Volume 44 ·  Issue 03 ·  2008

Choroidal neovascularization(CNV)especially CNV secondary to age related macular degeneration is becoming an increasing socio-medical problem as the global population aging.Recently,with novel insights in the pathogenesis of the disease,anti-angiogenesis pharmacotherapy blated its way into ophthalmogical practice and significantly changed the management of CNV,since at the first time achieving improvement in visual function.However,facing such promising drugs,we still need to take caution with the safety,long-time efficacy;to investigate more reasonable dosing schedule;to study the combined treatment strategies and so on,finally to find out the best individual clinical care for our patients.(Chin J Ophthalmol,2008,44:193-195)

Although great progress have been achieved in treating neovascularization(CNV)secondary to age-related macular degeneration(AMD)in recent years,some essential problem should be considered in gaining better theraputic results for CNV patients.Firstly we need to know clearly whether the CNV is classic or occult?Secondly we need to understand whether the CNV lesion is actuallv Dolypoidal choroidal vasculopathy(PCV)or retinal angiomatous proliferation(RAP)?Thirdly we need to determine to choose photodynamic therapy(PDT)or anti-vascular endothelial growth factor(VEGF)therapy or combination therapy for a individual AMD patient.(Chin J Ophthalmol,2008,44:196-199)

Objective To investigate the role of TNF-α in the development of laser-induced choroidal neovascularization(CNV)in the mouse.Methods Laser photocoagulation was used to induce CNV in wild-type C57BL/6J mice by making four separate choroidal burns in each eye.Animals were treated 3 days before or after laser injury with recombinant TNF receptor P75(etanercept,5μg/h,groupl,n=12),chimeric monoclonal antibody(infliximab,5μg/h,group2,n=12)for 7 days by intraperitonealy implanted osmotic pumps.PBS was used as control(group3,n=12).The left eyes were removed for histopathologic examination and the right eyes were removed for flatmounts immunohistochemistry immediately after fluorescien angiography.In mice treated with medications 3 days before laser injury,left eyes were collected at 1 or 2 weeks after laser injury.In mice treated with medications 3 days after laser injury,left eyes were collected at 10 days after laser injury.CNV responses were compared by flatmount analysis of CNV-related fluorescence area and by determination of fluorescein angiographic leakage.The level of protein expression of TNF-α was semiquantitatively evaluated by Western blot analysis of the choroidal and RPE layer from mice with or without laser treatment. Results Western blotting demonstrated that TNF-α was highly expressed in choroidal and RPE cells of wild type mice 1 week after laser treatment as compared to the control mice without laser treatment. Etanercept and infliximab administrated 3 days before laser-damage significantly reduced CNV size and pathological fluorescein leakage in comparison to the control group one and two weeks after laser injury. Only etanercept administered 3 days after laser injury still significantly reduced the development of CNV lesions.Histopathological examination confirmed that CNV lesions in treated mice had smaller diameter and thinner center as compared to the control animals.Conclusions Anti-TNF-α treatment reduces the size and leakage of laser-induced CNV.These results suggest the involvement of TNF-α in the development of laser-induced CNV and its potential use as a therapeutic agent in the age related macular degeneration.(Chin J Opbthalmol,2008,44:200-206)

Objective To observe the effect CA-074Me on the retinal neovascularization of C57BL/6J with retinal neovascularization,and to explore the new way of treatment for retinal neovascularization.Methods It was a experimental study.Sixty-seven-days-old C57 BL/6J mice were divided into four groups randomly including normal control group,blank control group,negative control group,experiment group.Blank control group,negative control group,experiment group were exposed to 75%oxygen to established a periOCHlar injection one time every eye for 5 days after mice left oxygen box.Negative control group were received the same dose of DMSO at the same time. Nomml control group and blank control group did not received any medicine.The Cathepsin B activity of the tissue of mice'eye were measured.The mean optical density of Cathepsin B of retina were measured by immunohistochemistry:the number of new vascular cell nuclei extending mto the internal limiting membrane in cross-sections was measured. Retinal neovascularization were tested by the vascular pattern in adenosine diphosphate-ase(ADPase)stained retina flat-mounts. Results CA-074Me reduced the Cathepsin B Activity,the number of new vascular cell nuclei extending into the internal limiting membrane,the non-vascular area of retina,and the ratio of the nonvascular area of retina and the whole retina area.Conclusion The specific inhibitor-CA-074Me of CatheDsin B can reduce the retinal neovascularization of C57BL/6J to some extent,may be a new treatment for retinal neovascularization in the future.(Chin J Ophthalmol,2008,44:207-211)

Objective To investigate the phenotype feature of bone marrow-derived cells in mice's eyes after induction of choroidal neovascularization by laser photocoagulation.Methods It was a experimental study. Green fluorescent protein(GFP)chimeric mice were developed by transplanting bone marrow cells from GFP +/+ transgenic mice to adult C57BL/6J mice.The chimeric mice underwent laser rupture of Bruch membrane to induce CNV.Fluorescein fundus angiography and histopathological study were used to confim the stable formation of CNV.Then the eyes were enucleated and processed for immunofluorescence to detect the distribution and phenotype of GFP+cells. Results The development of CNV has stabled by the 14th day after lasering. GFP-labelled cells appeared in CNV lesions(including choroid beneath CNV lesion),neurosensory retina over CNV,corneoscteral limbus,ciliary body,optic disc and sclera,retina and choroid distant from CNV.GFP+cells,which were immunoreactive for αSMA or CD31,appeared in lesions only.However,F4/80+green cells can be also detected in neurosensory retina over CNV,corneoscleral limbus and ciliary body. Condusions BMC which differentiated into vascular cells presented in CNV lesions only. Some BMC appearing in other positions might be macrophages or dendritic cells.There may be other functions apart from contributing to choroidal neovascularization for BMC in the eyes.(Chin J Ophthalmol,2008,44:212-216)

Objective To investigate the efficacy and safety of wavefront guided(WG)LASIK for the mvopia and astigrnatism.Methods This study is a randomized control trial.42 cases(78 eyes) were collected in the studv through the routine examinations and wavefront analysis,which were divided into two groups(A and B).The value of Z(3,-1)being less than-0.15μm was evaluated as Group A(24 cases,45 eyes):The value of Z(3,-1)being more than+0.15 μm was as Group B(18cases,33eyes).Both A and B were also divided into two subgroups(test and control).WG-LASIK was performed in tested groups,and classic LASIK was performed in control group. Visual quality,wavefront examination,and CSF were analyzed after surgery 3-6 months compared with that of preoperation. Results In the earlier period of postoperation time,diopters of the two groups were both slightly overcorrected, and then began to decrease slightly later and the diopters of both tested and control groups were corrected perfectly.RMSh of tested group increased higher than that of control group when Z(3,-1)was negative and the CSF in control group was better than that in test group after WG-LASIK in Group A.RMSh of tested group increased lower than that of control group when Z(3,-1)was positive and the CSF in tested group was better than that in control group after WG-LASIK in Group B.Conclusions These results suggest that retaining negative vertical coma and removing positive vertical coma were beneficial to the visual function after the WG-LASIK,which could save the corneal tissue reasonably in order to improve visual quMity effectively.(Chin J Ophthalmol,2008,44:217-222)

Objective To evaluate the accumulation of submacular fluid after surgery for retinal detachment.Methods It was a case control study. Sixty seven eyes of sixty six patients with rhegmatogenous retinal detachment which had undergone par plana vitrectomy(PPV)or buckle surgery for retinal detachment were recruited.All patients underwent clinical examination,optical coherence tomography (OCT)scan of the macular at the 1-month postoperative follow-up examination.Results Submacular fluid after PPV occurred in 21.7%eyes,and was significantly lower than that after buckle surgery(47.7%,x2=4.296,P＜0.05).No significantly differences of submacular fluid rate were found between different surgical technique groups(eryotherapy,transscleral diode photocoagulation,with or without drainage of subretinal nuid)in our buckle surgery series(x2=0.091,1.588;P＞0.05).There was statistically significant difference in the rate of submaeular fluid in cases of buckle surgery series with or without macular detachment (x2=9.537,P＜0.01).Visual acuity improved for 2 lines or more accounted for 80.8%eyes in patients with submacular fluid and for 80.1%eyes in patients without submacular fluid.Comparison of pre-and postoperative LogMAR between these two groups showed no significant difference(F=0.162,P=0.688).Conclusions The rate of submacular fluid is much lower after PPV than after buckle surgery.Different surgical techniques used in buckle surgery such as cryotherapy or transscleral diode photocoagulation and with or without drainage of subretinal fluid do not influence the rate of postoperative submacular fluid.The rate of submacular fluid is much lower in eyes without macular detachment than in eyes with macular detachment in buckle surgery series.(Chin J Ophthalmol,2008,44:223-228)

Objective To report the appearance of anterior segment intraocular foreign body in ultrasound biomicroscopy(UBM)and CT. To investigate the advantage and disadvantage of these two imaging methods and to evaluate the value of combining application of these methods in the diagnosis of anterior segment intraocular foreign body. Methods It was a comparative study. Forty-four cases of suspected anterior segment intraoeular foreign body were simultaneously examined by UBM and CT from July 2000 to Mav 2007,the results were compared with the operation results.Results In 44 cases examined by CT,foreign bodies in 40 cases showed high density shadows,including iron,copper,stone and other foreign bodies:2 cases showed slightly high density shadow,which were identified as plastics;in 2 cases,the foreign bodies could not be detected by CT,which were bamboo pick and Chinese chestnut sting. It wasdifficuItv to locate the foreign body exactly and to detect the complications of anterior segment intraocular foreign body by using CT.All 44 cases of anterior segment intraocular foreign body showed strong echo spot with acoustic shadow in the UBM.UBM could provide the exact location of foreign body and could detect all complications. But the examining procedure of UBM was complicated,the examining screen was relativelynarrow and the examination was time-consuming. Condusion In suspected anterior segment intraocular foreign body,CT examination should be performed first to detect the position and the nature of foreign body,then UBM could be used to obtain the exact position of foreign body and to detect the complications.(Chin J Ophthalmol,2008,44:229-232)

Objective To assess the in vitro susceptibilities of ocular bacterial isolates to Gatifloxacin and other fluoroqiunolones which are often used in ophthalmic treatment. Methods Nonrandomized,non-comparative,retrospective study.Ocular bacterial isolates(n=619)from Beijing Institute of Ophthalmology were tested for their susceptibilities to gatifloxacin,ciprofloxacin,ofloxacin and levofloxacin in vitro by the Kirby-Bauer disk diffusion method.Results The total number of ocular bacterial isolates was 619 from January,2005 to December,2006 including gram-positive cocci 372(60.1%),gramnegative cocci 7(1.1%),gram-positive bacilli 60(9.7%),gram-negative bacilli 177(28.6%),other 3(0.5%).The pereentage of susceptibility in total ocular bacterial isolates to gatifloxacin,ciprofloxacin,ofloxacin and levonoxacin Was 88.4%,72.1%,64.8%and 54.4%.The susceptibility of Staphylococcus species to gatifloxacin(89.9%)Was significantly higher than ciprofloxacin(38.8%),ofloxacin(48.2%)and levofloxacin(61.6%). Streptococcus species showed significantly higher susceptibility to gatifloxacin (93.2%),levofloxacin(89.2%)and ofloxacin(87.8%)than ciprofloxacin(62.2%).The susceDtibility of gram-positive bacilli to gatifloxacin(86.7%)Was significantly higher than ciprofloxacin(58.3%):All above differences are significant(P＜0.0083).Gram-negative Cocci,enteric bacillifamily and Pseudomonas species have the equivalent susceptibility to gatifloxacin,ciprofloxacin,ofloxacin and levofloxacin(P＞0.05). Conclusions Most of ocular bacterial are susceptible to gatifloxacin in vitro,especially gram-positive bacteria including Staphylococcus species,Streptococcus spectes and gram-postttve bacilli.(Chin J Opbtbalmol,2008,44:233-236)

Objective To determine the virulence of extracellular phospholipase B(PLB)of Candida albicans in experimental keratomycosis.Methods It was an experimental study.The PLB-deficient mutant strain of Candida albicans and its isogenic parental strain were used in this study.The effects of these two strains on the model of experimental keratomycosis in 48 New Zealand albino rabbits covered with contact lens was compared by observing the dynamic changes clinically and histopathologically. In vitro,these two strains were incubated with the corneal stromal cells separately(37℃,5%CO2).The influence of these two strains on monolayer keratocytes were detected by scanning electron microscopy(SEM),enzyme linked immunosorbent assay(ELISA),and flow cytometry with Annexin V/propidium iodide.Results The hvphae of tllese two strains grew perpendicularly to the corneal stromal lamellae.The difference of the hyphal invasion inoculated for 2 davs by these two isogenic strains was statistically significant(P=0.002),but at other intervals, no significant difference was found.The severity of the inflammation in parental kemtomvcosis was the same as that in PLB null strain at any time points(P＞0.05). Under SEM,the morphogenesis and the number of adherent germ tubes of these two isogenic strains appeared similarly(P＞0.05),but the number of geml tubes penetrating cell monolayer was significantly different(P=0.009).Obviously more prostaglandin E2(PGE2) was detected in the culture supernatants of parental strain group(65 466±5773)pg/ml than that ofthe null strain group(18 025±5232)pg/ml.The percentages of the cells with damaged cellular membrane in the parental group,the PLB null group and the control group,were 3.02%,2.04%and 0.12%,respectively.The percentages of apoptosis cells in these three groups were 33.17%,27.56%and 1.46%,respectively.The percentages of living cells were 63.81%,70.40%and 98.41%,respectively. Conclusions PLB shows virulent effects in triggering fungal invasion in comea immediately following fungal adherence by decomposing membrane phospholipids and leading to cell lysis.However,its virulent effect does not appear to be critical as in the hematogenous model of disseminated candidiasis.(Chin J Ophtbalmol,2008,44:237-243)

Objective To construct the expressing vector of siRNA in order to inhibit NgR expression,which provides a new gene thrapy approach to the optic nerve impairment.Methods It was a experimental study.Specific short chain oligonucletides was designed by using the siRNA software according to the mRNA sequence provided by genebank,the double chain DNA sequence was gained through annealing after chemosynthesis and was inserted to the pSUPER-EGFP vector linearized with BglⅡand Hind Ⅲ enzyme,the recombinant expression vector was evaluated by using EcoR Ⅰ and Hind Ⅱ enzyme cutting and sequencing,At last,the constructed vectors were transfected into wistar rat retinal ganglion cells and the expression level of NgR was observed.Results Identification by enzyme cutting and sequencing showed that the expression vector was constructed successfully,and it was proved that the NgR expression level was effiectively inkibited.Conclusion The constructed siRNA expression vectors can block the NgR gene expression,it will be the foundation for the research of gene thrapy to optic nerve regeneration.(chin J OphthMmol,2008,44:244-247)

Objective To test the neuroprotective effect of lithium to the photoreceptor apoptosis in mouse model of retinal degeneration.Methods It was a experimental study.FVB/NJ retinal degeneration mice were fed with lithium diet immediately after birth(P0).At day 7(P7)and day 14(P14),eye balls were removed and retinas were sectioned. Meanwhile blood was collected to measure the lithium concentration.H&E staining,TUNEL and immunofluorescence labeling were carried out to analysis the histology and photoreceptor cell apoptosis.Results TUNEL-positive cells were found in the outer nuclear layer in the control group.The thickness and count of cell layer in P14 was much lower than that in P7 in the control group.In lithium-treat group,the ONL thickness and count of cell layer was much higher than that in the control group in P14,but has no significant difierence with that in P7.Conclusions lithium can prevent photoreceptor cells from apoptosis in mouse model of retinal degeneration.(Chin J Ophthalmol,2008,44:248-252)

Clinical trial of off-label use of Bevacizumab for the treatment of neovascular diseases of the eve showed good therapeutic results.It has been demonstrated that this therapy is efficient and safe in the treatment of choroidal neovascularization due to age-related macular degeneration,pathologic myopia and other neovascular eye diseases in short term period.The potential risks to the patients are minimal,and the cost-effectiveness is so obvious that the treatment strategy using intravitreal bevacizumab is logical and understandable.(Chin J Ophthalmol,2008,44:281-284)

Epithelial-mesenchymal transition(EMT),a mechanism of cell transdifferentiation,plays a key role in embryonic development,tumor metastasis and tissue reparative process.The main manifestations of EMT are disappearance of epithelium polarity,lose of cell-cell junction,increased expression of mesenchymal phenotype and activated migratory ability of epithelium.EMT existed in the cornea epithelium regeneration,fibrosis,and wound healing.EMT also participates in the pathological development of lens trauma,catarct and proliferative vitreous retinopathy.This article outlined the recent progress of EMT in ophthalmology.(Chin J Ophthalmol,2008,44:285-288)

The patient was a 43-year-old male who came to our hospital in June 2007 because of the redness and swelling of his right eye for 7 years and aggravated for 3 months. Seven years ago, the patient found that his right eye was red and swollen, sometimes mild and sometimes severe, and obviously aggravated after exertion. He had been seen in another hospital without definite diagnosis and treatment. In the past 3 months, the patient felt that the redness and swelling of his right eye had aggravated, and at the same time, a mass appeared in the upper lid of his right eye, which gradually increased, making the upper lid of his right eye unable to lift up.

The incidence of central retinal artery occlusion is low, and children with atrial myxoma are rare. Our hospital once treated a child with recurrent left atrial myxoma with central retinal artery occlusion, and the analysis report is as follows.

Essential thrombocythemia is a myeloproliferative disease mainly caused by megakaryocytic proliferation [1]. It has a slow onset and complicated clinical manifestations. Most patients are first diagnosed in internal medicine. Our hospital once treated a patient with essential thrombocythemia with ocular symptoms for the first time. The analysis report is as follows.

Morning glory syndrome is a relatively rare congenital dysplasia of optic papilla. In 1970, kindler first reported this disease and named it morning glory syndrome. The vast majority of patients with morning glory syndrome have monocular onset, and very few have binocular onset. The main manifestation is low vision in childhood, and the visual acuity is mostly between the anterior index of 0.02, and few patients with visual acuity exceeding 0.1, and those with normal visual acuity are even rarer [1]. Some patients can be combined with other congenital ocular abnormalities [1]. In June 2006, a patient with morning glory syndrome with normal visual acuity was admitted to our hospital. The analysis report is as follows.

Myeloepithelioma is a rare malignant tumor in childhood, mainly occurring in the retina and optic nerve. Tianjin Eye Hospital admitted a case of medulloepithelioma originating in the orbit, which has no relationship with the retina and optic nerve. The report is as follows.

Neurofibroma is a benign tumor of peripheral nerve. According to different clinical manifestations, intraorbital neurofibroma can be divided into two categories: neurofibromatosis and solitary neurofibroma [1]. A case of solitary neurofibroma originating from frontal nerve is reported as follows.

The male child was admitted to hospital 5 days after birth because of "red, swollen and prominent left eye for 5 days". The child was born by caesarean section, and the left eye was found to be red, swollen and prominent immediately after birth, with rapid growth and bleeding. Ocular examination: the left eye was obviously bulged, about 5 cm ×5 cm ×4 cm in size, subcutaneous congestion of upper and lower eyelids, conjunctival edema and prominent palpebral fissure, subconjunctival hemorrhage, orbital pressure (T + +), tenderness (+), upward displacement of eyeball and inability to rotate (Figure 1).

Since Kelman [1] first reported the use of phacoemulsification technique for cataract removal in 1967, phacoemulsification technique of cataract has been constantly updated and matured, and has become a routine operation for cataract treatment at present.

Corneal transplantation is the only way to recover vision in corneal blind patients. Traditionally, the main index to evaluate the effect of corneal transplantation is vision. However, with the change of medical mode from biomedicine to physiological, psychological and social medicine and the particularity of corneal transplantation, people gradually realize that simple vision examination cannot fully reflect the impact of corneal transplantation on the physiological, psychological and social activities of patients.

At the 2007 American Ophthalmology Annual Conference (AAO) held in New Orleans, USA on November 10-13, 2007, Ma Zhizhong, Peking University Ophthalmology Center, Peking University Third Hospital, presented an article entitled "Autologous Bruch membrane band retinal pigment epithelium (RPE) cell transplantation for wet age-related macular degeneration (AMD)", which was rated as the best paper by the conference.

The patient was a 53-year-old male who came to our hospital on July 31, 2007 due to the decrease of visual acuity in his left eye for 3 years and pain for half a month. Three years ago, the patient gradually decreased his visual acuity in his left eye without obvious trigger, and there was no obvious redness and pain in his eyes. The patient denied the history of trauma. He went to a local hospital and was diagnosed as "cataract in his left eye and macular degeneration in his left eye" due to "opacity of lens and hard exudation in macular area". He was treated with drugs such as white neoplasm and vitamins, but his condition was not controlled. Half a month ago, the patient felt obvious swelling and pain in his left eye.

The construction of hospital information management system (HIS) is the core link of hospital information construction and the necessary means of modern management. As a special type of hospital, the information management of ophthalmology hospital has special needs [1]. Our hospital started the construction of HIS in 1998, based on its own platform of ophthalmology hospital, invested manpower and material resources, and after 8 years of innovative development and construction, it gradually established the "ophthalmology hospital information management system" from scratch, achieved good application effect, and owned the software copyright of the whole system. Now, in order to promote communication, the research and development and application of the system are introduced.

Type A1 Question 1. Compared with ordinary pulse mode phacoemulsification technique, the description of phacoemulsification WhiteStar technique is wrong