Chinese Journal of Ophthalmology
Volume 51 · Issue 03 · 2015
Chin J Ophthalmol
Corneal epithelial dysfunction (CED) is the abnormality of the regeneration, conjunction, adhesion and immigration of the corneal epithelium cells without the decompensation of the corneal limbal cells. Due to the affection resulting from the systemic problems of patients and the management in the preoperative period, some of the patients at one to two weeks after cataract surgery will present the edema and fluorescein staining of the corneal epithelium. Without correct therapy, the defect of the epithelium, or even persisting ulceration of the cornea will occur. The key points of the management for CED are the early diagnosis and reasonable therapy. We suggest paying special attention to CED in the patients with metabolism diseases, abnormality of the tear film and long-term blepharitis. (Chin J Ophthalmol, 2015, 51: 161-162)
Non-infectious inflammatory reaction after cataract extraction is a complication caused by perioperative antigen stimulation, surgical stress, changes of physical and chemical factors, etc. Excessive operation, stimulation of the iris and prolonged operation time during operation may aggravate the inflammatory reaction. In mild cases, it can cause pain and congestion in the operated eye, and in severe cases, it can lead to vision loss and even blindness. The mechanism of inflammatory response is that the intraoperative release of prostaglandins and leukotrienes destroys the blood-aqueous humor and blood-retinal barriers, resulting in increased vascular permeability and aqueous humor protein content. Therefore, blocking the production of prostaglandins and leukotrienes is the main target for controlling inflammatory response. At present, the drugs mainly used to control and treat inflammatory response in clinic include glucocorticoids and non-steroidal anti-inflammatory drugs.
The pathogenesis of primary angle closure glaucoma (PACG) is complex, its prevalence increases with age and is higher in women than in men. The main risk factors for the onset of PACG are pupil block caused by anterior lens position and shallow anterior chamber. In addition, peripheral iris hypertrophy and ciliary body advancement are also common risk factors for PACG. The darkroom challenge test is a challenge test designed for the diagnosis of PACG to screen high-risk patients at risk of angle closure from suspected shallow anterior chamber, narrow chamber angle patients. However, the accuracy of traditional darkroom excitation test is not high, so it needs to be further improved in order to improve the sensitivity and specificity of diagnosis[
Recent findings show that the difference between the intraocular pressure before the sieve plate of the optic papilla and the cerebrospinal fluid pressure behind the sieve plate (the pressure gradient across the sieve plate), rather than intraocular pressure, is a major risk factor for optic nerve injury in glaucoma[
To study the clinical features, diagnosis and treatment of Thygeson's superficial punctate keratitis (TSPK).
Twenty-one cases diagnosed as TSPK between June 2010 and July 2013 were retrospectively analyzed, including clinical manifestation, characteristics of morphological changes imaged by laser confocal microscopy, treatment and therapeutic effects.
All the 21 cases had the same presentation. Slit lamp examination showed several rough punctate intraepithelial opacities, which were usually slightly above the niveau of the surrounding epithelium. No cases had conjunctival congestions. Eight eyes of five patients with TSPK were imaged with a laser confocal biomicroscope. Clusters of highly reflective dots were revealed in the epithelium. The number of Langerhans cells was greatly increased in the basal cell layer of the focal corneal epithelium and the Bowman's layer in ten eyes affected by TSPK. The density of the subepithelial nerve plexus decreased. Some keratocytes had highly reflective cell bodies of irregular size, orientation, and shape in the anterior stroma in the affected eyes. After treatment with low concentration steroid eye drops and antiviral drugs, punctate opacities in all 21 cases were completely absorbed, leaving no scar, and the cure rate was 100%. But TSPK recurred in four cases. All recurrent cases were cured completely after treatment.
Thygeson's superficial punctate keratitis is a kind of chronic recurrent superficial keratitis, without conjunctivitis. Confocal microscopic images have certain specificity, help diagnose and contribute to its pathogenesis research. Local use of low concentration steroid eye drops combined with antiviral drugs is effective for TSPK. Clinicians should pay attention to recurrence of TSPK.(Chin J Ophthalmol, 2015, 51: 173-177)
To observe the change of teenagers with short-time and long-time orthokeratology discontinuation, including diopters, corneal curvature, corneal topography, axial length, and central corneal thickness, and to investigate the refractive correction methods after long-time orthokeratology discontinuation.
Retrospective study. A total of 141 patients (257 eyes) with a history of wearing and discontinuing wearing orthokeratology lenses in our center were collected. According to the spherical equivalent diopters, the patients were divided into two groups (≤-4.00 D for group Ⅰ and -4.00 D for group Ⅱ). Each group was further divided into two sub-groups by the discontinuation time (1 to 3 months for sub-group A and more than 3 months for sub-group B). Four sub-groups were named as ⅠA, ⅡA, ⅠB, and ⅡB. Some optical examinations were performed for the patients before orthokeratology lens wearing and after orthokeratology discontinuation, such as refraction, corneal curvature, corneal topography, corneal endothelial cells, axial length, and central corneal thickness measurement. The refractive correction methods used by patients who had long-term orthokeratology discontinuation were recorded. The observed data were analyzed with paired t-test and one-way ANOVA by SPSS16.
The statistically significant changes (t=3.222, 3.404, 3.141, 5.012, P<0.05) of spherical diopter values were (-0.31±0.58) D, (-0.48±0.68) D, (-0.35±0.65) D, and (-0.57±0.58) D for groups ⅠA, ⅠB, ⅡA, and ⅡB, respectively. astigmatism of the four sub-groups had no significant change (P>0.05) The average annual spherical growth was (-0.08 ± 0.17) D, (-0.12 ± 0.17) D, (-0.07 ± 0.19) D, and (-0.15 ± 0.16) D, respectively, for the four sub-groups, and there was no statistically significant difference among them (F=1.180, P>0.05). Compared to the state before wearing orthokeratology lenses, the corneal curvature measured by an autorefractor was statistically different for groups ⅠA and ⅡA, but not statistically different for groups ⅠB and ⅡB. For the long-time discontinuation groups, only the SRI of the corneal topography had a statistically significant decrease compared to the value before wearing orthokeratology lenses, and others had no significant change. The average annual increase of axial length was (0.22±0.16) mm and (0.16±0.10) mm for groups ⅡA and ⅡB, respectively, and the increase was statistically significant (P<0.05), but there was no significant difference between the two sub-groups (F=1.908, P>0.05). The central corneal thickness had no significant change (t=1.971, 2.017, P>0.05). The rates of the refractive correction methods after long-time discontinuation were 36.7%, 22.4%, 22.4%, 12.4%, and 6.1% for spectacles, rigid gas permeable contact lenses, soft contact lenses, either spectacles or soft contact lenses, and refractive operations, respectively.
The corneal morphology and central corneal thickness returned to the original after three months of discontinuation of orthokeratology. The myopia had no significant growth after discontinuation, and there was no significant difference between low to moderate and relatively high myopia. (Chin J Ophthalmol, 2015, 51: 178-182)
To investigate the difference in corneal epithelium between patients with and without soft contact lens (SCL) wearing, and to analyze corneal epithelial changes of the eyes with long-time SCL wearing.
In this cross sectional study, the subjects were divided into two groups: 13 patients of daily SCL wearers and 11 control subjects who had never worn contact lenses. The flap of corneal epithelium was observed by transmission electron microscopy. The corneal epithelial microvillus density was compared between the two groups.
Transmission electron micrographs of the control group showed a tight connection between cells, regularly aligned basal cells, and continuous basement membrane. Compared with the control group, SCL wearers showed incomplete basement membrane, swollen epithelial cells, swollen mitochondria, and widened intercellular interstices. The density of corneal epithelium microvilli [(0.071 466±0.015 889)/μm2 vs. (0.139 851±0.024 171)/μm2] was lower (t=8.312, P<0.05).
Long-term SCL wearing can induce remarkable changes of corneal epithelial tissue, and the density of corneal epithelial microvilli decreases. (Chin J Ophthalmol, 2015, 51: 183-187)
To compare the regeneration of subbasal epithelial nerve plexus in the central cornea and dry eye condition between patients undergoing conventional LASIK surgery and femtosecond-assisted LASIK surgery.
It was across-sectional study. Thirty patients (60 eyes) who had LASIK at our hospital from October 2011 to September 2012 were included in this study. Patients were divided into conventional LASIK group and femtosecond-assisted LASIK group based on the method used for corneal flap creation. Subjective and objective dry eye tests were carried out at 1 year after surgery. HRT III confocal microscopy was used to observe the regeneration of subbasal epithelial nerve plexus, and the images were analyzed by ACCMetrics software using quantitative parameters to determine the density and morphology of corneal nerve fibers. The data of corneal nerve fibers and dry eye condition in the two groups undergoing different LASIK procedures was compared using an independent sample t test.
During the one-year postoperative follow-up, the Schirmer test result, tear film break-up time value, and ocular surface disease index score in the F-LASIK group [(12.65±8.73) mm/5min, (7.85±2.81) s, (7.25±6.35) points] were not significantly different from that in the C-LASIK group [(16.73±10.55) mm/5min, (8.77±3.04) s, (4.46±5.37) points](t=1.399, -1.050, -1.613, P>0.05). Regarding the nerve fiber measurements, which included corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal total branch node, corneal nerve fiber width, and corneal nerve fiber tortuosit, there was no statistically significant difference in their results between patients who had femtosecond-assisted LASIK surgery [(16.46±6.65) /mm2, (19.27±9.56) /mm2, (10.88±4.70) mm/mm2, (65.10±38.43) /mm2, (4.76±0.34) μm, (2.30±0.34) grades] and those who had conventional LASIK surgery [(15.99±7.14) /mm 2, (19.39±7.07) /mm2, (11.30±3.17) mm/mm2, (68.43±34.94) /mm2, (4.73±0.24) μm, (2.14±0.34) grades]( t=-0.229, 0.049, 0.365, 0.306, -0.394, -1.629, P>0.05).
The difference between conventionalLASIK and femtosecond-assisted LASIK does not significantly affect the dry eye test values and nerve fiber measurements in patients at 1 year after LASIK. (Chin J Ophthalmol, 2015, 51: 188-192)
To investigate and analyze the characteristic changes of high order aberrations before and after small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK).
Prospective study. Thirty-four patients (16 men and 18 women) underwent SMILE, and 28 cases (15 men and 13 women) underwent FS-LASIK, aged 18 to 39 years. Only the right eye was selected to be analyzed from each patient. All patients had conventional and Pentacam examinations preoperatively, and the ocular higher order aberrations were measured with the Hartman-Shack wavefront analyzer before surgery and at 1 month and 3 months postoperatively. The paired t test, independent t test, and Pearson correlation analysis were used to analyze the collected data.
At the 1 month after SMILE group, C3-1、
(-0.205±0.199、0.027±0.071) were higher than the FS-LASIK group (0.004±0.316、-0.022±0.104) (t=-3.141, 2.216, P<0.05), for FS-LASIK group Sh、S4、S5、S6、
(0.609±0.199, 0.403±0.196, 0.117±0.065, 0.092±0.038, 0.343±0.253) were higher than the SMILE group (0.461±0.130, 0.271±0.096, 0.074±0.028, 0.053±0.018, 0.239±0.121) (t=-3.492, -3.461, -3.449, -5.301, -2.103, P<0.05); At the 3rd month of SMILE group, C3-1 (-0.177±0.175) was higher than the FS-LASIK group (-0.012±0.337) (t=-2.476, P<0.05), In FS-LASIK group, however, the data for Sh、S4、S5、S6、
(0.626±0.215, 0.421±0.200, 0.108±0.066, 0.082±0.036, 0.393±0.207) were higher than the SMILE group (0.457±0.113, 0.270±0.106, 0.082±0.031, 0.051±0.017, 0.243±0.115) (t=-3.935, -3.788, -2.049, -4.405, -3.576, P<0.05). With the correlation analysis, at the postoperative 1st and 3rd month of FS-LASIK group, Sh、
had negative relationship with the attempted myopic corrections (1 month post-op: r=-0.433, -0.476, P<0.05; 3 month post-op:r=-0.418, -0.447, P<0.05).
SMILE resulted in good optical quality early after operation. Compared with FS-LASIK, SMILE caused smaller change of ocular higher order aberrations, and each of them had its own particularity. Maybe it was associated with the surgery procedure and corneal wound healing after surgery. (Chin J Ophthalmol, 2015, 51: 193-201)
To investigate the clinical features of acute retinal necrosis (ARN) complicated by viral encephalitis.
Ten cases of ARN complicated by viral encephalitis were treated in the Department of Ophthalmology, Beijing Tongren Hospital from November 2013 to August 2014. Clinical manifestation, especially the fundus characteristics, was summarized.
In the10 patients (19 eyes; 6 men and 4 women) with an age of (40.1 ± 13.44) years, 1patients had unilateral ARN, and 9 patients had bilateral ARN. The visual acuity was no light perception in 9 eyes, light perception to hand motion in 7 eyes, 0.05 in 1 eye, 0.2 in 1 eye, and 0.3 in 1 eye. Seven cases suffered ARN during the onset of viral encephalitis, and other cases suffered ARN at 2 to 3 months after the recovery of viral encephalitis. Seventeen eyes had mild to moderate vitreous opacity, and 2 eye shad severe vitreous opacity. Sixteen eyes had focal (1 or 2quadrants) retinal necrosis, and 2 eyes had massive (>2 quadrants) retinal necrosis. Occlusive vasculitis obviously occurred in 18 eyes. Sixteen eyeshad retinal detachment. All affected eyes had early optic nerve atrophy.
ARN can occur during the onset of viral encephalitis or after the recovery of viral encephalitis. The clinical features of ARN complicated by viral encephalitis may be generally mild to moderate vitreous opacity, small range retinal necrosis foci, early and severe optic atrophy, and occlusive retinal vasculitis. (Chin J Ophthalmol, 2015, 51: 202-205)
To study the effects of posterior chamber phakic intraocular lens (IOL) on axial length (AL) measurements and whether a correction factor for later IOL power calculation before cataract surgery is necessary.
Twenty-two high myopic patients (39 eyes) with mean spherical equivalent -19.00±4.03 D received phakic refractive lens (PRL) implantation, and 24 patients (40 eyes) with mean spherical equivalent (-13.10±2.53) D received implantable Collamer lens (ICL) implantation. Pre-and postoperative AL measurements with the IOLMaster were compared.
The pre-and postoperative ALs were (30.87±2.18) mm and (30.94±2.16) mm, respectively (t=-2.635, P=0.012) in the PRL group, and (28.35±1.20) mm and (28.45±1.22) mm, respectively (t=-3.97, P<0.001) in the ICL group. Linear regression analysis showed: in the PRL group, preoperative AL=1.01×postoperative AL-0.24 (R2=0.99, P<0.001), or postoperative AL-preoperative AL=0.24-0.005 5×postoperative AL; in the ICL group, preoperative AL=0.96×postoperative AL + 1.17 (R2=0.99, P<0.001), or postoperative AL-preoperative AL=0.015 4×postoperative AL -0.376 3. The mean differences between pre-and postoperative ALs in the PRL and ICL groups were 0.075 mm and 0.054 mm, respectively.
Based on the SRK formula, a <0.1 mm AL difference would result in a <0.25 D change in the calculated IOL power, possibly a <0.20 D change in manifest refraction. Furthermore, for PRL, the longer the AL, the smaller the difference between pre-and postoperative ALs. These differences are so small that it is unnecessary to correct IOL power calculation. (Chin J Ophthalmol, 2015, 51: 206-209)
To evaluate GWAS significant associated SNP for primary angle closure glaucoma.
Experimental study. Taking advantage of different statistical models, the usefulness was evaluated by sensitivity, specificity and the area under the receiver-operating characteristic curve (ROC), which indicates the accuracy of genetic profiling in discriminating between primary angle closure glaucoma patients and normal controls.
rs11024102 (PLEKHA7) had a sensitivity of 55.88% with a specificity of 51.31%; the sensitivity and specificity of rs3753841 (COL11A1) was 54.47% and 51.00% respectively. The sensitivity of rs1015213 (PCNTD1-ST18) and rs1401999 (ABCC5) were 59.93% and 52.97%. The specificity of these two SNP were 45.32% and 50.00%. The positive predictive value curves of these four SNP were nearly reference line. The area under the curve (AUC) of four SNP combined was 0.51 and 0.52 in two situations.
These four GWAS significant SNP could not be used for primary angle closure glaucoma patients screening in clinic. (Chin J Ophthalmol, 2015, 51: 210-214)
The 69-year-old female was seen in Eye, Ear, Nose and Throat Hospital affiliated to Fudan University in April 2013 due to the gradual decline of vision in both eyes for more than 20 years and aggravation for 3 years. Eye examination: visual acuity: 30 cm manual in both eyes, no improvement in correction. Intraocular pressure measured by non-contact tonometer was 18.5 mmHg (1 mmHg =0.133 kPa) in the right eye and 17 mmHg in the left eye. Irregular yellow-white lesions were seen in the central visual axis of the cornea in both eyes, and the lesions were slightly higher than the corneal surface and were mulberry-like. A translucent grid-like lesion is visible within the corneal stroma surrounding the central lesion, which does not involve the limbus (
corneal ring infiltration (CRI) is characterized by white ring or semicircular stromal infiltration in the paracorneal center, with transparent corneal stroma in the annular center[
The patient was a 48-year-old male. In May 2013, I came to the Department of Ophthalmology of Peking Union Medical College Hospital due to repeated redness and swelling of my left eye for 2 years. The patient had been diagnosed with glaucoma cyclitis syndrome in an external hospital, and the symptoms were relieved at local points prednisolone acetate 1%. In the past 4 months, the intraocular pressure in the left eye was more than 50 mmHg (1 mmHg =0.133 kPa). After intravenous drip of 375 ml of 20% mannitol, the intraocular pressure dropped to about 30 mmHg. After using 1% prednisolone acetate, ganciclovir ophthalmic gel and 3 kinds of intraocular pressure lowering drugs, the intraocular pressure was still about 30 mmHg. Eye examination: naked eye visual acuity is 1.0 in the right eye and 0.6 in the left eye, which cannot be corrected. Non-contact IOP: 17.2 mmHg in the right eye and 29.3 mmHg in the left eye. Anterior segment examination of both eyes: there was no inflammation in the anterior segment of the right eye; The conjunctiva of the left eye is congested, the posterior wall of the cornea is deposited (+), distributed in clusters, relatively old, the aqueous humor flashes (–), the planktonic body is occasionally seen, the iris is loose in texture, there is no posterior adhesion, and the lens is transparent. The papilla boundary of both eyes was clear, the right color was red, C/D was 0.4, and the left color was light, C/D was 0.8, and there was no abnormality in the macular area. Visual field: Right eye normal, left eye 30° tube. Laboratory tests: blood routine, liver and kidney function, erythrocyte sedimentation rate, C-reactive protein, syphilis rapid serum response test, and anterolateral chest radiographs were no abnormalities. Diagnosis: viral anterior uveitis of the left eye? Secondary glaucoma. Treatment: Local medication in the left eye: 1% prednisolone acetate 4 times daily, 2% carteolol hydrochloride 2 times daily, brinzolamide 3 times daily, brimonidine tartrate 3 times daily, and ganciclovir ophthalmic gel 4 times daily. Aqueous humor virus test results: strong positive cytomegalovirus DNA 1.12×104/ml, negative for Epstein-Barr virus and herpes simplex virus, given a vitreous injection of ganciclovir 6 mg to the left eye, intraocular pressure the next day: 14 mmHg in the right eye and 16 mmHg in the left eye. After 3 days, the intraocular pressure was reexamined: 15 mmHg in the right eye and 49 mmHg in the left eye. The conjunctiva of the left eye was mixed and congested, there was no obvious corneal edema, the keratic precipitate (KP) was moderately large and gray-white, the aqueous humor flashed (+), the planktonic body (+), the iris texture was loose, there was no posterior adhesion, and the lens was clear. Treatment: Oral ganciclovir 1g 3 times daily, 1% prednisolone acetate 8 times daily, 2% cartenolol hydrochloride 2 times daily, brinzolamide 3 times daily, brimonidine tartrate 3 times daily. One week after treatment, there was no inflammation in the anterior segment of the left eye, and the intraocular pressure was 14 mmHg in the right eye and 23 mmHg in the left eye. The dose of 1% prednisolone acetate was gradually reduced, and the remaining drug was unchanged. Thereafter, the intraocular pressure in the left eye remained below 20 mmHg. Aqueous humor cytomegalovirus DNA was tested negative 2 weeks after antiviral therapy. Oral ganciclovir 1 g 3 times daily, reduced to 500 mg 3 times daily after 1 month, 0.1% flumetrolone 6 times daily at the local point in the left eye, 2% carteolol hydrochloride 2 times daily, and brinzolamide 2 times daily, the intraocular pressure in the left eye was maintained below 20 mmHg, and there was no inflammatory reaction in the anterior segment of the eye. Oral ganciclovir and topical 0.1% flumetrolone were stopped 2 months later. Check corneal endothelial count: 2 732/mm in right eye2692/mm in left eye2。 Thereafter, the left eye was spotted with ganciclovir ophthalmic gel 4 times daily, 2% cartenolol hydrochloride 2 times daily, and brinzolamide 2 times daily.
The patient was a 48-year-old male. Because the right eye was splashed with high concentration of peracetic acid, eye pain and visual acuity decreased for 1 h, and he went to the ophthalmology department of Shengli Oilfield Central Hospital. Ocular examination: the visual acuity of the right eye was 30 cm manual, the intraocular pressure was normal by finger measurement, the bulbar conjunctiva was pale and edematous, a large number of bubbles of different sizes could be seen under the bulbar conjunctiva, the cornea was gray-white edema, the aqueous humor was mildly turbid, a large number of bubbles could be seen in the anterior chamber, the pupil was round, the lens was gray-white and turbid, and the fundus was unclear (
The usual method to measure the tear river height is to observe the tear level height at the junction of the light band on the surface of keratoconjunctiva and the light band on the lower eyelid margin by slit lamp examination. This height can reflect the amount of tear secretion to a certain extent. Generally, the height ≤0.35 mm is diagnosed as dry eye syndrome. Noninvasive tear river height measurement is currently possible using the Oculus Keratograph ocular surface comprehensive analyzer to evaluate the continuous state of the tear river and the amount of tear secretion (cut-off value is 0.2 mm), with more objective, direct and accurate results (
Meibomian gland dysfunction (MGD) is a common ocular surface disease, characterized by terminal duct obstruction and (or) qualitative and quantitative changes in the glandular secretion. Meibomian lipids are a mixture consisting of various lipids, and they form the lipid layer of tear film and play important roles in preventing the evaporation and maintaining the stability of tear film. Patients with MGD may have different compositions of meibomian lipids, which could be an important indicator for diagnosis of MGD. The methods to analyze the composition of meibomian lipids mainly include chromatography and spectrum analysis. Because the pathogenic factors of MGD are still unclear, the main treatment is to relieve the symptoms. It can contribute to diagnose and treat MGD if we can find some convenient and effective methods to analyze the quality and quantity of meibomian lipids. (Chin J Ophthalmol, 2015, 51: 225-228)
MicroRNAs (miRNAs) are a class of small (21-25 nucleotides), single-stranded, noncoding RNA molecules that regulate gene expression at the post-transcriptional or translational level by binding to the 3'-untranslated region of the target mRNAs. miRNAs ubiquitously exist in the genome of an organism. More than two hundred miRNA species are expressed in the eye, of which 25% are found in the cornea. miRNAs play important roles in corneal development, differentiation, glycogen metabolism, post-injury regeneration, and maintenance of homeostasis. On the other hand, miRNAs are involved in the regulation of pathological processes in the cornea, such as keratoconus, corneal neovascularization caused by corneal transplantation, herpes simplex virus infection and alkali burns. Therefore, miRNAs are expressed in a tissue-specific manner and regulate physiological and pathological processes in the cornea. The study of miRNA expression and regulation in the cornea would provide a theoretical basis for exploring pathogenic mechanisms and novel therapeutic targets for corneal diseases.(Chin J Ophthalmol, 2015, 51: 229-235)
Age related macular degeneration (AMD) is the leading cause of blindness and visual disability among old patients in Europe and North America. AMD has been divided into two broad clinical categories depending on whether there is a presence of abnormal neovascularization: neovascular (exudative or wet) AMD and dry (or geographic atrophic) AMD. VEGF has been understood as a pathogenesis of wet AMD which allows us to get breakthroughs in treatment. While the progression of dry AMD treatment is very slow because the lack of pathogenesis, no acute loss of vision, and without appropriate standards for treatment. This review tries to introduce about the recent researches and progressions for dry AMD treatment. (Chin J Ophthalmol, 2015, 51: 236-240)
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