Volume 44 ·  Issue 05 ·  2008

Although the durgs, such as Memantine, Calpain, Erythropoietin, have demonstrated exciting results for neuroprotection in laboratories, the phase Ⅲ clinical trial of Memantine failed to prove such activity. So far, none of neuroprotection drugs has been approved by FDA for clinical use with the failure of Memantine clinical trail indicating that the gap between basic science research and clinical application in glaucomatous optic neuroprotection remains to be filled. This paper offers a new insight into the field of neuroprotecion in glaucoma. To make the dream of optic neuroprotection to reality, we have to implement new perspective strategies to integrate technologies and findings from the researches of human genomonics, proteomics, stem cells, and gene-transferred animal models.

ISGEO classification was proposed as the diagnostic criterion of primary angle closure glaucoma in epidemiological prevalence survey, which is preferable to be used in epidemiology rather than employing as a clinical diagnostic criterion. A different classification means a different definition. To unify the different point-views on the ISGEO classification, a further understanding of glaucoma definition is discussed and reviewed.

Objective To study the pathological changes of retinal glial cells and its effect on retinal ganglion cells (RGC) damage in a rat chronic ocular hypertension model. Methods Seventy-two of Sprague-Dawley (SD) rats with chronic elevated intraocular pressure (IOP) by ligating two superior or inferior episcleral veins were used in this study. Twelve normal rats served as control. The densities of glial cells were determined in flat mounted or transverse semithin sections of retinas, microglial cells were visualized by OX42 staining on whole-mounted retinas, and Muller cells were detected by expressing glial fibrillary acidic protein (GFAP) on frozen section or flat mounted retinas with confocal microscopy at 2 hours, 12 hours, 1 day, 1 week, 4 weeks, and 8 weeks after operation, respectively. Results Compared with control group, the densities of activated microglial cells were significantly ( F = 196. 56, P < 0. 01 )increased at 1 day (215.00±18.60 vs 327. 40±68. 32/mm2) and reached a peak value at 1 week ( 965.06±86. 63/mm2), then decreased gradually. But the densities of astrocytes and Muller cells were notsignificantly changed (F = 1.36, 1.89 ; P>0. 05 ) at all time points. The activated microglial cells were appeared at 2 hour while the activated Muller cells and astrocytes presented at 12 hours after operation. The activated Muller cells and astrocytes reached a peak value at 4 weeks, and then decreased gradually. The activated astrocyte had morphological changes including disappeared star-structure of cell body, stiffness,and shortness of cell processes. Conclusions The alteration of microglial cell densities appears to be the earliest pathological changes of retina in rat with chronic ocular hypertension. The activated astrocytes with morphological disorder may deteriorate the damage of RGC and result in a harmful microenvironment for axonal regeneration of RGC in glaucoma.

Objective To analyze the clinical features of hypoperfusion retinopathy induced neovascular glaucoma. Methods This retrospective case series included 18 cases (18 eyes) with hypoferfusion retinopathy induced neovascular glaucoma. Among them, there were 15 male and 3 female; 10 fight eye and 5 left eye. The average age was 40 year old ( ranged from 18 to 78 year old). Visual acuity and fundus were examined using fundus fluorescein angiography (FFA) , Color Doppler Flow Imaging (CDFI),magnetic resonance angiography (MRA), and Digital subtraction angiography (DSA)etc in all patients.Results The visual acuity was ranged from light perception to 0.8 in all patients. The clinical features in hypoperfusion retinopathy induced neovascular glaucoma were characterized by midperipheral intraretinal hemorrhages, narrowed retinal arteries, dilated retinal veins, neovascularisation in iris and anterior chamber angle, ocular hypertension, excavation and atrophy of optic disk, and visual field defects when glaucoma progressed. All eyes have either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries. Conclusions Neovascular glaucoma is a rare and severe complication of hypoperfusion retinopathy associated with either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries. Fundus degeneration is commonly involved in one eye.The characteristic clinical features are presented during the process of the disease.

Objective To analyze the morphology and the function of subconjunctival filtering bleb in patients with glaucoma by slit-lamp adapted optical coherence tomography (SL-OCT) and ultrasound biomieroscopy (UBM). Methods This retrospective study comprised 53 patients with glaucoma filtering surgery from 2002 to 2006. The post-operation blebs in 69 eyes of 53 patients were scanned by a SL-OCT or UBM and categorized by the reference of intrableb morphology. The function of pest operation bleb was clarified using Singh's or Yamamoto's criterion. The results of SL-OCT scanning were compared with those of UBM. Results This is a comparative study. The blebs were classified into four categories according to the images of filtering blebs' by SL-OCT or UBM. SL-OCT had 92.7% (38/41 eyes) sensitivity in predicting a functioning bleb by Singh's standard and 83. 3% (20/24 eyes) specificity in predicting a nonfunctioning bleb, whereas, UBM had 66. 7% ( 30/45 eyes ) and 75.0% ( 18/24 eyes ) by Yamamoto' s criterion,respectively. The sensitivity in predicting a functioning bleb in the SL-OCT group was significantly ( P =0. 003, Fisher exact test) different from the UBM group. Conclusions Our results suggest that SL-OCT scanning has more sensitivity and specificity than UBM in evaluating the function of filtering bleb. The close relationship between the function and the morphological classification provides an important objective basis in evaluating the outcome of antiglaucomatous surgery.

Objective To assess the applicability and reliability of Dynamic Contour Tonometry(DCT) in the measurement of intraocular pressure (IOP) and ocular pulse amplitude(OPA) in patients with primary open-angle glaucoma(POAG) , ocular hypertension(OHT), normal tension glaucoma (NTG) and normal controls. Methods 120 subjects were included in the present study as follows: 30 patients in each group, total four groups, I. E. , POAG, OHT, NTG and normal control. IOP measured by DCT was compared to that by Goldmann applanation tonometry (GAT). OPA, central cornea thickness (CCT), central cornea curve ( CCV), heart rate ( HR), systolic blood pressure (SBP) and diastolic blood pressure ( DBP), other associated parameters, were also determined for the subjects of each group. Results The IOP of all groups measured byDCTwas (21.68±2.02),(23.37±2.65),(18.43±3.08),(17.04±2.07) mm Hg (1 mm Hg =0. 133 kPa) ;and the IOP measured by GAT was (21.18±2. 95), (23.28±5.95), ( 16. 39±3.60), (14. 66±2. 27) mm Hg, there was no significant differences between the IOP measured by these two methods(t =1. 338,1. 445,1. 682,1. 803 ;P = 0. 197,0. 151,0. 136, 0. 081 ). Significant differences of OPA levels in different groups were observed ( F =21. 311, P =0. 000). OPA reading was affected by HR,SBP,DBP ,IOP and CCT, while there was no correlation with patients'age. Conclusions Regarding to the IOP measurement, DCT was in concord with GAT readings. The differences in OPA among POAG , OHT and the normal groups and the lowest OPA reading in NTG patients indicate different intraocular hemodynamic status among these groups. OPA measurement may be useful to early detection and progression follow-up of glaucoma patients.

Objective To investigate the effect of Rosiglitazone on the proliferation and the production of transforming growth factor-β1 (TGF-β1 )in cultured humans Tenon's capsule fibroblasts (HTFs). Methods It was a experimental study. HTFs were cultured and subcultured in vitro. After HTFs were treated with different concentrations of Rosiglitazone, the proliferation was detected by MTT assay. The migration ability was detected by a scratch method. The production of TGF-β1 was determined by ELISA.TGF-β1 mRNA expression was examined by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). Results Compared with control group, Rosiglitazone significantly ( F = 178. 293, P < 0.01 )inhibited the proliferation ( 0. 33±0. 01 vs 0. 29±0. 02 ) and the migration of HTFs in a dose-dependent manner with the concentrations ranged from 20 to 500 mg/L. Rosiglitazone also significantly ( F = 86. 404,P < 0. 01 ) reduced the production of TGF-β1 in HTFs (323.48±13.69 vs 267. 48±20. 31 ). TGF-β1 mRNA was significantly ( F = 176. 102, P < 0. 01 ) down-regulated ( 0. 69±O. 02 vs 0. 55±0.02 ) .Conclusions This study suggests that the inhibition of the proliferation of Tenon's capsule and the migration of HTFs by Rosiglitazone is due, at least in part, to decrease the production of TGF-β1.

Objective To determine the effects of CYP1B1 gene on the structure of anterior chamber angle in mice. Methods It is experimental study. Adult CYP1BI-null mice were used, in comparison C57BL/6J mice was used as control. The mice eyes were enueleated and plastic-embedded and the anterior chamber angle were sagittally sectioned in 3 μm thickness. The morphology and structure of the eye tissues was studied by light microscopy and transmission electron microscopy. Results The anterior chamber angle in C57BL/6J mice were well developed. But in CYPIBI-null mice, a variety of anomalies were found in the these tissues, including hypoplastic and compressed trabecular meshwork, abnormal structure of trabecular cells, a basal lamina extending from cornea over the meshwork, small or absent Schlemm's canal, and long iris process extending from the iris root to the trabecular meshwork. These pathological changes was demonstrated focally and the rest of the angle in CYP1BI-null were normal.Conclusions CYP1B1 gene plays an important role in the development of the anterior chamber angle.Deletion of this gene leads to the abnormalities in trabecular meshwork, Schlemm's canal and iris process,which may have some influence on the metabolism and function of the outflow facilities.

Objective To study the morphological representation of the orbital tissue in thyroid associated ophthalmopathy. Methods It was a retrospective ease series. 138 specimens of TAO( include 77 specimens of orbital fat, 41 specimens of orbital periosteum and 20 specimens of lacrimal gland tissue) were analyzed by light microscopy and immunohistochemical staining. Results The notable hyperplasia of fat was found in orbital tissue from 73 of 77 and in lacrimal gland tissue from 12 of 20. The hyperplasia of fibrous tissue and muscular metaplasia were observed in orbital periosteum. Conclusions The hyperplasia of fat in TAO orbital and lacrimal gland tissue is a very important and ubiquitous pathological changes. Study on the orbital fat and prevent against the hyperplasia of fat maybe have a significance of effective to hold back proptosis.

Objective To analyze the results and skill of surgical management of orbital osteoma retrospectively. Methods It was a retrospective case series. Nineteen cases of orbital osteoma (the diagnosis was confirmed by surgical and pathological studies) were analyzed retrospectively in the present study. Results The location of orbital osteoma was as following: 10 cases in medial wall of the orbit,4 cases in orbital roof and 5 cases in lateral wall of the orbit. Surgical approaches included anterior orbitotomy (8 cases), lateral orbitotomy (7 cases), and medial orbitotomy (2 cases). Complete resection was performed in 12 cases,while partial resection was done in 7 cases. Conclusions Orbital osteoma is easy to diagnosis but difficult in surgical treatment. Appropriate surgical approach and skilled surgical technique are able to reduce the surgical complications.

Objective To evaluate the clinical characteristics and therapeutic efficacy of occult scleral rupture. Methods It was a retrospective case series. Clinical data of 28 patients (28 eyes) with occult scleral rupture in recent 10 years was reviewed. All patients were performed with I -stage debridement and suturing surgery when the scleral ruptures were confirmed by operation search, and fourteen eyes of themwere performed II -stage vitrectomy in following up periods. Results In 28 cases with occult scleral rupture,the major clinical signs included bulbar conjunctival edema and subconjunctival hemorrhage (100%),vitreous hemorrhage (89. 3% ), hyphema (78.6%), ocular hypotension (75.0%), limitation of ocular movement (75.0%), reduction of visual acuity to light perception or less than light perception (67.9%),impairment or dislocation of the lens ( 39. 3% ), pupilla distortion or dilatation ( 35.7% ), choroidal hemorrhage or detachment (35.7%) and retinal detachment (32. 1% ). In 23 patients their eyes were scanned by A/B-uhrasonography, the image of eyeball wall were found to be interrupted or disorder in 5 eyes and the ocular axis was shorten in 4 eyes. X-ray computed tomography(CT) were performed in 10 patients before operation. It was found interruption or unsharpness of ocular ring in 3 eyes, the unevenness of ocular density in 2 eyes, and both signs were seen in 5 eyes. Total 28 eyes, the visual acuity were improved in 18 eyes after operation, no change 9 eyes and decreased 1 eye. Visual acuity was significantly increased post-operation (x2 = 13.29,P <0. 05 ). The result showed that the visual acuity increased in 21.4% (6/28) of eyes with I -stage operation and 85.7% (12/14) of eyes with Ⅱ-stage vitrectomy respectively. Conclusions The major sign of diagnosis of occult scleral rupture are visual acuity with light perception or less than light perception, bulbar conjunctival edema and subconjunctival hemorrhage, hyphema, ocular hypotension and limitation of ocular movement, etc after ocular trauma. The intraocular damage such as impairment or dislocation of the lens, vitreous hemorrhage, retinal detachment etc. , is regarded as the important references in the diagnosis, treatment and prognosis. The rates of misdiagnosis can reduce if auxiliary examinations of A or B-ultrasonography and CT are applied. The prompt and appropriate surgery play an important role in the recovery of visual function.

Objective To investigate the prevalence of lid-wiper epitheliopathy (LWE) and risk factors in dry eye patients. Methods One hundred forty-one patients ( 141 eyes) were recruited in Peking University First Hospital from September 2006 to March 2007. These patients were divided into three groups based on the dry eye symptoms and the results of break up time, Schirmer I test and corneal fluorescein staining. Group A: 60 patients (60 eyes) with no dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group B: 51 patients (51 eyes) with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group C: 30 patients (30 eyes) with dry eye. The patients in group A and group B were further divided into two subgroups based on wearing contact lens. Subgroup A1:30 patients (30 eyes) with no contact lens wearers; Subgroup A2:30 patients (30 eyes)with contact lens wearers. Subgroup B1:21 patients (21 eyes) with no contact lens wearers; Subgroup B2:30 patients (30 eyes) with contact lens wearers. Lid-wiper staining was graded in all patients following the instillation of fluorescein and lissamine green dyes. Impression cytology (IC) was made up in the patients in group C and the patients with LWE in group B. Results The prevalence of LWE was 18.3% (11 patients), 86. 3% (44 patients) and 100. 0% (30 patients) in group A, B, C respectively. The prevalence of LWE was 13. 3% (4 patients), 23.3% (7 patients), 81.0% (17 patients) and 90. 0%(27 cases) in subgroup A1, A2, B1 and B2. There was a significant statistical difference in the prevalence of LWE among groups A, B and C ( X2 = 78. 256, P < 0. 01 ). There were no statistical difference in the prevalence of LWE between subgroup A2 and subgroup A1 ( X2 = 1. 002, P = 0. 253 ), subgroup B2 and subgroup B1(x2 =0.854, P=0.301). In group B, IC was graded as mark zero in 74.0% of patients with LWE, as mark one in 26. 0% of patients with LWE. In group C, IC was graded as mark one in 40. 0% of patients, as mark two in 50.0% of patients, and as mark three in 10.0% of patients. There was a significant statistical difference in grade of IC between group B and C (M-W=36.0, P <0. 01). The result of the corneal fluorescein staining was positive in 18. 8% of patients with LWE. The result of lissamine green staining was positive in 14. 1% of patients with LWE. However, the result of both fluorescein and lissamine green staining was 67. 1% in patients with LWE. Conclusions The prevalence of LWE is higher in patients with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. LWE may be an early manifestation of the dry eye.

Filtering surgery is an effective and a most commonly used technique in managing glaucoma. However, the failure of surgery is often caused by the scar formation of the filtering pathway. It is important for clinicians to evaluate the morphology and the function of the filtering bleb, especially in the early period of post-operation when IOP is normal. The success of surgery relies upon the early intervention whenever the filtering bleb showing the tendency of scarring. This paper reviews recent development in the observation and the treatment of glaucoma filtering blebs.

The ability to measure intraocular pressure in rodents is very important for the advancement of glaucoma research. This review article describes various currently used methods, such as,microcannulation, servo-null mieropipette, Tonopen tonometer, rebound tonometer, Goldmann applanation tonometer, Schitotz indentation tonometer, pneumotonometer, and optic interferometry tonometer. Their principles of operation, advantages and limitations, as well as a calibration method are also discussed.

As a concentrated location for adult somatic stem cells, the niche plays a crucial role on maintaining the high proliferative ability and the inducing the particular differentiation of the stem cells by providing the special microcnvironment containing definite extracellular matrix and niche cells. Nowadays limbal stem cells (LSCs) are the acknowledged adult somatic stem cells of corneal epithelium. Rapid progress has been accomplished in the theory and clinical practice on LSCs. However, the understanding on its niche has obviously fallen behind. This review summarized and analyzed the status quo of the study on niche of LSCs, mainly through the following aspects: the precise location of the niche was described as limbal epithelial crypts; the blood-derived and stroma-derived cytokine could regulate the proliferation,differentiation and apoptosis of LSCs by triggering particular intracellular information pathway; the survival and function of LSCs could be influenced by damaged niche microenvironment, while the differentiation of LSCs could be veered by another type of niche; in ex vivo LSCs expansion, reconstruction of the niche is needed and could be achieved by 3T3 cells or using amniotic membrane as the carrier.

The treatment of irregular corneal astigmatism has always been a difficult point in clinic [1]. Since February 2004, the author tried to use excimer laser keratablation guided by the topography of the cornea of the American Scientist Company to treat irregular corneal astigmatism, and the curative effect was satisfactory. The typical cases with complete data and follow-up time of more than 6 months are reported below.

Retinoblastoma is generally not difficult to diagnose because of its characteristic age of onset, pupillary white light reflection (cat's eye), mass seen by ophthalmoscopy, solid mass and intratumoral calcification revealed by B-ultrasound and CT examination, etc. However, if the above characteristics are lacking, such as the onset age of the child, no mass in the eye, and no calcification by B-ultrasound and CT examination, the diagnosis is difficult at this time. The tumor cells of diffuse invasive retinoblastoma grow invasively along the retina without forming mass, and the vast majority of patients have no calcification, which makes the diagnosis more difficult. We once treated a child with invasive retinoblastoma in 2005, and now retrospectively analyze its early diagnosis problems to summarize its experience and lessons.

Sturge-Weber syndrome, also known as Sturge-Kalisher-Weber syndrome, has the main clinical manifestations: ocular-nerve-cutaneous hemangioma, meningeal-cutaneous hemangioma syndrome, vascular-cerebral trigeminal syndrome or trisomy 22 syndrome, neurocutaneous syndrome, cutaneous sclerosis syndrome, red maternal spot with congenital glaucoma, glaucoma and facial vascular nevus syndrome, etc.

The First Affiliated People's Hospital of Shanghai Jiaotong University will hold the "National Symposium on Retinal Detachment, Diabetic Retinopathy, New Progress in Minimally Invasive Vitreous Surgery and Application of New Ophthalmology Technology and Continuing Medical Education Study Class" in Shanghai from July 16 to 22, 2007. In order to better exchange the cutting-edge knowledge and information of the diagnosis and treatment of ophthalmic diseases in the current world, in addition to our ophthalmologists, this class will also invite many well-known ophthalmologists from all over the country to give wonderful special lectures. The main contents are: (1) the latest progress of vitreoretinal surgery technology; (2) surgical treatment of retinal detachment; (3) The latest progress in early intervention, grading and surgical treatment of diabetic retinopathy;

The "Study Class on Modern Diagnosis and Treatment of Orbital Tumors and Intraocular Tumors" organized by the Institute of Orbital Diseases of Beijing Armed Police General Hospital will be held in Qingdao, Shandong Province from June 6 to 10, 2008. The session will last for 5 days, and the conference fee will be 800 yuan. The study class will award the students with the National Class I Continuing Education Credit Certificate (10 points). Teaching contents: orbital tumor, orbital fracture, intraocular tumor diagnosis, surgical treatment and ocular plastic repair, analysis of typical difficult and misdiagnosed cases, etc. Equipped with extensive orbital surgery video; And prepared the orbital surgery model for the trainees, which can be operated by themselves, combining theory and practice. The teaching experts include Xiao Lihua, Song Guoxiang, Hu Shimin, Liang Jianhong, Li Dongmei and other well-known domestic experts.

The patient was a 31-year-old male. Fundus abnormalities were found in routine physical examination. He had no previous symptoms such as visual impairment and night blindness, and had no similar family history. See essence pictures 1~3 for fundus examination.

Glaucoma is a kind of optic neuropathy. It is of great significance for early diagnosis and follow-up observation of glaucoma, especially primary open-angle glaucoma, to understand the changes of glaucomatous optic head and retinal nerve fiber layer (RNFL). In recent years, new imaging techniques have been applied more and more in the diagnosis of glaucoma, and it seems to be an important and indispensable auxiliary diagnostic tool. However, recent research results show that these new methods are not superior to physicians' direct observation and evaluation of RNFL around the optic head and the optic head.

Type A1 Question 1. Which statement about the application of capsular tension ring (CTR) in cataract extraction surgery is wrong? A. Standard lens CTR is suitable for patients with mild localized lens capsular instability

This issue focuses on glaucoma research. The optic nerve damage of glaucoma is irreversible, and it has been listed as the second blinding eye disease by the World Health Organization. The World Glaucoma Federation and the World Glaucoma Patients Federation decided to designate March 6th every year as "World Glaucoma Day" since 2008, in order to arouse the attention and attention of all circles of society to glaucoma.