on September 4, 2001, due to the decrease of visual acuity in his right eye for 7 days. Except that he had a history of alcoholism (acute respiratory distress syndrome) with alcoholism 1 year ago, other medical history was denied.

Approved by China Association for Science and Technology, the "8th International Conference on Ophthalmology and Optometry" jointly sponsored by Shanghai Medical Association Ophthalmology Branch, East China Medical Association Ophthalmology Branch, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, Optometry Group of Ophthalmology Branch of Chinese Medical Association, Optometry College of Wenzhou Medical College and China International Science and Technology Conference Center will be held in Nanjing International Convention and Exhibition Center from April 3 to 6, 2008. At that time, ophthalmology and optometry experts, scholars and well-known manufacturers from South Korea, Japan, the United States, European countries, Hong Kong, Macao and Taiwan will gather in Nanjing. Conference website: http: / /www.cooc.cn.

The 10th National Conference on Ophthalmic Pathology and Clinical Diagnosis and Treatment Technology, co-sponsored by the Ophthalmic Pathology Group of Ophthalmology Branch of Chinese Medical Association and the Editorial Board of Chinese Journal of Ophthalmology, will be held in Sanya, Hainan Province from November 23 to 26, 2007. This conference aims to demonstrate the latest developments in ophthalmic pathology diagnosis technology to ophthalmic pathologists and ophthalmologists interested in ophthalmic pathology, strengthen academic exchanges between ophthalmologists across the country on ophthalmic pathology, strengthen knowledge exchange between pathologists and clinical ophthalmologists, and promote basic and clinical research in ophthalmology. The conference has the following topics: (1) basic knowledge training of ocular pathology; (2) Clinical application and case discussion of ophthalmic pathology; (3) Basic clinical research; (4) Technical exchange of clinical diagnosis and treatment. Ophthalmologists and graduate students from all over the country are welcome to participate.

The first International Symposium on Uveitis will be held in Guangzhou from November 30 to December 1, 2007. This conference was sponsored by the State Key Laboratory of Ophthalmology of Sun Yat-sen Ophthalmology Center of Sun Yat-sen University, the Uveitis Research Center of Sun Yat-sen University and the International Uveitis Research Laboratory of Guangdong Province, and co-organized by the Ocular Immunology Group of Ophthalmology Branch of Chinese Medical Association. The conference invited well-known foreign uveitis experts, such as Jerry Niederkorn, Jim Rosenbaum and ChiChao Chan of the United States, Puhc Lehoang of France and Shigeaki Ohno of Japan to give special presentations.

Type A1 Question 1. Pentacam anterior segment analysis system can achieve functions, not including A, corneal thickness measurement B, corneal anterior and posterior surface topography measurement C, anterior chamber volume measurement D, intraocular lens position observation E, eye axis measurement

Since the first national sample survey of the disabled in 1987, with the continuous development of China's economy and the improvement of people's living standards, the situation of the disabled in China has changed to varying degrees. In order to grasp the number, structure, regional distribution, causes of disability and the actual situation of rehabilitation, employment, education and family of the disabled in China, the second national sample survey of the disabled was carried out in 2006-2007 with the approval of the State Council. The results of this survey are directly related to the cause of the disabled and the formulation of the national economic and social development strategic plan.