Volume 44 ·  Issue 02 ·  2008

Corneal transplantation is an effective procedure for the treatment of opaque cornea,but the application of lamellar keratoplasty is limited because its optical results are not as good as penetrating corneal transplantation. Recently,with the appearance of new surgical procedures,deep lamellar keratoplasty(DLKP)and deep lamellar endothelial keratoplasty(DLEK),clinicians should re-evaluate the value of lamellar keratoplasty. This article discusses the designs,the indications and the characteristics of these new surgical procedures,analyzes the problems existed in China,and looks forward to the future about the development of lamellar keratoplasty.

Pediatric corneal transplantation is one of most important means to avoid corneal blind and promote infant vision development,but low scleral rigidity increases the forward displacement of the lefts-iris diaphragm and significant refractive errors after corneal transplantation. The undedying disease process will also influence the timing of surgery.For high risk of grafts failure in pedigtric penetrating keratoplasty, it is potential for excellent long term outcome to determine operative opportunity cautiously and prevent and treat appropriately grafts rejection,glaucoma,infection and corneal erosions.

Toxic anterior segment syndrome is a sterile postoperative inflammatory reaction,with typical clinical features and serious secondary complications.The causes of TASS are numerous and varied.It is informed that irrigating solutions and ophthalmic viscosurgical devices,ophthalmic instrument contaminants,ocular medications and intraocular lenses are correlation factors. TASS is easy to be confused with the infectious endophthalmitis and difficult to diagnose. It is reported that the steroid therapy for TASS is effective but the mainstay of treatment for TASS centers on prevention.

The background,technical characteristics and operation procedures of anterior segment optical coherence tomography(OCT)are introduced.The ophthalmic applications of this technique are summarized.The initial studies showed that anterior segment OCT can be a promising tool for the observation of image and analysis of the cornea,the imaging and biological measuring of the anterior chamber,the observation of image and quantitative evaluation of the anterior chamber angle,the observation of image and assessment of phakic intraocular lenses,the observation of image and evaluation of trabeculectomy blebs as well as the observation of ocular accommodation.

In order to better implement the journal running policy of combining theory with practice, popularization and improvement, and further improve the clinical diagnosis and treatment ability and academic level of ophthalmologists, the editorial committee of Chinese Journal of Ophthalmology continued to launch the column "Continuing Education Garden" in 2008, inviting experts with deep academic attainments and rich clinical experience in the field of ophthalmology to give lectures. Published contents: corneal disease, cataract, glaucoma, fundus disease, orbital disease, eye plastic surgery, eye tumor, strabismus and amblyopia, etc. Each issue focuses on a special topic, with five questions to think about at the end of the article,

In order to further expand the information content of this journal, strengthen the role of this journal in promoting talent exchange, and provide more comprehensive services for the development of disciplines, this journal continued to open the "talent exchange" column in 2008, publishing and transmitting the information of recruiters, further study information, postgraduate and doctoral students and postdoctoral candidates in ophthalmology institutions, etc., so as to build a bridge between supply and demand. Units that need to provide services can contact Li Bin of this journal, telephone: 010-85158241; Fax: 010-85158372; Email: libin@cma.org.cn.

According to international practice and the actual situation in China, for papers that meet the following conditions, the Chinese Medical Association series journals allow and accept the republication of relevant papers of the same research in different languages.

In order to better express the central content of the full text, after discussion and approval by the 12th editorial board of Chinese Journal of Ophthalmology, the writing of Chinese and English abstracts of this journal has been appropriately adjusted. The format of the abstract is still divided into four parts: purpose, method, result and conclusion, each part is titled with corresponding titles. However, in "Methods" the author should inform the name of the study design and the main method. I hope the authors will pay attention to the writing standards of Chinese and English abstracts in future submissions.

With the development and improvement of clinical diagnosis technology, the role of all kinds of ophthalmology clinical pictures in disease diagnosis has been paid more and more attention. In order to encourage clinical accumulation of relevant data, promote experience exchange, improve clinical diagnosis and treatment technology, provide a new platform for academic exchange for readers, and at the same time enrich the content and form of this journal to better serve the majority of ophthalmologists, Chinese Journal of Ophthalmology continued to open the "Picture Essence" column in 2008. The submitted pictures can be arranged according to the types of cases or diagnostic techniques, and related instructions can be attached to clarify the arrangement mode of the pictures,

1. Statistical symbols: According to the relevant provisions of GB 3358-1982 (Statistical Nouns and Symbols), all statistical symbols are printed in italics. Commonly used: (1) The arithmetic mean of the sample is in English lowercase-↑x (median is in M); (2) Standard deviation is in English lowercase s; (3) Standard misuse of English lowercase s-↑x; (4) t test is in English lowercase t; (5) F test is in English uppercase F; (6) Chi-square test is in Greek lowercase Х ^2; (7) The correlation coefficient is lowercase r in English; (8) Degrees of freedom are lowercase v in Hiven;

The Atlas of Diagnosis and Differential Diagnosis of Retinal Detachment, one of a series of ophthalmological atlases edited by the Department of Ophthalmology, Beijing Tongren Hospital affiliated to Capital Medical University, has been published by Beijing Science and Technology Press, and the editor-in-chief is Professor Wei Wenbin. This book is compiled and edited by the author of thousands of color fundus photographs and related imaging materials related to the diagnosis and differential diagnosis of retinal detachment accumulated in clinical practice in the past 20 years. More than 1,000 pictures are printed on color coated paper. Good imaging is better than profound textual descriptions. For ophthalmologists,

The Atlas of Fundus Diseases, edited by Professor Zhang Huirong of Ophthalmology Center of Peking University Third Hospital, and compiled by many fundus disease experts from Peking University Ophthalmology Center of Peking University Third Hospital, Beijing Tongren Ophthalmology Center of Beijing Tongren Hospital affiliated to Capital Medical University, and Peking Union Medical College Hospital of Chinese Academy of Medical Sciences, was published and distributed by People's Medical Publishing House in June 2007.

The book "Keratology", co-edited by Professor Xie Lixin and Professor Shi Weiyun of Shandong Institute of Ophthalmology, academicians of Chinese Academy of Engineering, was published by People's Medical Publishing House in April 2007.

It was edited by Professor Wang Yusheng, Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University and Institute of Ophthalmology, written by frontline scientific and technological personnel engaged in clinical and basic research of ophthalmology and visual science in Fourth Military Medical University, reviewed by Professor Yan Yan, West China Ophthalmology Center, Sichuan University, and prefaced by Professor Luo Chengren. The first book "Choroidal Neovascular Diseases" at home and abroad was officially published by People's Medical Publishing House in November 2007. The contents of this book include basic research and clinical diagnosis and treatment of choroidal neovascular diseases, taking into account both advancement and practicality.

With the approval of 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 Chinese Medical Association Ophthalmology Branch, 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. By then, ophthalmology and optometry experts, scholars and well-known manufacturers from South Korea, Japan, the United States, European countries, mainland China, Hong Kong, Macao and Taiwan will gather in Nanjing.

Eye Plastic and Aesthetic Surgery, edited by Xu Naijiang, Zhu Huimin, Yang Li and Luo Min, and deputy editors by Li Dongmei, Fan Xianqun, Song Weixian and Wu Zhongyao, was published by Shanghai Science and Technology Education Press in August 2007.

The book "Conjunctival Relaxation" written by Zhang Xingru and reviewed by Chen Jiaqi has been published by Shanghai Science and Technology Press. Conjunctiva relaxation is a common ophthalmic disease. Patients complain mostly of eye dryness, foreign body sensation, and lacrimal overflow, mainly due to excessive relaxation of bulbar conjunctiva and/or high tension of lower eyelid margin, causing relaxed conjunctiva to accumulate between the eyeball and lower eyelid margin, medial canthus and lateral canthus causing abnormal tears on the ocular surface, accompanied by ocular discomfort and other symptoms. The book summarizes the research results on conjunctiva relaxation at home and abroad, from the etiology, pathogenesis,

Objective To explore the indications,efficacy,and complications of different types of lamellar keratoplasty(LKP)for peripheral corneal perforation.Methods In our nonrandomized retrospective case series,40 cases(42 eyes)with peripheral corneal perforation at Zhongshan Ophthalmic Center between January 2003 and June 2006 underwent semi lunar LKP(14 eyes),crescent LKP(11 eyes),biconvex LKP(7 eyes),ring-shaped LKP(5 eyes),and total LKP(5 eyes).The selection of various procedures was based on the size and shape of corneal ulceration and perforation.Postoperative visual acuity(VA),corneal clarity,astigmatism,and complications were studied during a follow-up of 3 to 21 months. The initial causes and recurrence for peripheral corneal perforation were analyzed.Results The initial causes of corneal perforation were mostly Terrien's marginal degeneration(35.7%),Mooren's ulcer (31.0%),herpes simplex keratitis(11.9%),chemical/thermal burns(9.5%),and corneal ecstatic diseases(7.1%).The lamellar graft attached to the host well and was transparent in 34 eyes(81.0%)following LKP.VA less than 0.1 were presented in 13 eyes(31.0%)preoperatively and in 3 eyes(7.1%)postoperatively.VA in 27 eyes(64.3%)improved after LKP,and best-corrected VA in nine eyes (21.4%)was 0.5 or better. The mean corneal astigmatism was(7.23 ± 1.22)D three months postoperatively,and this decreased to(3.72 ± 1.76)D in six to nine months postoperatively when sutures were removed.The postoperative complications included graft-host interface effusion(8 eyes,19.1%),secondary glaucoma(8 eyes,19.1%)and reoccurrence of primary diseases,including Mooren's ulcer(3 eyes,23.1%)and herpes simplex keratitis(1 eye,20.0%).Conclusions LKP is effective to restore the integrity of the eyes with peripheral corneal perforation. Choosing the appropriate type of LKP based on different shape of corneal perforations can remove the corneal lesion and spare the normal tissue to the maximum.Moreover,the well-matched graft configuration can reduce the postoperative astigmatism,helping restore or improve the vision in most cases.

Objective To study the characters,diagnosis,treatment and risk factors of the recurrence of fungal keratitis after lamellar keratoplasty(LKP). Methods In this nonrandomized retrospective case series,two hundred and eighteen cases of fungal keratitis were undertaken partial LKP from January 1998 to July 2005.The case history was inquired in detail preoperatively.A trephine with diameter 0.5 mm larger than the area of fungal infeetion was used to incise the lamellar corneal ulcer,and the hyphae of some cases were inspected with microscope during the operation. The recurrence of fungal keratitis was observed after the surgery. Medical treatment and/or operation were used in the management of recurrent cases. The risk factors for the recurrence of fungal keratitis after LKP,such as fungal species,glucocorticoid or immunosuppressant therapy,hypopyon or endothelial plague,were also analyzed. Results Seventeen cases(7.80%)recurred within 2 weeks after surgery and mainly(15 cases)within 1 week.The recurrence displayed with increased local irritation and hypha infihration on recipient LKP bed. All recurrent fungal infections were controlled by performing penetrating keratoplasty(PKP). Risk factor analysis:(1)The recurrent rate of Aspergillus infection(19.23 %)was higher than that in Fusarium infection(5.63%)(P=0.0323). (2)The recurrence rate of cases treated with glueocorticoid or immunosuppressant preoperatively(21.70%)was much higher than that in non-treated cases(6.15%)(P=0.0219).(3)The recurrence rate of cases with hypopyon or endothelial plague preoperatively(17.02%)was much higher than that without these signs(5.26%)(P=0.0134).Conclusions The recurrence of fungal keratitis after LKP OCCUrs mainly within the 1 st week. Aspergillus infection, glucocortieoid or immunosuppressant therapy,hypopyon or endothelial plague are the risk factors for LKP.

Objective To evaluate the efficacy and safety of keratoplasty combined with corneal foci resection in the treatment of Terrien's marginal degeneration(TMD). Methods In this nonrandomized retrospective case series, the records of 48 eyes from 40 patients with TMD who received keratoplasty from January 1995 to December 2005 in Zhongshan Ophthalmic Center were reviewed retrospectively.Orbscan topography examination was undertaken in 8 eyes of 8 patients and tlle refractive error of 9 eyes from 9 patients was tested before and after the operation. Results The mean age of the patients was(30±6)years old.The mean follow up period was(7±6)years.It took(3±1)months postoperatively to obtain a stable visual acuity. Before operation,the naked eye and best corrected visual acuity(VA)(Q25,Q75)were (0.05,0.4),and(0.1,0.5),respectively,while improved to(0.2,0.6)and(0.4,0.7)after operation,respectively(Z=4.63,3.85,both P＜0.01). VA was improved in 39 eyes(81.3%),remained at the same level in 4 eyes(8.3%),decreased 1-2 lines in 3 eyes(6.3%),and decreased more than 2 lines in 2 eyes (4.1%)after the operation. The median spherical diopter and cylinder diopter were(-2.00 D,-8.50 D)and(2.50 D,12.00 D)before operation,while decreased to(-1.25 D,-4.75 D)and(0.75 D,4.25 D)after operation(Z=2.49,2.54,P=0.01,0.01). The improvement in Sim K's astigmatism,astigmatism in 3 mm zone and mean power in 3 mm and 5 mm zone were reduced statistically significant after the operation (P＜0.05);with the exception of astigmatism in the 5 mm zone, which was not reduced significantlv after the operation(Z=1.86,P=0.06).The operative complications included corneal perforation during operation in 5 eyes(10.4%),hydrops between graft and recipient interface in 8 eyes(16.7%),epithelial in-growth in 4 eyes(8.3%),choroidal detachment in 1 eye(2.1%),graft rejection in 7 eyes(14.6%),and recurrence in 3 eyes(6.3%).Secondary surgery was required in 5 eyes(10.4%)for interface hydrops,epithelial in-growth and recurrence of TMD.Condusions Keratoplasty combined with foci resection is effective and safe in the treatment of TMD. This procedure can preserve and improve the visual activity.

Objective To investigate the surgical procedure,clinical efficacy,complications,density of endothelial cells and histological changes after Descemet's stripping endothelial keratoplasty (DSEK)surger.Methods It was a experimental study.Twenty four New Zealand rabbits were divided into 3 groups,8 rabbits per group.Donor grafts were dissected from 16 New Zealand rabbit eyes.Group A Was experimental group,a 5 mm limbal tunnel incision was made.Descemet's membrane was striped off at 10 mm diameter,then the same diameter donor cornea(including Descemet's membrane and endothelium with a little of posterior stroma)was inserted into the recipient's anterior chamber.Air was injected into the anterior chamber to press the graft up against the recipient cornea. Group B was the control group,only striped the Descemet's membrane at the recipient cornea. Group C was the experiment control group,the procedure was similar to the group A,but the donor graft was without endothelial cells. Results All corneas of group A were transparent,and the mean density of the endothelial cells was(2195 ± 77)/mm2(t=12.455,P＜0.001).Endothelial grafts attached to the recipients well and no scar formation between them under histological observation.The corneas were severe edema in groups B and C one month after surgery.Conclusions DSEK is a safe surgery,can be recovered rapidly with little damages,and without interface scale formation after surgery.DSEK may be the first choice for the treatment of bullous keratopathy.

Objeetive To investigate the ophthalmic manifestations of Wilson's disease(WD).Methods In this nonrandomized retrospective ease series,fifty-two WD patients were investigated retrospectively,based on the family history,clinical signs and the laboratory test.Patients were divided into 4 groups:asymptomatic group,only with hepatic disorders,only with neurological disorders and with both hepatic and neurological disorders group.Results Thirty two males and twenty females were studied.The majority(78.8%)of patients belonged to younger age groups(10-30 years). The family history showed members with WD in 14 patients(26.9%),probable WD in 3 patients(5.8%).Out of 52 patients,2 asymptomatie patients(3.8%)were detected by family screening,12 patients(23.1%)only had hepatic disease,11 patients(21.2%)only had neurological disorders and 27 patients(51.9%)had both hepatic and neurological disorders.Among 45 patients(86.5%)with Kayser-Fleischer(K-F)ring,1 patient was asymptomatic,7 patients had hepatic disease,11 had neurological disorders and 26 had both hepatic and neurological disorders.One patient(1.9%)was presented with sunflower cataract. Fifty one patients (98.1%)had low serum ceruloplasmin levels and high urinary copper excretion.Conclusions K-F ring is a common and characteristic manifestation of WD.This is often found in patients with neurological disorders.

Objective To study a new domestic potential acuity meter(PAM)for predicting visual acuity(PVA)in patients with cataracts and to compare the results to that measured by PAM-1000 and Lotmar.Methods One hundred and fifty cataract eyes were enrolled in this study. PVA was evaluated with three difierent dioptometers before the surgery and compared to actual best corrected visual acuity (BCVA)obtained two months after the surgery. Results PVA obtained from domestic PAM correlated well with BCVA.In 56 eyes witll non-identical resuhs between PVA and BCVA,52 eyes were false-negative and 3 eyes were false-positive,indicating that PAM tended to underestimate postoperative BCVA.In severe cataract patients,the correlation between PVA obtained from these three dioptometers and postoperative BCVA was decreased. The identical rates(as compared with postoperative BCVA)for the results obtained from PAM-1000 and Lotmar were 64.0%and 62.7%,respectively.Conciusions Domestic PAM is relatively reliable for predicting postoperative visual acuity. It is a valuable metllod in the examination of PVA before the cataract surgery.

Objective To evaluate visual development after extraction of congenital cataract in young patients.Methods This was a retrospective clinical study.Forty one congenital cataract patients(62 eyes)at 0-3 years old were divided into 4 groups:＜0.5 year old,≥0.5 and＜1 year old,≥1 and＜2years old and≥2 years old.Capsulectomy and cataract aspiration combined witIl anterior vitrectomy were performed in all cases.After the operation,patients were treated with optical correction by spectacles and visual training with occlusion therapy.Flash visual evoked potential(F-VEP)was examined by using Mini stimulator 3 days and 12 weeks after surgery.VISTON visual plasticity system was used to assess visual acuity 1 week and 12 weeks after surgery.Results VEP examination revealed that P100 latent time was reduced by visual training 3 months after surgery as compared with that of 3 days after surgery.Both P100 amplitude and visual acuity were increased. The younger patients obtained the better improvement.The group for lower than 0.5 year old recovered best.Conclusion Congenital cataract patients should be operated as early as possible and wear suitable spectacles for optical correction and undertake visual training after surgery,these procedures play a significant role for visual development and improvement in these patients.

Objective To study the disease-causing gene for a Chinese family with X-linked congenital idiopathic nystagmus.Methods It was a retrospective study.The phenotype of a Chinese family with congenital nystagmus was identified by investigating the history and the clinical features of each family member.The mode of inheritance in this family Was ascertained by the pedigree analysis.Linkage analysis was performed to identify the possible locus harboring the disease-causing gene.Direct DNA sequence analysis Was performed to find the mutation responsible for this disease.Results The positive LOD score Was obtained for 10 microsateuite matters on chromosome Xq25-Xq27,and the maximum LOD score with DXS1211 Was 3.91. A 2-bp deletion in exon 8 of FRMD7 Was detected after direct DNA sequence analysis.which was eosegregated with all patients in this family.Condusion Congenital nystagmus is a clinically and genetically heterogeneous ocular movement disease. Mutation of the FRMD7 gene is the cause of congenital nystagmus in this family.

Objective To study the histopathological classification and changes of eyelid neoplasms.Method In this retrospective case series.the pathological specimens of 2734 cases with eyelid neoplasms examined between 1993-2005 were claimed and analyzed.Results There were 1248 eyelid tumors (45.65%)in 2734 cases with eyelid neoplasms,including 875 benign neoplasms(71.11%)and 960 malignant cases(29.89%).The three leading malignant eyelid tumors were basal cell carcinoma,meibomian gland carcinoma and squamous cell carcinoma.The mean ages of the occurrence of these three tumors were 64.16,63.30 and 60.38 years old,respectively. Conclusion Pathologic classification of eyelid neoplasms is helpful for the pathological diagnosis and provides information for the diagnosis and treatment of these diseases.

Objective To identify the mutation gene of two Chinese families with primary open angle glaucoma.Methods It was a ease control study.Clinical observation and pedigree analysis were undertaken in two families with primary open angle glaueoma.Venous blood were drawn from 6 affected and 6 unaffected subjects in family L, and from 4 affected and 4 unaffected subiects in family C.Genomic DNA Was extracted.Linkage to OPTN gene locus was determined.Mutation of this gene was screened by PCR of OPTN gene exons and direct sequencing. Results A missense mutation A1274G in exon 10 of OPTN gene Was identified in affected members of family L. The corresponding amino acid change Was Lys322Glu.This mutation Was not found in unaffected family members of family L.all members of family C and 87 unrelated normal controls. Conclusion A novel mutation of OPTN gene with Lys322Glu change is responsible for the occurrence of primary open angle glaucoma in a Chinese family.

The occurrence of proliferative vitreoretinopathy is largely related to the migration, migration, metaplasia and proliferation of retinal pigment epithelial (RPE) cells into fibroblasts [1-2].

The incidence rate of ocular lesions in leukemia can be as high as 90% [1], and the pathogenesis can be divided into two kinds: direct infiltration of leukemia to the eye and secondary lesions such as hyperviscosity and opportunistic infection to the eye.

The patient was a 28-year-old female who came to our hospital on June 27, 2007 due to deformation of vision in her left eye for 2 months. Both eyes were myopic since childhood, and other systemic diseases were denied.

Since Khodadoust and Attarzadch [1] first reported corneal endotheliitis in 1982, it has been found that corneal endotheliitis is not uncommon in clinic, and its characteristics are: ciliary hyperemia; Localized or diffuse edema and opacity of corneal endothelium; Edema of corneal stroma and epithelium, sometimes large vesicles; The back elastic layer is thick and wrinkled; retrocorneal deposits (KP); It may be accompanied by iriditis, and the pupil may have posterior adhesion; Some patients have high intraocular pressure; It can relapse or occur after surgery.

This issue focuses on corneal transplantation. Because lamellar keratoplasty takes a long time and the postoperative visual acuity recovery is not as good as penetrating keratoplasty, its application in the field of optical keratoplasty has been limited. In recent years, the emergence of new surgical methods such as deep lamellar keratoplasty (DLKP) and deep lamellar endothelial keratoplasty (DLEK) has significantly broadened the indications of lamellar keratoplasty surgery, and the postoperative optical effect is better, which makes lamellar keratoplasty surgery gain important clinical significance again.