Volume 49 · Issue 01 · 2013

To analyze the distribution of pathogenic bacterium of the fungal keratitis patients for providing the data of clinical diagnosis and treatment.

From July 2005 to December 2010 in Shandong Eye Hospital there were 352 smears of corneal ulcers and corneal tissue exemplar removed in surgery from fungal keratitis patients.The all exemplars were cultured with the Sabouraud dextrose agar culture media in 28℃under the humidor for 7 days.The strains was identified according to the appearance of fungal colonies,mycelium,spore shape,spore arrangement and fungal shape.And there did the retrospective analyses about the positive rate of fungal culture,genus distribution,seasonal distribution and sources of patients,sex ratio,age distribution and occupation.etc.

There were 334 stock positive fungal culture in 352 cultured specimens from fungal corneal ulcers,the positive rate was 94.9%.There were 187 positive culture from 203 corneal scraping exemplars,the positive rate was 92.1%; there were 147 positive culture from 149 corneal tissue removed in surgery,the positive rate was 98.7%.The Fusarium strains was most common in all isolated strain,211 (63.2%).The Aspergillus was secondly 47 (14.1%).The character of seasonal distribution of culture positive strain: the 48 strains (14.4%) were cultivated from January to March; the 48 strains (14.4%) were cultivated from April to June; the 64 strains were cultivated (19.2%) from July to September; the 174 strains (52.0%) were cultured from October to December,the ratio were 1∶1∶1.3∶3.6 quarterly (χ²=3.360,P=0.339).The incidence of fungal keratitis were higher in the autumn and winter than in spring and summer.The ratio of the male and the female was 2.04∶1 in 334 culture-positive patients; the mean age was (48±22) years old.The 217 (65%) came from farmer in the developed group,and the other 117 cases came from other occupations (35%).The 289 (87%) cases came from Shandong Province in 334 positive patients,the 45 cases (13%) came from other province of Province.Chi-square test method was used to analysis the differences of incidence of fungal keratitis among the four seasons using SPSS11.5.

The Fusarium is the most important pathogen in fungal keratitis in Shandong Province.The high positive culture rate of fungal keratitis specimens plays an important role in clinical diagnosis and treatment. (Chin J Ophthalmol,2013,49:12-15)

To realize the effectiveness and security of Tobramycin and Dexamethasone Eye Ointment for blepharitis treatment.Design Case control studies.Participants 148 patients be diagnosed as blepharitis including 81 cases as research group and 67 cases as control group.

Multi-center randomized controlled clinical trial.The patients met the inclusion criteria from First Hospital Peking University,Beijing Tongren Hospital,Southwest Hospital,Ophthalmology Center Zhongshan University and Third Hospital Peking University were divided into two groups in Aug.to Dec.2011.Tobramycin dexamethasone eye ointment was applied to eye lid in research group while patients in control group used tobramycin eye ointment.All patients were informed to apply warm compress to the lids,mechanically washing to the eyelids and artificial tears.At the beginning,the 7^thday,the 14^thday and the 28^thday of treatment,observation of symptom,sign and side effect were recorded.

Before treatment the difference of the symptom scores of burning sensation,tears,photophbia and itch of two groups has no statistically significant (t=1.87,0.43,-0.64,0.93,P>0.05),but the symptom scores have a statistically significant decrease (t=1.99-6.90,P<0.05) at the 7^thday,14^thday,28^thday.Before treatment the difference of signs scores have no statistically significant except the term of new blood vessels (t=2.32,P=0.02) while all the signs scores have a statistically significant decrease at the 7^thday,14^thday,28^thday.Side effect:the number of patients with elevated intraocular pressure of research and control group is 3 and 1 respectively and the ratio is 3.7% and 1.5%.

The tobramycin dexamethasone eye ointment can improve signs and symptoms of blepharitis patients.Some patients have to face with the risk of elevated intraocular pressure and it's necessary to monitor the intraocular pressure. (Chin J Ophthalmol,2013,49:16-21)

Aotologous labial salivary gland transplantation has been a promising alternative for the treatment of severe dry eye.In this article,we describe the results of the ocular surface changes after labial salivary gland transplantation and investigate the feasiblity of this treatment.

The results of this technique in 8 patients (eyes) who suffered from severe dry eye were prospectively analyzed after surgery (follow-up of 6 months).The best-corrected visual acuity,Schirmer Ⅰ test, degree of discomfort,usage of pharmaceutical tear substitutes,tear interferometry and slit lamp examination were investigated at different time before and after surgery.

All grafts remained viable and the survival rate is 100%.All patients showed significant increase in the Schirmer's test and they expressed great improvement in their ocular discomfort.The use of artificial tear substitutes was reduced because of the increased ocular surface lubrication.

Although the authors' long-term experience still is limited,we believe that the procedure is a promising alternative approach for severe dry eye (Chin J Ophthalmol,2013,49:22-26)

To study the change of tear film and lacrimal secretion after lacrimal gland tumor removal operation.

It was a retrospective case series study.Nineteen cases (19 eyes) with pleomorphic adenoma of the lacrimal gland from January,2010 to July,2011 in Eye and ENT Hospital of Fudan University were elected.The evaluation included subjective complaints of dry eye,tear break up time (BUT),reflex lacrimal secretion,corneal fluorescein staining,and size of lacrimal lake were analyzed before surgery and 3 days,1 month and 6 months postoperatively.Simultaneously,the opposite eye was set as control.

Subjective complaints of dry eye increased and the mean tear break up time,reflex lacrimal secretion,and size of lacrimal lake were significantly reduced (t=23.91,16.90,11.47;t=19.31,20.81,11.95,P<0.05) on day 3 and 1 month after operation which were (4.9±2.0) s (3 d),(5.2±1.6) s (1 moth) ; (4.05±2.07) mm (3 d),(3.58±1.98) mm (1 moth) ; (0.009±0.004) mm² (3 d),(0.008±0.003) mm² (1 moth) respectively.However,only reflex secretion test (3.53±1.50 mm) was significantly reduced (t=21.57,P<0.05),other values (BUT:17.4±4.9 s,size of lake:0.032±0.005 mm²) recovered to preoperative levels by the time of the sixth month follow up visit.Corneal fluorescein staining score increased greatly when measured at day 3 and 1 month visit (t=0.23,1.69,P<0.05),but had returned to preoperative values at the sixth month visit.The result of the opposite eye control is the same as preoperative control.

During the early stage after lacrimal gland tumor removal,tear film present abnormal changes,mainly in tear stability and reduction of reflex lacrimal secretion. (Chin J Ophthalmol,2013,49:27-31)

To investigate the clinical efficiency of calf blood extract gel on dry eye induced by chronic graft versus host diseases after bone marrow transplantation.

It was a two-stage cross-over design double-blind controlled study.Twelve patients (twenty-four eyes) diagnosis dry eye induced by chronic graft versus diseases in Ocular Surface Out-patient Clinic of Xiamen UniverSity Affiliated Xiamen Eye Center 2009 from 2010 to were divide into two groups: group A accepted the treatment of autologous serum in the first stage and group B accepted the treatment of calf blood extract gel,after one month of elution,group A accepted calf blood extract gel and group B accepted autologous serum.The signs and symptoms with different therapies were recorded at the time of pre and post therapies,which were analyzed by Wilcoxon analysis and twostage cross-over analysis.

Ocular dry eye symptoms including visual tiredness,dry and unsmooth sensation,foreign body sensation,photophobia,pain,redness and visual acuity had been improved in both autologous serum therapy (U=22.5,43.2,27.0,17.4,21.5,38.5,23.0,P<0.05) and calf blood extract gel therapy (U=333.0,24.5,29.0,40.5,26.0,36.0,51.0,P<0.05) after two-week treatment.Corneal FL had significantly been improved (2.00±1.00,3.00±1.50) (Group AU=273.0,Group BU=135.0,P<0.01).Ocular dry eye signs and symptoms including visual tiredness,dry and unsmooth sensation,burning sensation,photophobia,pain,tearing,redness,visual acuity,corneal FL,TFBUT and SⅠt hadn't significantly improved between two kinds of therapies (F=1.45,2.43,2.14,1.91,1.63,0.51,1.19,0.68,2.75,0.77,1.23,P>0.05) or between two kinds of offering drug orders (F=3.17,2.62,0.91,1.42,0.89,2.17,0.95,1.54,3.21,6.72,1.37,P>0.05) in the two-stage cross-over design.Only foreign body sensation had significantly statistical difference between two kinds of drug (F=11.38,P<0.05),while without significant statistical difference between two kinds of offering drug orders (F=2.62,P>0.05).

Calf blood extract gel can be consider as a alternative for the treatment of dry eye induced by cGVHDs,because of its functions on releasing ocular dry eye symptoms and promoting corneal epithelial cells repair. (Chin J Ophthalmol,2013,49:32-36)

To analyze the pathological classification of ocular tumor in children.

213 cases (214 eyes) of ocular tumor in children below 14 years old between January 2001 and December 2007 in Henan Eye Institute were reviewed retrospectively,the pathological classification were made according to the location and nature of the tumor.

There were 17 eyes (7.94%) of 214 eyes with benign tumor of eyelid,the leading two tumor were 4 eyes with cyst,in which 1 eye with epidermoid cyst and 3 eyes with dermoid cyst were included,and 3 eyes with squamous papilloma.There were 84 eyes (39.25%) of 214 eyes with conjunctival and corneal tumor,1 eye with intraepithelial tumor was found,other tumors were all benign tumor,the leading three tumors were corneal dermoid (64 eyes),conjunctival nevus (10 eyes) and suamous papilloma (4 eyes).There were 73 eyes (34.11%) with intraocular tumor including 66 eyes (90.41%) with retinoblastoma,6 eyes (8.22%) with iris cyst and 1 eye (1.37%) with iris melanoma.Of 38 eyes of orbital tumor,cyst (16 eyes),vascular hamartoma (7 eyes) and inflammatory pseudotumor (4 eyes) were the most common benign tumors,there were 3 eyes (7.89%) with orbital extention of retinoblastoma and 2 eyes (5.26%) with rhabdosarcoma.There were 2 eyes with scleral tumor,including 1 eye with scleral bony choristoma and 1 eye with congenital scleral cyst.Altogether,there are 135 eyes (63.08%) with benign tumor and 79 eyes (36.92%) with malignant tumors.

Most children's ocular tumors are congenital and embryonic tumors.Retinoblastoma is the most common malignant ocular tumor in children,then is corneal dermoid. (Chin J Ophthalmol,2013,49:37-40)

To detect the color discrimination changes in early-stage diabetic patients.

Retrospective series case study.A total of 78 type 2 diabetic patients (126 eyes) without diabetic retinopathy were enrolled.Another 64 healthy individuals were selected as the normal control.Total error scores (TES) and each error score (ES) in distinguishing the red,green and blue colors were measured via the Farnsworth-Munsell 100 hue tester.The TES origin scores and their square roots were used for statistical analysis.The results of the two groups were compared.The influence of gender,age,duration of diabetic mellitus and application time of insulin on TES and each color's ES values was investigated.The t,t'or u-test was adopted to compare the mean of TES and ES values between these two groups; the Spearman rank correlation analysis was used to analyze the relationship between TES and ES values and age,duration and duration of insulin usage; the t test was employed to analyze the relationship between TES and ES values vs.gender; the number of superior,average,low discrimination eyes were analyzed via theχ²test.Wilcoxon rank sum analysis was adopted in determining the color discrimination ability between these three groups.

The TES and its square root values in the diabetic and normal groups were 63.80±34.19,30.39±4.57 and 7.69±2.17,5.50±0.42,respectively.There were differences in both values between these two groups (t=4.87,4.91;P<0.05).The error scores and its square root values in distinguishing the red,green,blue colors in the diabetic group were 9.39±8.61,12.67±9.71,12.39±8.05 and 2.62±1.60,3.23±1.51,3.28±1.27,respectively,and the values were 5.13±3.59,7.00±1.84,6.81±2.70 and 1.95±1.17,2.62±0.36,2.52±0.68,respectively,in the normal group.There were differences between these two groups (u=3.62,4.94,5.40 and 2.40,3.32,4.03;P<0.05).Differences existed in discriminating the three colors between two groups (u=4.071,P<0.05).Except for age (r=0.38,P<0.05),there was no relationship between color vision defects and age,duration (r=-0.02~0.23,P>0.05),gender (r=0.32~0.39,P>0.05) or duration of insulin usage (r=-0.03~0.11,P>0.05).

Color vision defects appear in early-stage diabetic patients.Color discrimination can play an important role in the evaluation of color perception damage and visual function in diabetic patients. (Chin J Ophthalmol,2013,49:41-46)

To study the imaging and histologic features of adenoid cystic carcinoma (ACC) of the lacrimal gland.

It was a restrospective case series study.Twelve patients with ACC of the lacrimal gland were surgically treated in Tianjin First Center Hospital from September 2009 to November 2011.The 5 men and 7 women aged from 22 to 63 years (average 42.6 years).The imaging and histologic features of 12 cases with ACC of the lacrimal gland pathologically confirmed were retrospectively reviewed.Twelve cases were performed with CT scan,10 cases with MRI scan.All patients were followed up by telephone and reexamination in the outpatient service,and 2 patients were lost to follow-up.

The lesions originated in the orbital lobe of the lacrimal gland.The most commom presenting symptom was pain;it was followed by proptosis,ptosis,decreased visual acuity and diplopia.The 7th Edition of the American Joint Committee on Cancer TNM Classification system for Lacrimal Gland Tumors stages were as follows:T1N0M0 1 patients,T2N0M0 4 patients,T4N0M0 7 patients.Preoperative CT imaging suggested that bony involvement of the lacrimal gland fossa in 7 patients;this was histologically confirmed in 6 of the 7.Preoperative CT imaging suggested no bone involvement in 5 patients,1 of whom had bone involvement by histology.The positive rate of CT scan was 6/7.Preoperative MRI imaging suggested that bony involvement of the lacrimal gland fossa in 7 patients;this was histologically confirmed in 6 of the 7.Preoperative MRI imaging suggested no bone involvement in 3 patients who were confirmed by histology.The positive rate of MRI scan was 6/7.Overall,7 of 12 histologically evaluable cases had bone invasion.Five of the histologically proven 7 patients with bone involvement had a predominantly basaloid pattern,2 mixed pattern.Three patients had local recurrence.

The imaging for ACC of the lacrimal gland is characteristic.ACC of the lacrimal gland is associated with the high rate of bone invasion.The basaloid variety has more aggressive biologic behavior.The risk of local recurrence may be associated with the histologic types and stages of lacrimal gland adenoid cystic carcinoma. (Chin J Ophthalmol,2013,49:47-51)

To investigate the association between angiotensin converting enzyme (ACE) gene locus rs1799752 insertion/deletion (I/D) polymorphism and diabetic retinopathy (DR) in type 2 diabetes mellitus.

Case-control study.Type 2 diabetes patients were recruited and assigned into DR group,which included proliferative diabetic retinopathy (PDR) group or diabetes without retinopathy (DWR) group.Volunteers without diabetes from the same community were recruited as the control group.PCR and agarose gel electrophoresis methods were adopted to determine the rs1799752 I/D polymorphism genotypes of the ACE gene.The frequency of genotypes and alleles was compared among the various groups.

Four hundred and twelve diabetes patients: (207 subjects of DR,including 53 subjects of PDR and 205 subjects of DWR) and 97 nondiabetic control subjects were included in the study.The frequencies of the I and D alleles of ACE rs1799752 polymorphism were 54.1% and 45.9%,respectively,in the DR group,52.8% and 47.2% in the PDR group,and 48.0% and 52.0% in the DWR group.There were no statistical differences between DR and DWR groups (χ²=3.02,P>0.05) or between PDR and DWR groups (χ²=0.77,P>0.05).Moreover,there were no statistical differences in the distribution of the ACE genotypes between DR group (II 25.1%,ID 58.0%,DD 16.9%) and DWR group (II 22.0%,ID 52.2%,DD 25.9%) (χ²=4.92,P>0.05) or between PDR group (II 20.7%,ID 64.2%,DD 15.1%) and DWR group (χ²=3.19,P>0.05).No statistical differences were found in the frequencies of the I and D alleles,and the distributions of I/D genotypes between diabetic group and the control group (χ²=0.25,4.98;P>0.05).In the multiple regressions model including clinical factors such as the age of onset of diabetes,urinary albumin,insulin usage,creatinine,glycated hemoglobin,fast glucose,and the use of ACE inhibitor,no association was found between ACE gene polymorphism and DR (OR=0.80,95%CI:0.59-1.09) or PDR (OR=1.23,95%CI:0.78-1.93).

There is no association between ACE rs1799752 gene insertion/deletion (I/D) polymorphism and DR in patients with type 2 diabetes mellitus. (Chin J Ophthalmol,2013,49:52-57)

To investigate the expression of matrix metal proteinase (MMP) -2 and MMP-9 in adenoid cystic carcinoma of lacrimal gland as well as their relation with biological behaviour of adenoid cystic carcinoma.

Experimental study.The research objects were 60 cases of adenoid cystic carcinoma of lacrimal gland which were collected from No.2 Hospital of Tianjin Medical University from January 1991 to Jule 2011.There were 25 males and 35 females aged from 29 to 42 years.Based on histological revision,there were 36 cases of cribriform-tubular subtype and 24 cases of solid subtype.Forty-five cases were primary lesions and 15 cases were recurrent lesions.Ten samples of normal lacrimal gland around polymorphic adenoma were selected as the control group.The expression of CD105,MMP-2 and MMP-9 were evaluated by immunohistochemistry.The microvessel density (MVD) was defined by expression of CD105.One way ANOVA,χ²-test and spearman correlation test were used to analyzed the data.

The number of MVD[ (17.71±5.63) /100 folds field of vision] and the positive rates of MMP-2 (45.0%,27/60) and MMP-9 (55.0%,33/60) in the samples of adenoid cystic carcinoma of lacrimal gland were higher than those in the normal lacrimal gland[the number of MVD was (0.70±0.95) /100 folds field of vision,the expressions of MMP-2 and MMP-9 were negative] (t'=2.039,P<0.05;χ²=5.550,P<0.05;χ²=8.315,P<0.01),the solid subtypes had more MVD[ (26.12±5.32) /100 folds field of vision]and higher positive rates of MMP-2 (62.5%,15/24) and MMP-9 (79.2%,19/24) than the cribriform-tubular subtypes (t'=2.060,P<0.05;χ²=4.950,P<0.05;χ²=9.439,P<0.05) ;the recurrent lesions had more MVD and higher positive rate of MMP-2 and MMP-9 than the primary lesions (t'=2.129,P<0.05;χ²=9.899,P<0.05;χ²=8.103,P<0.05).The number of MVD in ACC of lacrimal gland patients was correlated with the positive rate of MMP-2 and MMP-9 respectively (r_s=0.636,P<0.05;r_s=0.524,P<0.05).

The number of MVD and the expression of MMP-2 and MMP-9 are higher level in adenoid cystic carcinoma of lacrimal gland and are significantly correlated with pathological type and recurrence.Detecting the number of MVD and the expression of MMP-2 and MMP-9 may become biological indexes for malignancy,recurrence and metastasis of adenoid cystic carcinoma of lacrimal gland. (Chin J Ophthalmol,2013,49:58-63)

Fungal keratitis is one of major blindness disease in corneal infection.At present,mistake and missed diagnosis were often happened in Fungal keratitis.Initial doctor was insufficient knowledge of diagnosis.There were not to do etiology examination in corneal fungal infection,and lead to some case getting worse during medicinal treated.Highly ratio patients need controlled infection by corneal transplantation due to severe lack antifungal eye drops,and poor understood the way of antifungal medicine in clinic.Finally,Fungal keratitis is still one of major intractable disease in corneal infection,because some doctor were short of experience to hold surgical opportunity and indication,and corneal donor severe shortage in China. (Chin J Ophthalmol,2013,49:2-5)

Dry eye disease is a common ocular surface disorder among ophthalmological conditions.Treatment generally focuses on tear supplement by topical artificial tears but less focus on the immunological changes in the pathogenesis of the dry eye.As our understanding of the pathology of the disease improves,new definitions are being developed.It turns out that inflammation,and dry eye accompanied relationship can not be ignored.Topical corticosteroid therapy for dry eye should be more cautioned and topical use of Cyclosporin A (Cs A) and nonsteroidal anti-inflammatory drugs (NSAIDs) require more attention.In order to standardize management strategies for dry eye,multicenter studies for the link between inflammation and dry eye are needed,and epidemiological survey should be performed. (Chin J Ophthalmol,2013,49:6-7)

With the progress of cataract surgery skills,continuous capsulorhexis as an ideal technology is widely applied to phacoemulsification.However capsular contraction syndrome is a phenomenon after the continuous capsulorhexis technology was applied.It can affect visual quality,the observation of fundus,cause lens dislocation,etc.At present,the etiology,especially for intraocular lens on the influence of capsular contraction is not entirely clear.There is also a lack of effective prevention methods clinically.Its pathology,influencing factors,prevention and treatment were reviewed in this paper. (Chin J Ophthalmol,2013,49:79-83)

Visual field is critical to evaluation of glaucoma progression.Various methods of detection of progression were used in clinical practice,but none of them is received as an ideal standard.It is very difficult to choose a method to distinguish progressive glaucomatous visual field loss from test variability.To help analysis visual field progression and identify real progressive loss,benefits and drawbacks of most commonly used methods were reviewed in present article. (Chin J Ophthalmol,2013,49:84-87)

Degenerative fundus diseases are a group of outer retinal disease caused by dysfunction of photoreceptors,some of which have the inner layer defection.Brain-derived neurotrophic factor (BDNF) has been shown to play a key role in the neuronal survival,which accomplishes its protection via receptors,including a low affinity p75 and a high affinity tyrosine kinase receptor TrkB,retinal growth cone filopodia and cofactor of Zinc.It is proved that BDNF can induce differentiation of stem cells and retinal progenitor,in case for the effective retinal transplantion.The protection by BDNF has also been observed through the interaction with retinal neurons such as photoreceptors,bipolar cells,horizontal neurons,ganglion cells and dopaminergic cells,as well as other cells of eyes.Furthermore,BDNF has been used to attenuate the injuries of optic nerve and the application of BDNF combined with other neurotrophic factors and drugs also manifests a certain efficiency. (Chin J Ophthalmol,2013,49:88-92)