Volume 45 ·  Issue 02 ·  2009

Drug induced keratopathy is a corneal disease caused by the application of systemic and topical drugs. Toxic corneal diseases are mainly istrogenic in nature, especially caused by abuse of topical drugs on the ocular surface. Clinical manifestations of drug induced keratopathy are usually nonspecific, such as repeated diffuse punctate epithelial disease, delayed recovery of inflammation or ulceration of corneal stroma accompanied with an inflammatory reaction of the anterior chamber. Drug induced keratopathy is always accompanied by primary corneal diseases, which may impede the diagnosis and management. It is important to use drugs properly to avoid drug induced keratopathy. (Chin J Ophthalmol, 2009,45:97-99)

Local medication is the main method for the treatment of corneal diseases. Eye drops and eye ointment are the main preparations. But many corneal diseases are related closely with systematic diseases and local medication is insufficient for the treatment of these corneal diseases. Lack of systemic medication can aggravate these corneal diseases. Conversely, if systemic medication is used in all patients with corneal disease, it can lead to an adverse drug reaction. Therefore, it is very important to use systemic medication in corneal disease properly. This article discusses the ignorance and abuse of systemic medication in the treatment of corneal disease. (Chin J Ophthalmol, 2009,45:100-103)

Objective To explore the clinical value and management of complications of the transplantation of Titanium skirt compounded keratoporsthesis for severe corneal blindness eyes. Methods It was a retrospective case series study. Nine eyes from 9 male patients, aged 28 to 52 years old, accepted permanent keratoprosthesis transplantation in Zhongshan Ophthalmic Center from March 2002 to June 2005. All patients had corneal lesion in both eyes for 1.5 to 5.0 years. Among the 9 treated eyes, 6 eyes was severe vascularization after alkali burns, 3 eyes explosive injuries. Light perception was remained in all patients before surgery, however, 2 eyes only had a questionable orientation of light perception among them. Surgical management was divided into two stages. In the first stage, transplantation of Titanium skirt compound keratoprosthesis was performed, and the explant was reinforced by the self auricular cartilage and Tenons capsule. The second stage of surgery was performed in 5 to 6 months later, in which the membrane in the front of keratoprosthesis was cut. After the surgery, visual acuity, visual field, intraocular pressure and retina were examined. The complications were noticed and managed. Results All treated eyes were followed up for 1 to 3 years. After the treatment, 7 eyes divorced from blindness with uncorrected visual acuity 20/200 (0.1), and 2 eyes among them got corrected visual acuity 20/30 (0.6). Two eyes with the questionable orientation of light perception before treatment gained uncorrected visual acuity 4/200 (0.02) and 8/200 (0.04) after treatment respectively. Complications were found to include 5 recurrent frontal membrane of keratoprosthesis, one back membrane of keratoprosthesis, and one limited corneal melting.Complications were controlled by the corresponding treatments, such as membrane resection for the recurrent frontal membrane of keratoprosthesis, curage under microscope for back membrane of keratoprosthesis, and reinforcement of acellular demis for corneal melting. All keratasprothesis were maintained in situ, and no rejection and leakage of aqueous humor happened. Conclusions It is effective to use transplantation of keratoprothesis for the severe corneal blindness eyes. Combination with self auricular cartilage and Tenons capsular reinforcement may reduce the complications and improve the biocompatibility of keratoprothesis. (Chin J Ophthalmol, 2009,45:104-109)

Objective To develop a multiplex, microsphere-based DNA suspension array for the identification of important pathogenic fungi of cornea and to study the feasibility of its application in the clinical diagnosis of fungal keratitis. Methods Fusarium solani, fusarium moniliforme, fusarium oxysporum, aspergillus fumigatus and fspergillus flavus, which covered about 80% of pathogenic fungi of fungal keratitis, were chosen as target species of this study. Five species-specific capture probes were designed in the internal transcribed spacer (ITS) regions of ribosomal DNA and synthesized with 5' amino modifier C12 to covalently bind to different sets of fluorescent beads. Biotinylated amplicons of 5 reference strains and 42 clinical strains were generated with a pair of universal primers to yield fragments for detection. Comparison between single species detection and multiplex detection were designed, as well as detection between array and agarose gel electrophoresis (AGE). Spearman rank correlation analysis and t test were applied to evaluate the specificity, sensibility and reproducibility of suspension array. Results Five reference strains and 40 of 42 (95.2%) clinical strains were correctly identified within 3 h post-PCR amplification while 2 other clinical strains were not identified because of their high background fluorescence intensity. Positive S/B ranged from 5.6 to 13.3. There was no significant difference between respective detection and mixed detection of 5 species (t=0.2524, P=0.8132). The sensitivity limit for this assay was determined to be 0.94 ng PCR products. The MFI presented positive correlation with amount of PCR products (rs=1.0000, P<0.01). Coefficient variation of four repeated detections was 1.8%-13.7%. Conclusion The suspension array is a rapid, sensitive and specific method for the identification of the most important species of corneal pathogenic fungi and might be used in the clinical laboratories. (Chin J Ophthalmol, 2009,45:110-114)

Objective To explore the lymphangiogenesis process in alkali burned human cornea and to discuss factors modulating this process. Methods It was a retrospective case series study. Twenty-two cases (22 eyes) of hospitalized patients suffering from alkali burned cornea and requiring keratoplasty from January to December 2005 were analyzed retrospectively. Before surgery, injury time (IT) and injury degree (ID) were recorded. Furthermore, inflammation index (II) and relative area of new blood vessels (BVA) were measured. Cornea specimens were assessed for lymphatic vessel counting (LVC) and blood vessel counting (BVC) via immunohistochemical staining and transmission electronic microscopy. Meanwhile, HE staining was also performed to observe infiltration of polymorphonuclear (PMN) leucocytes in corneal tissues. Student t-test, Pearson correlation test and Stepwise regression analysis were used to investigate the influencing factors. Results In these 22 cases, IT was (57.62±31.72) months; ID was (12.00±2.76) scores; II was (2.32±2.63) scores; BVA was (29.79%±18.61%); BVC was (14.45±9.29) units; LVC was (2.73±4.57) units and PMN was (13.45±13.09) units. In 7 patients with IT more than 64 months (accounted for 32% of 22 cases), lymphangiogenesis[(8.6±3.8) units] and hemangiogenesis [(22.3±11.1)units] were beth present. In these 7 patients, the whole number of LVC was 60 units, constituting 16% of all vessels (BVC+LVC =378 units). The correlation coefficient of LVC with IT, ID, BVA, PMN and II was-0.673, 0.604, 0.755, 0.806 and 0.873, respectively. P value of all these correlations was less than 0.05. Further regression analysis revealed that LVC could be approximately calculated from II and BVA multiplying certain constant coefficients separately (resulting in lymphatic index, LI). Lymphatic vessels with characteristic ultrastructures and inflammatory cells were identified by transmission electronic microscopy. Conclusions Lymphatic vessels exist in part of alkali burned human corneas and may be estimated through II and BVA indirectly. Lymphatic index may be a convenient and useful clinical index for evaluating lymphangiogenesis in corneal alkali burn. (Chin J Ophthalmol, 2009, 45:115-121)

Objective To evaluate and compare the visual performance between the patients with the diffractive multifocal and monofocal intraocular lens (IOL). Methods It was a prospective nonrandomized controlled study. Sixty-five patients (80 eyes) received phacoemulsification and IOL implantation were divided into two groups, 41 patients (50 eyes) in the multifocal group, and 24 patients (30 eyes) in the monofocal group. Three months or longer after surgery, the results of the uncorrected distance, intermediate and near vision; the best-corrected distance, intermediate and near vision; the intermediate and near vision after the distance vision corrected; the contrast sensitivity and the wave-front aberrations were recorded. The subjective visual performance after surgery was evaluated by the questionnaire. The chi-square test was applied to compare categorical variables, and the independent-samples t test was used to compare the measure data. Results The difference of the uncorrected distance, intermediate vision; the best-corrected distance, intermediate and near vision; intermediate vision after the distance vision corrected between the multifocal and monofocal groups was no statistical significance. The uncorrected near vision (0.82±0.20 vs 0.33±0.14, t=8.99, P=0.000) and the near vision after the distance vision corrected (0.83±0.17 vs 0.32±0.11, t=9.83, P=0.000) were statistically better in the multifocal group than the monofocal group. Photopic contrast sensitivity at high spatial frequency(18 c/d) and mesopic sensitivity with glare at medium frequency (6 c/d)was statistically lower in the multifocal group (P<0.05). The total aberration and spherical aberration of the multifocal group were smaller than the monofocal group (t=3.74, P=0.00; t=3.56, P=0.00). The spectacle independent rate of multifocal and monofocal group were 70. 73% (29/41) and 8. 33% (2/24) respectively (X2=23.63, P=0.00). The mild and moderate glare and halo were existent in both groups (X2=0.50, P=0.78). Moderate visual disturbances were reported 24% (12/50) in the multifocal group and 26.67% (8/30) in the monofocal group. No serious glare and halo phenomenon were reported. Conclusions Compared with the monofocal intraocular lens, the diffractive multifocal intraocular lens could provide a satisfactory recovery of vision function and good visual performance except the slight decrease of the contrast sensitivity. (Chin J Ophthalmol, 2009,45:122-126)

Objective To evaluate the results of eyelid defect reconstruction using periosteal stripe of the lateral orbital rim. Methods This was a retrospective analysis of eyelid defects reconstruction in 13 patients with lateral cantus eyelid defect following the excision of the eyelid tumors including: seven patients with basal cell carcinoma, four patients with sebaceous cell carcinoma and two patients with squamons cell carcinoma. All eyelid defects were reconstructed with zygomal periosteal stripe as the posterior layer of the eyelid. The anterior layer of the eyelid was reconstructed by myocutaneous flap. Results After follow-up at 8 to 56 months, all reconstructed eyelids showed a normal appearance with good function and without deformities, e.g. eyelid notch, entropion and ectropion. There was no relapse of the eyelid tumor. All patients were satisfied with the results. Conclusions This method is good for repairing lateral eyelid defect involving 1/3 to 2/3 eyelids and without the tumor invasion of lateral orbit rim. This procedure obtains satisfactory results, especially for simultaneous reconstruction of upper and lower eyelids defects. (Chin J Ophthalmol, 2009,45:127-130)

Objective A population-based study was conducted to oompare the prevalence of congenital color vision deficiencies (CVD) in high-school students of Uygur and Han nationalities in Xinjiang Uygur autonomous region. Methods Students from 7 high schools were examined with pseudoisochromatic color plates and further with Famsworth Munsell 100 test. The chi-square test was applied to compare categorical variables, and the independent-samples t test was used to compare the measure data. Results In the study population of 3764 Uygur students, 88 students had CVD, including 69 males and 19 females. 48 of 2055 Han students were diagnosed with CVD, including 46 males and 2 females. No significant difference existed in the prevalence of CVD in boys between two nationalities. The prevalence of CVD in Uygur girls was higher than that in Han girls. Conclusions No significant difference was found in the prevalence of CVD in boys between two nationalities. The prevalence of CVD in Uygur girls was higher than that in Han girls. (Chin J Ophthalmol, 2009,45:131-134)

Objective To analysis tear proteins by using shotgun strategy, and to study pathogenesis mechanism of conjunctivochalasis by comparing tear proteins between the conjunctivochalasis and normal body. Methods Tears were obtained from 8 conjunctivochalasisi cases and 8 normal controls. Fifteen microliters of tears was collected by microcapillary tubes from each eye. Shotgun strategy was used for tear protein analysis. Trypsin digestion in-solution, separation of peptide mixture by reverse-phase high-pressure liquid chromatograph (RP-HPLC) followed by electrosprayionization mass spectrometry (ESI-MS/ MS) identification and bioinformation analysis were used in this study. Results Three hundred and fifty-six proteins were exised in conjunctivochalasis patients and 352 proteins in the normal controls, and among them 119 proteins were the same. The functias of tear proteins were classified with GOA, which found some apoptosis regulation proteins and apoptosis related proteins and inflammatory response related proteins in conjuntivochalasis but not in normal controls group. Defensin was also found in conjuntivochalasis. Conclusion Shotgun strategy can separate and anlysis tear proteins effectively, which provide a new method for tear protein component of conjunctivochalasis. The special component in conjunctivochalasis tear show conjunctivochalasis maybe related to cell apoptosis and inflammatory. (Chin J Ophthalmol, 2009,45:135-140)

Objective To analyze the types, distribution characteristics and in vitro susceptibility of antibiotic agents of ocular non-viral microbial isolates in children. Methods Experimental research. 785 specimens obtained from children below the age of 14 in Beijing Tongren Hospital during 1999 to 2004 were cultured and identified for bacterium, fungus and Acanthamoeba respectively at Beijing Institute of Ophthalmology. Microbial culture-positive rate, susceptibility patterns and the organisms distribution of positive cultures were retrospectively analyzed. The results were statistical analyzed by X2. Results Of the 785 specimens, 211 were culture positive. The percentage of positive culture was 26.88%. Of those positive cultures, 176 (83.41%) had pure bacterial infections, 32 (15.17%) had pure fungal infections, and 3 (1.42%) had pure cultures of Acanthamoeba. Of the 176 bacterial positive cultures, polymicrobial infection was present in 38 cases (33 bacterial, 5 fungal and bacterial). Of 214 bacterial isolates, the most common isolate was Neisseria gonorrhoeae (39/214, 18.22%), followed by Staphylococcus epidermidis (37/214, 17.29%), and Corynebacterium spp. (36/214, 16.82%). The most common fungal pathogen isolated was Fusarium spp. Representing 25.00% (8/32) of all positive fungal cultures, followed by Aspergillus spp. (15.63%, 5/32). The sensitivity of tobramycin, norfloxacin, gentamicin, amikacin, ciprofloxacin, ofloxacin, rifampicin and levofloxacin of bacteria was 62.57%, 64.94%, 70.06%, 70.87%, 71.19%, 73.89%,85.80% and 87.50%. Gram-positive isolates were susceptible to levofloxacin. Gram-negative isolates showed high susceptible to ciprofloxacin, ofloxacin and levofloxacin. The fungal isolates were most susceptible to natamycin, followed by terbinafine, but resistant to fluconazole. Conclusions Bacteria are the most common pathogens in non-viral microbial eye infection in children. Neisseria gonorrhoeae, Staphylococcus epidermidis, and Corynebacterium spp. Are the most common bacterial pathogens, which are highly susceptible to levofloxacin and rifampicin. Fusarium spp. And Aspergillus spp. Are the most common fungal pathogens, which are highly susceptible to natamycin but resistant to fluconazole. (Chin J Ophthalmol, 2009,45:141-145)

Objective To explore the inhibiting effect of rapamycin (RAPA) on corneal neovascularization(CNV) of rats and the functional mechanism. Methods A design group was adopted. 102 Wistar rats were divided into four groups at random, including rapamycin liposome treated group(24 rats), the rapamycin solved in bean oil treated group (24 rats), blank liposome treated group (24 rats), blank treated group (24 rats) and normal control group (6 rats). All right eyes of 96 rats were induced by alkali cauterization. Rapamycin liposome were prepared by thin film hydration and the major factors were studied by the method of orthogonal design. After alkali burn, cauterized rats were observed by slitlamp biomicroscope every day. On the 1st,4th,7th,14th days after operation,the expression of HIF-1α and VEGF were examined by immunohistochemical method and semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). The analysis of variance and q test groups for analysis were adopted to analyze the results. Results (1) The bodies of RAPA liposome were intact kinds of spheres, the average diameter was 145.2 nm,and the envelopment rate was 90.02%. (2) Mter the burn of 14 d, CNV area of B,C,D and E group were (28.289±0.703), (28.005±0.801), (20.002±1.005) and (22.300±0.853) mm2(F= 159.62, P<0.05). The CNV of both the rapamycin liposome treated group and the rapamycin solved in bean oil group grew slowly and smaller than that of blank liposome treated group and blank treated group (q= 47.80,46.20, 34.60, 32.90; P=0.00). While the rapamycin liposome treated group changed more obviously than the rapamycin solved in bean oil group (q=13.20, P=0.00). After alkali burn, the expression of HIF-1α and VEGF increased dramatically, meanwhile the expression of HIF-1α and VEGF were significantly decreased by RAPA. Conclusions Liposome body is an excellent medicine carrier for the RAPA. RAPA can obviously suppress the growth of CNV. The possibly mechanism is weakening VEGF expression by inhibiting the transcription factor HIF-1α. (Chin J Ophthalmol, 2009,45:146-152)

Objective To investigate the effects of epidermal growth factor (EGF) on the proliferation of cultured rabbit corneal epithelial (RCE) cells and the expression of cell cycle-regulatory proteins in these cells. Methods It was an experimental study. Cultured RCE cells were exposed to EGF at different concentrations (0, 1,5, 10, 25 and 50 ug/L) and different time(0, 2, 4, 6, 8 and 10 days). Cell morphologic changes were observed under a phase contrast microscope. Cell proliferation was measured using the WST-1 cell proliferation assay. The expression of cell cycle-regulatory proteins, cyclinD1, CDK4, p27, p21 and p18, was examined using Western blot analysis. The data was statistically analyzed with SPSS 11.5 software, difference between two groups and multiple groups was compared by t test and ANOVA, respectively. Results Treatment with EGF did not obviously change the cell morphology. EGF significantly induced the proliferation of RCE cells in a dose-and time-dependent manner. In cells treated with different concentrations of EGF, the proliferation rate of 5, 10, 25 and 50 ug/L EGF group at 72 h were 9.0%, 23.5%, 20.8% and 17.7%, respectively. The difference was statistically significant as compared with the control group (F=45.48, P<0.01). EGF at 10 ug/L showed maximally stimulating effect. After EGF treatment for 0.24. 48 and 72 h. the expression of cyclinD1 and CDK4 proteins was markedly increased (cyclinD1/beta-actin ratio was 0.253, 0.591, 0.885 and 1.043; CDK4/beta-actin ratio was 0.422, 0.588, 0.804 and 1.241 at different periods, respectively). Furthermore, p27 protein expression was significantly inhibited by EGF (p27/beta-actin ratio was 0.225, 0.163, 0.107 and 0.082 after EGF treatment for 0, 24, 48 and 72 h, respectively). However, there was no detectable difference in p21 and p18 protein expression between EGF treatment and control groups (p21/beta-actin ratio was 0.432, 0.391, 0.407 and 0.329 and p18/beta-actin ratio was 0.268, 0.274, 0.231 and 0.309, respectively). Conclusions This study suggests that EGF could induce RCE cell proliferation. EGF up-regulates cyclinD1 and CDK4 and down-regulates p27 in RCE cells. These changes may be the causes for EGF-induced proliferation of RCE. (Chin J Ophthalmol, 2009,45:153-157)

Objective Intraocular pressure (IOP) is a elementary data in diagnosis and therapy of glaucoma. Many studies have confirmed that most tonometry,including Goldmann applanation tonometry, are influenced by central corneal thickness (CCT) and CCT varies greatly among the general population. As a result, the measurement of CCT has a great implication in management of glaucoma. Further, CCT is confirmed a risk factor for progression from ocular hypertension to primary open angle glaucoma. The idea of that CCT may bear an inverse relation with the risk for developing glaucoma damage is in debating. Many specialists bring forward that CCT measurement should be one of the regular examinations in treatment of glaucoma patients. (Chin J Ophthalmol, 2009,45:184-188)

At present, it has been confirmed abroad that wearing protozoan-contaminated contact lenses and mild corneal abrasion are the main causes of Acanthamoeba keratitis [1]. The cysts of Acanthamoeba have strong resistance to the outside world, and the clinical efficacy of drugs is not good, so corneal transplantation is often needed for treatment [2]. Therefore, establishing good animal models is very important for the in-depth study of this disease. In previous studies, there have been reports of establishing animal models of Acanthamoeba keratitis in rats and rabbits by various methods [3-4], but these methods do not conform to the natural course of this disease, which obviously limits the basic research of this disease. In this experiment, a new animal model of Acanthamoeba keratitis was designed, and its clinical process and pathological changes were observed.

Dry eye syndrome is a common eye disease. At present, the commonly used examination methods include Schirmer test, break-up time (BUT), fluorescein staining, etc., BUT all of them have defects such as poor repeatability, invasiveness and low sensitivity [1]. tear meniscus examination is helpful for the diagnosis of dry eye syndrome, BUT the traditional tear meniscus examination method is greatly influenced by subjective factors. Video tear meniscus meter can measure tear river quantitatively, and its detection index is more accurate, BUT its application is greatly limited because its equipment has not widely entered the market [2].

The patient was a 50-year-old male who came to our hospital on September 30, 2008 due to 5 months of rainbow vision in his right eye. The patient underwent trabeculectomy in both eyes due to glaucoma in both eyes in another hospital 20 years ago, and there was no obvious decrease in visual acuity since the operation. Eye examination showed that the visual acuity was 1.0 in the right eye and 0.8 in the left eye, and the intraocular pressure was 14 mm Hg (1 mm Hg =0.133 kPa) in the right eye and 16 mm Hg in the left eye.

neuroparalytic keratitis (neuroparalytic keratitis) is a disease caused by corneal dystrophy due to the damage of the trigeminal nerve that innervates the cornea, resulting in decreased corneal perception and corneal dystrophy. Most of them are acquired, and a few are congenital. Its causes include viral infection, eye surgery, radiation keratopathy, long-term use of contact lenses, postmenstrual trigeminotomy and long-term diabetes, etc. The disease develops slowly, and the prognosis is general, which is related to its causes, because the nerves will not grow in large quantities, and the main purpose of treatment is to prevent complications. In 2006, a patient with trigeminal neuralgia complicated by neuroparalytic keratitis who was treated by radiofrequency was diagnosed and treated in our hospital.

On December 18, 2008, the signing ceremony of the continuing education scholarship cooperation agreement between the Ophthalmology Branch of Chinese Medical Association and Shenyang Xingqi Pharmaceutical Co., Ltd. was held in Beijing. Pursuant to this agreement, Shenyang Xingqi Pharmaceutical Co., Ltd. will fund the Ophthalmology Branch of the Chinese Medical Association to organize continuing education classes during the annual ophthalmology conference in the form of continuing education scholarship starting from 2009, so as to promote the development of continuing education in ophthalmology in China.

The 10th National Academic Conference on Corneal and Ocular Surface Diseases, sponsored by the Keratology Group of Ophthalmology Branch of Chinese Medical Association, jointly organized by Xiamen University Ophthalmology Research Institute, affiliated Xiamen Ophthalmology Center and Xiamen Medical Association, was grandly held in Xiamen, Fujian Province from October 23 to 26, 2008.

The "2008 National Study Class on Clinical and Basic New Progress in Neuroophthalmology" co-sponsored by Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Chinese Journal of Ophthalmology of Chinese Medical Association was successfully held in Beijing from November 15 to 17, 2008. More than 100 ophthalmologists from all provinces, municipalities and autonomous regions across the country participated in the study. This class was hosted by Zhong Yong, Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Li Xiaoxin, Peking University People's Hospital, Zhao Kanxing, Tianjin Eye Hospital, Wang Ningli, Song Weixian, Zhang Xiaojun, Jiang Libin, Wang Huaizhou and Shi Wei, Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University, Wei Shihui, PLA General Hospital, Xiao Lihua, Armed Police General Hospital,

Tear film is an important refractive medium, and its stability plays an important role in maintaining good visual quality. Because the tear film layer is very thin, its stability is affected by many factors, and the description method is limited, which hinders the understanding of its role in the analysis of visual quality.

1. The necessary conditions for the diagnosis of polypoidal choroidal vasculopathy (PCV) are A. indocyanine green angiography (ICGA) shows abnormal branched choroidal vascular network B. ICGA shows choroidal neovascularization C. Fundus examination shows orange-red subretinal bulge D. ICGA shows polypoidal choroidal vasodilation E. Subretinal hemorrhage