Volume 44 ·  Issue 09 ·  2008

There are several methods of fundus examination in clinical practice.Each method has its own characteristic and should not replace for each other.Though the combination of these methods has been conformed to improve the level of diagnosis and therapy for the fundus diseases,some ophthalmologists are puzzled how to choose the methods and how to explain the results of each examination.Some suggestions are provided to solve these problems.

Nowadays there are many methods to check out the fundus diseases,including fundus fluorenscense angiography (FFA),indocyanine green angiography (ICGA),optical coherence tomography (OCT) and so on,which have already been used widely all over the world.However,the value of fundus autofluorenscense angiography (FAF) in diagnosing fundus diseases,which has been paid much attention worldwide over the past ten years,does not cause enough attention in our nation.The reasons are that we are deficient about the knowledge of the machanism of fundus autofluorescence produced,and its meaning of the clinical application of fundus antofluorescence and so on.This passage aims to base on demonstrating the problems above,and emphasize that fundus autofluoroscence is as a promising,non-invasive imaging method and has high value in the clinical application,especially in the diagnosing the fundus diseases,monitoring its development and therapeutic results.Therefore,it needs to be siren high attention,dissemination and spread in our nation.

Objective To assess the risk factors and prognosis of peripheral retinal breaks complicating pats plana vitrectomy.Methods Retrospective observational cage series.Four hundred and four consecutive vitrectomies pedormed on eyes without preexisting retinal breaks or retinal detachments were retrospectively reviewed.Cases with peripheral retinal breaks found during or after the vitrectomy were recorded and analyzed.Results Of the 404 vitrectomies,32 eyes had 55 iatrogenic peripheral retinal breaks with an average incidence of 7.9%.Peripheral retinal breaks were most common in csses with branch retinal vein occlusion (BRVO) (13.3%) and less common in proliferative diabetic retinopathy (PDR) (3.7%) (χ2=9.18,P＜0.01).Of the 55 breaks,51(92.7%) occurred around the sclerotomy sites,and 29(52.7%) in the quadrant corresponding to the predominant hand of the surgeon. Cases with breaks detected during surgery had a better outcome of retinal reattachment as compared with cases identitied postoperatively.Conclusions Peripheral retinal breaks complicating pans plana vitrectomy is mainly sclerotomy-related and is more common in cases with BRVO than in cases with PDR. Early detection during surgery tends to have a better outcome.

Objecttve To investigate the clinical features of choroidal neovascularization (CNV) in different classifications.Methods In this retrospoctive case series,393 eyes of 312 patients with CNV between May 2005 and March 2007 in our department was classified based on their etiology,location,fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) findings.Results The relative frequency of various causes in CNV was as follows:there were 153 cases (49.04%) from age-related macular degeneration (AMD),94 cases (30.13%) from idiopathic CNV,37 cases (11.86%) from pathologic myopia,15 cases (4.81%) from inflammatory disorders,7 cases (2.24%) from polypoidal choroidal vasculopathy (PCV),3 cases (0.96%) from angioid streaks and 1 case (0.32%) from either hereditary disease or trauma or tumor,respectively.The majority cases from AMD was male (64.71%),whereas most from pathologic myopia,idiopathic CNV and inflammatory disorders were female (78.38%,73.40%,73.33%).The age range of the cases from AMD was 49-95 years (68.73±8.31),and 98.04% of them were at least 50 years old. Patients with idiopathic CNV aged 13-43 years old (29.86±6.45),and 84.04% of them were between 20 and 40 years old.The sex (χ2=57.17,P＜0.05) and age (F=172.57,P＜0.05) had significant difference in each etiological group.FFA showed that CNV in 43.48% from AMD and 66.67% from PCV were occult and non-classic.CNV in 91.67% from pathologic myopia,76.19% from inflammatory disorders and 95.00% from idiopathic CNV was classic.In each group,most of the CNV was subfoveal type (58.00%-100.00%),followed by iuxtafoveal type (0%-35.00%).In the ICGA of 54 eyes with AMD,11 eyes (20.37%) were occult CNV (plaque,spot and mixed CNV),17 eyes (31.48%) were CNV fibrosis.CNV was active in most cases.The frequency of active and inactive CNV in AMD was approximately 61.11% and 37.04%,respectively,no lesions were noted in 1 eye (1. 85%) in ICGA.Conclusions The clinical characteristics and frequency of various types of CNV are different due to different causes.Classification of CNV based on its etiology,FFA and ICGA findings,location,and activity in detail is important for the diagnosis,treatment and prognosis judgment in CNV.

Objective To investigate the natural course and visual outcomes of traumatic macular hole.Methods This was a case series observation study.Patients with traumatic maeular hole were foilowed-uD for 3 months or-longer from August 2004 to December 2007.Examinations included bestcorrected visual acuity,fundus photography and optical coherence tomography.Results In a consecutive case series of 48 patients (48 eyes) with traumatic maeular hole,28 eyes of 28 patients were followed for more than 3 months,with an average of 14 months.Of the 28 patients (28 eyes),16 patients (16 eyes,57.1%) had traumatic choroidal or retinal changes surrounding the macular hole.The size of the macular holes changed in 16 (16 eyes) of 28 patients (28 eyes) during the follow-up period.Maeular hole enlarged in 9 (9 eyes) of the 28 patients (28 eyes),became smaller in 1 patient (1 eyes),and closed spontaneously in 3 patients (3 eyes).Macular hole closure occurred 4.5,3.5,and 1 month after the onset of macular hole,respectively.The closure rate was 10.7% (3/28).Visual acuity improved in all the patients with macular hole closure.Final best-corrected visual acuity rsngea from 0.5 to 0.7.Retinal detachment occurred in 2 pailents (2 eyes) and the occurrence rate was 4.2% (2/48).The retina re-attached and visual acuity improved in these 2 cases (2 eyes) after surgical treatment.Conclusioas Visual acuity remains stable or improves in most patients with traumatic maeular hole.Spontaneous closure occurs in some cases 4 to 5 months after the onset of the macular hole with good visual recovery.Retinal detachment is rare in traumatic macular hole.

Objective To assess the clinical effect of combination facula photodynamic therapy (PDT) on patients with circumscribed choroidal hemangioma.Methods It was a retrospective case series.Ten cases of circumscribed choroidal hemangioma were diagnosed by ophthalmoscopy,fundna fluorescein angiography and B-scanning ultrasound examination.Clinical data of these cases were retrospectively analyzed.All of these patients had undergone combination facula PDT.The best corrected visual acuity before PDT was FC to 0.3.The maximum diameter of the tumor was 5.5-9.9 mm and averaged 6.8 mm. The maximum thickness of the tumor was 1.1-3.8 mm and averaged 2.7 mm. Four patients suffered from retinal detachment. The intravenous injection of visudyne (6 mg/m2) was performed in 10 minutes.Five minutes later,later irradiation (wave length 689 nm) was performed with the parameters of 50 J/cm2,83 s,and 2 to 3 spots.The follow-up period was 3.0 to 15.0 months (mean 8.5 months).Results The visual acuity in the last examination after treatment was FC-1.0,which was 2-line increased in 7 patients and was steady in 3 patients.B-scanning ultrasound examination showed that the hemangioma was undetectable in 2 patients,and in the other 8 patients,the hemangioma had the diameter of 4.2 to 8.3 mm (average 6.4 mm) and the thickness was 0.5 to 2.7 mm (average 1.9 mm).Retina detachment disappeared in 2 patients .Conclusions Combination facula PDT may lead to the shrinking of choroidal hemangioma,disappearance of subretinal fluid,reattachment of retina and the increase or saving of the visual acuity.It is a effective and safe treatment for the macular circumscribed choroidal hemangioma.

Objective To observe the morphology and function of the macular in pathologic myopia by the combination of the fundus examination,optic coherence tomography and multifocal electroretinogram (mERG).To analyze the relationships among macular function,ocular axis length,refraction and corrected visual acuity.Methotis Case aeries including 36 eyes of 31 consecutive pathologic myopia cases, which were chosen from Tongren Eye Center from February to April 2006 and divided into two groups according to ocular axis length:group A,composed of 12 eyes from 10 cases (axis length≥30.00 mm) and group B,composed of 24 eyes from 21 eases (＜30.00 mm).Manifest refraction,A and B scan,fundus examination,OCT scan for the macular area,the measurement of the thickness of the retinal neuroepithelial layer and mERG were carried out for each eyes.The results were further analyzed by comparing the ocular axis length,diopter of myopia,corrected visual acuity,results of the OCT study and mERG.Relationships among the macular function,ocular axis length,refraction and ocrrected visual acuity were also analyzed. Results The mean ocular axis length,diopter of myopia,corrected visual acuity of group A were (31.77 ±1.27) mm,(-22.92±7.10) D and (0.31±0.25),respectively.The mea ocular axis length,diopter of myopia,corrected visual acuity of group B were (28.64 4-1.17) m,(-14.03±5.37)D,(0.55±0.35),respectively.Statistically significant difference was shown between these two groups (t=-2.28,P＜0.05).The thickness of neural retina of area 1 to 5 in group A was smaller than that of group B,and significant differences exists between these two groups (P=0.016,0.032,0.048,0.009,0.002).There were statistical differences in amplitude densities of P1 waves in central macular,super-temporal quadrants,super-nasal quadrants and infer-nasal quadrants between these two groups (t=3.63,2.71,2.21,2.32,2.64,P＜0.05).Amplitude densities of P1 waves showed negative correlation to ocular axis length (r=-0.498,P＜0.01)and positive eorrelation to corrected visual acuity (r=0.468,P＜0.01).Ocular axis length showed positive correlation to diopter of myopia (r=0.800,P＜0.01) and negative correlation to corrected visual acuity (r=-0.605,P＜0.01).Diopter of myopia was negatively correlated to corrected visual acuity (r=-0.616,P＜0.01).Condusions Visual function loss in pathologic myopia is correlated with the ineresse of diopter of myopia,decrease of corrected visual acuity,increased macular disease and decreased macular function and extensive elongation of ocnlgr axis in pathologic myopia.A eombination of fundus examination,OCT scan and mERG may contribute to the earlier detection and monitoring of progression of the macular abnormality.

Objective To determine whether the endoplagmic reticulum stress participates into the apoptosis process of the retina during experimental retinal detachment-by detecting the level of mRNA and protein of the GADD153,the marker of endoplasmic reticulum stress.Methods Completely random design is applied.Experimental retinal detachment was created in the left eyes of 77 wistar rats by injecting hyaluronic acid into the subretinal space.Rats were sacrificed at 1/2 d,1 d,2 d,4 d,8 d,16 d and 32 d after creation of retinal detachment.Apoptosis of retinal cells was detected bv TdT-mediated fluorescein-16-dUTP nick-end labeling (TUNEL) assay.GADD153 mRNA expression in the retina was determined using semi-quantitative reverse transcription polymerase chain reaction (RT-PCR).The GADD153 protein expression was determined using western blotting.Retinal sections were studied by immunoflureseence labeling and confocal microscopy.The SPSS 10.0 software was applied to analyze data;Kruskal wallis test was applied to analyze the data about the apoptotic rate of retinal cells and the expression of GADD153 mRNA;One-way ANOVA test was applied to analyze the data about expression of GADD153 protein.P＜0.05 represents statistically significant difference.Results TUNEL positive staining cells were mainly presented in photoreceptor cell layer.peaked at 2-4 days and markedly decreased at 8 days after retinal detachment.The difference of apoptotic retinal cell rate between groups is significant (χ2=22.423,P＜0.05):The expression of retinal GADD153 mRNA was significantly increased at 1/2 d,1 d,2 d,4 d after retinal detachment (χ2=27.223,P＜0.05);The expression of retinal GADD153 protein was significantly increased at these days (F=16.052,P＜0.05).GADD153-positive ceils were located in the photoreceptor cell layer.Conclusions GADD153,the maker of endoplasmic reticuhm stress mediated apoptosis,is activated and over-expressed, associated with the occurrence of apoptosis during retinal detachment.Endoplasmic reticulum stress participates into the apoptosis process during retinal detachment.

Objective To investigate the expression of endoplasmic reticulum (ER) stress proteins in photoreceptor apoptosis in rd mouse (Pde6bRd1/Rd1).Methods Photoreceptor apoptosis in rd mouse was detected by terminal dUTP transferase nick end labeling (TUNEL).The protein expression of ER stress sensors including glucose-regulated protein-78 (GRP78/BiP),easpase-12,phospho-eukaryotic initiation factor 2α (elF2α) and phospho-pancreatic ER kinase (PERK) was examined by immunoflurescence and Western Blot analysis.Results Accompanying photoreceptor apoptosis in rd mouse,protein expression of GRP78/BiP,caspase-12,phospho-eIF2α and phospho-PERK was up-regulated in a time dependent manner.The up-regulation of these proteins coincided with or preceded the photoreceptor apoptosis.At the peak of their expression,they were mainly located in the photoreceptor inner segment and/or outer nuclear layer (ONL).Condusion Activation of ER stress proteins appears to play an important role in rd retinal degeneration.Therefore endoplasmic reticulum stress modulators could be a strong candidate as a therapeutic agent in the treatment of these diseases.

Objective To probe the intervention and mechanism of the inhibitor of heparanase (PI-88) on the experimental CNV model.Methods Experimental CNV was induced by laser photocoagudation in 29 mail (Brown Norway) BN rots (647 nm wave length Krypton laser,360 mW power,50 μm spot size,0.05 second duration),and randomly divided into vacant control group,physiologic saline control group,preventive group and treated group,another 3 rata were acted as normal group,15 days continuous intraperitoneal injection of PI-88 (25 mg·kg-1·d-1) was administrated in preventive group (PI-88 was administered the salne day as photocoagulation) and treated group (PI-88 was administered 1 week after photoeoagulation when CNV had been formed),for the physiologic saline control group,PI-88 was replaced by physiologic saline.To comprehensively evaluate the effect of PI-88 on the CNV by the quantitation of CNV area marked by FITC-dextran in choroid-sclera fiat mounts,fluorescence fundus angiography and histopathology:the changes of HPA expression were surveyed by western blot and immunohistochemistry.Results CNV area of preventive group and treated group decreased 52.1% and 53.8% respectively at the time point of 3 weeks after photocoagulation:the relative thickness of CNV membrane in eyes of treated group had been decreased 46% as that of control group by hiatopathology;CNV occutrenced 1 week after photocongulation both in the control group and preventive group,while the fluorescein leakage of the preventive group had been inhibited significantly;3 weeks after photoeongulation,there had been 7 days discontinuation for the prevent group,the fluorescein leakage did not enhanced,while there had been 15 days continuous administration for the treated group,the fluorescein leakage had been decreased significantly compared to the time point of 2 week:western blot showed that the relative expressed levels of HPA protein in both preventive and treated group decreased:HPA displayed distribution at the leading edge of CNV membrane migrating toward inner retina and the vascular tissue by immunohistochemistry,the expression of HPA was inhibited significantly in treated group.Conclusion PI-88 may not only prevent CNV in certain degree,but also make it partially subsidise for the existed CNV,and the effect is associated with the inhibition of HPA production.

Objective To compare the results of the Q-factor guided LASIK with the conventional LASIK for the correction of myopic astigmatism.Methods Forty-three eyes underwent Q-factor guided LASIK and 41 eyes were received conventional LASIK.The patients were followed up for more than 3 months .Examinations included refraction,distance and near vision,noncontaet tonometer,topography (provide Q value),aberrometer,ultrasonic pachymetry,contrast sensitivity function.Results At 3 months,97.67% of Q-factor guided LASIK eyes attained UNCVA 1.0 or better and 97.56% eyes in the control group.The mean postoperative SE for Q-factor guided LASIK group was (-0.19±0.20) diopters (D) at 3 months and (-0.17±0.17) diopters (D) in conventional LASIK group.The postoperative Q value of Q-factor guided LASIK was (0.50±0.28) and (0.82±0.40) in the conventional LASIK group,significant difference was noted between two groups.Both Q-factor guided LAsIK and conventional LASIK significantly increased spherical aberration,the mean RMS of postoperative spherical aberration were (-0.265±0.156) μm,(-0.487±0.159) μm respectively,significant difference were noted between two groups at 3 months .Contrast sensitivity was reduced at l week and restored at 1 month postoperatively in Q-factor guided LASIK,while in conventional LASIK it was reduced at 1 week,1 month and restored at 3 months.Comeal topography revealed in Q-factor guided LASIK the diameter of effective optical zone (EOZ) was (5.74±0.22) mm. However postoperative EOZ of conventional LASIK was (5.34±0.29) mm in control group. Conclusions Q-factor guided LASIK is effective,safe and predictable for correction of myopic astigmatism.The postoperative visual quality of Q-factor guided LASIK is better than that of conventional LASIK due to its superiority for correction of spherical aberration.

Objective To compare two methods for preparing acellular corneal strnma and evaluate the possibility of culturing corneal epithelium on xenogeneic acellular corneal stroma.Methods Experimental study,applying completely randomized design method.Dispase followed by Triton-X-100 detergent and sodium chloride SDS detergent followed by trypsinase were apphed respectively to treat the rabbit comeea.The characteristics of corneal stroma and acellular status after treatment were examined with slit lamp,optical microscope and transmission electron microscope.The rabbit limbal cells were then cultured on the acellular porcine Bowman's membrane/stroma.Rabbit corneal epithelium lamella reconstructed in vitro and evaluated in morphology,histopathology and immunohisto-chdmistry.Results Acellolar corneal stroma prepared by two different methods is quite similar in morphology,being gray and opaque with visible edema and soft texture.Collagen fibers of the stroma were regularly in histopathology and ultrastructure.But the one prepared by the NaCl-SDS-Trypsinase metllod retained a amounts of cell debris,while there was none in the other did by Dispase-Tfiton-X-100 method.The limbal cells began to shift out at 24 hours after being inocdated on xenogeneic acellular corneal stroma,then attached on it,formed a confluent monolayer containing normal-appearing in 7 days.The tissue engineering corneal epithelium was cryosectioned and characterized immunohistochemically at 14 days after inoculation.Meanwhile,epithelium associated antigen CK3 in endochylema was stained.Conclusions Dispase-Triton-X-100 was proved better in obtaining acellular corneal stroma.It is possible to reconstruction tissue-engineered rabbit's corneal epithelium on acellular porcine corneal Bowman's membmne/stroma.

Optic nenre injury is one of factors leading to blindness,and the effective thempy is still not available in clinic.The neurotrophic factors (NTF) can significantly enhance the survival of retinal ganglial cells (RGC) and the regeneration of axonal but showed a short-term effect in vivo.The continue expression of NTF by transgenic technology could overcome this disadvantage,which may provide a new therapeutic approach for the optic nerve injury.We reviewed the articles regarding the research progress of transgenic technology in the treatment of optic nerve injure by NTF recently.

Goldmann-Favre syndrome is a rare autosomal recessive genetic disease [1]. Its typical manifestations include early night blindness, progressive decrease of binocular visual acuity, atypical retinal pigment atrophy of the fundus and vitreous degeneration [2]. In addition, it can be combined with cataract, retinal or macular schisis, macular edema [3], and full-field flash electroretinogram has characteristic changes. Two patients with Goldmann-Favre syndrome were admitted to our hospital from 2003 to 2007. The clinical data analysis report is as follows.

Syphilis is a chronic infectious disease caused by Treponema pallidum, with a slow course, which can invade any organ and tissue in the whole body and produce various symptoms [1]. Uveitis is the most common ocular manifestation. When chorioretinitis occurs, retinal blood vessels are often involved, manifesting as retinal arteritis or periarteritis, usually complicated by optic neuritis and secondary optic nerve atrophy [2]. In February 2007, a case of syphilis-related ophthalmopathy was diagnosed and treated in the Department of Ophthalmology of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences.

laser in situ keratomileusis (LASIK), as a method to correct eye refractive errors, has become the most important method to correct myopia because of its advantages such as fast postoperative visual acuity recovery,less pain and reliable correction effect.LASIK firstly requires a corneal flap with a thickness of about 150 μ m on the cornea, then laser cutting a certain thickness of corneal tissue on the corneal stromal bed, and then resetting the corneal flap. Because of the existence of a corneal flap, there is a risk of corneal flap displacement in LAISK eyes when encountering external force.This paper reports a case of corneal flap displacement caused by eye punching injury 10 years after LASIK.

A 75-year-old male was admitted to Tianjin Eye Hospital in August 2007. He had a history of hypertension and worked as a cook for 58 years.

Sun Yat-sen Ophthalmology Center of Sun Yat-sen University, a national continuing education base in ophthalmology, will hold a study class on new progress in ophthalmology from November 26 to 28, 2008. This class will award 12 points of Class I credits of national continuing education to those who pass the assessment.

As a journal with strong academic strength and extensive academic influence in ophthalmology in China, in order to better serve the majority of ophthalmologists in China, strengthen clinicians' cognition of various ophthalmology surgical concepts, surgical standards and surgical effects, and thus promote the development and improvement of clinical surgical skills in China, Chinese Journal of Ophthalmology will hold a series of select activities of Chinese Journal of Ophthalmology for ophthalmologists all over the country. The participating materials are surgical videos, and the evaluation committee of this activity is composed of the editorial board of relevant majors of Chinese Journal of Ophthalmology.

The appearance deformities after orbital contents enucleation included: missing eyelid, serious depression of orbital socket and inability to install prosthetic eye lenses, etc., and the appearance was seriously damaged. In the past, the orbital cavity was repaired and reconstructed by autologous muscle or fascial tissue filling, but the operation was difficult, often requiring multi-stage surgery, which caused great trauma to patients, and the repaired appearance was difficult to achieve bilateral symmetry.

The patient was a 34-year-old female who came to our hospital on November 27, 2007 due to the decline of visual acuity in both eyes for 19 years. Ocular examination showed that the corrected distance visual acuity of both eyes was 0.2, the near visual acuity of both eyes was J1, and there was no abnormality in the anterior segment of both eyes; The lesions in the macular area of the fundus of both eyes were similar, with dark red circular spots with clear borders (Essence Picture 1); The results of coherence optical tomography showed the loss of neuroepithelial layer in the macular area of both eyes (Quintessential Picture 2). Diagnosis: giant macular hole in both eyes.

Glaucoma has become the second most blind eye disease in the world, and the prevention and treatment of glaucoma has become an urgent problem in ophthalmology and public health. In recent years, the diagnosis and treatment technology of glaucoma has developed rapidly, and new diagnosis and treatment methods have been continuously used in clinical practice. In order to further standardize the diagnosis and treatment of glaucoma, ophthalmology societies in the United States, Europe and Asia-Pacific have successively formulated the clinical work guidelines of glaucoma in their regions, and formed expert consensus opinions on the basic problems of diagnosis and treatment of glaucoma, which has played an important guiding role in improving the diagnosis and treatment level of glaucoma in clinical practice.

On May 12, 2008, a major earthquake occurred in Sichuan Province, China. Under the orders of the Central Military Commission, a 360-member earthquake relief expert medical team from the PLA General Hospital assembled in the morning of May 14. Seven doctors from the Department of Ophthalmology, including Wei Shihui, Guan Juan, Wang Zhijun, Yao Yi, Liu Tiecheng, Wang Fengxiang and Sheng Yu, set off with the team.

This issue focuses on the research of fundus diseases. Fundus diseases are the main eye diseases that affect the visual function of patients, and accurate diagnosis and early treatment are crucial for saving and improving the visual function of patients. In recent years, the rapid development of imaging examination and diagnosis technology provides a new means for the correct diagnosis of fundus diseases. Different imaging examination methods have different characteristics and functions, and can not replace each other in the diagnosis and treatment of fundus diseases, but can complement each other. If multiple imaging examination methods can be combined and applied organically, the diagnosis and treatment level of fundus diseases can be significantly improved.