Chinese Journal of Ophthalmology
Volume 56 · Issue 05 · 2020
Chin J Ophthalmol
This issue focuses on the research progress of cataract diagnosis and treatment. The responsible editorial committee responsible for the planning, composition and review of the key contents of this issue is Professor Lu Yi.
Since the founding of the People′s Republic of China, with the unremitting efforts of several generations of ophthalmologists, the level of cataract diagnosis and treatment in our country has made great progress, which has made a significant contribution to the cause of preventing and treating blindness. On the occasion of the 70th anniversary of Chinese Journal of Ophthalmology, this article reviews the development of cataract surgery and intraocular lenses, aiming to help better understand the key points and breakthroughs in cataract diagnosis and treatment in our country at various historical periods, and to encourage the new generation of ophthalmologists to work hard to further promote the progress of ophthalmology in China. (Chin J Ophthalmol, 2020, 56: 321-324)
The recent years has witnessed the fast growing number of cataract patients with diabetes mellitus (DM). The complexity and diversity of DM-related ocular complications has made the cataract treatment of such patients intractable and easily ignored. Cataract surgery has become an essential part of the comprehensive treatment of diabetic ophthalmopathy. Therefore, it is more necessary to implement proper perioperative management. In this article, we discuss the preoperative blood glucose control and the prevention of infective endophthalmitis. Moreover, the importance of ocular surface health and the strategy-making in the patients with diabetic retinopathy are elaborated. We also emphasize the details of surgical techniques and postoperative follow-up. We strive to create a holistic concept throughout the process of diagnosis and treatment with an individualized and standardized view, so that the concurrence of cataract and DM may not be a challenge in the future. (Chin J Ophthalmol, 2020, 56: 325-329)
This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on March 2, 2020. Prevention and control of novel coronavirus pneumonia is now the top priority, and the protection of the eyes in the fight against the epidemic has also been an issue of great concern. Based on the latest progress made in basic and clinical research and practical experience in epidemic prevention and control, this article delivers objective guidance on whether the eye is a route of transmission of novel coronavirus infection, the precautions that should be taken by ophthalmologists in clinical practice during the epidemic, the novel coronavirus infection in the eyes and its clinical manifestation, and the public health education on eye protection, so as to provide valuable evidence for the scientific prevention and control of the epidemic and developing targeted countermeasures. (Chin J Ophthalmol, 2020, 56: 330-332)
Since the advent of intraocular lenses (IOL), the accuracy of IOL measurements has been paid much attention. With the continuous development of eye biometric equipment and the diversification of IOL power calculation formulas, the precision of IOL power calculation has increased, the function of IOL has improved, and refractive cataract surgery has become popular. However, there is an excessive pursuit of the emmetropization of postoperative refraction after cataract surgery in order to demonstrate the accuracy of IOL measurements, and postoperative emmetropization may cause visual discomfort in some patients with preoperative myopia. This phenomenon is worthy of concern. (Chin J Ophthalmol, 2020, 56: 333-336)
Patients with diabetes have a higher incidence and faster progression of cataracts, and can be combined with fundus lesions. Although the technique of cataract extraction is becoming more and more mature, the incidence of intraoperative and postoperative complications in cataract patients with diabetes is still higher than that in ordinary patients. In order to further standardize the clinical treatment of cataract in diabetic patients, the Cataract and Intraocular Lens Group of Ophthalmology Branch of Chinese Medical Association, after comprehensive discussion, put forward guiding opinions on the control of perioperative systemic diseases of cataract in diabetic patients, the selection of operation timing, perioperative medication, prevention and management of intraoperative and postoperative complications, intraocular lens selection and postoperative follow-up, so as to be referred by ophthalmologists in China in clinical work. (Chinese Journal of Ophthalmology,2020，56：337-342）
To observe the preliminary clinical effect of intraocular lens optic capture through posterior continuous curvilinear capsulorhexis in the treatment of pediatric cataract.
It was a retrospective case series study. Forty-three eyes of 28 children underwent posterior continuous curvilinear capsulorhexis with posterior chamber intraocular lens optic capture to treat cataract from June 2017 to October 2018 in Qingdao Eye Hospital. Postoperative best corrected visual acuity, diopters, intraocular pressure, the position of intraocular lens, and postoperative complications were assessed. The distribution of preoperative and postoperative best corrected visual acuity was analyzed by Fisher′s exact probability test.
Twenty-eight patients were 14 females and 14 males aged from 2 years old to 12 years old [mean age, (7±4) years]. All intraocular lenses were successfully captured in the posterior capsule. Patients were followed-up for 6.0 to 12.0 months (mean, 8.4 months). Except 2 eyes from one uncooperative child, the distribution of preoperative and postoperative best corrected visual acuity (<0.1, 0.1-<0.3, 0.3-<0.5, ≥0.5) had a significant difference (17, 17, 4, 3 eyesvs. 4, 4, 5, 28 eyes, P<0.01). At the last postoperative follow-up visit, the mean spherical equivalent was (0.21±0.74) D. Transient intraocular hypertension occurred in 3 eyes at 1 week after surgery and was controlled with stopping the use of corticosteroid eyedrops. No visual axis opacification or intraocular lens decentration or tilt was observed during the follow-up period. No other complications such as iris synechia, secondary glaucoma, retinal detachment, and cystoid macular edema were observed.
Posterior continuous curvilinear capsulorhexis with intraocular lens optic capture is a safe and effective technique to treat pediatric cataract. It has a significant effect on the prevention of visual axis opacification after cataract surgery in children. (Chin J Ophthalmol, 2020, 56: 343-348)
To investigate the relationship between corneal astigmatism and age, axial length (AL) in age-related cataract patients over 50 years old.
In this retrospective study, 1 906 eyes of 953 patients with age-related cataract were diagnosed from February 2016 to August 2016 atPeking University People′s Hospital, and their demographics, preoperative AL, magnitude and meridian of the corneal astigmatism measured by IOL Master were collected. Restricted cubic splines and Spearman rank correlation coefficients were used to investigate the relationship of the magnitude of cornea astigmatism to age. Chi-square test was used to assess the relationship of the meridian of astigmatism to age, AL and the magnitude of cornea astigmatism.
The patients were 410 men and 543 women. The corneal astigmatism was with-the-rule (WTR) in 570 eyes (29.91%), against-the-rule (ATR) in 1 005 eyes (52.73%) and oblique in 331 eyes (17.37%). The mean age was (72±9) years old. The medians (min, max) of AL and corneal astigmatism magnitude were 23.49 mm (19.83 mm to 33.89 mm) and 0.97 D (0.06 D to 4.65 D) in right eyes and 23.41 mm (17.54 mm to 32.09 mm) and 0.92 D (0.11 D to 4.88 D) in left eyes, respectively. The corneal astigmatism was ≥0.75 D in 64.95% (619/953) of the right eyes and 61.59% (587/953) of the left eyes. Among the elderly patients over 65 years old, when the AL was between 22.00-25.99 mm (r=0.186-0.279), the value of corneal astigmatism was positively correlated with age (all P<0.01) in both eyes. The value of ATR corneal astigmatism was positively correlated with age (right eyes, r=0.278, P<0.01; left eyes, r=0.225, P<0.01), while the value of WTR corneal astigmatism had no statistically significant correlation with age (right eyes, P=0.335; left eyes, P=0.633). The prevalence of WTR astigmatism decreased with age from 43.81% (46/105) to 20.73% (51/246) in right eyes and from 40.00% (42/105) to 24.80% (61/246) in left eyes, while the prevalence of ATR astigmatism increased with age from 38.10% (40/105) to 61.38% (151/246) in right eyes and from 33.33% (35/105) to 58.94% (145/246) in left eyes. The prevalence of oblique astigmatism was not significantly changed with age (right eyes, χ 2=31.986, P<0.01; left eyes, χ 2=27.686, P<0.01). There was no statistically significant difference in the distribution of corneal astigmatism meridians between different AL groups (right eyes, P=0.497; left eyes, P=0.897). With the increase of the magnitude of corneal astigmatism, the prevalence of oblique astigmatism significantly decreased from 25.45% (85/334) to 0 in right eyes and from 29.78% (109/366) to 1.35% (1/74) in left eyes, while the prevalence of ATR astigmatism significantly increased from 39.82% (133/334) to 79.27% (65/82) in right eyes and from 41.80% (153/366) to 59.46% (44/74) in left eyes (right eyes, χ 2=72.229, P<0.01; left eyes, χ 2=72.166, P<0.01).
A majority of age-related cataract patients over 50 years old have astigmatism ≥0.75 D before cataract surgery. When the AL is between 22.00 mm and 25.99 mm, the magnitude of corneal astigmatism increases with age among people over 65 years old, especially the magnitude of ATR corneal astigmatism, while the magnitude of WTR corneal astigmatism has no obvious increase with age. The percentage of ATR astigmatism increases while the percentage of WTR astigmatism decreases with age. (Chin J Ophthalmol, 2020, 56: 349-355)
To gain insight into the transcriptional landscape including mRNA, long non-coding RNA (lncRNA), and circular RNA (circRNA) of the differentiated lens.
Experiment research. The total RNAs of the differentiated lenses were extracted and purified. Total RNAs of 16-week, 23-week, and 25-week differentiated lenses were then sequenced using Illumina HiSeq 2500, and analyzed using bioinformatics tools. The top expressed and differentially expressed mRNAs and lncRNAs were screened. The expressions of overlap genes among the 16-week, 23-week, and 25-week lenses were analyzed by Venn diagram. The expression tendency of lens-specific genes was obtained and verified with real-time polymerase chain reaction.
A total of 67 518 311 mapped reads were obtained from differentiated lenses at 16 weeks, 99 440 160 at 23 weeks, and 67 262 320 at 25 weeks. The gene overlap expression analysis showed 740 of the top 1 000 highly expressed mRNAs, 170 of the top 300 highly expressed lncRNAs, and 69 of the top 100 highly expressed circRNAs overlapping expressed in lenses at 16, 23, and 25 weeks, respectively. Lens specific gene expression analysis revealed that the expression of crystallin (CRY) AA, CRYGA, CRYGB, CRYGC, CRYGD, CRYGEP, and CRYGS was upregulated, while the expression of gap junction (GJ) A3 and GJA8 was downregulated with the differentiation of lenses.
The lens transcriptome profile shows that more than half of the high expressed mRNA, lncRNA and circRNA at different differentiation stages are overlapping expressed, and all of them have high expression of lens specific protein genes, such as CRY, GJ etc. (Chin J Ophthalmol, 2020, 56: 356-363)
To analyze the pathological classification and age distribution of primary neoplasms of the lacrimal drainage system.
Retrospective case series study. A total of 64 patients (65 eyes) were diagnosed with primary neoplasms of the lacrimal drainage system and received surgery at Tianjin Eye Hospital from January 2006 to December 2016. All the clinical data of the patients were analyzed, including gender, diseased eye, age, clinical manifestations, composition of benign and malignant masses, and prognosis. The histopathological composition and age distribution of patients with primary lacrimal mass, lacrimal duct mass and lacrimal sac mass were analyzed according to the different diseased sites.
Twenty-three patients (24 eyes) were male, and 41 patients (41 eyes) were female. The right eye was involved in 36 patients, the left eye in 27 patients, and both eyes in one patient. The age at diagnosis ranged from 12 to 78 years old [mean, (46±4) years]. The course of disease was (13.1±4.2) months, ranging from 1 month to 7 years. The chief complaint was tear discharge in 43 patients, tumor in 19 patients, and abscess discharge in 2 patients. There were 29 patients with angular displacement and 21 patients with swelling pain. There were 51 patients with benign lesions, 4 with borderline lesions, and 9 with malignantlesions. These neoplasms consisted of primary peripunctal neoplasms in 17 patients, primary canalicular neoplasms in 2 patients, and primary lacrimal sac neoplasms in 45 patients. All primary peripunctal neoplasms (17 cases) were benign, among which nevi (10 cases) occupied the first place. All primary canalicular neoplasms (2 cases) were benign, there were 1 case of epidermoid cysts and 1 case of degenerative disease. Among the primary benign lacrimal sac masses (32 cases), mucous epithelial cysts (9 cases), dermoid cysts (6 cases), and epidermoid cysts (6 cases) occupied the first three places. Among the primary borderlin lacrimal sac masses (4 cases), there were 2 cases of giant cell tumor of soft tissue, 1 case of solitary fibrous tumor, and 1 case of inflammatory myofibroblastic tumor. The primary malignant mass of lacrimal sac (9 cases) was dominated by squamous cell carcinoma (3 cases). In terms of age distribution, the patients with primary peripunctal mass were mainly in the group of 40-59 years old (14 cases). The primary benign mass of lacrimal sac mainly occurred in the group of less than 40 years old (15 cases) and the group of 40-59 years old (11 cases). The patients with primary lacrimal sac borderline and malignant masses were all in the groups of over 40 years old. A total of 49 patients were followed up for 27 months to 16 years. The average follow-up time was (57.2±3.8) months. Lacrimal sac transitional cell carcinoma relapsed 7 months after surgery in one patient, and lacrimal sac melanoma relapsed 1 year after surgery in one patient. The patients did not relapse in 24 months and 38 months after surgery respectively. There were no recurrence of other cases.
Primary peripunctal neoplasms are mostly characterized with benign lesions, among which nevi are most common. Mucous epithelial cysts, epidermoid cysts, and dermoid cysts are the major benign lacrimal sac neoplasms. Squamous cell carcinomas are the most common malignant lacrimal sac neoplasms. The malignant tumor of lacrimal sac often occurs in the middle-aged and elderly patients. (Chin J Ophthalmol, 2020, 56: 364-369)
To analyze the clinical characteristics and treatment of ocular injury caused by chestnut burr.
Retrospective case series study. Data of 48 patients (48 eyes) with ocular injuries caused by chestnut burrs hospitalized in Qingdao Eye Hospital were collected from January 2013 to March 2019. All patients were followed up for at least 3 months. The time of seeking medical advice, lesion region, and characteristics and treatment methods were analyzed.
There were 48 patients, including 33 males and 15 females, aged 19 to 74 years [mean, (56±10) years]. The time of injury was late September (25 cases) and early October (23 cases). The shortest time to visit our hospital was 3 hours after injury, and the longest was 8 months after injury. There were 13 cases (27.1%, 13/48) with corneal and/or scleral foreign bodies. All patients were treated with corneal or scleral foreign body extraction. Twenty-four patients (50.0%, 24/48) developed fungal keratitis. Among them, 18 patients had a corneal ulcer, and the infection involved the superficial or full-thickness corneal layer. Six patients had no corneal ulcer, and the infection involved the deep stroma and corneal endothelial surface. The positive rate of fungal examination by confocal microscopy was 87.5% (21/24). Antifungal drugs (2 cases), corneal debridement (5 cases), conjunctival flap covering (2 cases), corneal stroma injection (1 case), and penetrating keratoplasty(14 cases) were given according to the depth of fungal infection. Most of the pathogens were Alternaria spp. Eleven patients (22.9%, 11/48) with necrotizing scleritis were treated with exploration of the sclera. Three patients had scleral foreign body residues on ultrasound biomicroscopy examination, which were removed by operation. Four patients were found to have fungi at the necrotic site of the sclera.
The main types of ocular injuries caused by chestnut burrs are corneal and/or scleral foreign bodies, fungal keratitis, and necrotizing scleritis. Chestnut burr foreign bodies should be removed as soon as possible. In the case of fungal keratitis, a drug or surgical intervention should be carried out as early as possible. Necrotizing scleritis is often induced by long-term foreign body retention. Scleral incision and exploration is an effective form of treatment. (Chin J Ophthalmol, 2020, 56: 370-375)
To explore the potential neuroprotection effects and associated mechanism of baicalin in a rodent acute hypertensive glaucoma model and oxygen-glucose deprivation/reperfusion (OGD/R) induced retinal ganglion cell (RGC) injury.
Experiment research. A rapid and substantial elevation of intraocular pressure was performed to establish an acute hypertensive glaucoma model, and retinal thickness was assessed at 1, 3, 5, and 7 days. The mice were then randomly divided into three groups: normal control group, hypertension group, and baicalin (50 mg/kg) for hypertension group. The effects of baicalin on the RGCs were evaluated by retrograde transporting of Fluoro-Gold. The mRNA levels of tumor necrosis factor-α, interleukine-1β (IL-1β), and inducible nitric oxide synthase were detected by real-time PCR, and the protein levels were measured by Western blot in the retina tissue of acute hypertensive glaucoma model. Purified primary RGC survival under OGD/R stress was measured by flow cytometry, which was also performed to measure the survival rate of RGCs pretreated by different doses of baicalin (2.5 μmol/L, 5.0 μmol/L, and 10.0 μmol/L). The effects of baicalin on primary RGCs co-cultured with mouse microglia cell line BV2 were evaluated by flow cytometry. The cytokine IL-1β in the culture supernatant was measured by immunochemical analyses. Statistical analysis was performed using analysis of variance.
Retinal tissue injuries and RGC loss were observed both in vivo and in vitro. Retinal thickness was decreased to 87.32%±0.94% at 3 days (t=6.73, P<0.01), 74.86%±2.43% at 5 days (t=13.40, P<0.01), and 63.53%±2.15% at 7 days (t=19.46, P<0.01). Treatment of 50 mg/kg baicalin significantly promoted the RGC survival from 61.32%±5.94% to 89.93%±10.08% (t=4.84, P<0.01). Baicalin alleviated the retinal damages by suppressing the expression of inflammatory cytokines as revealed by Western blot and real-time PCR. In vitro the RGC survival under OGD/R stress was increased from 51.53%±1.36% to 69.37%±7.09% and 66.23%±4.25% with 5.0, 10.0 μmol/L baicalin administration ( t=5.50, 4.53; both P<0.01). BV2 under OGD/R stress did extra damage to RGCs, and baicalin could reverse the damages and increase the survival from 69.37%±7.09% to 73.00%±5.20% (t=2.82, P=0.048) by reducing the release of IL-1β [(39.97±8.76) pg/mlvs. (61.33±5.78) pg/ml, t=4.19, P=0.010].
Baicalin could alleviate retina tissue injury directly and promote the survival of RGCs by downregulating the expression of inflammatory cytokines and protecting RGCs from ischemia reperfusion injury. (Chin J Ophthalmol, 2020, 56: 376-382)
Surgeon IntroductionYao Ke, Chief Physician, Prof. Chairman of Ophthalmology Branch of Chinese Medical Association, Head of Cataract and Intraocular Lens Group, Editor-in-Chief of Editorial Committee of Chinese Journal of Ophthalmology. Member of the International Council of Ophthalmology, Academician of the International Academy of Ophthalmology, Vice President of the Asia-Pacific Society of Cataract and Refractive Surgery, and Head of the Asia-Pacific Society of Ophthalmology in China. He has obtained six national invention patents, and has successively undertaken and completed more than 30 national, provincial and ministerial major projects, such as key projects of the National Natural Science Foundation of China, national support projects of the Eleventh Five-Year Plan and the Twelfth Five-Year Plan, key projects of national funds and general projects. The first winner won three second prizes of national scientific and technological progress awards, more than 10 provincial and ministerial scientific and technological major contribution awards and Swiss Ophthalmology Alfred-Vogt Award.
The patient was a 15-year-old female. He went to the Department of Ophthalmology of Eye, Ear, Nose and Throat Hospital affiliated to Fudan University due to decline of visual acuity in his right eye and dark shadow occlusion for 10 days. Eye examination: visual acuity was 0.25 for the right eye and 1.0 for the left eye; The anterior segment of both eyes was normal; The fundus of the left eye is normal, and the fundus of the right eye shows the essence picture 1; Coherence optical tomography angiography examination is shown in Quintessential Picture 2; Sweeping light source coherence light tomography examination is shown in Essence Picture 3. Clinical diagnosis: choroidal neovascularization secondary to choroidal osteoma in the right eye. (The picture in this article won the Excellence Award of TOPCON Cup Photo Exhibition of the 24th National Ophthalmology Academic Conference in 2019)
Congenital cataract is a common eye disease that seriously affects the visual development of infants and children. Nearly 30% of cases have cataract-linked, inherited mutations. With the development of molecular genetics, especially gentechnik, more and more genes, such as crystallin genes, membrane protein genes, transcription factors and cytoskeletal protein genes, have been confirmed to be associated with the onset of congenital cataract. There have been many studies on crystallin genes, but studies on the pathogenesis of membrane protein genes have gradually been emphasized as well in recent years. Furthermore, major intrinsic protein (MIP) genes belong to membrane protein genes, and the MIP translated by them accounts for about 50% of the total cell membrane proteins.It has been found that more than twenty mutations in MIP genes participate in the development of congenital cataract. How do these mutations further affect the cellular function and eventually lead to cataract? The recent progression about inherited congenital cataract related with MIP genes at the levels of genes and proteins is summarized in this review. (Chin J Ophthalmol, 2020, 56: 386-392)
Implantation of intraocular lens under the support of aphakic capsule is one of the difficulties in clinical surgery, and the surgical technique is demanding. Although there are many surgical methods to choose from, surgical complications are still not uncommon. This paper introduces several kinds of intraocular lens fixation with aphakic capsule support, which are traditional and developed in recent years, and emphasizes on the surgical indications, surgical characteristics and key points, so as to provide reference for clinical related work. (Chinese Journal of Ophthalmology,2020，56：393-397）
This article was pre-published on the official website of Chinese Journal of Ophthalmology on February 20, 2020. At present, China's prevention and control of the 2019 novel coronavirus epidemic is in a critical period. Delaying the start of school is an important measure to reduce cross-infection on campus, protect the health of children and adolescents, and jointly fight the epidemic. At the same time, the large-scale development of distance teaching model has led to a huge change in learning patterns and eye habits of children and adolescents, and its potential impact on the visual health of children and adolescents cannot be ignored. This article summarizes the eye health problems and ophthalmic diseases related to online learning, and puts forward targeted preventive measures to provide effective guidance for children and adolescents' visual function protection during online learning. (Chinese Journal of Ophthalmology,2020，56：398-400）
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