Volume 44 ·  Issue 11 ·  2008

We need to establish a guidelines for the prevention and treatment of children amblyopia. In this amblyopia treatment system, high quality optic correction should be emphasized, customized occlusion therapy should be made based on the type of amblyopia, and the age of the patient. Penalization therapy is highly suggested to moderate and mild amblyopia, as well as patients with poor compliance. Multiple-center research with random comparison is expected, which wiU evaluate the effect of current treatment with the methods of evidence based medicine.

There are two types of convergence excess esotropia in the classification of strabismus in our country. One is nonrefravtive accommodative esotropia and another is nonaccommodative convergence excess esotropia. Inadequate heterophoria method to determine the AC/A ratio does not distinguish between a high AC/A ratio and nonaccommodative convergence excess. The diagnosis of nonrefravtive accommodative esotropia is based on the presrnee of a high AC/A ratio as established with the gradient method to distinguish this condition from nonacconunative convergence excess.

：Objective To investigatethe follow-up results of the prophylactic laser treatment to macular soft drusen inage-related macular degeneration. Methods Prospective, 10 persons with bilateral softdrusen and with good visual acutity were observed for 8 years. 10 eyes were treated. Thefellow eyes were as control group. Fluorescein angingrapby and Amsler test were studiedafter 8 years. Scanning laser ophthalmoscope was performed after 2 years. Some of themwere performed multifocal ERG to test the macular function after 3 years. Results There isno cboroidal neovaseularization in both the laser group and the control group. There is nodifferences in the best corrected visual acuity after 8 years. All eyes had good foveafixation. Light sensitivity of both eyes had no significant difference to be found byscanning laser ophthalmoscope. The latencies and amplitude densities of the N1 and 1 wavesin the cental first ring remained unchanged at 3 years post-treatment (before treatment t= -0.779,0.722, -0.491,0. 286;after treatment t = 1.342,0.043,0.937,0.350 ;P 0.05)compared with the fellow eyes. Conclusions There is no impairment to be found in themacula after preventive laser treatment. The treatment did not demonstrate a clinicallysignificant benefit for choroidal neovascularization in eyes of people with bilaterallarge drusen.

Objective To study biometric measurements of emmetropic adult eyes with magnetic resonance imaging technology (MR]). Method MRI technology, with super-resolution, hyper-speed imaging and the integration of the thin-scanning layer, is applied to measure the three-dimensional biometric parameters of the eyeball. From January to December, 2003, emmetropic eyes from 31 normal Chinese adults (16 males and 15 females) aged from 18 to 32 years old (23.32±3.32) were successfully measured to obtain the volume of the eyeball and vitreous cavity; inner dimensions of the eye, including the anterior-posterior, vertical and horizontal diameters. The length of ocular axis was measured by A-echo too. Data was analyzed by SPSS 11.0 statistical software. Results The volume of the eyeball, anterior chamber, lens and the vitreous cavity is (6.013±0.449) ml, (0.348±0.020) ml, (0.183±0.015) ml, and (5.482±0.440) ml, respectively. The length of anterior-posterior diameter of the vitreous cavity is (16.008±0.707) mm. The ocular inner dimensions of horizontal, vertical and anterior-posterior planes were (22.455±0.983) mm, (23.290±0.815) mm and (22.619±0.912) ram, respectively .The length of the ocular axis is (23.10±0.92) mm (with MRI % Orbscan Ⅱ) and (23.67±0.82) mm (with A-echo). Conclusions The value of the ocular length in emmetropic eye measured with both MRI + Orbscan Ⅱ and the (A-echo) in the present study is very close to the value of the Bennett-Rabbetts schematic eye (24.09 mm). MRI technology is valuable for obtaining more reliable and precise data in the study of ocular physiology and clinical ophthalmology.

Objective To assess the preventive effects of extract of buddleja offieinalis on dry eye in castrated rabbits and to discuss the mechanism of these effects. Methods It was a experimental study. Thirty male rabbits were divided equally into normal group (A), disease group (B) and treatment group (C, D, and E). The dry eye model was established with orchiectomy (ORX) in Group B, C, D and E. Group C, D and E were gastrically perfused with single-dose or double-does of buddleja officinalis extract or genistein for 30 days. All rabbits were examined with Schirmer I test (SIT). TGF-β1, IL-1β, TNF-α, Fas, FasL, Bax and bcl-2 were detected by immunohistuchemistry. Morphological and ultrastructure changes were observed by electron microscopy. Results The SIT value of group C, D, E was significantly greater than that of group B (P <0.01). The expression of IL-1β, TNF-α, Fas, FasL and Bax in acinar cells and glandular tube cells of group C, D, E were significantly lower than those of group B (P < 0.01) and the expression of TGF-β1 and bcl-2 in acinar cells and glandular tube cells of group C, D, E were significantly higher than those of group B (P <0.01). Furthermore, ultrastructure of lacrimal gland in group C, D, Ewas much healthier than that of group B. The results obtained from all of these studies showed that the lacrimal glands status in group C, D was significantly better than that of group E (P < 0.05). Conclusion Extract of buddleja officinalis has a significant effect on the prevention of experimental dry eye in castrated male rabbits. The main components of extract of buddleja officinalis are the flavonoids. The flavonoids display androgen-like activity. Therefore, it can adjust gonadal hormone level in vivo. As a result, it can inhibit local inilaannation in lacrimal gland and reduce apoptosis of lacrimal gland cells.

Objective To observe the ultrastructure of the strains of acanthamoeba isolated from acanthamoeba keratitis (AK), the morphologic changes of acanthamoeba after culture with 0.02% chlorhexidine, and ultrastructure characteristics of acanthamoeba in corneal tissue of AK. Methods It was a experimental study. The uhrastructure of acanthamoeba strains cultured with 0.02% chlorbexidine was observed with scanning electron microscope (SEM). The excited cornea tissues from AK were observed with transmission electron microscope (TEM). Results Cultured acanthamoeba trophozoites were approximately 15-45 μm in diameter, appeared irregularly round or oval in shape, with rough surface and intrusion of cytoplasm. The trophozoite propagated by ways of binary division. The acanthamoeba cysts were approximately 10-25 μm in diameter, round in shape and with a plica-like surface. The acanthomoeba could change from trophozoite to cyst. The amoeba emerging through ostioles could turn into trophozoite and left an empty cyst After cultured with 0.02% chlorhexidine for 24 hours, the trophozoite and cyst collapsed and distorted. However, after clinical treatment with 0.02% ehiorhexidine, only the cysts could be seen in corneal tissue of AK. Eetro-and endo-cystic walls were preserved, but the cytoplasma was aggregated and the sub-cytoarehitectures were degenerated or disappeared. Discussion Chlorhexidine at a concentration of 0.02% kills acanthamoeba trophozoites and cysts in vitro. Chlorhexidine (0.02%) also kills trophozoites and inhibits the activity of cysts in corneal tissues. However, it should be noticed that the inactive cysts can stay in the cornea for a long time and may cause an immuno-pathologic inflammation of the cornea.

Objective To observe the effeet of botulium toxin A(BTXA) management in childhood with intermittent extropia. Methods A prospective non-random clinical study was performed in 60 children aged from 4 to 12 years, who diagnosed to be intermittent exotropia. Patients were divided into surgery groups and BTXA group according to the intention of patients parent. The recession of bilateral rectus muscle was performed in 30 patients in surgery group. BTXA injection into bilateral rectus muscle was performed in 30 patients in BTXA group. Eye alignment and the binocular vision were evaluated 6 months after the treatments. Results In BTXA group, the deviation was (- 41.33±12.17)△(-30△ to - 75△) at the baseline, and (6.23±9.80) △ (-30△ to 0△)6 month after BTXA injection. Among the patients, 7 cases were under-correct. In surgery group ,the deviation was (-42.83±11.72)△ (-25△ to - 80△) at the baseline, and (2.67±5.21)△ (-15△ to + 15△)6 months after surgery. Among these patients, 1 case was under-corrected, and 2 cases were overcorrected. The recovery rate was 76.67% and 90.00% respectively in BTXA and surgery group, and was no statistically significant difference these two groups(P =0.177)and the covery rate(X2 =0.42,P =0.166). Some patients were found to have fusion and distance stereopsis re-built, while some others were found to have near stereopsis improvement in beth groups. Conclusion BTXA injection is a rapid, less invasive and effective procedure for the intermittent exotropia.

Objective To analyze the clinical features and therapeutic outcome in patients with strabismus due to orbitototmy. Methods Retrospective case series. Nine cases of strabismus following orbital operation seen between March 1998 and July 2003 in Zhongshan Ophthalmic Center,Sun Yat-sen University were reviewed retrospectively. Results All of the 9 cases were treated by strabismus surgery. Among them,5 cases were male and 4 were female, with their age ranging from 12 to 40 years (average 26. 4 years). The right eye was involved in 4 cases and the left one in 5 cases. Most of them belonged to restrictive strabismus secondary to the formation of surgical scar,accounting for 66. 7% of them. The methods of surgery included the excision of fibrous tissue around the involved extraocular muscle, the routine recession and resection and the Jeneen procedure,combined with the fixation suture. Six cases obtained excellent results. Two cases were slightly undercorrected and one case was remarkably undereorrectod. Of the 4 eases with diplopia before operation, the diplopia disappeared in 2 cases after surgery. The other 2 cases had diplopia only in one direction far away from the primary position. All of the ocular movement improved obviously after strabismus surgery. Conclusions Most of the deviation happened after orbitotomy was restrictive strabismus caused by the muscle fibrosis and scar formation around the muscle. Excision of fibretie tissue, combined with the routine recession and resectiou,Jenasn procedure,and the fixation suture can have quite satisfactory results.

Objective To observe the change of expression in quantity of AMPA receptor subunit GluR2 and mEPSCs from monocular deprivated rats. The preparative work was conducted for the further study on mechanism involved in regulation and control of the visual development plasticity. Methods It was an experimental study. Forty 14 d healthy Wistar rats were divided into two groups randomly; twenty in each group which were divided into two groups (Ⅰ, Ⅱ) and deprivated monocular in experiment group (group Ⅰ) ,and then were killed at a week later. For Ⅰ A and Ⅱ A 5 μn thick section was cut from tissue of visual cortex in coronary side, then the expression of GluR2 was observed by microscope and image analyze of GluB2 was conducted after inununohistochemical staining; for Ⅰ B and Ⅱ B,mEPSCs was investigated which was used Voltage-clamp technique with whole-cell mode. Result The level of GIuR2 in visual cortex of normal rats was higher than experiment group. The mean amplitude and frequency of mEPSCs increased in the deprivated monocular group. Conclusions The level of GIuB2 has changed association with the visual stimulation,which suggests that GluR2 should have the important physiological function on the postnatal development of visual system of rats.

Objective To understand the indication,surgical principle,outcome and complications of large-diameter lamellar keratoplasty combined with deep lameUar endothelial keratoplasty for whole cornea destruction. Methods Eleven hospitalized patients with whole cornea destruction in Zhongshan Ophthalmic Canter,Sun Yat-Sen University from May,2005 to March ,2006 were involved in this study. Five left eyes and six right eyes underwent large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty. The patients were followed up for 12 to 18 months and their pinhole postoperative visual acuity, intraccular pressure, pachymetry of the central cornea and corneal endothelial cell density was recorded. Results The pinhole postoperative visual acuity of all patients improved and averaged separately 4.4±0.3, 4.5±0.3 and 4.5±0.3 at the 3rd,6th and 12th postoperative month. There was a temporary increase of the pestoperative intrancular pressure within one postoperative week which can be controlled by medication and released soon. And the postoperative intraccular pressure averaged (19.8±2.7), (19.2±1.7) and (19.5±2. 0)mm Hg respectively at the 3rd,6th and 12th month postoperatively. At the same following up times, the pachymetry of the central cornea averaged (538.9±8.9), (536.3±6.3) and (537.2±6.9) μm respectively and the corneal endothelial cell density averaged (2519.8±110.7), (2244.4±137.9) and (2093.3±141.9) cells/mm2 respectively. The main complication was the interspace between the two lamellar grafts and it would disappear automatically within one postoperative month. Conclusions Large-diameter lamellar keratoplesty combined with deep lamellar endothelial keratoplasty can avoid postoperative glaucoma. It may offer further advantages over traditional surgery to treat whole comea destruction.

Objective To evaluate the morphological changes of cornea in iridocomeal endothelial syndrome(ICE) under the examination of in vivo confocal microscopy. Methods The experimental design was retrospective observation case series. Twenty-three eyes of 23 consecutive patients, each diagnosed as ICE,had their both eyes examined with the in vivo confocal microscopy (N1DEK, confoscan 3.0). The images were recorded and analyzed by software NAVIS. Measurements were performed on endothelium density, average endothelial area, the percentage of hexagonal cells and the percentage of endothelium with nuclei, and the ANOVA was done to assess the differences. Results In vivo confocal microscopy highlighted two main patterns of endothelial changes: "kite-llke" and " eplthelial-like" abnormal endothelium, characterised by marked hyperreflective nuclei and loss of regularity in cellular size and shape. With the progression of disease, the endothelium density and the percentage of hexagonal endothelial ceils decreased, which were (1687.1±122.6), (1210.6±168.7), (947.3±145.2), (856.8±73.4) cells/mm2 and (51.5±6.3) %, (39.8±9.2) %, (32.7±8.1) %, (24.1±5.6) % respectively in detail In contrast, the average endothelial area the percentage of endothelium with nuclei increased, which were (678.3±56.3), (928.7±96.2) ,(1188.5±72.6) ,(1337.5±60. 8)μm2 and(12.6±1.4)% ,(56.8±3.7)% ,(78.7± 5.6) %, (84.3±2.8) %. The differences all had statistical significance (F = 7.158,7.736,6.876,14.452 respectively ,P = 0.000). The morphology of keratocyte and endothelium were normal, compared with the eontralateral healthy eyes. However, the stremal nerves became thicker and more tortuous with the disease advancement. Conclusions The application of confocal microscopy indicates that the ICE is charactcrised by epithelial-like endothelial cells with hyperreflecfive nuclei. The technique has great potential in diagnosing ICE,especially in evaluating the disease progression.

Objective To investigate the characteristics of the size and distribution of primary iris-ciliary body cysts and its associated with the change of anterior chamber angle. Methods It was a cross sectional study. Patients with shallow anterior chambers found in routine health examinations were evaluated with UBM scan. Any primary iris-ciliary body cysts detected were recorded in the parameters of quantity, size,location, and quadrant. The shape of the angle in the UBM was compared to the surrounding area of angle without the cyst, and also whether the angle was narrowed or closed was recorded. The factors related to the corresponding narrowed or closed angle were analyzed. Results The 502 cysts were detected in 134 (29.32%)of the 457 patients,which were all primary iris-ciliary body cysts. The cysts were located in the iridociliary sulcus (41.24%) and pars plicata (58.37%) and distributions were 44.22% situated at the inferotemporal quadrant,26.88% at the inferonasal quadrant,23.11% at the superotemporal quadrant and 5.38% at the superonasal quadrant. The largest base size of the cysts was 0.6289±0.2329 mm and most were mid-sized cysts (86.05%). The incidence of the cysts with corresponding chamber angle narrowing or closure in the iridociliary sulcus was 82.13% (170/207) ,and in the pars plicata was 22.87% (67/293). The difference between them was statistical significant(X2 = 170.83 ,P <0.01). The relationship between the cyst size and the proportion of the cysts which caused corresponding angles narrowing or closure was analyzed by way of rectilinear correlation, and it was found to be a positive correlation (r= 0.9939, P< 0.01). Conclusions The incidence of primary iris-ciliary body cysts in the normal population is high and some may cause corresponding angle narrowing or closure; The location and size of the cysts are the factors to induce narrowing or closure of the angle in the corresponding area.

Visual experience plays an instructive role in the development of the visual nervous system. , it can induce persistent modification of developing visual circuits via Hebb's synaptic plasticity. The application of in vivo two-photon imaging to monitor structural changes during Monocular deprivation (MD) will determine how amblyopia are related to remodelling of synapses. As the most important process of amblyopia, ocular dominance(OD) shifts served as a usefull model for examining how cortical circuits are shaped by experience. MD can induce OD shifts toward the no-visual deprivation eye, what are the neuronal mechanisms underlying it? How the functional plasticity turn to structural plasticity? Do the aldults share the common mechanisms with the juveniles? In this review we will discuss the researching progress of neuronal mechanisms of amblyopia in these years.

Bone marrow mesenehymal stem cell (BMSC) is a special kind of cells which has the ability of serf-renewal, high proliferation and multi-potentialities. Because of the characteristic of plasticity, it plays an important role in the reparation of various tissues and organs. Furthermore it is convenient to harvest which should make it more applicable in tissue engineering. Here the pre-clinical study advance of BMSC in treating eye diseases is reviewed.

In recent years, ophthalmologists have applied intracomeal stromal ring (ICR) implantation for correction of mild to moderate refractive error in the treatment of keratoconus. After preliminary observation, it has been found that it can effectively reduce axial myopia and irregular astigmatism caused by corneal thinning and protrusion in keratoconus patients [1-3].

The patient was an 18-year-old male with left eye discomfort for more than half a year, and his visual acuity suddenly decreased for 1 week. The patient began to feel discomfort in his left eye six months ago, accompanied by eyelid edema and occasional pain. He had no symptoms such as light fear, tearing, and visual acuity decreased. He was diagnosed as "conjunctivitis" in another hospital, and was given ofloxacin, fluconazole and other eye drops, but the curative effect was not good.

The patient was a 31-year-old male who had sudden blurred vision in his left eye for 22 days without obvious trigger. He had no other symptoms such as eye pain, flash sensation, and dark shadow obstruction in front of his eyes. He was diagnosed as "fundus bleeding and neovascular glaucoma" in the local hospital, and was treated with "prednisone" and other drugs, but the symptoms did not improve.

A 55-year-old female came to the ophthalmology department of our hospital on August 29, 2006 due to a sudden decline of visual acuity in her right eye for 10 days. No obvious abnormalities were found in the physical examination. Ocular examination: visual acuity in her right eye was several fingers in front of the eye, and visual acuity in her left eye was 0.6. IOP (Canon TXF-non-contact tonometer): 12.2 mm Hg (1mm Hg =0.133 kPa) in her right eye and 10 mm Hg in her left eye. The anterior segment of both eyes was normal.

Thallium is a highly toxic heavy metal, and acute poisoning is extremely rare, but the rate of disability and mortality is high. Early diagnosis and treatment are extremely important for saving the lives of patients. The typical clinical features of thallium poisoning are gastroenteritis, polyneuropathy and alopecia. After large dose of thallium poisoning, about 1/4 of patients have visual impairment; Almost all patients with low-dose thallium poisoning will have visual impairment, mainly as visual acuity decrease and central visual field defect.

Axenfeld-Rieger syndrome is an autosomal dominant disease, which is relatively rare in clinic. We admitted one case in early 2008, and the diagnosis and treatment of Axenfeld-Rieger syndrome is reported as follows. The patient was a 13-year-old female who gave birth naturally at full term. Her father was Han nationality and her mother was Lisu nationality. She denied any history of ocular abnormalities in her family.

A 23-year-old male came to our hospital on January 5, 2008 due to a sudden and sharp decline in binocular vision accompanied by pain in both eyes for 4 d. The patient had cold, headache, nausea and other symptoms one month ago due to high work pressure, which was slightly relieved after taking medication.

Recalling the course of studying ophthalmology, I recalled the four ophthalmology seniors who trained me in my youth, namely Professor Guo Bingkuan, Professor Zhang Junjie, Professor Zhang Wenshan and Professor Bi Huade. Their voices and smiles are still in front of my eyes. They played a decisive role in my life of study and work in ophthalmology, and I will never forget it. Therefore, I write this short article to commemorate them. In the process of writing this article, Professor Wu Zhenzhong provided me with precious materials about the work of Professor Zhang Junjie and Professor Zhang Wenshan in their later years.

1. At present, the most significant treatment methods for central retinal artery vaginal occlusion are A. Intravenous papaverine hydrochloride B. Intravenous urokinase C. Retroocular injection of atropine D. Contact thrombolysis in ophthalmic artery