Volume 44 ·  Issue 08 ·  2008

Traumatic optic neuropathy(TON) had an increasing tendency. The patients with TON had severe visual loss and poor visual outcome. It was recognized that early diagnosis and treatment could obtained higher visual improvement rate. The key of success treatment was in time. Taking TON as an emergency, quick and accurate clinical diagnosis, immediate CT scan on optic canal area and necessary visual electrophysiology check, early and rational therapy including surgery, good visual outcome would be obtained. (Chin J Ophthalmol,2008,44:673-675)

Objective To evaluate the problems presented in the diagnosis and treatment of orbital foreign body. Methods This was a retrospective case series. We reviewed and analyzed 24 cases of orbital foreign bodies treated by us in the past 5 years. Results Twenty four orbital foreign body cases were treated by the authors from May 2002 to May 2007. Eleven cases were plant foreign bodies, 6 cases were metallic foreign bodies, 2 cases were glass foreign bodies and 5 cases were other types of foreign bodies. Wound cleaning operations were performed in 18 cases. Foreign body removal surgery was performed in 12 cases. In 7 cases, three or more operations were undertaken. The problems presented in the diagnosis and treatment of orbital foreign body included: (1)History taken was inadequate and failed to recognize the presence of orbital foreign body. (2) The necessary CT examination was not perfromed. (3) CT films was not read correctly and failed to detect the orbital foreign bodies. (4) An exploration operation was not performed during the emergency operation and subsequent operation for draining of pyogenic infection. (5)Only part of the wood or plastic fragments were removed during the operation. (6)Foreign bodies could not be extracted or were pushed deeply due to unfamiliar with the structure of the orbit, lack of adequate surgical skills or absence of necessary instruments. (7)A second CT examination was not performed and foreign body was not re-localized before the second surgery. (8)An inappropriate anesthesia method were selected (such as using local anesthesia insteand of general anesthesia ) so that the patient could not stand the painful operation. Conclusions Many problems presented in the diagnosis and treatment of orbital foreign body,including the handling of the structure of the orbit, correct reading of CT imaging and diagnosis of orbital foreign body, well-informed operative approach, increasing the removal of orbital foreign body and decreasing the complications, these should be focused by ophthalmic surgeons. (Chin J Ophthalmol,2008,44:676-680)

Objective To evaluate the security and efficacy of surgical procedure combined with Nd:YAG laser in the management of orbital venous malformation. Methods A total of 17 successive patients with orbital venous malformation were treated with surgical excision in conjunction with Nd:YAG laser from July 2003 to June 2005. General anesthesia was performed in all patients. Appropriate approach was used according to the location and size of the lesion as well as its relation with adjacent tissues. Surgical procedure and laser coagulation were performed alternatively. Intermittent or continuous photocoagulation aimed at minor and deep lesions or large and superficial lesions was administrated, respectively, when indicated. Laser power of these two procedures was set at 60 to 90 J/cm2 or less than 100 J/cm2,respectively. Cold saline solution was used to cool the targeted region immediately after photocoagulation in case of damage to surrounding normal tissues. Results Seventeen patients were followed-up for 12 to 26 months. Notable lesion regression was found in 15 cases and fair reduction of the lesion in 2 cases. Vision acuity decrease did not occur and vision acuity increase was found in 2 patients. Exophthalmos was completely corrected, enophthalmos was found in 4 patients, the movement of the eyeballs was markedly improved. Complications consisted of superior oblique muscle paralysis (1 case) and ptosis (1 case).Relapse or aggravation of residual lesion was not found during the whole follow-up period. Conclusions Surgical procedure combined with Nd:YAG laser is a safe and effective procedure in managing patients with orbital venous malformation. Laser treatment can decrease the hemorrhage during operation, make the surgical procedure easier, reduce the risk of operation and improve the results of surgical treatment. (Chin J Ophthalmol,2008,44:681-686)

Objective To evaluate the type, clinical features and diagnostic methods of orbital metastatic tumors. Methods In a retrospective study, the records of 30 consecutive cases with orbital metastatic tumors as confirmed by pathologic examination were analyzed with special attention to the epidemiology, clinical manifestations and imaging findings. Results Most orbital metastatic tumors in China originated from the breast, followed, in order, by the lung and liver. The metastatic tumors of the orbit most frequently originated from the liver and lung in males, and from the breast and lung in females. The male or female ratio of patients with orbital metastasis was 1 : 1. The orbital metastases were more common in the children and the elderly. In 50% of patients, the orbital symptoms were the first signs of the disease. The longest course was seen in metastasis from the breast and the shortest from various types of blastomas. Orbital metastases could occur unilaterally or bilaterally. The most common symptoms of orbital metastatic tumors included diplopia and orbital pain. The signs included proptosis, limited ocular movement and increased intraobital pressure. Based on the images of computed tomography or magnetic resonance imaging, orbital metastatic tumors could be divided into four different types according to the location and morphology of the tumors. Follow-up results revealed that 60% of orbital metastasis had poor prognosis. Conclusions The spectrum of orbital metastatic tumors in China is different from that in western countries. Familiarity with the clinical manifestation and diagnostic methods of orbital metastatic tumors can be helpful to relief the ocular symptoms and prolong the life of patients. (Chin J Ophthalmol,2008,44:687-690)

Objective To study clinicopathologic features, histologic characteristics, differential diagnosis and the treatment of orbital solitary fibrous tumor (SFT). Methods Clinical, radiographic and pathologic findings of 6 cases of SFT were retrospectively analyzed. Immunohistocbemistry were performed on selected samples. Results Four patients were males and 2 were females. Patients age ranged from 19 to 57 years old. The location of the tumor was in the muscle cone(case 1 and case 5), medial(case 3), lateral (case 4) , superior (case 2) and inferolateral (case 6) portion of the orbit, respectively. The presenting symptom was proptosis in 3 cases and was mass of subconjunetival or orbit margin in other 3 cases. Image examination: SFT appeared as a round (case 6 showed irregular) and well-circumscribed parenchymatous mass that could be homogenously enhanced by contrast. Histologically, SFT displayed as a mass of spindle cells in an irregular arrangement. Sometime, tumor cells could be storiform or sarciniform. Mitotic figures were infrequent and usually there were 0 to 3 mitotic figures per 10 high-power fields. Hyalinization and staghornform blood vessels were frequently observed. SFT was immunoreactive for markers such as Vim,CD34 and CD99. Two cases were recurred. Conclusions SFT is a rare orbital tumor and could be confused with other types of orbital tumors. This tumor can be diagnosed by pathological and immunocytochemical studies, these characteristics can be used to differentiate it from other types of orbital tumors. (Chin J Ophthalmol,2008, 44:691-695)

Objective To investigate the procedure of transcranial operation via pterional approach for cranio-orbital communicating tumors, to improve surgery skills, to summarize the incidence of main complications and to discuss tips for avoiding damage of the normal orbital tissues. Methods Pterianal approach was adopted for the operation. After the medial orbital wall or lateral orbital wall was bitten with rongeur and the orbital roof was removed, the extraocular muscles at orbital apex were separated and protected. The head of condenser was used to freeze the tumor, and the tissue around the tumor was separated until the tumor was extirpated. In cases where the tumor penetrated the dura mater and invaded the brain, surgery was performed by neurosurgeons. Results In 37 cases, 32 cases undertook total resection of tumors and palliative resection was performed in 5 cases due to severe tumor invasion of the cavernous sinus or sphenoid sinus. Of the 37 cases, 28 cases were benign tumors and accounted for 75.67% of total cases (28/37); 9 were malignant tumors and accounted for 24. 32% (9/37). Pathological examination showed that 11 cases were meningioma which was the most common type of tumor and accounted for 29. 73% of total cases(11/37). The most common complication was injury to extraoeular muscles, which occurred in 21 cases and accounted for 56. 76% of all cases(21/37). The most serious complication was vision loss, which occurred in 4 cases and accounted for 10. 81% of all cases(4/37 ). Conclusions Resection of cranio-orbital communicating tumors via pterional approach provides a wide observation field and facilities exposing tumors.Protecting important tissues in posterior orbital region will result in less postoperative complications. (Chin J Ophthalmol ,2008,44:696-699)

Objective To investigate the influence of enucleation with or without orbital implant on the occurrence of apoptosis of orbital osteocytes and to explore the mechanism of orbital implant in the prevention and treatment of orbital malformations. Methods It was an experimental research. Twenty-one age and weight-matched New Zealand rabbits were divided into three groups: enucleation group, enucleaion with implant group and the control group. At one-month-old, the left eyes of the rabbits were enucleated in the enucleation group; an orbital implant was inserted after enucleation in the implant group. The left orbits of rabbits in the control group were served as the controls. At two-month-old, all rabbits were sacrificed,apoptosis of osteocytes of the zygomatic bones was observed by photomicroscopy, electron microscopy and TUNEL staining technology. The ratios of apoptosis osteocytes were calculated and analyzed in these three groups. Results Classical apoptosis of asteocytes was found with photomicroscnpy and electron microscopy. The distribution of apoptosis of osteocytes was irregular in bone sections. The ratio of apoptosis cells in the enueleation group was significantly different from that in the other two groups (P<0.01). There was no significant difference in ratios of apoptosis cells between the implant group and the controls (P>0.05). Conclusions Apoptasis of osteocytes participitates in the normal development of bony orbit. The results of this study indicate that apoptosis of asteocytes plays a role in the development of orbital malformation after enucleation and orbital implant can prevent the orbital malformation after enucleation. (Chin J Ophthalmol, 2008,44:700-704)

Objective To study the effects of CDDP (cis-dichlorodiamine platinum) on the telomerase of human choroidai melanoma cells and to investigate the toxic effects of CDDP on these cells. To study the relationship between these two effects and to explore the possibility of using CDDP in the chemotherapy of choroidal melanoma. Methods It was an experimental research. CDDP was added to the culture medium of primary cultured human choroidal melanoma cells at different concentrations (0.01,0.1,1, 10 and 100 mg/L, 72 h)and times (12, 24, 48, 72 and 96 h, 10 mg/L) and the results were compared with that of the controls. Toxic effects of CDDP were evaluated by MTT test and the level of telomerase was measured by PCR-ELISA assay.The correlation between these two effects was analyzed. Results The telomerase activity was inhibited by CDDP time dependently and dose dependently. Cell viability was decreased when the concentration of CDDP attained 0.1 mg/L and acted for 24 hours. The cell toxicity of CDDP was correlated negatively (r=-0.900 ,P=0.037) with the inhibition of telomerase. The cell deathwas lagged behind the decrease of telomerase. Conclusions CDDP is an effective telomerase inhibitor which can decrease the telomerase activity of cultured human choroidal melanoma cells significantly. This effect is dose and time dependent. CDDP can also cause the death of cultured melanoma cells. (Chin J Ophthalmol, 2008,44:705-710)

Objective To improve near stereopsis in pseudophakic eyes after phacocmulsification and implantation of posterior chamber intraocular lens (IOL). Methods This prospective case-series study comprised 92 eyes of 46 patients aged 50 to 70 years [mean age (61.33±5.54 ) years ] who hod phacocmulsification and implantation of posterior chamber IOL, including 24 unilateral pseudophakias (Group A ) and 22 bilateral pseudophakias (Group B ). The accommodative amplitude, relative accommodation, reading addition, near stereoacuity, etc. Were measured. All data were analyzed with the SPSS11.0 for Windows. Results (1) The mean value of monocular accommodative amplitude in the group A and group B was (2.05±1.12) and (2.35±1.30) D, respectively. (2) In the group A and group B,the binocular odd was (2.08±0.37) and (2.13±0.46) D, respectively, and the monocular odd was (2.20±0.42) and (2.01±0.39) D, respectively. There was a significant difference between the binocular add and the monocular add (t=2.33, 2.20 ,P<0.05), and between left monocular add and fight one (t=3.70, 5.02,P<0.01) in each group. (3) The near stereopsis with monocular odd was better than that with binocular add in each group, the difference was significant (X2=6.46, 7.02, P=0.04, 0.03). Conclusion Monocular add is beneficial to a pseudophakia with posterior chamber IOL implantation to improve near stereopsis. (Chin J Ophtbalmol, 2008,44:711-714)

Objective The aim of this study was to investigate the corneal hysteresis (CH) and corneal resistance factor(CRF) in normal eyes and to determine their relationship between central corneal thickness(CCT), corneal curvature, sphere equivalence (SE) and intraocular pressure (IOP). Methods Cross-sectional study. This study included 205 normal eyes (205 patients). Ocular Response Analyzer (ORA, Reichert Ophthalmic Instruments, New York, USA ) was used to measure CH and CRF.Multivariate regression analysis was applied to study their relationship between CCT, corneal curvature, SE, IOP (noneontact tonometer). Results The values of CH and CRF in 205 eyes presented normal distribution and concentrated on 8. 1 to 11.0 mm Hg( 1 mm Hg =0. 133 kPa). No statistical significant difference was found in both CH and CRF of different gender and ages(<25 years or ≥25 years)(P>0.05). 95%referenee interval of CH and CRF in 205 eyes were 6. 8 to 13.0 mm Hg and 6. 6 to 13.6 mm Hg. The correlation of CH and CRF with CCT, corneal curvature, SE and IOP were significant (P<0.05).Conclusion CH and CRF measure different biomeehanieal aspects of cornea, they may reflect the combined effect of CCT, corneal curvature, rigidity, hydration and IOP. These values of CH and CRF in normal eyes established foundation to further investigate their relationship with eye diseases. (Chin J Ophthalmol, 2008,44: 715-719)

Objective To evaluate the clinical efficacy between protein-free calf blood extract eye drops and recombinant human epidermal growth factor (rhEGF) eye drops for mechanical corneal epithelial defects in human eyes. Methods A multi-center, randomized and double-blind study with a parallel, positive-control designation was carried out from April to November in 2005 at Department of Ophthalmology,Eye Ear Nose and Throat Hospital of Fudan University, Xinhua Hospital of Shanghai Jiaotong University, the First Hospital of Zhejiang University, the Second Hospital of Zhejiang University and Qingdao Municipal Hospital. 240 patients(240 eyes)with confirmed diagnosis of corneal epithelial defects at that six hospitals were enrolled in this study and were randomly arranged into two groups in average. One group (120 eyes) were treated by 20% protein-free calf blood extract eye drops which was defined as the experimental group while the other (120 eyes) by 5000 IU/ml recombinant human epidermal growth faetor (rhEGF) eye drops as the positive control group. The drug was delivered in both groups 4 times per day, one drop each time in the 14 days duration. The symptoms and signs were scored and the safety was evaluated on the pre-delivery day,the third pest-delivery day (day 3) ,day 7 and day 14. The variants in the study were tested for the different efficacy and safety between the two drugs using non-inferiority test, paired t-test, Wilcoxon signed-rank test, chi-square test, continuity correction chi-square test, Fisher's exact probabilities, analysis of variance, Cochran-Mantel-Hacnszel chi-square test and so on. The criterion for statistical significance was P<0. 05. Results There was no significant difference in efficacy between the protein-free calf blood extract group and the recombinant human epidermal growth factor group (day 3:X = 1.5677, P = 0.4566, day 7:X2= 1.7152,P = 0. 4242, day 14: X2 = 3. 0814, P = 0.2142 ). The total scores of symptoms and signs in experimental group had a obvious descending (6. 009±3.030 ) compared with the positive control group with a descending of (5. 177±2. 582), which reached the significant level (t=2.2367, P=0.0263). Ocular local stimulates and general side effect were not observed within the treatment course. There was no significant difference between the two groups in the comparison of pre-and post-therapy visual acuity. The difference was not significant when comparing the uncomfortable feelings, including eye burning and eye itching(eye burning:day 3:X2 =0.4394,P=0.932,day 7:X2=1.4710,P=0.479,day 14:X2 =2.1875,P = 0. 335, and eye itching: day 3: X2 = 2. 1045, P = 0. 349, day 7 : X2 = 2. 0192, P = 0.364, day 14 : X2 =0. 6863 ,P=0. 407). And the positive control group gave priority to the experimental group in comfortability.A better comfortableness was reported in the protein-free calf blood extract group on the third day post-dilivery(X2=6.626 ,P =0. 0100). However, no obvious difference was examined on day 7 and day 14 post-dilivery. Conclusion Protein-free calf blood extract eye drops has confirmed efficacy, good safety, quick effect and better comfortableness. (Chin J Ophthalmol , 2008,44:720-725)

It has been found that various extracellular matrix (ECM) probably play an important role in the occurrence of proliferative vitreoretinopathy (PVR), including structural proteins, adhesive proteins, anti-adhesive proteins, matrix metalloproteinase (MMP), and tissue inhibitor of MMP (TIMP) Structural proteins, including collagen and elastic fiber family, are the major non-cellular components of PVR membrane, and could promote contraction of membrane. Adhesive proteins, including fibronectin, vitronectin, laminin, could promote adhesion between cells and ECM in PVR, they promote the attachment,migration and differentiation of retinal pigment epithelium (RPE). Anti-adhesive proteins, including thrombospondin-1, osteonectin, tenascin, could promote RPE migration and tissue remodeling of PVR, etc.MMPs and TIMPs could degrade some components of ECM, enhance permeability of blood vessel and promote neovascularization in PVR. (Chin J Opbtbalmol, 2008,44: 759-763)

Leber hereditary optic neuropathy (LHON) is a mitochondrial DNA (mtDNA) hereditary disease that seriously harms the visual function of patients. The clinical onset is characterized by painless, acute or subacute visual acuity in both eyes. The acute stage is often manifested as optic papillitis, and the late stage is characterized by optic nerve atrophy, so it is also called Leber optic nerve atrophy. We analyzed the clinical data of 6 patients (8 eyes) with LHON in the acute stage who underwent fundus fluorescein angiography (FFA) from July 2004 to December 2006 in this department, in order to explore the characteristics of FFA images in the acute stage of this disease.

Modern cataract extraction surgery has gradually evolved into a kind of refractive surgery. Patients' requirements for postoperative visual quality are increasing. Wavefront aberration has gradually become an important index to objectively evaluate the quality of eyeball imaging before and after surgery.

Lymphoma accounts for the fourth place in the incidence of orbital malignant tumors, but diffuse large B-cell lymphoma is rare, with high malignancy and poor prognosis. A patient with diffuse large B-cell non-Hodgkin's lymphoma with onset of extraocular muscle enlargement admitted to the Department of Ophthalmology of PLA General Hospital is reported as follows.

Atopic dermatitis is a rare chronic, inflammatory and recurrent skin disease, and patients with ocular complications are even rarer. There is only one case of retinal detachment reported in the literature in China [1]. One patient with atopic dermatitis complicated with rhegmatogenous retinal detachment was treated in our hospital, and the report is as follows.

Infectious keratitis is one of the most serious complications after laser in situ keratomileusis (LASIK), which often seriously endangers vision and even leads to eyeball loss. The incidence rate is 1/1000~1/5000 [1], but the actual incidence rate may be higher than this, because some cases of infection have not been reported. The causes of the disease reported in the literature are Staphylococcus aureus, Streptococcus, Coagulase-negative Staphylococcus, Diplococcus pneumoniae, Mycobacterium, fungus, actinomycetes, Acanthamoeba and virus, etc. The author encountered a patient with mixed infection, which is reported as follows to arouse the attention of colleagues.

The patient was a 15-year-old male who came to our hospital on October 13, 2007 due to poor visual acuity for 7 years. He was diagnosed as "amblyopia" after seeing a doctor in other places, and the treatment with glasses was ineffective for many years. He had no family history, and his parents were not close relatives. Ocular examination showed that the corrected visual acuity of both eyes was 0.1; the fundus manifestations of both eyes were shown in the essence picture 1; and the fluorescein fundus angiography of both eyes was shown in the essence picture 2.

Orbital inflammatory pseudotumor or orbital pseudotumor was first described by Birch-Hirschfeld in 1905. It is a common orbital disease, accounting for 7.1% of orbital lesions, and ranks third among intraorbital diseases after thyroid-related ophthalmopathy and orbital hemangioma [1-5]. It can affect the whole orbit or only a certain tissue in the orbit; It can be acute, subacute or chronic; It can be similar to infectious inflammatory reaction, and can be manifested as tumor-like characteristics.The course of the disease is often repeated and gradually aggravated.Patients can often be seen rushing to various hospitals without definite diagnosis and without standardized and reasonable treatment, resulting in repeated disease course and serious consequences of blindness.Therefore, it is necessary for ophthalmologists to pay attention to the clinical characteristics and correct diagnosis and treatment of orbital inflammatory pseudotumor.

The Wenchuan earthquake that shocked the world on May 12, 2008 caused huge losses to Sichuan and other regions in China. Among them, Mianyang and its surrounding areas were the hardest hit areas, while its subordinate counties of Beichuan, Pingwu, Anxian and Jiangyou were the hardest hit areas. The sudden earthquake caused a large number of casualties in an instant [1]. After the earthquake, a total of 8431 injured cases were treated in 16 hospitals in Mianyang, including 854 patients with ocular trauma or combined ocular trauma (10.1%).