Volume 49 · Issue 03 · 2013

Diagnosis of uveitis based on etiologies and entities is essential for the treatment of the uveitis patients.A careful and meticulous inquiry about history may provide important clue to the diagnosis.Careful and detailed clinical ocular examinations allow us to make a correct diagnosis in most uveitis patients.Auxiliary examinations and laboratory examinations chosen principally based on clinical manifestation enable us to make a definite diagnosis in almost all the uveitis patients. (Chin J Ophthalmol,2013,49:193-195)

Acquired immune deficiency syndrome (AIDS) is a kind of fatal disease which involve multiple organs and the public health of global intention.The incidence rate in China is escalating obviously.Currently there is lack of large samples and long-term systematic observations of ocular pathological changes in the human immunodeficiency virus (HIV) infected and AIDS patients.Diagnostic errors and missed diagnosis still exist in hospitals,even in some advanced hospitals.They delay the therapy of patients,also easily result in hospital acquired infections.It is notable that there is insufficient attention to preoperative test of anti-HIV in some hospitals,especially in outpatient surgeries.Therefore potential iatrogenic infection risks are hidden.Some clinical doctors are afraid of AIDS patients,therefore they are lack of subjective initiative to comprehensively examination and treatment the patients.For the past few years,highly active antiretroviral therapy is widely used,AIDS related morbidity and mortality is significantly reduced,and the prevalence rate of ocular complications decreased from 55% to 95%.But due to the HIV/ AIDS patient volume increased year by year,and the survival rate raised,prolonged survival,results in the increase of the absolute number of patients with ocular complications.Therefore it is critical to pay attention to the HIV/ AIDS ocular lesions in the diagnosis and treatment of iatrogenic infection. (Chin J Ophthalmol,2013,49:196-198)

Uveitis is multiple disease entities with complicated causes and various manifestations.To better understand and compare the severity and improve multi centers clinical research,standardized nomenclature and grade is needed.Based on the result of Standardization of Uveitis Nomenclature working group,this paper briefly introduce the classification,onset and course,inflammation grading,diagnosis standard for complications. (Chin J Ophthalmol,2013,49:199-201)

To investigate the effect and safety of immunosuppressive treatment (IMT) combined with steroids in patients with Behçet's uveitis.

Case-series study.Eightyfive patients (167 eyes) were enrolled in this study from June 2010 to June 2011 at the Beijing Tongren Hospital.The patients were examined before the initiation of IMT and were followed up once every 3 months after the therapy.The corrected visual acuity,inflammation score,ocular complications and side effects of IMT and steroid use were recorded.The rate of positive outcomes was reported in person years (PY) or eye years (EY).The intervals between the episodes of ocular inflammation were analyzed using Kaplan-Meier survival analysis.The difference of the proportion of stable cases before and after treatment was analyzed by Log-rank test.

There were 67 males and 18 females.The mean age of diagnosis with Behçet's disease was (30.4±9.5) years.The total follow-up period was 255.5 EY and 129.67 PY.The percentages of eyes with inflammation that had been stable for at least 3 months (91.6%,153/167) or more than 1 year (22.3%,37/167) after treatment were significantly higher than those before treatment[34.7% (58/167) and 1.0% (2/167),respectively] (χ²=137.80, P<0.01).The incident rate of a decrease in visual acuity was 0.11 per EY,and the incident rate of an increased in visual acuity was 0.22 per EY.The incident rates of cataracts,an intraocular pressure greater than 30 mm Hg (1 mm Hg=0.133 k Pa) or a severe vitreous haze were 0.39 per EY,0.07 per EY and 0.79 per EY,respectively.The incident rates of obesity,osteoporosis and hypertension caused by steroid use were 0.4 per PY,0.22 per PY and 0.13 per PY,respectively.The common side effects of IMT were reversible leukopenia (0.26 per PY by chlorambucil and 0.46 per PY by methotrexate),hepatotoxicity (0.21 per PY by cyclophosphamide,0.13 per PY by azathioprine),hematuria (0.21 per PY by cyclophosphamide) and gum hyperplasia caused by cyclosporine (0.15 per PY) .

Although the use of IMT combined with steroids is effective for the control of intraocular inflammation in patients with Behçet's uveitis,the occurrence of complications is still high,and the vision prognosis is poor.We should pay attention to the side effects of the long-term use of steroids,such as hypertension,obesity and osteoporosis.The initiation of IMT is recommended over the longterm administration of large doses of steroids.The side effects of IMT should be monitored. (Chin J Ophthalmol,2013,49:202-206)

To investigate relevant factors affecting the prognosis of acute retinal necrosis syndrome (ARN).

Case-series study.The clinical data of 41 patients (53 eyes) with ARN were retrospectively analyzed.Eyes were divided into two groups according to best corrected visual acuity at final visit.The groups were best corrected visual acuity better than 0.1 (group A,28 eyes) and worse than 0.1 (group B,25 eyes).Data were analyzed using theχ²test,Fisher exact test,Mann-Whitney test,bivariate correlation statistics,and multinomial logistic regression analysis.

All patients were treated with systemic antivirus drugs and glucocorticoid.Ten eyes were treated with prophylactic laser retinopexy,26 eyes underwent intravitreal ganciclovir,and 31 eyes underwent vitrectomy.All contralateral eyes of unilateral ARN patients were not involved after systemic antivirus treatment.Compared to group B (16.0%,4/25),more eyes with best corrected visual acuity better than 0.1 at first visit were observed in group A (85.7%,24/28) (χ²=23.037,P=0.000).Duration from onset of symptoms until first administration of antivirus drugs was shorter in group A[ (15±13) days]than in group B[ (30±34) days,Z=-2.414,P=0.016].Compared to group A (25.0%,7/28; 10.7%,3/28;7.1%,2/28;39.3%,11/28),more eyes in group B suffered from retinal detachment (80.0%,20/25),occlusive central retinal vasculopathy (56.0%,14/25),optic atrophy (36.0%,9/25) and proliferative vitroretinopathy (92.0%,23/25) (χ²=13.862,10.440,5.048,13.749;P=0.000,0.001,0.025,0.000).Logistics regression analysis showed that visual prognosis were related to factors including best corrected visual acuity better at first visit (OR=27.225,P=0.003) and occlusive central retinal vasculopathy (OR=0.065,P=0.053).No difference in the number of eyes with increased intraocular pressure was observed between group A and group B (P>0.05).Prophylactic laser retinopexy before retinal detachment and intravitreal ganciclovir were not associated with visual prognosis (P>0.05) .

Worse visual acuity at first visit and occlusive central retinal vasculopathy are major relevant factors threatening visual prognosis. (Chin J Ophthalmol,2013,49:207-211)

To investigate anterior chamber inflammation after phacoemulsification with intraocular lens (IOL) implantation in patients with Vogt-Koyanagi-Harada (VKH) syndrome or Behçet's disease (BD).

Cohort study.Seventeen patients (20 eyes) with complicated cataracts and VKH syndrome or BD who underwent phacoemulsification with IOL implantation at Zhongshan Ophthalmic Center,Sun Yat-Sen University (SYSU) between January 2010 and June 2011 were included as the experimental group in this study.Cataract surgery was performed on these patients only when uveitis had been under control for more than three months.Thirty patients (40 eyes) with age-related cataracts who underwent phacoemulsification with IOL implantation in the same period were included as the control group. Quantitative measurements of anterior chamber aqueous flare and inflammatory cells were conducted preoperatively and postoperatively using a Laser Flare Cell Meter (LFCM).Independent t-test was used to compare patients' ages,and the energy and time of phacoemulsification between the two groups.The Student's t-test was used to assess the differences between paired data preoperatively and postoperatively.Independent t-test was also used to assess the quantitative data between groups.

The study recruited 20 eyes in the experimental group and 40 eyes in the control group,including 11 eyes from 9 VKH patients and 9 eyes from 8 BD patients.The preoperative and postoperative flare values in the experimental group were (19.86±6.47),(44.28±18.47),(35.60±12.65),(23.85±8.41),and (13.86±4.27) pc/ ms,respectively,which were statistically higher than that of the control group preoperatively,and on days 1,7,30,and 90 after surgery (t _pre=4.643,P_pre<0.01;t₁=6.035,P₁<0.01;t₇=3.595,P₇=0.001; t ₃₀=4.658,P₃₀<0.01;t ₉₀=3.308,P₉₀=0.002).Aqueous flare in Group A and Group B declined to preoperative levels on day 30 (t=0.320,P=0.753) and day 7 (t=0.454,P=0.653).For the experimental group,the inflammatory cell count on day 1 and 7 was (83.46±27.08) and (27.56±8.32) cells/0.5 mm³,respectively,which was significantly higher than the preoperative level[ (6.47±3.56) cells/ 0.5 mm³,t₁=5.261,P₁<0.01;t₇=2.766,P₇=0.012].On days 30 and 90,the inflammatory cell count was (11.43±4.81) and (4.82±2.29) cells/0.5 mm³,respectively,and there was no statistically significant difference in the inflammatory cell count compared with the preoperative level (t₃₀=2.348,P₃₀=0.042;t₉₀=1.376,P₉₀=0.186).For the control group,inflammatory cell count reduced to pre-operative level on day 7 (t ₇=2.464,P₇=0.018).

Anterior chamber inflammation reaches peak levels one week postoperatively in VKH and BD patients who receive phacoemulsification with IOL implantation.It takes three months for the inflammation to recede,and might take longer for complete restoration of the blood-aqueous barrier. (Chin J Ophthalmol,2013,49:212-216)

To investigate the genes and signalling pathways located upstream of the inflammatory processes in human leukocyte antigen (HLA) -B27-associated acute anterior uveitis by gene expression microarray.

Experimental study.HLA-B27-positive and-negative monocytes isolated from human peripheral blood were stimulated with Vibrio cholera lipopolysaccharide (LPS).Gene expression microarrays were used to identify the differentially expressed genes.Differentially expressed (DE) genes were testified by real-time PCR and analyzed by a series of bioinformatics-based techniques such as Gene Ontology,Kyoto Encyclopedia of Genes and Genomes.

Gene expression microarray analysis revealed marked differences between HLA-B27-positive acute anterior uveitis (AAU) and HLA-B27-negative healthy control peripheral monocytes in the genes that were upregulated in response to LPS stimulation with 1105 genes and 25 genes respectively.Gene Ontology enrichment and pathway analysis indicated that genes participating in protein transport and folding were essential to the inflammatory process.The LPS receptor-Toll-like receptor (TLR) 4 induced TLR signalling pathway and pathway related to Vibrio cholerae infection were located upstream of the network and contribute to the overall response.Among the DE genes,PIK3CA,PIK3CB,AKT3,and MAPK1 might play critical roles in inflammation.

Equivalent LPS stimulation induces a different response in HLA-B27-positive peripheral monocytes compared to normal control,suggesting that the TLR pathway is involved in the pathogenesis of HLA-B27-associated AAU. (Chin J Ophthalmol,2013,49:217-223)

To explore the effects of exogenous interleukin (IL) -2 and IL-23 on differentiation of IRBP 1-20-specific T cells originated from C57BL/6 mouse with experimental autoimmune uveitis (EAU) and to investigate the difference in pathogenicity.

Experimental study.Thirty C57BL/6 mice were immunized subcutaneously with 200μl emulsion containing 200μg interphotoreceptor retinoid-binding protein (IRBP) 1-20 and 0.8 mg mycobacterium tuberculosis in complete Freund's adjuvant,distributed over six spots at the tail base and on the flank.On postimmunization Day 13,spleens and draining lymph nodes were removed from mice,and a part of spleens,as the control group,was reserved for examining the expression of IFN-γmRNA and IL-17 mRNA by RT-PCR.T cells were isolated from the rest of spleens and lymph nodes by passage through a nylon wool column,and then T cells were stimulated for 48 hours with IRBP 1-20 in the presence of antigen-presenting cell and mouse recombinant cytokine IL-2 or IL-23.The IRBP 1-20-specific T cells were separated by Ficoll gradient centrifugation,the expressions of IFN-γmRNA and IL-17 mRNA were assessed by RT-PCR,and IFN-γand IL-17 in T cells supernatant were detected using a commercial ELISA kit.The T cells were cultured for another 48 hours,and then the proportions of IL-17⁺γδ⁺T cells were analyzed by flow cytometry.EAU models were built in 30 C57BL/6 mice,T cells from which were randomly divided into two groups according to the methods mentioned above: IL-2 group and IL-23 group.Transfer EAU models were built in other 6 mice and divided into two groups,IL-2 group and IL-23 group,by intraperitoneal injection of 3.5×10⁶IRBP-special-T cells from IL-2 group or IL-23 group respectively.Clinical changes were observed by indirect ophthalmoscopy on postimmunization day 3,7,14.For histopathological evaluation,whole eyes were collected on postimmunization day 21.Rank sum test,one-way ANOVA and paired t test were used to analyze the results.A comparison of pathogenicity was made between Th1 and Th17 through clinical observation and histopathological evaluation of B6 mouse.

Rosette formation was found among T cells on poststimulation day 2.There was a statistical difference in the expression of IFN-γmRNA between the IL-2 group and normal group or IL-23 group (0.26±0.02 vs.0.12±0.05 or 0.10±0.00) (F=80.51,P=0.003) ;however,the experssion of IFN-γin the IL-2 group[ (13 124.67±107.73) μg/L] was higher than that of the IL-23 group[ (3953.67±117.34) μg/ L] (t=169.61,P=0.000) ;and the expression of IL-17 mRNA in the IL-2 group[ (588.67±77.43) μg/ L] was lower than that of the IL-23 group[ (5038.33±88.00) μg/ L] (t=-361.71,P=0.000).Flow cytometer showed that the concentration of IL-17 in the IL-2 group[ (3.23±0.28) %] was significantly lower than that in the IL-23 group[ (9.93±0.55) %] (t=-33.18,P=0.001).There was a significant difference in the proportion of IL-17⁺γδ⁺T cells between the IL-23 group and IL-2 group (9.93±0.55 vs.3.23±0.28) (t=-33.18,P=0.001).Inflammatory response could not be detected in either group three days after injection of IRBP 1-20-specific T cells.Both groups of mice had the most severe inflammatory response on the 14 th day,of which that of the IL-23 group was significantly more severe.

IL-23 facilitates IRBP 1-20-specific T cells to differentiate into Th17,whereas IL-2 inhibits this process and induces these cells to differentiate towards Th1.Further studies showed that the pathogenicity of Th17 cells was significantly higher than that of Th1 cells. (Chin J Ophthalmol,2013,49:224-229)

To determine the dry eye awareness in the populations visiting general eye clinic.

This was a cross-sectional study.A questionnaire about dry eye was designed and administrated to Peking University Third Hospital General Eye Clinic patients (n=804) from June 2010 to June 2011.The questionnaire contents included general demographic characteristics,experience of healthrelated work,past medical history,medication history and ocular surface symptoms associated with dry eye,contact lens wearing,ocular operation history,etc.Chi-square and Binary logistic regression analysis was used to determine the influence of demographic and clinical features on awareness of dry eye.

Awareness of“dry eye”in the general eye clinical patients was relatively low (26.9%,216/804).Participants whose age were between 40 and 60 years had better dry eye awareness (41.7%,73/175) (χ²=27.365,P=0.000).Dry eye awareness of female was better than that of male[female:33.8% (151/447), male:18.2% (65/357),χ²=24.500,P=0.000].Those who had been in health-related work (71.4%,30/ 42),and whose friends or relatives were ophthalmologists (54.7%,52/95) had better dry eye awareness (χ²=31.582,36.400;bothP<0.01).Participants with a history of rheumatoid arthritis (7/10) or diabetes mellitus (63.0%,17/27) had better dry eye awareness (χ²=32.301,29.887;bothP<0.01).Those who had been using artificial tears (77.5%,31/40),oral contraceptives (9/14),diuretics (10/18),sedatives (70.4%,19/27) and anti-depression drugs (4/4) had better dry eye awareness (χ²=54.928,10.154,7.713,26.912,10.943;allP<0.01).Except frequently blinking (29.5%),participants who had ocular irrigating symptoms (all>33.0%) had better awareness than those who had not (χ²=7.831-32.522,allP<0.01).Those who were allergic to environment irritating factors (all>30.0%) had better awareness (χ²=5.033-24.564,allP<0.01).Participants who had medical history of ocular surgery (47.2%,34/72),experience of wearing contact lens (33.2%,94/283),who were diagnosed as dry eye (100.0%,45/45) and who had regular ocular examinations (31.0%,96/310) had better awareness (χ²=4.321-129.763,all P<0.01).Those who had visited general practitioners (14.8%,16/108) had lower awareness than those who went to hospital of higher level (28.7%,200/696) (χ²=9.324,P=0.002).The result of binary logistic regression analysis showed that gender,health-related working experience,relatives or friends working as Ophthalmologists,using artificial tears,oral contraceptives and sedatives,ocular irritations or environment sensitivity,eye surgeries and wearing contact lens were factors that affected dry eye awareness (OR>1.000,P<0.10).

Dry eye awareness in the population who visit general eye clinic is low.The knowledge of dry eye should be added to the patient education and public popularization. (Chin J Ophthalmol,2013,49:230-234)

To evaluate the efficacy,safety and clinical value of calculating the posterior chamber phakic intraocular lens (ICL) length according to the corneal horizontal diameter.

This was a retrospective study.A Staar Visian implantable contact lens (ICL) was implanted in 32 patients (64 eyes) with high myopia in the Department of Ophthalmology,the First Affiliated Hospital,College of Medicine,Zhejiang University between November 15,2005 and January 15,2011.The lens length was calculated according to the corneal horizontal diameter measured by OrbscanⅡ.Patients were followed up postoperatively at 1 day,1 week,1,3,6 and 12 months and every 6 months thereafter.The evaluations included visual acuity,manifest refraction,applanation tonometry,endothelial cell count,slit-lamp microscopy to detect cataract,and UBM to assess the degree of ICL tilt and distances between the corneal endothelium,the ICL,and the crystalline lens.All of the preoperative and 12-month follow-up observations were analyzed using SPSS 16.0 software.

No anterior subcapsular cataracts were found in any of the eyes after surgery.Pigmentary dispersion was observed on the anterior and posterior surface of the ICL,but the difference was not statistically significant (χ²=2.24,P=0.13).The intraocular pressure changed from (15.67±3.23) mm Hg (1 mm Hg=0.133 kPa) to (15.78±3.23) mm Hg,but the difference was not significant (t=0.24,P=0.38).The corneal endothelium-lens (central section) distance measured by UBM postoperatively was (2.97±0.25) mm and the corneal endothelium-ICL (central section) distance was (2.24±0.27) mm; the difference between them was statistically significant (t=15.77,P<0.01).The degree of ICL tilt measured by UBM was 1.20°±1.05°.The percentage of eyes with a trabecular-iris angle (TIA) greater than 30°,between 21°and 30°,between 11°and 20°,and smaller than 10°were 29.1%,50.0%,11.6%,and 9.3%,respectively.The angle opening distance at 500 micron (AOD500) measured by UBM postoperatively was (0.32±0.15) mm.The contact distance between the iris and the ICL measured by UBM postoperatively was (0.85±0.46) mm and the ICL-lens central distance was (0.47±0.25) mm.The Pearson's correlation coefficients between the ICL-lens central distance and the corneal horizontal diameter,sulcus diameter,anterior chamber depth (ACD) and ICL length were 0.11,0.16,0.04 and 0.19,respectively; none were statistically significant.The ICL-lens peripheral distance measured by UBM postoperatively was (0.25±0.20) mm.

Selecting the length of the ICL according to the corneal horizontal diameter is appropriate,and assures the safety,effectiveness and predictability of ICL implantation. (Chin J Ophthalmol,2013,49:235-241)

To present a new technique for orbital decompression that minimizes surgical approaches while maximizing the removed areas of orbital walls and to evaluate the efficacy and safety of it for patients with severe thyroid associated ophthalmopathy (TAO).

A retrospective review of 40 cases (66 eyes) with severe TAO undergoing the modified decompression between January 2009 and January 2011 was conducted.All patients were assigned to three groups,which were group CON:compressive optic neuropathy in 30 eyes,group MP:marked proptosis in 30 eyes,and group EK:exposure keratopathy in 6 eyes.The deep lateral,medial walls and orbital floor decompressions were underwent via an eyelid crease or a lateral sub-brow S-shape approach with a transcaruncular approach.Clinical outcomes were recorded including visual acuity,exophthalmometry,diplopia,clinical activity score (CAS) and CT scans before and 6 months after surgery.Intra-and postoperative complications were recorded.

The postoperative visual acuity was improved in 17 eyes (56.7%,P<0.05) of group CON.The mean proptosis reduction was (8.1±2.7) mm (t=11.73,P<0.01) and (11.4±3.1) mm (t=15.52,P<0.01) in group CON and group MP,respectively.The CAS was decreased in group CON (P<0.01).Compared with preoperative records,the degree of diplopia was not significantly different in group CON (U=131.0,P=0.309) and group MP (U=157.5,P=0.881).Diplopia resolved in 7 cases (39%) of group CON,5 cases (28%) of group MP.New-onset dipopia or its aggravation was recorded in 3 cases (17%) of group CON,4 cases (22%) of group MP.The other postoperative improvement included recovered color vision,reduced intraocular pressure,and healing keratopathy.The important complications were intraoperative dural tears,new-onset diplopia and ocular inferior displacement.

The modified orbital decompression offers wide exposure to the three orbital walls,marked proptosis reduction,and no apparent scar.It is efficacious and safety for the treatment of CON and inflammatory activity of TAO without serious complicaitions,meanwhile,has little risk of induced diplopia. (Chin J Ophthalmol,2013,49:242-249)

To evaluate the repeatability and agreement of central and peripheral corneal thickness (CT) measurements by high resolution Pentacam rotating Scheimpflug photography and Visante optical coherence tomography (OCT) in unoperated myopic eyes and eyes after Laser In Situ Keratomileusis (LASIK).

CT at central,thinnest,1.0 mm and 2.5 mm superior,inferior,nasal and temporal periphery locations,and the location of the corneal thinnest thickness were measured using Pentacam and Visante OCT in 60 myopia patients (60 eyes) and 60 patients (60 eyes) after LASIK.The rerults were analyzed by paired-ttest,Pearson correlation analysis and Bland-Altman method.

Both Pentacam and Visante OCT demonstrated high intraobserver repeatability,with all intraclass correlation coefficients and Cronbach's alphas were more than 0.9,and coefficient of variation were less than 0.9%.Significantly higher Co V was measured with Pentacam than by Visante OCT in at central (0.46±0.30),thinnest (0.43±0.28) and 1.0 mm locations in both groups (t=2.465,2.226,P<0.05),but no statistically significant difference were found at 2.5 mm locations in healthy subjects and all locations in post-LASIK eyes (t=-0.518,1.542,-0.876,0.756,P>0.05).The thickness of central corneal with Pentacam was (543.01±22.89) μm,the thinnest point was (540.61±22.84) μm,they were greater than the value of Visante OCT (t=17.946,23.071,P<0.05).The Pearson correlation coefficients were all more than 0.9 (allr>0.9,P<0.01).The Bland-Altman plots showed the 95% Lo A between both devices were lower than 22μm at central,thinnest and 1.0 mm locations.However,the 95% LoA were 24μm to 44μm at 2.5 mm locations.

Pentacam and Visante OCT demonstrate high repeatability for central and peripheral CT measurements in young myopia and post-LASIK eyes.However,both devices can't be used interchangeably for measurements of peripheral CT. (Chin J Ophthalmol,2013,49:250-256)

To evaluate the influence of corneal thickness (CT) on the intraocular pressure (IOP) measurements,the agreement of IOP readings with ICare rebound tonometer (RBT) and Goldmann applanation tonometer (GAT),and the agreement of central and peripheral IOP values obtained by RBT.

Thirty-seven eyes of 34 patients after Descemet's stripping with automated endothelium keratoplasty (DSAEK) underwent CT measurement using anterior segment OCT (AS-OCT) followed by IOP evaluation with the GAT at corneal center and with the RBT at corneal center and at 1 mm from the limbus in the nasal and temporal directions.The mean IOP measurement by the RBT and measurement by the GAT were analysed by paired t test.Pearson correlation analysis were performed to assess the correlations between the measurement and the influence of CT on IOP values.Agreement between the tonometers was calculated using the Bland-Altman method.

IOP obtained by GAT was (16.2±4.7) mm Hg (1 mm Hg=0.133 kPa),and IOP obtained from central cornea,nasal cornea and temporal cornea by RBT were (16.0±5.3) mm Hg,(17.4±5.0) mm Hg and (17.1±5.0) mm Hg,respectively.There was no statistical difference between the IOP on central cornea obtained by GAT and RBT (t=0.77,P=0.446),IOP on the peripheral cornea were higher than on central cornea by RBT (t=3.24,3.17,P=0.003),and they were positively correlated (r=0.869,0.911,P<0.05).The IOP readings showed positive relationship to CT values.Bland-Altman scatter plots showed reasonable inter-method agreement between each technique of IOP measurements.

After DSAEK,the IOP readings obtained by RBT or GAT show positive relationship to CT values.There are reasonable agreements between each technique of IOP measurements.Considering the special advantages,RBT is an effective method to observe the IOP changes after DSAEK. (Chin J Ophthalmol,2013,49:257-262)

Uveitis is a group of common sight-threatening intraocular inflammatory diseases.Besides of few patients caused by infectious agents,most of patients caused by the autoimmune reactions.In recent years,the basic and clinical researches in the immunology of uveitis had many advances.The complex immunologic mechanisms in uveitis were explained from the levels of cellular and molecular immunology.And the theoretical basis on the treatment of uveitis was established.But there are some unresolved questions existed in the fields of uveitis researches,such as the mechanisms of body defense system to prevent the intraocular inflammation,the pathogenesis of infection that causes the autoimmune response and the autoimmune uveoretinitis,the susceptible gene of uveitis and the related factors associated with occurrence and chronic in uveitis.The deeper studies on these questions will be benefit to the diagnosis and treatment of human refractory uveitis. (Chin J Ophthalmol,2013,49:277-280)

Uveitis is a group of common eye disease and is one of the major causes of blindness worldwide.Corticosteroids and immunosuppressive agents are commonly used for the treatment of uveitis.However,long-term application of these drugs frequently lead to numerous side effects.Recently,with the development of gene transfer techniques,viral vector mediated gene therapy has achieved remarkable success in experimental uveitis.Inhibition of ocular inflammation in animal models is obtained mainly by two ways:first,increase of the expression of different immune modulators including IL-10,IL-1Ra,IL-4 and IFN-alpha,or IL-27p28;secondly,induction of immune tolerance by transferring uveitis related antigens via viral vectors.Uveitis is characterized by long-lasting and recurrent,the unique properties of local administration,long-term effectiveness and minor side effects of gene therapy may provide a novel strategy for the treatment of the devastating uveitis. (Chin J Ophthalmol,2013,49:281-284)

Uveitis is one of the common sight-threatening eye diseases,which is usually recurrent and refractory to treatment.It is generally considered that the development of uveitis is closely related to the autoimmune response of uvea.Tumor necrosis factor (TNF) -α is one of the key cytokines involved in the emergence and progression of uveitis.Blocking the production or inhibiting the activity of TNF-αcan inhibit the development or progression of uveititis.Presently,the commercially available TNF-αblockers include infliximab,adalimumab,etanercept,and golimumab.This review describes the clinical studies and adverse effects of TNF-αblockers in the treatment of uveitis,and discusses the principle for clinical use of TNF-αblockers in synergy with other immunosuppressive agents. (Chin J Ophthalmol,2013,49:285-288)