Volume 44 ·  Issue 10 ·  2008

The present paper addresses the changes of clinical pattern and etiological factors in uveitis in China.Beh(c)et's disease and Vogt-Koyanagi-Harada syndrome have been shown to be the two most common and the most severe sight-threatening uveitis entities in China.Uveitis or endophthalmitis caused by tuberculosis,syphilis,fungi and acquired immune deficiency syndrome has increased in frequency during recent years.Masquerade syndrome seen in intraocular-central nervous system lymphoma,retinoblastoma and metastases of cancers to the eye is not a rare disease.

There has been a dramatic increase in the incidence of syphilis over the last five years in the world.Some of the syphilitic patients have ocular uveitis as the initial presentation of syphilis,which may be misdiagnosed and can lead to a delay of treatment. Multiple manifestations of ocular syphilis include interstitial keratitis:anterior,intermediate,posterior uveitis and optic neuropathies.Uveitis,which my involve unilateral or bilateral eyes,is the most common ocular manifestation of syphilis.The serologic tests for syphilis should be considered for unexplained uveitis patients.All patients diagnosed with ocular syphilis should be tested for co-infection with human inununodeftciency virus.The preferred treatment for ocular syphilis remains hiish dose intravenous penicillin G.

Objective To investigate the single nucleotide polymorphism of the promoter of HLA-DQB1(QBP)in Chinese Han patients with Vogt-Koyanagi-Harada syndrome.Methods Case-control design wag applied.Eighty-eight Chinese Han patients with Vogt-Koyanagi-Harada syndrome and 88 non-Vogt-Koyanagi-Harada syndrome controls were admitted.DNA wag extracted from the peripheral white blood cells of the subjects by the phenol-chloroform method.Polymerage chain reaction-single strand conformation polymorphism(PCR-SSCP)and clone-sequencing were applied to determine the sequences of the promoter of HLA-DQB1.Chromas and Bioedit software were used to analyze the sequences of the promoter of HLA-DQB1.Chi-square test and Fisher exact test were applied to compare the frequencies of bands of QBPs and SNPs for the two groups.Results Sixteen band patterns of HLA-QBP were shown by polyacrylamide gel electrophoresis(PAGE).The band frequencies of QBPb(corresponding gene sequence was QBP2.1+77C＞A,χ2=26.01,Pc＜0.001)and QBP1(corresponding gene sequence was QBP3.3,χ2=16.99,Pc＜0.001)were significantly higher in patients with Vogt-Koyanagi-Harada syndrome than that in normal controls(Pc＜0.001).However,the frequencies of QBPg(corresponding gene sequence wag QBP3.1,χ2=12.10,Pc＜0.05)and QSPn(corresponding gene sequence wag QBP6.1+39G＞A,χ2=14.64,Pc＜0.05)were significantly lower in patients with Vogt-Koyanagi-Harada syndrome than those of the controls.Twelve SNPs were found in all subjects.The frequency of C allele at position-189C/A in patients with Vogt-Koyanagi-Harada syndrome was significantly higher than that in controls(χ2=45.92,P=0.000).However,the frequency of G allele at position-227G/A in patients with Vogt-Koyanagi-Harada syndrome Was significantly lower as compared with that in the normal controls(χ2=15.63,P=0.000).Conclusions C allele of-189C/A is a genetically susceptible factor of Vogt-Koyanagi-Harada syndrome and G allele of-227G/A is the protective factor of Vogt-Koyanagi-Harada syndrome.

Objective To investigate the expression and significance of suppressor of cytokine signaling(SOCS)mRNA and protein in retina of rats with experimental autoimmune uveoretinitis(EAU).Methods Research was designed with randomized controlled trials.Eighty Lewis rats were immunized with interphotoreceptor retinoid-binding protein(IRBP)to induce EAU.They were stratified randomly into two groups:nontreatment group(40 rats)and treatment group(40 rats).The treatment group wss administered saline buffer in the same way,ten normal Lewis rats without immunization and treatment as normal control group.The rats in both groups were stratified randomly into four sub-groups.Each sub-group had 10 rats and the rats were sacrificed at day 0,7,14,21,28 after immunization. All eyes were evaluated by slit-lamp microscopy.Retinas of rats were snbjected to analysis of SOCS mRNA and protein expression using quantitative RT-PCR and western blot,respectively.IL-4,IL-12 and IFN-γ in the serum were measured by ELISA.Results At day 14,the nontreatment group developed acute anterior uveitis and showed typical signs including aqueous flare,small or irregular pupil due to posterior synechiae and hypopyon,the score of inflammation was 1.5±0.5:but the treatment group did not suffer from severe anterior chamber inflammation,the score of inflammation was 0.5±0.3.The highest level of IL-4.IL-12 and IFN-γ production occurred at day 14(P＜0.05),followed by decline in the secretion of IL-12 and IFN-γ secretion to the baseline at day 28,while the concentration of IL-4 did not decrease significantly in the nontreatment group(P＞0.05).IL-12 and IFN-γ did not change significantly(P＞0.05)and IL-4 production reached the highest level at day 28 in the treatment group.Both SOCS1 and CIS mRNA increased to the highest level at day 14.Compared to normal controls,the copies of SOCS1 and CIS mRNA were 3.41 fold and 3.36 fold in the nontreatment group,and were only 1.44 fold and 1.73 fold in treatment group,respectively.Both SOCS3 and SOCS5 mRNA reached the highest level at day 28 after immunization in both groups.The copies of SOCS3 and SOCS5 mRNA were 1.95 fold and 3.16 fold in the nontreatment group,and were 1.59 fold and 3.58 fold in the treatment group,respectively.Marked increased expression of SOCS1 and CIS proteins in the nontreatment group as compared to normal controls was detected at 7,14,21 days;in the treatment group these proteins only increased significantly at day 14(P＜0.05).Expression of SOCS3 and SOCS5 proteins in both groups were higher than those in normal controls(P＞0.05).Conclusions Marked increased expression of SOCS1 of retina may involve in the development of a Th1 mediated immune response in EAU.CIS and SOCS3 of retina may play important roles in mitigating pathogenic effects of proinflammatory cytokines during different stages of EAU.Up-regulation of SOCS5 may have protective functions.

Objective To evaluate the efficacy of surgical intervention of complicated cataract in patients with uveitis.Methods Fifty-one patients(69 eyes)with complicated cataract secondary to uveitis who had cataract surgery in Peking Union Medical College Hospital between January 2000 and August 2006 were retrospectively analyzed.Surgical procedures,visual outcome,postoperative recurrence of uveitis and complications were investigated.Results Phacoemulsification was performed on 64 eyes(92.8%),while extracapsular cataract extraction(ECCE)was performed on the remaining 5 eyes(7.2%).Posterior chamber intraocular lens(IOL)was implanted in 61 eyes(88.4%),while the remaining 8 eyes(11.6%)remained aphakic,6 of those were in patients who were blind in the other eye.At the final follow-up,38 eyes (55.0%)had a best corrected visual acuity of 0.5 or better,an improvement that was highly significant (Z=8.26.P＜0.001).Postoperative recurrence of anterior uveitis occurred in 19(27.5%)eyes,however,18 of them were pseudophakic,among which 5 eyes had 3 or more episodes of recurrence.Neodymium:YAG(Nd:YAG)laser posterior capsulotomy Wag performed in 24(34.8%)eyes,however,23 of them were pseudophakic,among which 7 eyes underwent at least two separate capsulotomies.Conclusions Surgical intervention of complicated cataract in patients with uveitis is effective and safe.In comparison with the pseudophakia group,less postoperative complications are found in patients without IOL implantation.Accordingly.it seems feasible that cataract extraction without IOL implantation is the procedure of choice for treating uveitis patients who are blind in the other eye.

Objective To evaluate the efficacy and complication of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction.Methods In this retrospective cases series,148 patients(187 eyes)with congenital nasolacrimal duct obstruction between 2006 and 2007 from Beijing Children's Hospital,whose age ranged from 5 to 40 months(average 13 months),underwent silicone intubation with the Ritleng lacrimal intubation system.who received unsuccessful probing procedure previously.The therapeutic effect including dacryorrhea disappearance and lacrimal passages excretory function regaining was observed and the complications such as epistaxis,lacrimal duct edema or silicone tube prolapse were recorded.The follow-up period was from 4 to 17 months(average 11 months).Results Dacryorrhea disappeared in 157 eyes(84.0%)within 1-3 days after the surgery.The tubes were left in the place for 3 or 6 months.All the 187 eyes were successfully taken out of tubes.As follow-up,the overall successful rate was 95.2%(178/187).Seven eyes(3.7%)relief from symptoms and two eyes(1.1%)were ineffective.46 cases(52 eyes),whose ages were about 5 months,regained normal lacrimal passages excretory function within 1 month after surgery.Complication included epistaxis(9 eyes)and lacrimal duct edema(9 eyes).The silicone tube prolapsed in eight eyes(4.3%).Conclusions The Ritleng lacrimal intubation system is an easy,effective and nontraumatizing procedure for the treatment of congenital nasolacarimal duct obstruction.The lacrimal intubation procedure offers an early and active treatment fur congenital nasolacrimal duct obstruct patients.

Objectlve To evaluate the significance of detecting macular edema by the Retins Module of the Heidelberg retina tomograph Ⅱ(HRTⅡ).Methods Comparative clinical study,One hundred and twenty-six eyes were divided into two groups according to FFA results,one with macular edema and the othcr without macular edema.Morphological changes in macular edema were observed by HRT Ⅱ and e(edema index)in two areag of each eye were determined.E value in these two groups and the correlation of e with retinal thickness,BCVA,amplitude and latency of N1 and P1 by multifocal electroretinogram were analyzed.Results HRTⅡ-RM scan could distinguish different kinds of macular edema(cystoid,local and diffused)and the difference of e between these two groups was significant(e1:t=-19.238,e2:t=-12.436;P＜0.01).The best critical value of e was 1.475 and 1.411(e1=1.475,e2=1.411).The sensitivity of e was 92.9%and 91.8%(e1=92.9%.e2=91.8%).The specificity of e was 97.6%and 95.1%(e1=97.6%,e2=95.1%).The correlation coefficient between e and retinal thickness was 0.816 and 0.587(e1:r=0.816,e2:r=0.587;P＜0.01);was-0.658 and-0.640(e1:r=-0.658,e2:r=-0.640;P＜0.01)between e and BCVA;was 0.266 and 0.312(e1:r=0.266,e2:r=0.312;P＜0.01)between e and latency of N1;was-0.609 and-0.586(e1:r=-0.609,e2:r=-0.586;P＜0.01)between e and amplitude of N1;was 0.529 and 0.431(e1:r=0.529,e2:r=0.431;P＜0.01)between e and latency of P1 and was-0.783 and-0.714(e1:r=-0.783,e2:r=-0.714;P＜0.01)between e and amplitude of P1,respectively.Conclusions There are characteristic changes in the appearance of macular edema as examined by HRT Ⅱ-RM.The quantitative index e value also shews remarkable changes.HRT Ⅱ-RM not only detects morphological changes,but also relates to functional changes.This method is capable for evaluating the macular edema.

Objectives To investigate the effective method for the calculation of intraocular lens power retrospectively from post-IASIK cases.Methods It was a retrospective case series.40 eyes of 28 patients(14 male and 14 Female)had the Phacoemulcification post-LASIK in HongKong Sanitorium & Hospital;the age ranged from 41.00 to 69.00 years ages,(50.68 ±6.56)years.LASIK was done from January,1997 to April,2005.Phacoemulcification was done from October,2000 to September,2005.Results Average axial length was(28.06 ±1.98)mm(rang from 24.28 to 31.96 mm).The initial refraction power (Spherical Equivalent,SE)before LASIK was from-3.13 to-18.00 D,(-10.44 ±3.93)D.K value pre-LASIK was 41.40 to 46.90 D,(43.57 ±1.47)D.The best corrected visual acuity(BCVA)preLASIK was 20/20 in 19 eyes,20/25 in 10 eyes,20/30 in 7 eyes and 20/40 in 4 eyes.The refraction power of 6 months post-LASIK(SE)was-2.83 to+1.25 D,(-0.32 ±0.95)D.The refraction power pre-phaco (SE)was-5.75 to+1.13 D.(-2.35±2.16)D.The calculated K1(KpreLASIK-RpostLASIK+RpreLASIK)was 27.60 to 40.70 D.(34.62±3.56)D.The K from the IOLmaster(K2)wag 32.39 to 43.53 D,(38.04±2.45)D.The target refraction of K1 was-3.69 to 0.61 D,(-1.32±1.00)D,the target refraction of K2 was-3.67～3.95 D,(-0.60±1.84)D.There was significant difference between these two target refraction,(t=-2.40,P=0.02).The refraction power of post-phaco(＞3 months)was -4.50 to+1.75 D,(-1.10±1.51)D.The BCVA post-Phaco was 20/20 in 20 eyes,20/25 in 9 eyes,20/30 in 5 eyes and 20/40 in 6 eyes.Conclusions The formula used in the study for the calculation of intraocular lens power is accurate and effective.

Objective To explore the expression of telomerase activity of the lens epithelial cells in posterior capsule opacification of rabbits.Methods Clear corneal tunnel phacoemulsification was performed in both eyes of 11 New Zealand rabbits.After the model of posterior capsule opacification succeed in all eyes.Then,telomerase activity of the lens epithelial cells in the equator and posterior capsule opacification of 20 eyes was detected with TRAP-ELISA and TRAP-PAGE techniques.Results HepG2 cells were used as positive controls.Telomerase activity was detected in the lens epithelial cells in the equator capsule and posterior capsule opacification in rabbits,which showed several dim gradient stripped electrophoresis pattern.A450-690 value of telomerase activity in the equator capsule and posterior capsule opacification was 0.85±0.23 and 0.67±0.19,respectively,indicating statistically significant difference(t=2.526,0.021;P＜0.05).Conclusions Telomerase activity exists in the lens epithelial cells of posterior capsule opacification in rabbits.The telomerase activity in this area is lower than that in the equator capsule.

Objective To investigate cell proliferation and apeptosis status of human retinoblagtoma cell line SO-Rb50 after knockdown of Survivin gene by means of small interfering RNA(siRNA).Methods Survivin specific siRNA designed from the human gene sequence and nonsense siRNA(as a negative control)Waft transfected into SO-Rb50 cells.The inhibition of the expression of Survivin mRNA and protein levels were detected by reverse transcription-polymerage chain reaction(RT-PCR)and Western blot Proliferation inhibition rate of SO-Rb50 cells was analyzed by MTT assay.Apoptotic rate and cell cycle were analyzed by flow cytometry(FCM)and the apoptotic morphology was observed by fluorescent microscope.Results The expression of Survivin at both mRNA and protein level in specific siRNA group decreased significantly in comparison with untransfected group and nonsense siRNA group after 24 hours of transfection.The proliferation of SO-Rb50 was inhibited in the Survivin specific siRNA group at the concentrations of 35,70 and 100 nmoL/L(P＜0.05).Flow cytometry showed obvious apoptotic peak in Survivin specific group with an accumulation of cells in the G0/G1 phage and a decrease in G2/M phage and S phase.Typical apoptosis morphyology was also observed under fluorescent microscope.Conclusions Sunrivin specific siRNA could inhibit SO-Rb50 cell proliferation and induced apeptosis by knockdown of Survivin gene.Our data suggests that the use of Survivin-specific siRNA deserves further investigation as a novel approach to retinoblastoma therapy.

Objective To study the morphology differences of ocular rectus muscles pulley between preschool children and adults.Methods It was an experimental research.Ten fresh cadaver orbits(five children and five adults)were fixed in situ and serially sectioned at 4 μm thickness.Every section was stained with Masson's trichrome and picrosirius red methods.After being stained,extraocular muscle pulley in typical sections was examined through gross anatomy and light microscopy.Two-factor analysis of variance for quantitative data was used in statistical treatment.Results Near the equator of the globe,the children and adults' extraocular muscle pulleys were all at the points where the rectus penetrate posterior Tenon's fascia,encircling the rectus orbit side by fiber ring structure.There were pulley bands among rectus pulleys.The rectus pulley length and the origin distance from the comeoscleral limbus of the children were significantly less than those from the adult group(P＜0.05).The main composition of the children rectus pulley was similar to that of the adults,but the smooth muscle and collagen typeⅢfibers contents of the medial rectus puUey in children were significantly greater than those in the adults group(P＜0.05).Collagen type Ⅰ fibers in the children were significantly less than that of the adults group(P＜0.05).Conclusion There are morphological differences in rectus pulley between preschool children and adults,which provides an anatomic basis for the better understanding of the pathogenesis of strabismus.

Objective To study cytotoxic effects of arsenic trioxide(As2O3)on the human lens epithelium cells and to identify the bioiogical mechanism for these effects.Methods In this experimental study,human lens epithelium cells(FHL124 cells)were cultured in Eagle's minimum essential medium supplemented with 5%fetal calf serum.The effects of As2O3 on FHL124 cells growth were tested by MTT,and apoptosis was detected by TUNEL assay.Gene changes were detected by real-time PCR(Taqman).As2O3-induced changes in cell calcium level were measured by real-time fluorometric single-cell digital imaging techniques after Fura-2 incorporation.Results As2O3 inhibited the growth of FHL 124 cells in vitro in a dose-dependent manner,given an IC50 value of 1.5 μmol/L As2O3 induced apeptosis of FHL124 cells as showed by TUNEL assay.As2O3 provoked an endoplasmic reticulum(ER)stress response identified through an up regulation of EIF2A,ERN1 and ATF6(F=8.51,P=0.0005).As2O3 depleted the calcium store and consequently lead to a decrease of calcium signaling(P=0.0018).Moreover,As2O3 had a modcrate effect on the caicium influx pathway.Conclusions As2O3 inhibits the growth and induces apoptosis of human lens epithelium cells.As2O3 provokes an ER stress which could be the cause of apoptic processes.

Uveitis is a common immune-related intraocular inflammation,the topical or systemic corticosteroids are the first-line drugs for the treatment of uveitis.The cornbined immunomodulatory agents of cyclosporine,mycophenolate mofetile,azathioprine or cyclophosphamide are helpful for the treatment of severe or refractory uveitis.The new bidogic agents,tumor necrosis factor inhibitors,interferon α or the interleukin-2 receptor antagonists,are also helpful for certain types of refractory uveitis.Intravitreal steroids injection or vitrectomy would be beneficial for specific types of uveitis and their complications.The advances of uveitis treatment in recent years are reviewed.

The cognitive mechanisms and functional brain imaging research on blind individuals provide special information for exploring the plasticity of the developing human brain.This paper focuses on five aspects of recent progress in this field:(1)the behavior compensation of the blind;(2)the influence of early visual deprivation and later visual deprivation on cross-modal reorganization;(3)the relationship between the complexity of task requirement and cross-modal reorganization;(4)the relationship between the sensitive periods of the visual system and the time course of cross-modal reorganization;(5)the neural mechanisms of cross-modal reorganization.These findings contribute greatly to the theoretical basis of the rehabilitation of individuals with perceptual deficits.

Lacrimal duct disease is a common disease in ophthalmology, and the primary diagnosis is mostly based on simple lacrimal duct irrigation. Although lacrimal duct angiography and imaging system [1] can accurately judge the lesion site, the operation is complicated, expensive and cannot be treated simultaneously. The classical lacrimal duct surgery, external dacryocystorhinostomy, is more injured, easy to bleed, and leaves surgical scar on the face, so it is not accepted by young patients.

Many corneal diseases are associated with corneal neovasculaxation (CNV), which is a high risk factor for corneal transplant rejection [1] and one of the most common causes of blindness. A large number of studies have shown that heparanase (HPA) plays an important role in neovascularization of tumors [2-3] and neovascularization during wound healing [4].

Coats disease is a kind of outer exudative retinopathy characterized by abnormal dilatation of retinal capillaries and microvessels, often accompanied by intra-or subretinal lipid exudation, and even exudative retinal detachment.

Conjunctiva relaxation is a common eye disease in the elderly. It is a disease caused by excessive relaxation of bulbar conjunctiva and/or increased tension of lower eyelid margin, which causes the relaxed bulbar conjunctiva to accumulate in the eyeball and lower eyelid margin and form wrinkles between the medial and lateral canthus, resulting in abnormal lacrimogenesis of the ocular surface, accompanied by dryness of the eye, foreign body sensation, lacrimal discomfort and other symptoms.

May 12, 2008! On that day, the earth shook, the mountains shook, and the boulders rolled; That day, countless houses collapsed in an instant; That day, the survivors threw themselves pathetically at their loved ones who were forever silent on the stretcher…Seeing all this, who else could hold back the sadness?!

The First International Symposium on Uveitis in China was held in Guangzhou from November 30 to December 1, 2007. The conference was co-sponsored by Asia-Pacific Society of Intraocular Inflammation, State Key Laboratory of Ophthalmology of Sun Yat-sen University, Ocular Immunology Group of Ophthalmology Branch of Chinese Medical Association, Guangdong International Uveitis Research Laboratory, Sun Yat-sen Ophthalmology Center of Sun Yat-sen University and Uveitis Research Center of Sun Yat-sen University.