Volume 44 ·  Issue 01 ·  2008

On the occasion of 2008, on behalf of the editorial board and the editorial department of Chinese Journal of Ophthalmology, I would like to express my sincere gratitude and congratulations for the New Year to the authors and editors who have made important contributions to this journal, to the readers and groups who have long supported and cared about this journal, to the fellow ophthalmologists in China and the academic groups of ophthalmology at home and abroad!

Diabetic retinopathy(DR)is one of the most important causes of blindness in China as well as in the world.Recent years.the screening of DR and the therapy based on the evidence-based medicine are emphasized for effectively controlling the increase of the prevalence of DR.Extensive screening of DR in the community and secondary hospitals,periodic follow-up and evaluation of the patients are the key measures for reducing the rate of the visual impairment.The new international classification of DR is helpful for improving the communication among primary eye care workers,endocrine physicians,and ophthalmologists.The outcomes of several multi-center prospective randomized clinical trials on the photocoagulation,vitrectomy and systematic therapy for DR are useful for the early prevention and management of DR.If the therapy is based on the evidence-based medicine,the visual impairment caused by DR may be controlled effectively.

Diabetic retinopathy is a complication of diabetes which is difficult to reverse and can result in blindness.Ophthalmologists in China are facing quite a challenge according to the weak prevention and treatment system of DR.At present,the emphasis should be placed on the early prevention and treatment,but the appropriate guidelines founded on evidence-based medicine still have been absent.Currently,we should deeply realize the problems existing in early prevention and treatment of DR in China,fully recognize the necessity and importance of it,actively spread the new international classification,adopt the ways of public health,start by primary health care and fully cooperate with different fields of the society to strengthen the practice and research work on the early prevention and treatment of DR.

The 13th International Conference on Ophthalmic Oncology 2007 was held in Siena, Italy from June 26 to 30, 2007. The conference was divided into orbital tumors, eyelid tumors, conjunctival tumors, uveal melanoma and other uveal tumors, retinoblastoma and other retinal tumors, and discussed the latest research trends and hot issues in the field of ophthalmic oncology.

Diabetic retinopathy is a common complication of diabetes mellitus.Studies on the pathogenesis of diabetic retinopathy are important for the prevention and treatment of this disease.Neurodegeneration and microvascular dysfunction are the major events of diabetic retinopathy happened in the early stage of diabetes mellitus.The pathologic changes include neuron apoptosis,release of inflammatory mediators and impaired glutamate metabolism.Diabetic retinopathy has many pathological changes with inflammatory characteristics.Because of the adhesion and migration of the leucocyte,increased permeability of blood vessel,haemodynamic change and many inflammatory mediators involved in the process of diabetic retinopathy,more and more researchers believe that diabetic retinopathy is a chronic inflammatory disease.These studies provide new notion of mechanisms of diabetic retinopathy and theoretical foundation for the treatment of this disease.Further studies on the pathogenesis of diabetic retinopathy can provide novel procedures for the prevention and treatment of this disease.

Intraocular lens power calculation after corneal refractive surgery is complicated.It is common to have a great postoperative deviation with the traditional method.The reasons for IOL power calculation error after corneal refractive surgery are analysed and many solutions are listed in this article,which we hope could provide basis for these patients.

Objecfive To study the consistency of the color fundus photography and fluorescdein angiography for grading the diabetic retinopathy.Methods It was a retrospective case series.The agreement study was conducted in a series of diabetic patients.who were excluded from the mild non-proliferative diabetic retinopathy(NPDR)and the severe proliferative diabetic retinopathy(PDR).Ninety-nine cases (188 eyes)met the selected criteria.Five 50°non-stereoscopic photography for each eye were taken in all cases before FFA was performed.The diabetie retinopathy was graded from the fundus photography and FFA images according to international diabetic retinopathy disease severity scale.The kappa value was calculated according to the grading outcomes from the fundus photography and FFA images to estimate the agreement of the grading outcomes.Results The fundus photography showed 59 moderate NPDR(31.4%),76 severe NPDR(40.4%)and 53 PDR eyes(28.2%)respectively,FFA showed 50 modcrate NPDR(26.6%).72severe NPDR(38.3%)and 66 PDR(35.1%)respectively.The agreement for the grading of DR by the fundus photography and FFA was substantial(κ=0.601).In the evaluation whether it was necessary to implement PRP(more serious than NPDR and PDR),there was higher agreement between them(κ=0.652).Conclusions Five 50°photography can provides the support of the application of PRP for diabetic patients,FFA may be earlier and restively accuracy in the diagnose of diabetic retinopathy.

Objective To investigate the 4-port pars plana vitrectomy in eyes with severe proliferative diabetic retinopathy(PDR).Methods It was a case-control study.Twenty-eight eyes in 27 patients with extensive fibrovascular proliferation associated with PDR were retrospectively collected,who were undergone 4-port pars plana vitreous surgery with bimanual manipulation techniques,such as membrane dissections and enbloc membranectomy.The control group consisted of 30 eyes in 30 patients with PDR which were undergone 3-port pars plana vitrectomy by the same surgeon.Results Twenty-eight eyes were undergone membrane dissection and enbloc membranectomy smoothly during 4-port pars plana vitrectomy,2 iatrogenic holes occurred in 1 eye.During the follow up 7 months to 4.5 years,the retina was fully attached in all eyes.visual acuity had improved except 1 eye which complicated with neovascular glaucoma.In the control group,membranes partially remained in 2 eyes,4 iatrogenic holes appeared in 3 eyes,neovascular glaucoma occurred in 3 eyes,the retina was reattached during the follow-up time from 12 to 34 months.Conclusions For severe proliferative diabetic retinopathy,the 4-port pars plana vitrectomy with bimanual manipulations of membrane peeling is safe and efficiency.

Objective To describe the clinical features and surgical and visual outcomes in a series of children with rhegmatogenous retinal detachments(RRD).Methods Retrospective case series of pediatric patients(14 years old or younger)with RRD who underwent primary surgery at a tertiary referral center between Mav 1995 and May 2006.Patients with perforating ocular trauma were excluded.Results Thirty-six eyes of 33 patients were included in this study.The median age was 12 years,and 26 patients (78.8%)were male.Bilateral RRD was present in 10 patients(30.3%);22 patients(66.7%)had some form of bilateral ocular pathology.At least one predisposing factor could be identified in 31(86.1%)of eyes examined.Thirteen eyes(36.1%)experienced trauma,11 eyes(30.6%)had structural abnormalities,high myopia and eyes underwent previous intraocular surgery were 7(19.4%)each,and 3 eyes(8.3%)had inflammatory fundus disorders.Macular detachment was found in 28 eyes(77.8%).Median follow-up was 12 months.At the end of follow-up for this report,silicone oil was still in place in 4 eyes.Retinal reattachment was ultimately achieved in 29 of the 32 eyes (90.6%)with a mean of 1.9 surgeries per eye,however,visual recovery was modest.Predictors of a poor visual outcome were:hand motions or worse in preoperative vision(P=0.001),macular-off retinal detachment(P=0.003),proliferative vitreoretinopathy grade C or worse(P=0.000),the need for vitrectomy surgery(P=0.002),and the use of silicone oil(P=0.005).Condusions Trauma and congenital or developmental anomalies were the most common predisposing factors for pediatric RRD in this series.Retinal reattachment can be achieved in most cases with modern vitreoretinal surgical techniques.Predictors of visual outcomes are similar to those observed in adults.Regular follow-up for children at risk of developing RRD is necessary for early detection.

Objective To investigate the effects of vitrectomy in vitreo-retinal complications associated with intermediate uveitis.Methods Retrospective case series of sixteen eyes of 16 patients in vitreo-retinal disease associated with infermediate uveitis in a 3-year period from Mar 2002 to Jun 2005 were included in the study.They were treated with vitrectomy and the mean follow-up was(14.25±7.90)months (range:5-32months).Visual acuity in final follow-up,post-operative complications and the recurrence of intermediate uveitis were retrospectively reviewed.Resuits Four patients were associated with tuberculosis,rheumatoid arthritis,multiple sclerosis or Behcet disease,respectively.The remaining 12 cases had idiopathic diseases.Pre-operatively.all patients were treated with steroids for a long time and the mean treatment time was(9.94±2.67)months(range:6-16months).Pre-operative vitreo-retinal complications included severe vitreous organization(5 eyes),tractional retinal detachment(6 eyes),rhegmatogenous retinal detachment(1 eye),vitreous hemorrhages(2 eyes),epimacular membrane(2 eyes)accompanied with vitreous tissue,and peripheral retinal neovascularization(16 eyes).In the post-operative period,tractional retinal detachment in one eye and complicated cataract in 3 eyes were observed.Post-operatively,only 4 cases need long-term immunosuppression therapy(more than 6 months).Fourteen of 16 eyes achieved a final visual acuitv equal to or better than baseline(x2=4.923,P＜0.05).Recurrent intermediate uveitis was not found in these patients.Conclusions The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the intermediate uveitis which was severe or uncontrolled by immunosuppressive drugs and accompanied with vitreo-retinal complications.The beneficial effects include improving visual acuity,reducing need for long-term immunosuppression treatment.

Objective To observe clinical effect of accommodative IOL on different age patients.Methods Retrospective case series of fifty-four patients implanted with accommodative IOL were divided into three groups according to their age:39-60,60-75 and older than 75 years.Three months after the cataract surgery,distant visual acuity,near visual acuity and defocusing with minus glasses(D)were examined and depth of anterior chamber was measured by ultrasound biomicroseope.Result There were no statistically significant differences in distant visual acuity among these three groups.Near visual acuity in older than 75 group was significantly lower than the other two groups.There were no statistically significant differences in the depth of anterior chamber among these three groups.When patients watched the target moving from 5 meters away to near,the change of depth of anterior chamber in older than 75 group was significantly less than that in the other two groups.Accommodation power in older than 75 group was significantly lower than that in the other two groups as measured by defocusing with minus glass(D).Conclusion Patients implanted with accommodative IOL can get good distant and near visual acuities.Younger patients may obtain more benefit from accommodative IOL such as obtaining higher accommodative power.

Objective To measure visual acuity(VA)at different distances after implantation of ReSTOR multifocal intraocular lens(MIOL)and to evaluate the variation of VA with different distances.Methods It was a prospective case series study.Thirty eyes of 22 patients received the ReSTOR MIOL in this prospective case series study.VA was measured at several distances,and was recorded in a defocused range of 0 to-4.5 diopters(D)with gradually reduced minus spectacles based on distant refraction.A questionnaire was used to assess the satisfaction about VA of different distances.The mean follow-up time was three months.Results Postoperatively,the manifest refraction spherical equivalent was within±1.00 D in 28 of 30 eyes(93.3%)and the astigmatism was within 1.00 D in 23 of 30 eyes(76.7%).The mean uncorrected distance(5 m),intermediate(60 am)and near(33 cm)VA were 0.91,0.40 and 0.64,respectively.The mean VA at 0 D,-1.50 D and-3.00 D pseudoaccommodation were 1.00,O.49 and 0.79,respectively.On the questionnaire,five patients complained of unreality when walking,and two computer workers complained that they could not see screen clearly,and one hair-cutter complained that he could not see hair clearly.Self-score of satisfaction about distant.intermediate and near VA were 8.0,7.5 and 8.0,respectively.Conclusions Implantation of the ReSTOR MIOL offers excellent distant and near VA.The VA decreases significantly at intermediate range as compared to distant and near vision.which might reduce the quality of life for patients who need excellent vision at intermediate range.

Objective To describe the histopathologic spectrum and patient characteristics of eyelid tumors in Beijing Tongren Hospital.Methods It was a claims database analysis.A total of 2639 evelid tumors verified histopathologically from January 1997 to December 2006 were included in the study.Results of the 2639 eyelid tumors,the 5 most common eyelid benign lesions were inflammatory lesion.melanocytic nevus,papilloma,dermoid cyst and epidermoid cyst,and epithelial cyst.The 5 leading eyelid malignant tumors were basal cell carcinoma,sebaceous gland carcinoma,lymphoma,squamous cell carcinoma and melanoma.The mean age at diagnosis was 61 years for basal cell carcinoma and sebaceous gland carcinoma.57 years and 52 years for squamous cell carcinoma and melanoma,respectively,and 48 years for lymphoma.There was no significant sex predilection in basal cell carcinoma and sebaceous dand carcinoma.Melanoma and lymphoma occurred more commonly in women,whereas squamous cell carcinoma occurred more commonly in men.Conclusions Basal cell carcinoma and sebaceous gland carcinoma were the most common malignant eyelid tumors,and lymphoma ranked third and had an increasing trend.The malignant tumors occurred predominantly in the elderly of 60 years and above.

Objective To investigate clinical manifestation,diagnosis and treatment of orbital natural killer(NK)-T cell lymphoma.Methods It was a retrospective case series.Seven orbital NK-T cell lymphoma patients confirmed by surgical biopsies were collected during the past 22 years.We reviewed the records,surgical and treatment procedures.Surgical specimens were studied with HE staining,immunohistochemical staining and molecular biological analysis.Results These patients had proptosis,eye motive inhibition or fixation and visual acuity was decreased or even without light perception.Skin of inner canthus and eyelids appeared red and swollen,with ulceration and cavity formation.CT scan revealed that the tumor showed uneven density and an unclear border.Tremendous lymphocyte infiltration and tissue necrosis in the tumor were observed in the biopsy tissue.LCA,CD45RO and CD57 immunohistochemical staining revealed positive results.Clonal T-cell-receptor gene rearrangements of two patients showed negative results and the Epstein-Barr virus was detected.Conclusions Orbital NK-T cell lymphoma is a rare disease.The characteristics of this disease include a highly aggressive clinical course.severe destruction and a poor prognosis.The final diagnosis depends on HE staining,immunohistochemical staining and molecular biological examination.

Objective To explore the various clinical features of aniridia and its treatment.Methods It was a retrospective case series.All the 8 cases of 16 aniridia patients in our department from January,1984 to January,2007 were assayed.All the patients were bilateral aniridia sufiering from abnormal vision and manifested with various degree of cataract,5 eyes manifested with refractory glaucoma,8 eyes with horizontal nystigmus.These patients underwent cataract extraction and intraocular lens implantation,trabeculectomy,ciliary process laser photoeoagulation,in some of patients glass and cover strabismus exercise,color contact lens therapy were applied.Results Vision acuity in all of patients with severe cataract were improved after cataract surgery.One glaucoma eye underwent trabeculectomy,but failed to control the IOP and then received ciliary process laser photocoagulation.Three glaucoma eyes only underwent ciliary process laser photocoagulation,1 eye received topical anti-glaucoma eye drops.The IOP of 3 eyes was controlled.However,the IOP of 2 eyes was not to be controned.Vision acuity was improved in 4 strabismus eyes after wearing glass and strabismus exercise,the symptom of photophobia was disappeared in 2 eyes after wearing a pair of color contact lens.Conclusion Although it is hard selection to select the proper treatment for aniridia,most of the cases can obtain a better vision,and relief of the symptom after proper treatment.

Objective The aim of this study was to assess the protection of recombinant human erythropoietin(rhEPO)in light-induced injures in human retinal pigment epithelial(RPE)cells.Methods It was a experimental study.Cultured human RPE cells were exposed to light of 8w 2000±500 Lux for 12 hours.The 3-(4,5-dimethyhhiazole-2y1)-2,5-diphenyl tetrazolium bromide(MTY)cell viability assay were used to assess the effects of rhEPO in light-induced injury on human RPE cells.The effect of inhibiting apoptosis of rhEPO was detected by AnnexinV-flunoreseein isothiocyanate/Propidium iodium labeling and flow cytometry.The enzyme hnked immunosorbant assay(ELISA) and immunocytochemical staining were used to assess the expressions of caspase-3 treated by different doses of rhEPO in light-induced injury on human RPE cells and examine the protective mechanism of rhEPO by treatment with AG490(the special inhibitor of jak2).Results There was a significant increase of inhibiting apoptosis in every rhEPO group,and cell viability was the highest in 40 U/ml rhEPO group,the value was 4.93±1.45/ml.The decrease in expression of caspase-3 was the most obvious in 40 U/ml rhEPO group,in which the value was 0.125±0.029 ng/ml.There was a significant increased effect on inhibiting apoptosis in every rhEPO group,and it was the most conspicuous in 40 U/ml rhEPO group.But these increased cell viability and effect on inhibiting apoptosis in rhEPO group were restrained by AG490,in which the value of apoptosis was 11.29±2.11/ml and the density of caspase-3 increased to 0.362±0.042 ng/ml.Conclusions It is suggested that rhEPO can protect human RPE ceils from the light-induced injures.Its protective mechanism is principally mediated by the EPO-EPOR pathway,which subsequently leads to jak2 activation.

With the arrival of the new year, the Chinese Journal of Ophthalmology will start a new chapter. On the occasion of congratulating the colleagues of ophthalmology in China on the new year, the editorial board and editorial department of the journal are more willing to review the past of the journal and look forward to the bright future.

Orbital cavernous hemangioma is the most common primary benign orbital tumor in adulthood, and the incidence rate accounts for 14.5% ~21.3% of orbital tumors. With the development of modern imaging, ultrasound, CT and MRI have become the main methods for diagnosing orbital diseases. The qualitative diagnosis accuracy of orbital cavernous hemangioma is close to 100%, and it can accurately locate the tumor, and it can accurately estimate whether the tumor has obvious adhesion.

Papillary hemangioma is a congenital developmental vascular tumor from the parenchyma of the optic papilla, which can be combined with exudative retinal detachment in the macular area, but it is rare to combine macular hole. A case of papillary hemangioma combined with macular hole is reported as follows.

diabetic macular edema (DME) is one of the serious complications of diabetic retinopathy (DR), which often affects the visual acuity of patients. At present, there are more than 40 million diabetic patients in China, more than 2/3 of them will suffer from DR [1].