Volume 45 ·  Issue 04 ·  2009

Uveal melanoma (UM) is the most common intraocular malignant tumor in the adults. So far, known treatments have not been able to effectively improve the prognosis of the patients' life and the survival rate. Based on the above issues, it is imperative to think of what can we do for uveul melanoma. This paper reviews using local preservative therapy in combined treatment of UM, how to predict and evaluate the risk of metastasis, how to detect early metastasis, and whether or not systemic therapy to UM patients is necessary. We hope that through etiological study and through the evaluation of the effects of combined treatment of UM by large sample prospective control studies, we can find an effective therapy which can save the patients' eye and useful vision while simultaneously improving the prognosis, and ultimately, improving clinical diagnosis and treatment of UM in China.

Orbital vascular lesions, mainly including hemangioma and vascular malformation, are the most common disorders among orbital diseases. Vascular lesions of the orbit have clinically complicated presentations and are very hard to deal with. Selection of therapeutic modality on orbital vascular lesions requires an appropriate classification of them. An improved classification of these lesions has been proposed by the Orbital Society based on the pathological types and hemodynamic features and has been extensively used in developed countries. However, orbital vascular lesions are still being classified based on morphology in China. This classification system does not represent the pathological difference between hemangioma and vascular malformation of the orbit, nor the hemedynamic characteristics among different vascular malformations of the orbit. Morphology based classification has hampered scientific dialogue and confused clinicians, with occasionally serious consequences for patients. Thus, the use of a pathology and hemodynamics based classification of orbital vascular lesions should be highly advocated. We can expect that the use of appropriate classification can improve the management of these lesions in our country.

Objective To investigate the clinical manifestation and follow-up of melanocytoma of the optic disc. Methods Retrospective case series study was taken to study the clinical data of the cases with melanocytoma of the optic disc at Peking Union Medical College Hospital from 1978 to 2007. The examination included direct and indirect ophthalmoscopy, fundus photography, fundus fluorescein angiography (FFA), fundus indocyanine green angiography (ICGA), optical coherence tomography (OCT) and B-scan. The clinical manifestation and the outcome in follow-up period were analyzed. Results Ten cases aged 31-58 years (mean 43 years) were included in this study. Among them, 9 cases were male, 1case was female. All cases were unilateral involved, 5 cases were right eye, 5 cases were left eye. The distribution of the visual acuity was follows: light perception in 2 eyes, 20/200 in one eye, 20/20 or above in 7 eyes. The tumor mass at the optic disc with extensive serous detachment of retina was detected on B-scan in one eye. The benign melanocytoma was diagnosed by vitreous fine needle biopsy for this eye. In other case, the tumor was found to be enlarged, visual field defect deteriorated, pigment granules appeared in the vitreous adjacent to the tumor during on year follow-up period. On the patient request, enucleation was performed to rule out the malignancy of the tumor. Pathologic study showed that the tumor cells were active, but benign state. The tumor size and visual acuity in other eight eyes remained stable in the follow-up period with one to 18 years (mean 3.5 years). On FFA and ICGA, bilateral choroidal nevi were found in one eye. Conclusions Melanocytoma of the optic disc is a benign tumor that rarely causes visual impairment. However, visual acuity may be impaired due to enlargement of the tumor or necrosis in tumor. It is important to follow-up every case with melanocytoma of the optic disc as long as pessible.

Objective To study the clinical characteristics of choroidal metastasis (CM)to promote the early diagnosis and differentiate from other choroidal tumors. Methods Retrospective clinical observational cases. All patients with choroidal metastasis underwent ophthalmologic examination including best corrected visual acuity (VA), slit-lamp examination, binocular indirect funduscopy, color photography, fundus fluorescein angiography (FFA), indocyanine-green angiography (ICGA), optical coherence tomography (OCT), A and B scan ultrasound examination, magnetic resonance image (MRI) as well as CT of the thorax, etc. Results Nine eyes of 5 patients with CM were examined. Unilateral choroidal involvement was present in 1 patient,bilateral in 4 cases. There were 1 ease male and 4 case females. The age of these patients ranged from 31 to 56 years,median 45 years. Ocular symptoms included reduced vision in 4 patients and visual distortion in 1 patient. Visual acuity was 20/400-<20/63 in four eyas;20/63-<20/30 in two eyes and ≥ 20/30 in three eyes. The primary cancer site was in the lung in 3 patients, in the breast in 1 patient and in the stomach in 1 patient. Fundus characteristics: Typical CM was more often in the plateau-shaped than in the dome-shaped; yellow-white or mottled in color and associated with subretinal fluid and retinal detachment. The tumor was found in the macular area and juxtapapillary area in 6 eyes, in the area between the macula and the equator in 3 eyes. CM was solitary in 5 eyes and showed multiple lesions in 4 eyes. By FA the lesions showed mottled hyperfluorescenee in early stage and leakage in late stage. By ICGA the lesion showed blocked fluorescence and hypofluarescence. Choroidal mass showed moderate irregular internal reflectivity in A-scan ultrasound. B-scan showed a plateau-shaped solid mass. MRI examination of the lesion revealed moderate short T1W and T2W signals. The cancer antigen increased to 16.28 and 4.95 μg/L in two eases. CA125 increased to 160.5 kU/L in one case. Conclusions The choroid is the moot common site for matastases. CM may precede the diagnosis of primary tumor. Evaluation of A, B scan ultrasound, CT of thorax and cancer antigen test may be important to exclude primary carcinoma from lung and breast in patients with yellow-white in color, pLateau-shaped choroidal lesions, especially in beth eyes, and without known metastatic diseases.

Objective To summarize the treatment outcomes of orbital adenoid cystic carcinoma and to evaluate prognostic factors. Method A retrospective case series study was performed on 75 patients with orbital adenoid cystic carcinoma treated from 1991 to 2006. Results The 2-and 5-year local recurrence rate of solid type orbital adenoid cystic carcinoma was significantly higher than that of the adeno-tubiform type [2-year, 85% (17/20) vs 23.53% (8/34), χ2= 19.14, P =0.000; 5-year, 100% (19/19) vs 64.52% (20/31), Fisher's exact test, P = 0.003]. The regional extension and distant metastasis of solid type were more than those of adeno-tubiform type. The 5-year local recurrence rate treated by postoperative radiation was lower than that treated with only surgical excision [70% (14/20) vs 92.86% (13/14) ;Fisher's exact test, P = 0.198]. The 5-year local recurrence rate in patients initially treated by orbital evisceration during the first time was lower than that of cases which evisceration procedure was used after the recurrence [25% (1/4) vs 75% (6/8), Fisher's exact test, P =0.222]. Tumors may extend into intracalvarium, nasal cavity and temporal fossa. They may spread to the lung, bone, liver and lymph node. The 5-year metastasis rate was 25.71% (9/35). Both of the lung and bone metastasis rates were 33.33% (3/9). The overall 5-year accumulative survival was 74.29% (26/35), mortality was 25.71% (9/35),and rate of survival without tumor recurrence was 37.14% (13/35). The 10-year disease free survival rate was 17.14% (6/35). Patients were most likely to die with intracranial extension. Surgical excision with postoperative radiation improved the 5-year survival rate to 80% (16/20). Conclusions Orbital adenoid cystic carcinoma is one of the most malignant tumors in the orbit. They have a high local recurrence rate and survival rate. Tumor histological types and the treatment procedure can influence the prognosis. Combined therapy may decrease the recurrence and increase the survival rate.

Objective To detect the expression of P-glycoprotein (P-gp), lung resistance associated protein (LRP) and muhidrug resistance associated protein (MRP) in retinoblastoma (Rb), to analyze the relationship between the expression of multidrug resistant (MDR) markers with clinic. pathological factors, the correlations among these three markers, and to study the possible mechanism of multidrug resistance in Rb. Methods It was an experimental study. Seventy-five cases of Rb were studied with immunohistechemical methods using antibodies against P-gp, LRP and MRP. The relationship betweer their expression and the clinicopathological features of Rb, and the relationship between the expression of these three markers were investigated. Results The positive expression rates of P-gp, LRP and MRP were 64.0%, 25.3%, 36.0% in R.b, respectively. The co-expression rates of P-gp and LRP, P-gp and MRP, LRP and MRP were 18.7%, 32.0%, 20.0%, respectively. All tested proteins showed significan correlation to the differentiation of the tumor (P = 0.006, 0.000, 0.000, respectively), but no correlatior was found between the expression of these markers and the age or sex of the patients. Significant positive correlations were observed between P-gp and MRP expression (P = 0.001), and between LRP and MRP expression (P = 0.000). Conclusions The intrinsic multidrug resistance of Rb involves the combined effects of P-gp, LRP and M R P.

Objective To explore if vasculogenic mimicry (VM) exists in retinoblastoma (Rb)and to explore the clinical significance of VM. Methods It was an experimental study. Sixty Rb specimens with complete clinical and prognostic data were collected. Periodic acid-Schif staining and immunohistochemical staining of CD34 were conducted to explore if VM exists in those Rb specimens. The expression of HIF-1α and VEGF were examined by immunohistochemical staining. The expression of CD34 endothelial antigen was used to label the neo-microvessels. Microvesseldensity (MVD) in retinoblastoma tissues was calculated. Results In HE staining slides, VM was present in Rb specimens and was formed by tumor cells but not endothelial cells. Red blood cells were present in the VM. VM existed in 18.33% (11/60) of the Rb specimens. Low R-E graded Rb specimens exhibited a higher VM positive rate than that in the high R-E graded Rb (χ2=8.861 ,P <0.05). The positive rate of VM was 4.34% in differentiated type of Rb and was 22.02% in undifferentiated type of Rb (χ2= 4.872, P <0.0). HIF-1α and VEGF expressions in Rb with VM were significantly greater than those in Rb without VM (P = 0.001). The density of endothelial vessels correlated with VM. The mean MVD was 49.77±2. 05 in Rb without VM and 36.53±1.15 in Rb with VM (P <0.05). Conclusions VM exists in Rb. Highly differentiated Rb exhibits more VM than that in less differentiated Rb. Expression of HIF-1α and VEGF is greater in Rb with VM, indicating that these factors may stimulate the occurrence of VM.

Objective To study the development of stereopsis in children from 30 to 50 months of age. Methods It was a prospective study. We examined the visual acuity and stereopsis of 152 normal children from 30 to 50 months of age. The stereopsis was examined with Titmus, RPS and TNO. Results In 152 children, a complete examination was performed in 119 children had visual acuity of ≥0.6; 12children had visual acuity of < 0.6 ; 21 children could not complete the examination. The mean age of these 21 children was significantly lower than the others. Using Titmas 60", Titmus 100" and RPS 60" as the normal criteria, the normal ratio of near stereopsis acuity in the 119 children was correlated to the age by χ2test. They were divided into four groups by 5 month-age groups. The normal ratio in the 46 to 50 month group was significantly greater than that in the other three groups. The normal ratios was 89.9%, 94.1%and 95.0% for the criteria of Titmus 100", RPS 200" and TNO 240", respectively. Conclusions The stereopsis in children from 30 to 50 months of age is still in developing status. We suggest using 100" for Titmus, 200" for RPS and 240" for TNO as normal stereopsis creteria in 3 to 4 year old children. RPS provides a reliable procedure for the measurement of stereopsis acuity in preschool children.

Objective To assess the visual outcomes and accommodative amplitude of accommodating intraocular lens (AIOL). Methods Case control study. Thirty eyes of 22 patients with cataracts had undergone phacoemulsification and implantation of AIOL Twenty nine eyes of 22 age-and sex-matched patients with cataracts had the same surgery but foldable acrylic IOL were used as the controls. All patients were assessed for accommodation amplitude, visual acuity and for change of anterior chamber depth (ACD) at 6 and 12 months after surgery. Accommodation amplitude was measured using the pushing-up test. The change of ACD was measured with OCULUS Pentacam analysis system. Results During the follow-up time,the patients in the test group had better uncorrected near vision acuity (UCNV) and distance corrected near vision acuity (DCNVA) (P =0.000). The test group had the same corrected vision acuity as the control group. Six months after surgery, push-up test showed that the mean accommodative amplitude was (1.60±0.57) D in the test group and (1.10±0.70) D in the control group. The change of the ACD was 0.50±0.37) mm in the test group and (0.08±0.06)mm in the control group. Twelve months after surgery, push-up test showed that the mean accommodative amplitude was (1.38±0.52) D in the test group and (1.06±0.61) D in the control group. The change of the ACD was (0.30±0.27) mm in the test group and (0.10±0.09) mm in the control group. Conclusions In the present study, the Tetraflex AIOL showed greater accommodative amplitude and better near visual acuity than those of the control group with conventional IOL But 6 months later, all of these measurements in the test group were decreased.

Objective To assess the repeatability and difference of ocular wavefront aberrations measured with ray-tracing, dynamic skiascopy, and Hartmann-Shack aberrometers. Methods It was an agreement study. Ocular aberrations data obtained by using iTrace (Tracey Technologies), OPDSCAN (Nidek) and WASCA (Zeiss) wavefront aberrometers were analyzed. Eighty six eyes of 45 patients were measured three times. The difference between the measurement and the mean of three consecutive measurements were analyzed to verify the reproducibility. The difference in sphere, cylinder, spherical equivalent (SEQ) and high order aberration (HOA) errors obained from different aberrometers were evaluated. Results Repeatability errors of these three wavefront analyzer were found to be low. Comparisons on the same eye showed that there was a significant difference (P < 0.01) in sphere and cylinder between ray-tracing aberrometer and the others in high SEQ group (≥-6.00 diopter). For HOA , all aberrometers obtained similar results in low SEQ group (<-6.00 diopter). In the high SEQ group, the ray-tracing aberrometer showed statistically higher data in HOA and coma (P < 0.01), and there was no significant difference between the skiascopy and the Hartmann-Shack aberrometer. The iTrace-OPD and iTrace-WASCA HOA difference correlated with spherical equivalent in the high SEQ group (r =-0.418,-0.399, P <0.01). Conclusion All devices produced similar results of reproducibility, but showed varying results in the ocular total wavefront reading.

Objective To evaluate the effect of trabeculectomy on intraocular pressure (IOP) and complications in eyes with primary angle closure glaucoma (PACG). Methods It was retrospective clinical study. PACG was classified as acute primary angle closure glaucoma (APACG) group and chronic primary angle closure glaucoma (CPACG) group. APACG was then divided into acute attack phase and chronic phase, and CPACG was divided into chronic phase and late phase, IOP, best corrected visual acuity were compared before and after trabeculectomy in different subgroup of PACG. In addition, the incidence of complications of trabeculectomy was assessed. Statistical analyses were performed using SPSS 12.0 statistics software. Categorical variables such as best corrected visual acuity were compared using nonparametric test, continuous variables such as age and IOP were compared between the two groups using independent two-sample t-tests. Pre-and postoperative IOP were compared using one-way analysis of variance of repeated measures. Results 40 eyes (37 cases) of APACG and 56 eyes (45 cases) of CPACG were enrolled in this study. The median follow-up period was 24 and 25 months, respectively, IOP was significantly decreased from (53.6±17.9)mm Hg (1 mm Hg = 0.133 kPa, preoperation) to (10.5±4.9)nun Hg (postoperation)at time of discharging from hospital and (14.0±10.3) nun Hg at time of final follow up in APACG(F =100.783,P<0.01), respectively, and from (36.8±13.8) nun Hg to (11.7±4.2) mm Hg at time of discharging from hospital and (13.8±4.5) mm Hg at time of final follow up in CPACG(F = 54.383 ,P <0.01), respectively. The IOP remained eontrolled (≤21 mm Hg) without antiglaucomatous medication in 38 eyes (95.0%) of APACG and in 50 eyes (89.3%) of CPACG. Visual acuity was significantly (H =12.316,P < 0.01) decreased after trabeeulectomy in all sub-types of PACG by Kruskal-wallis analysis. Shallow anterior chamber was conunonly occurred after trabeculectomy. Conclusions Trabeclectomy is an effective method to control IOP in APACG and CPACG. However, the high proportion of impaired vision was found following trabeculectomy in this study and warranted further clinical investigation.

Objective To analyze the morphology of human bulbar conjunetiva by in vivo laser scanning confocal microscopy. Methods This research was a cross-sectional study. From February to July 2008, 50 eyes of 50 healthy subjects were enrolled in this study. They had no history of ocular trauma, infection or contact lens wear and had no found after routine slit-lamp examinations. In vivo laser scanning confocal microscopic examinations were performed on the superior, inferior, nasal and temporal bulbar conjunctiva and the images were recorded. The morphology of bulbar conjunctiva was analyzed and the density of epithelial cells, dendritic cells and goblet cells were calculated. One-way analysis of variance (ANOVA) was used to compare the means of epithelial cell densities in different layers and goblet cell densities in different positions. Subsequently the datum between two groups were analyzed by least significant difference (LSD). Results Superficial epithelial cells of bulbar conjunctiva were characterized as large loose-arranged cells with a hyporeflective nucleus. The mean density is (1643±206) cells /mm2.Intermediate epithelial cells were captured with features of oval small tight-arranged cells with a punctiform hyperrcflective nucleus. The mean density is (4693±228) cells/mm2. Basal epithelial cells appeared to be polygonal and regular-arranged within hyperreflocfive cell borders. The mean density is (4420±230) cells/mm2.There was a significant difference among three kinds of conjunctival epithelium (F = 1160.312,P =0.000). The presumed goblet cell was defined as a large hyperreflective oval-shaped cell with relatively homogeneous brightness, crowded in groups or mainly dispersed. The mean density is (432±72) cells /mm2. The dendritic cell appeared to be hyperreflective corpuscular particles with dendritic processes scattered among conjunctival epithelial cells. The mean density is (22±25) cells /mm2. The basement membrane, a prominent hyperreflective band, separated epithelial cells from subepithelial structure. Bulbar conjunctival substantia propria, beneath the basement membrane, was mainly composed of highly vascularized, loose connective tissues which were irregularly arranged fibers or a network of fibers, punctiform hyperreflective immune cells and sharp flows of blood vessels. Conclusion In vivo laser scanning confocal microscopy is a useful tool in the analysis of the bulbar conjunctival morphology, which provided a fast and noninvasive method for the diagnosis of ocular surface diseases.

The risk factors related to the progress of glaucoma have been investigated and revealed the involvement of the systemic factors and ocular factors that include intraocular pressure (IOP) and non-IOP factors. Multi-center randomized studies have demonstrated that IOP is an important risk factor in the development of ocular hypertension (OHT) to the onset of POAG or POAG progress. These large scale randomized clinical trials indicate that the only effective way to delay the deterioration of progressive optic neuropathy is to low IOP. Establishing a target IOP, reducing IOP, and especially controlling nocturnal IOP fluctuation arc important measures for the prevention of glaucoma progress. While non-IOP risk factors come from age, central corneal thickness (CCT) , duration of optic disc hemorrhage, the degree of severity of glaucoma and glaucoma in both eyes. The risk factors affecting glaucoma have also been found in patients with myopia, family history of glaucoma, low ocular perfusion pressure, systemic hypotension, cardiovascular disease, cerebrovascular disease, systemic hypertension, and high blood cholesterol. The efforts to study the glaucoma risk factors offer insight into the etiology and clinical development processes of glaucoma and provide an improved therapeutic strategy for glancomatous.

In order to comply with the development trend of network and digitalization of journals and provide high-quality services for authors and readers, the Journal of Chinese Medical Association has developed a remote manuscript management system. The system is designed according to the business requirements of manuscript processing process, editing and processing specification, manuscript review system and management specification of Chinese Medical Association series magazines. It adopts advanced database and network technology, and has strong data processing and analysis ability.

Founded in 1989, Tianjin Medical University Eye Center celebrated her 20th birthday in 2009. To celebrate its 20th anniversary and the 66th anniversary of teaching by Professor Yuan Jiaqin, the founder of the Ophthalmology Center, the 8th International Conference of Tianjin Medical University Ophthalmology Center and China Fundus Disease Forum-Neuroophthalmology Symposium, jointly sponsored by Tianjin Medical University Ophthalmology Center, Ophthalmology Branch of Chinese Medical Association, Chinese Journal of Fundus Diseases and International Retina Foundation, will be held at Tianjin Saixiang Hotel from September 24 to 28, 2009.

Following the successful "National Symposium on Clinical Rational Drug Use in Ophthalmology" and "National Symposium on Application of New Technologies and New Equipments in Ophthalmology" held by the Editorial Board of Chinese Journal of Ophthalmology of Chinese Medical Association in 2008, at the request of the majority of ophthalmologists, the "First Chinese Ophthalmology Young and Middle-aged Forum (and Organizing Meeting)" sponsored by this journal and co-organized by Ophthalmology Branch of Zhejiang Medical Association will be held in Hangzhou, Zhejiang Province from June 19 to 23, 2009. The content integrates the rational application of ophthalmology drugs and the promotion of new technologies and new equipment, focusing on comprehensively improving the diagnosis and treatment level of ophthalmologists.

With the extensive application of excimer laser refractive corneal surgery in clinical practice, more and more ophthalmic medical workers and researchers not only pay attention to the evaluation of its clinical effect, but also focus on the research of its basic theory. In recent years, ophthalmology medical workers have gained good experience in excimer laser treatment of ocular refractive errors.

nuclear factor-kappa B (NF-κ B) is a key factor that regulates the transcription of cellular genes. It is involved in the transcriptional regulation of many genes related to cell proliferation and apoptosis [1-2], and plays an important role in the occurrence and development of tumors. retinoblaatoma (Rb) is the most common intraocular malignant tumor in infants and young children. In recent years, chemotherapy has gradually become the first-line therapy for the treatment of intraocular Rb, and good results have been achieved.

The patient was a 20-year-old female who was admitted to our hospital on December 3, 2007 due to "head and face mass for more than 20 years". The patient had a rice-sized mass on the right eyelid since birth, which gradually increased diffusely with age, but the right eyeball existed normally and could see objects. As the tumor grew, the right upper eyelid moved downward, gradually covering the right eyeball, and the palpebral fissure moved downward with the growth of the tumor, and the right eye lost sight, and the right eyeball separated from the right palpebral fissure. He was in good health in the past, but denied family history. Physical examination: general condition was acceptable, and no obvious positive signs were found in the heart, lungs and abdomen.% Zou Hailan, Email: paihoo@163.com Corresponding author

A 21-year-old male patient came to Tianjin Medical University Eye Center for treatment due to swelling of left eyelid and maxillofacial region for 1 year. One year ago, the patient developed swelling of left eyelid and ipsilateral maxillofacial region without obvious trigger, without obvious pain, fever and other discomfort, and was diagnosed as inflammatory pseudotumor of left orbit and maxillofacial region in another hospital. After treatment with glucocorticoid (prednisolone), the symptoms were relieved, and relapsed in a short time after stopping the drug. Systemic examination: body temperature 36℃, diffuse swelling of left face and parotid gland area, palpable hard lump (Figure 1), no obvious tenderness, normal skin temperature, no obvious swelling of lymph nodes, no obvious abnormalities in heart, lung, liver and spleen.

Descemet's membrane detachment is a rare and serious surgical complication. Small and limited detachment can heal itself with conservative treatment, while extensive detachment often requires reduction surgery, and full-thickness keratoplasty is often performed in those who are unsuccessful in surgical reduction. Therefore, long-term extensive Descemet's membrane detachment is rarely seen in clinic.In September 2006, a patient with successful Descemet's membrane detachment after 104 days after cataract surgery was diagnosed and treated in Beijing Tongren Hospital and Beijing Tongren Eye Center affiliated to Capital Medical University:

The patient was a 47-year-old female who came to the Department of Ophthalmology of Beijing Hospital on June 1, 2007 due to the decrease of visual acuity in both eyes for more than 2 months. The eye examination showed that the far visual acuity of the right eye was 0.3, the near visual acuity was J7, and the visual acuity chart of Early Treatment diabetic retinopathy study (ETDRS) was 45 letters. The distant visual acuity of the left eye was 0.25, the near visual acuity was J7, and the ETDRS visual acuity chart examination was 43 letters.Diagnosis: vascular streaks in both eyes with choroidal neovascularization in the submacular fovea in both eyes.Treatment was given with intravitreal injection of Lucentis 0.5 mg.