Volume 49 · Issue 08 · 2013

Open globe injury is a common cause for blindness.Injured eyes with no light perception (NLP) should not be enucleated before exploratory vitrectomy.Some NLP eyes may attain light perception or better vision through the vitrectomy.The decision of enucleation should be determined during exploratory vitrectomy.The timing of vitrectomy in the open globe injury still has controversy,but more surgeons agreed that vitrectomy should be performed within 2 weeks after open globe injury.The deadline of timing of vitrectomy is 4 weeks after injury.Retinectomy around the edge of the wound and retinal re-attachment surgery are the key points to prevent proliferative vitreoretinopathy resulted from the injury. (Chin J Ophthalmol,2013,49:673-675)

Congenital and acquired microphthalmos or anophthalmos are common ocular disorders that cause facial disfigurement in children.It is important to have timely and reasonable treatment to promote orbital growth.At present status,many patients miss the optimum opportunity for orbital reconstruction because of non-standardized management in China.The correct management for promoting orbital growth in microphthalmos or anophthalmos is thus elaborated.Conformers with progressively increasing size can be used in children at 1-3 years of age; while orbital implants could be used after 3-5 years of age.Rational and regular evaluation of the efficacy is critical for guiding the treatment process. (Chin J Ophthalmol,2013,49:676-678)

To evaluate the indications,operative skills and effects of transsubperiosteal approach for excision of orbital cavernous hemangiomas (OCH).

In a retrospective study,the records of 42 cases with OCH confirmed by pathologic examination between June 2004 and June 2010 were analyzed.Preoperative diagnoses were based on clinical signs,CT and MRI examinations.According to the locations of the tumor,patients were assigned to 4 groups: groupⅠ:tumors located in the superotemporal quadrant in 18 cases; groupⅡ:tumors located in or near the superior orbital fissure in 15 cases; groupⅢ: tumors in the inferior peripheral space extending to the orbital apex in 4 cases; groupⅣ:tumors in the inferonasal quadrant in 5 cases.In all 4 groups the periorbital skin was incised and then the periosteum of orbital rim was exposed.Tumors were removed from subperiosteal space.The complications and follow-up results were recorded.

The rate of preoperative correct diagnosis was 100%.All cases were cured by once surgical procedures for average 20-30 min.Thirty-eight (90.5%) tumors were removed intact.The deblocking removal was recorded in 4 (9.5%) cases.In order to improve the surgical exposure of orbital apex in groupⅡ,superolateral orbital rim was removed in 6 (14.3%) cases and the walls were drilled in 3 (7.1%) cases.Follow-up periods ranged 1 to 7 years.No recurrent or remnant was recorded on imaging reviews.The visual acuity was improved in 6 (14.3%) cases.The temporary complications included chemosis in 9 (21.4%) cases,limited ocular movement in 4 (9.5%) cases and ptosis in 3 (7.1%) cases.The permanent complications included limited ocular extreme movement and dilated pupil,both in 2 cases (4.7%).

Transsubperiosteal approach is eligible for the removal of OCH in the superotemporal,inferonasal quadrant and the floor of the orbit and is

To monitor and summarize the clinical manifestation of thyroid associated ophthalmopathy (TAO) and to analyze the thyroid function and any other factors that may have effects on the progression of TAO.

Retrospectively,403 TAO cases (676 eyes) were collected from November 2009 to June 2012 and their clinical manifestations were summarized and analyzed (quantitative and qualitative data were analyzed by using chi-square test and t-test,respectively; the relationship between various factors and TAO was analyzed with logistic regression).

TAO occurred mostly in individuals over 40 years with no gender preference (χ²=0.133,P=0.715) and characteristically bilateral.In our study,abnormal thyroid function was present in 303 cases,in which hyperthyroidism was found in 289 cases.In 62 hyperthyroidism patients accepting I¹³¹treatment,51 cases (82.26%) developed hypothyroidism and 64.71% of them developed TAO or showed progression of TAO.TAO with over 2 grade in severity (67.66%) and 4 grade in CAS (40.29%) occurred more frequently in patients with abnormal thyroid function than those with euthyroidism (37.00% vs.21.32%).Edema of eyelids was the major manifestation and main reason for ophthalmic examination.Eye lids retraction and lagging eyelids were present in 75.93% and 83.37% cases,respectively.Involvement of extraocular muscle presented in 49.38% cases.Lagophthalmos and damage of the cornea appeared in 10.42% and 9.43% cases,respectively.CT examination showed that the most common involvement of extraocular muscles was inferior rectus; medial and superior rectus were the second and the third involved muscles,respectively.Lateral rectus was seldom involved.TheⅥandⅤgrade of TAO occurred in 67.47% of 56 cases with smoking habit.

Thyroid function has a certain relationship to the severity of TAO.

To study the feasibility and effectiveness of the extraction of intraocular foreign body (IOFB) at or near the ciliary body by using endoscopic vitrectomy.

It was a retrospective case series study.Clinical materials and data of 15 patients (16 eyes) with IOFB at or near the ciliary body from July 2002 to December 2010 were analyzed retrospectively.Vitrectomy and IOFB extraction under endoscope were conducted in all cases.

Thirty six IOFB (18 magnetic and 18 nonmagnetic IOFBs) were extracted successfully.The size of IOFB ranged from smaller than 1 mm×1 mm×1 mm to 9 mm×6 mm×4 mm.Among them,31 IOFB were extracted from ciliary body or nearby and 5 IOFB were located at other places.The cornea was opaque before the operation in 11 eyes.Postoperative visual acuity was improved in 12 eyes.Vision was improved from fingercounting and below to 0.1-0.3 in 4 eyes.Intraocular pressure was normal in 14 eyes.The retina was reattached in 12 eyes.The cornea was clearer than before in 8 eyes.After the end of the fellow-up,vision was remained in finger-counting and below in only 7 eyes.

There was almost no blind spot by using endoscope to observe the ciliary body,periphery retina tear or other pathological changes,the IOFB at or near ciliary body and the whole retina in the vitrectomy.This makes the extraction of IOFB at or near the ciliary body and the conduct of cyclophotocoagulation more accurate and simple. (Chin J Ophthalmol,2013,49:691-695)

To study the microanatomy of cadaver skulls related to lateral orbital approach operation.Microanatomy data were recorded and analyzed by multi-angle digital camera.

Experimental study.Five adult formalin-fixed cadaver skulls were examined,simulating the lateral orbital approach procedure,the optic nerve,oculomotor nerve,ophthalmic artery,superior ophthalmic vein and various levels anatomical structures and adjacent regions were dissected and examined on both sides of each specimen under surgical microscope.

Lateral orbit approach operation involved many important structures in the orbit.From the lateral side,ophthalmic artery (the second segment),ciliary ganglion and abducens nerve located outside of optic nerve were involved.From the superior side,ophthalmic artery (the third segment),superior ophthalmic vein,nasociliay nerve and the upper branch of oculomotor nerve located above the optic nerve were involved.From the inferior side: ophthalmic artery (the first segment),central retinal artery,the inferior branch of oculomotor nerve located below the optic nerve were involved.There were many blood vessel and nerves in the orbital apex,including optic nerve,oculomotor nerve,ciliary ganglion,abducens nerve,the ophthalmic division of the trigeminal nerve,ophthalmic artery and superior ophthalmic vein.

The anatomic structures involved in the lateral orbital approach surgery are complex,especially in the orbital apex.Optic nerve,oculomotor nerve,ophthalmic artery,superior ophthalmic vein are located in this region.The operative space is narrow,the damage of nerves and blood vessels will result in serious complications. (Chin J Ophthalmol,2013,49:696-699)

To compare the results of secondary in-the-bag intraocular lens (IOL) implantation with secondary sulcus IOL implantation in the eyes which received cataract extraction during early infancy.

A case control study.We selected 60 eyes of 44 patients with pediatric aphakia that meet the inclusion criterion in Affiliated Eye Hospital of Wenzhou Medical College from September 2005 to August,2011.Thirty eyes received in-the-bag secondary IOL implantation and were compared with 30 eyes that received secondary sulcus IOL implantation.Data were collected for the ages at cataract extraction and at secondary IOL implantation,the preoperative axial length,the length of follow-up,postoperative complications,postoperative best-corrected visual acuity (BCVA)

To explore the application value of computed tomography (CT) dacryocystography in children lacrimal diseases.

Retrospective case series.The results of CT dacryocystography in 300 children (395 eyes) with lacrimal diseases from October 2009 to October 2011 in Beijing Children Hospital were analyzed retrospectively.

Among 240 children (326 eyes) with congenital nasolacrimal duct obstruction,the sites of obstruction were in the common canaliculus or upper position in 6 eyes (1.8%),in the lacrimal sac in 38 eyes (11.7%),at the borderline between lacrimal sac and nasolacrimal duct in 213 eyes (65.3%) and at the terminal of nasolacrimal duct in 69 eyes (21.2%).CT dacryocystography could display the obstruction position of lacrimal duct in congenital nasolacrimal duct obstruction.In unilateral congenital nasolacrimal duct obstruction,CT dacryocystography indicated that nasolacrimal canal in affected side were much larger than that in normal side.It could show the destruction of lacrimal soft tissue and the fossa of lacrimal sac in traumatic lacrimal duct obstruction.CT dacryocystography was also the main subsidiary method for the diagnosis of congenital dacryocystocele,congenital nasolacrimal canal agenesis and lacrimal sac diverticula.

CT dacryocystography can provide important aspects for the diagnosis and treatment of children lacrimal diseases.Therefore,it can be used as an important image examination method in children with lacrimal diseases. (Chin J Ophthalmol,2013,49:706-710)

To assess the safety,efficacy,stability and changes in cylindrical degree and axis after real-time iris recognition guided LASIK with femtosecond laser flap creation for the correction of myopic astigmatism.

Retrospective case series.This observational case study comprised 136 patients (249 eyes) with myopic astigmatism in a 6-month trial.Patients were divided into 3 groups according to the pre-operative cylindrical degree: Group 1,-0.75 to-1.25 D,106 eyes;Group 2,-1.50 to-2.25 D,89 eyes and Group 3,-2.50 to-5.00 D,54 eyes.They were also grouped by pre-operative astigmatism axis:Group A,with the rule astigmatism (WTRA),156 eyes; Group B,against the rule astigmatism (ATRA),64 eyes;Group C,oblique axis astigmatism,29 eyes.After femtosecond laser flap created,real-time iris recognized excimer ablation was performed.The naked visual acuity,the best-corrected visual acuity,the degree and axis of astigmatism were

To explore the mechanism of optic nerve damage in glaucoma by study on structure of glial lamina cribrosa (LC) in rats.

Experimental study.Albino Swiss (AS) rats were divided into 3 groups.Bilateral eyes of 10 normal rats were employed to be groupⅠ (right eye) and groupⅡ (left eye).GroupⅢwas from the left eyes of 13 rats underwent artificially intraocular hypertension in the right eyes.All rats were perfused and fixed with electronic microscopy fixative (2% paraformaldehyde+ 2% glutaraldehyde).Trimmed optic nerves were embedded with resin.Serial 1.5μm thick'semithin' sections were cut,either (2 eyes from groupⅢ) longitudinally,through the optic nerve head (ONH) from the retinal end to the commencement of the optic nerve,or (31 eyes) transversely (cross-sections).Ultrathin sections were cut in the middle of glial LC.The morphological observation of glial LC was obtained by light microscopy and transmission electron microscopy.Bonferroni correction was used to cownteract the multiple comparision of each group.

Fortified astrocytes formed the main supportive structure of glial LC in all rats,including

To study the effects of premature birth on the development of rat retinal vasculature.

Experimental study.Sixty pregnant Sprague-Dawley rats were divided into four groups: bacterial lipopolysaccharide-induced preterm group (LPS group),RU-486 induced preterm group (RP group),cesarean section induced preterm group (CP group),and the normal delivery rats as the control group.The weight of rats from each group was recorded until postnatal day 21.On postnatal day 4,7,10 and 14 (P4,P7,P10 and P14),the retina of right eye was dissected and wholemounted.Each premature group was divided into two subgroups based on the number of rats in each litter,the small subgroup (6-8 rats per litter,group 1) and the large subgroup (14-18 rats per litter,group 2).The development of retinal vascularization process was observed on P4,P7 and P10 (n=6)

To investigate the capability of RB cells that represent characteristics of tumor stem cell and trans-differentiate towards endothelial cells under hypoxia microenvironment,as well as their mechanism.

Experimental research.RB cell line Y79 was cultured in hypoxia

Viscocanalostomy is used as the surgical intervention for open angle glaucoma.It has advantage of creating gradual filtration through the thin trabeculo-descemet membrane to reduce markedly the postoperative complications.Lately,many surgeons modified VCO,like combined it with phacoemulsification,or use the implant.Many to lower IOP to a greater degree and enhance success rates.This article reviewed the history of VCO,specially on the point of the surgical methods,effect,development,progress and tendency of VCO. (Chin J Ophthalmol,2013,49:749-751)

Proliferative vitreoretinopathy (PVR) is a leading blinding disease,which is often associated with ocular trauma,rhegmatogenous retinal detachment and diabetic retinopathy.PVR involves the vitreous and retina and its occurrence is characterized by vitreoretinal cells migration,transformation and excessive proliferation which lead to the formation of pre-or sub-retinal membrane or membrane formation in the vitreous.The subsequent contraction of the membrane can lead to retinal detachment and loss of vision.At present,vitrectomy is the standard treatment modality for the treatment of PVR.However,this procedure is expensive and post-operative vision is often unsatisfactory.With the advances of biological studies,the pathogenesis of PRV becomes clear,and the corresponding pharmacological intervention studies targeting the relevant pathways developed rapidly.This review is aiming to highlight the new developments in pharmacological prevention and treatment for PVR. (Chin J Ophthalmol,2013,49:752-757)

Photodynamic therapy (PDT) as a new therapeutic method is increasing widely used in ocular surface disease.Along with intensive studies of microorganism inhibition and promoting function in tissue repairing of PDT have been developed,PDT been gradually applied to treating infectious keratitis in clinical.We review mechanism,sterilization and application in infectious keratitis of PDT. (Chin J Ophthalmol,2013,49:758-761)