Volume 44 ·  Issue 04 ·  2008

Development of different kinds of new intraocular lenses(IOL)provide more selections to meet various clinical requirements,which may plays an active role in making cataract surgery more perfectible.But there are many misunderstandings about how to select the proper IOL.For example,"the expensive one is the best one","new product is absolutely perfect",and SO on.Some surgeons prefer more practice and ignore the summary of the experiences.Someone unilaterally exaggerates some special function of IOL When selecting the IOL,it is a common challenge for us to fully consider the patients needs,and properly manage the relationship between the basic need and special need,and to avoid fanaticism,and provide the best benefits to the patients.

Dry eye syndrome following carrot surgery W88 concerned about recently.Two kinds of dry eye were clinically observed after cataract surgery,early dry eye and chronic dry eye.Most cases of early dry eye,who usually had the normal lacrimal secretion before surgery,were reversible and involved in some of factors associated with surgery and pest-surgery medicatiotr But most cases of chronic dry eye,who have abnormal lacrimal secretion or"borderline state"of lacrimal secretion test before surgery,may suffer from the ocular surface diseases related to irreversible dry eye disease.It is significantly important for maintaining of the ocular surface stability and recovery of vision acuity after cataract surgery to do early diagnose and promptly manage the dry eye syndrome.

Objective To study the results of using AcrySof ReStor multifocal intraocular lens (M1OL)after the cataract operation．Methods It was a non-random comparative clinical study.After the small incision phacoemulsification。AcrySof ReStor MIOL was inserted into the eye in 22 cases(30 eyes.observed group);single focal intraocular lens(SIOL)Was inserted in 20 cases(30 eyes,control group).Visual acuity,corneal astigmatism,operative complications,spectacles independence,patient satisfaction and untoward visual symptoms were observed.The follow up period Was 3～14 months.Results Patients with uncorrected near visual acuitv 0.5 or better accounted for 86.7%(26/30)in the observed group and 33.3%(10/30)in the control group,respectively.There was a significantly statistical difference between these two groups 3 months postoperatively(χ2:17.78,P<0.05).Patients with uncorrected near visual acuity 1.0 or better accounted for 66.7%(20/30)in the observed group and 0%(0/30)in the control group here was a significantly statistical difference between these two groups 3 months postoperatively (x2=21.82,P<0.05).There Was no statistically significant difference in the corrected near and distant visual acuities and uncorrected distant visual acuity between these two groups(X2=0.13,0.35,0.35;P>0.05).There Was no statistically significant difference in preoperative corneal stigmatism and corneal astigmatism 1 week,1 month and 3 months after the operation between these two groups(t=-0.46,-0.47,-0.44,-0.48;P>0.05).Spectacles were not necessary in 86.7%(26/30)and 13.3%(4/30)cases in observed and control groups,respectively.In the observed group,glueocorticoid-induced hiigh ocular pressure occurred in two eyes.One eye required Nd:YAG laser posterior capsulotomy in the control group.Conclusions AcrySof ReStor M10L implantation provides a better distant and near vision．Spectacles are not required in 86.7%Cases and the life quality is improved.

Objective To observe the location of posterior chamber intraoeular lenses(PCIOL) after secondary transscleral fixation,to evaluate its impact on the stuctures of anterior segment and its correlation with visual outcome.Methods It was a retrospective case series,included 32 aphakic patients (32 eyes)with secondary transscleral fixation of PCIOL Postoperatively,the accurate position of the lens and their relationship with adjacent structures were observed by ultrasound biomicroscopy(UBM).The follow-up time period ranged from 6 to 18 months.Results Best-corrected visual acuity were improved postoporatively in 30 eyes while the other 2 eyes remained unchanged.No tilt or decentration of the lens Wag demonstrated by the slit lamp microscopy.While using UBM,optic tilt Was found in 9 eyes and decentration in 2 eyes.The decentration and tilt of the lens correlated with visual outcome and Was statistically significant (x2=4.36,P<0.05).In 12 eyes(37.5%),both haptics were located in the sulcus.In 20 eyes (62.5%),one haptie Was located in the suleus and the other one was in the back of the iris.pars plica (43.8%),pars plana(9.4%)or vitreous cavity(6.3%).The different haptic locations were no correlated with visual outcome(2:0.26,P>0.05).Conclusions The current suture technique for transscleral fixated PCIOLs can not ensure the proper anatomical outcome.The decentration and tilt of the lens correlate with the postoperative best corrected visual acuity．In our study.we could not find the correlation between the haptic location and visual outcome.

Objective To study the changes in anterior chamber configuration after phacoemlsification and foldable intraocular lenses (IOL) implantation with panoramic ultrasound biomicroscopy(UBM).Methods A novel panoramic UBM Was developed for anterior segment scanning．Small.incision phacoemulsification and foldable IOL implantation were performed in 102 eyes of 81 patients with age.related cataract.The anterior chamber diameter in horizontal meridian and vertical meridian and the anterior chamber depth(ACD)were measured by computer calipers before and two months after the surgery. The changes of the anterior chamber angle were measured in 36 eyes．Results Diameter of anterior chamber in vertical meridian Was greater than that in horizontal meridian in most cases.In all patients.horizontal anterior chamber diameter Was widened significantly two months after surgery(t=7.10,P<0.01),a significantly negative correlation existed between preoperative and postoperative data(r=0.801,P<0,01).The ACD Was deepened(t=39.97.P<0.01).In 36 eyes,the anterior chamber angle Was widened.Conclusions Diameter of the anterior chamber in vertical meridian is greater than that in horizontal meridian in most cases.After phaeoemulsification and foldable IOI implantation.UBM revealed that the anterior chamber diameter iS increased and postoperative chamber diameter can be estimated by preoperative one.After the operation.the iris diaphragm shifts backward,the anterior chamber is deepened and anterior chamber angle iS widened.

Objective To evaluate the outcomes of phacoemulsification with NeoSoniX handpiece.Methods It was a prospective random controlled clinical trial．Six hundred and fifty-nine cases(659 eyes) having phacoemulsification were prospectively comprised in this study.All cases were divided into two groups randomly.Group l(NeoSoniX handpiece) include 317 cases.Group 2(standard handpieee)include 342 cases.Preoperative measurements included best correct visual acuity (BCVA) and cataract grade according to the Emery classification.Intraoperative measurements included active power(AP)and effective phaco time(EPT).Postoperative measurements included BCVA and corneal edema.Results Grade I to Ⅲ nuclear sclerosis.The AP Was 3.53%±1.76%with NeoSoniX and 3.84%±1.93%with standard handpiece,the EPT Was(0.23 4-0.15)minutes and(0.25 4±0.19)minutes,respectively.There was no significant difference in the postoperative BCVA and cornea edema between the two groups.Grade IV or V nuclear sclerosis.the AP was 6.31%±2.78% with NeoSoniX and 9.45%±4.17%with standard handpieee,the EPT Was(0.55±0.28)minutes and(0.83±0.44)minutes.respectively.There Was significant difierence in the postoperative 1 day BCVA and cornea edema between the two groups.There Was significant difierenee in the postoperative 7 days BCVA and cornea edema between the two groups.Conclusions Ultrasound energy consumption with NeoSoniX Was significantly less than with US alone in emulsifying cataracts of optimum density and dense hard cataracts.

Objective To investigate the kiNing efficiency of pwzlL plasmid-mediated herpes simplex virus-thymidine kinase(TK)and E.coli cytosine deaminase(CD)on human lens epithelium cells followed by the treatment of prodrugs.Methods PWZL plasmid was used ills a vehicle.to transduce double suicide genes into the human lens epithelium in vitro.then the cells were treated with flurocytosine(5-FC) and/or ganciclovir(GCV)at difierent concentrations.The cell growth of the lens epithelium cells Wasobserved by light microscope.MTTT analysis Was used to estimate the cell survival rate and the bystander effect was analyzed simultaneously.The significance of difference between each group WaS treated by statistical tests. Results The CD and TK gene could be ioined into PWZL plasmid successfully,and did not have any special effect on normal cells.There was no significant difference in cell viability between CD-TK transfeeted cells and control cells.Cell viability in cells treated with predrugs was decreased in a time.dependent manner.At the end of the experimant.Cell viability Was lowest in GCV 10 ms/I+5-FC 60mg/l,group,GCV 10 mg/L+5-FC 100 mg/L group and GCV 100 mg/L+5-FC 100 mg/L group.There were no significant differences between these three groups(x2=1.25,P>0.01).Analysis of bystander effect indicated that the cell viability in GCV 100 mg/L+5-FC 100 mg/L group and GCV 10 mg/L+5-FC 60 mg/L group Was significantly lower than that in the controls (t=10.26.13.16;P<0.01).Conclusions PWZL plasmid Can transfect the CD and TK genes into lem epithelium cells successfully and efficiently.CD and TK genes Can be expressed steadily.Transfection of double suicide gene reduces the dosage of prodrugs required for killing cells.The combination of 5-FC with GCV shows the greatest killing effect and also has the bystander effect.

Objective To determine whether matrix metalloproteinases inhibitor can prevent human lens epithelial cell migration in lens capsule bag model from the donor eyes, Methods This study was an experimental investiation.Sham cataract surgery were performed in 16 human donor eyes. The donor lens capsule bags were cultured and treated with a broad MMP inhibitor (GM6001) at different concentrations (1,10and 100 μmol/L)and without CM6001 (negative control).The distance of lens epithelial cells migration on the posterior capsule was measured in all capsule bags under microscope and total MMP-2 and MMP-9 protein priduction was determined by ELISA. the cell viability in all groups was determined using methylthiazoltetrazolium (MTT)test. Results Lens epithelial cells at the equator began to migrate by day 4.Epithelial cells migration onto the posterior capsule was sigificantly reduced by GM6001 in a dose dependent manner as compared with the controls (F=53.79,P<0.01).Seventy percent reduction (P<0.01)and 98% Reduction (P<0.01)of migration were observed in 10μmol/L and 100μmol/L GM6001 Treated cultures, respectively, as compared with that in control on day 20.MMP levels in capsular bag were reduced by GM6001, the greatest inhibitory effect was found at the highest concentrations of GM6001 (F=86.59,72.96;P<0.01).By day 20,the reduction in total MMP-2 level (p<0.01)and MMP-9 level (P<0.01)in 10μmol/L GM6001 treated cultures was 70% as compared with that in control.Ninty percent reduction in MMp-2 level (P<0.01)and 87% reduction in MMP-9level (P<0.01)were found in 100μmol/L GM6001 treated cultures. Lens epithelial cells remined viable and proliferated in the presence of all concentrations of Gm6001.No significant difference of cell viability between the controls and GM6001 treated cultures (1,10,and 100μmol/L)was foud by the MTT assay (F=0.62,P>0.05).Conclusions MMP inhibitor inhibits the lens epithelial cell migration onto the posterior capsule and does not affect the cell viability in cultured lens capsule bags in vitro.Therefore ,MMP inhibition may have a role in the treatment of posterior capsule opacification.

Objective To describe clinical phenotype in a Chinese family with Best vitelliform macular dystrophy(BVMD)and to identify the mutation of the VMD2 gene in this family.Methods It waft a retrospective case analysis.Five patients(10 eyes)were diagnosed as BVMD by the fundus photography,EOG,fluorescein angioography(FFA)and optical coherence tomography(OCT).Their clinical data were analyzed retrospectively.Molecular genetic analysis was performed on DNA extracted from peripheral leucocytes of all patients and 2 unaffected family members．Exon 1 to 11 of the VMD2 gene were amplified by polymerase chain reaction for direct sequencing.Results The pedigree showed aJl autosomal dominant inhefitance.Ten eyes from 5 patients were classified into Stage 0,lI a,II b,lU and 1V with different clinical manifestations.Direct sequencing of all affected members revealed a T→G transition at codon 301.producing Asp301Glu mutation of VMD2 gene．Conclusions Asp301Glu mutation of the VMD2 gene is found in a Chinese fay with BVMD.The phenotype of BVMD in this family belongs to geographic type. Molecular genetic approach may be useful for the proper diagnosis of BVMD.

Objective To describe and evaluate a refraction-derived method and a clinical-derived method to calculate the correct corneal curvature for intraocular lens (IOL) power calculations after laser in situ keratomileusis (LASIK) and to compare the results to the commonly used history-derived method.Method Retrospective analysis of consecutive case treated with LAIK clinically.We measured pre-LASIK and post-LASIK spectacle refraction.pre-LASIK and post-LASIK K readings in each patient．We then calculated pre.and post.LASIK refraction at the corneal plane and the amount of correction obtained by the refraction surgery.Patients were divided into two groups.Group I Was used to establish the two different formulas for the refraction-and clinical-derived methods.The values obtained with these two methods were compared with the K by history-derived method(Kc.hd) in group II to validate the results.Results The K values calculated using the refraction-derived method and clinical-derived method were correlated significantly with that obtained from Kc.hd.Conclusion The calculation of corneal curvature for intraocular lens(IOL) power calculation after LASIK can use the refraction-and clinical-derived methods instead of history-derived method when some refractive parameters are not available.

objective To study glutamate substrate-induced regulation on the expression of glutamate transporter L-glutamate/L-aspartate transporter(GLAST)of retinal Müller cells (RMCs)in mice.Methotis Activity of GLAST was measured through L-3H-glutamate uptake detection.The exDression of GLAST protein in lysated cells Was studied using Western blot.Results Glutamate was applied to cultured RMCs at various concentrations for 30 min.L-3H-glutamate accumulation in RMCs increased as the increase of concentration of substrate glutamate and reached the maximum at 100 umoL/L glutamate.Glutamate treatment of RMCs increased GLAST transporter expression as compared with untreated cultures.Glutamate at 100 umol/L caused a maximal increase of GLAST protein expression．Conclusion Glutamate substrate increases GLAST activity and up-regulate the expression of GLAsT protein.

It has been proposed that a few kinds of autoantigens imitate the development of autoimmune uveitis while the immunodominant epitopes of these antigens have not been identified.Researches on retinal S-antigen and interphotoreceptor retinoid-binding protein as well as tyrosinase-related protein epitopes mapping have shown that each autoantigen contains several immunopathogenic epitopes and immunogenic epitopes and that the immunopathogenic sites ale not coincident with the immunogenic epitopes.The reactivity of peripheral blood mononucleal cells from uveitis patients against each autoantigenic epitopes displays high heterogeneity.Epitopes spreading phenomenon has been disclosed in human uveifis study and reinforced in animal experiments.Study on this epitope spreading may contribute to our understanding of immune tolerance induced by different epitopes in the treatment of autoimmune disease including uveifis.

Retinal angiogenesis could be attributed to complex interactions among multiple angiogenic stimulators.Under pathological condition,angiogenic molecules,such as metalloproteinase,erythropoietin,integrin,promote retinal neovascularization through different pathway．Therapy target to these molecules involving in retinal angiogenesis could suppress retinal neovascularization effectively.This article reviews recent progress in studies OH the molecules participating in retinal angiogenesis and therapy targeting it.

Cataract is a common disease in ophthalmology and one of the main ocular diseases causing blindness. Scholars at home and abroad are actively exploring effective methods for the treatment of cataract. With the rapid development of molecular biology technology, gene therapy of cataract has entered the research scope of people. The abnormal expression of oncogene is closely related to the proliferation and differentiation of lens epithelial cell (LEC), and the proliferation and differentiation of LEC is the pathological basis of cataract development. Many research results show that c-myc gene is the key gene in the development of cataract [1-2]. Inhibiting the abnormal expression of c-myc gene may be an effective way to block the development of cataract. In this experiment, a rat galactose cataract model was used, and cationic liposome was used as the transfection vector of c-myc antisense oligonueleotide (AON) by prophylactic therapy. The effect of c-mye AON on the formation of galactose cataract was studied and its mechanism was preliminarily discussed.

IOL Master (Zeiss, Germany) is a coherent optical biometric instrument that integrates the measurement of axial length (AL), corneal curvature, corneal diameter and anterior chamber depth (ACD). It also provides various formulas for calculating intraocular lens power, which can directly calculate intraocular lens power [1-3]. The measurement results of IOL Master may be affected by refractive corneal surgery, thus affecting the calculated intraocular lens power. in this study, IOL Master was used to measure and compare the indexes before and after laser in situ keratomileusis (LASIK) in patients, and the reliability of IOL Master measurement results after LASIK was discussed.

In the past, some scholars have assumed to establish animal models of optic nerve injury by optic nerve extrusion, partial cutting, increasing intraocular pressure and injecting vasoconstrictors, etc. However, the model limited to anterior optic nerve injury is relatively rare. The authors established a rat anterior optic nerve injury model by photodynamic method, and observed its reliability, which is reported as follows.

Congenital analgesia is an extremely rare hereditary disease [1-2]. Patients mainly show analgesia, which can be accompanied by autonomic nerve dysfunction and intellectual development disability. Due to the impairment of pain perception, patients often lead to self-injury damage. The ocular manifestations are recurrent and difficult to heal corneal ulcers, which seriously affect the patient's vision. In April 2007, a patient with congenital analgesia accompanied by corneal ulcers was admitted to our hospital outpatient department, and the report is as follows.

The patient was a 65-year-old male who came to our hospital on January 2, 2006 due to pain, decreased vision and inability to open his eyes for 3 weeks after right eye trauma. The patient fell while walking in the woods 3 weeks ago, causing pain and bleeding in his right eye. He immediately came to our hospital for debridement and suture treatment. Due to financial constraints, he did not perform orbital CT examination, and was treated with anti-infection in the local clinic. Six days later, the suture was removed, but he still could not open his eyes, and at the same time, he was complicated with exophthalmos and decreased vision. He went to our hospital again. The orbital CT examination results showed a mixed shadow of massive low density and stripe-shaped slightly higher density in the right orbit (Figure 1), and was diagnosed as hemorrhage in the right orbit and contusion of the soft tissue of the right orbit.

The patient was a 52-year-old male who came to our hospital on August 26, 2006 due to dark shadows in front of both eyes and gradual decline of visual acuity for 2 months. Three months ago, the patient was found to have pancreatic head cancer on physical examination, and underwent pancreatic head cancer resection and subtotal gastrectomy. He fasted for 2 weeks before and after the operation, and was given nutritional drugs such as fat emulsion and amino acids by intravenous drip, and broad-spectrum antitoxin was applied to prevent infection after operation. He had fever 3 days after operation, and his body temperature returned to normal after 2 weeks. There were no signs of infection at the place of venous catheter placement, but dark shadows in front of both eyes and visual acuity decreased. He was diagnosed as "uveitis in both eyes" in a local hospital. He was given local and systemic antibiotics and local glucocorticoid therapy successively, but his condition did not improve, and the visual acuity of his left eye decreased significantly.