Objective:To evaluate the efficacy and safety of the XEN gel implant in the treatment of glaucoma.Methods:It was a retrospective case series study. Eight patients (8 eyes) in the First Affiliated Hospital of Fujian Medical University from January 2020 to September 2020 were included, including six males and two females, aged 29 to 74 years. The patients treated with the XEN gel implanting for glaucoma. After detailed ophthalmic examination, all the patients met the surgical indications for the XEN gel implanting. Preoperative and postoperative intraocular pressure (IOP), anterior segment and fundus examination results, medication, and surgical complications were evaluated.Results:There were seven patients with primary open-angle glaucoma and one patient with glaucomatocyclitic syndrome. Five patients had received anti-glaucoma surgeries, and the remaining three patients had not received surgical treatment. All XEN gel stents were implanted successfully. All patients were followed up for 4 to 12 months. The preoperative maximum IOP ranged from 11 to 44 mmHg (median, 28 mmHg, 1 mmHg=0.133 kPa), and the IOP was 10 to 18 mmHg (median, 13 mmHg) at the last follow-up. Two to 4 types of medication were used for glaucoma preoperatively (median, 3), while 0 to 2 types (median, 0) were used at the last follow-up. During the follow-up, 7 cases were completely successful and only one case failed. Intraoperative hemorrhage occurred in two patients, and after effective treatment, the IOP decreased to below 20 mmHg. One patient was found to have an increased IOP with the XEN luminal obstruction, and the XEN drainage tube was recanalized. The IOP was about 10 mmHg at the last follow-up, and no anti-glaucoma drugs were used, but the surgery was assessed as failure by standard. The remaining patients had no other serious complications.Conclusion:This preliminary study shows that the XEN gel drainage may be a safe and effective treatment for patients with glaucoma. (Chin J Ophthalmol, 2021, 57: 679-684)
PURPOSE:To evaluate pre- and postoperative microvasculature features in eyes with different idiopathic macular epiretinal membrane (iERM) classifications using optical coherence tomography angiography (OCTA).METHODS:In this retrospective study, 100 eyes with iERM were enrolled; 62 eyes underwent pars plana vitrectomy (PPV). All iERM eyes were evaluated and graded using optical coherence tomography (OCT). According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into three grades. Optical coherence tomography angiography (OCTA) was used to measure the foveal avascular zone (FAZ)-related parameters and the superficial and deep capillary plexus layers using 3 × 3 mm scans. Measurements were taken at baseline and 3 months postoperatively. Best corrected visual acuity (BCVA), vessel density (VD), FAZ area, FAZ perimeter (PERIM), acircularity index (AI), and foveal vessel density (FD) were evaluated.RESULTS:Idiopathic macular epiretinal membrane (iERM) eyes with a higher grade had a lower FAZ area and perimeter (p < 0.0001), higher foveal vessel density (FVD) both in the superficial capillary plexus (SCP) (p < 0.0001) and in the deep capillary plexus (DCP) (p < 0.05), and a lower parafoveal vessel density (PRVD) in the DCP (p < 0.0001). The macular vessel density ratio (MVR = FVD/PRVD) increased with an increase in grade both in the SCP and in the DCP (p < 0.0001). For grade 1 iERM eyes, only PRVD in the DCP significantly changed before versus after the operation (p < 0.05). For grade 2 iERM eyes, the FAZ area and perimeter became larger after the operation (p < 0.05). The MVR of grade 2 iERM eyes decreased postoperatively both in the SCP (p < 0.05) and in the DCP (p < 0.001). For grade 1 and grade 2 iERM eyes, preoperative LogMAR BCVA was negatively correlated with the FAZ area (p < 0.01) and perimeter (p < 0.01), and was positively correlated with the MVR in the SCP (p < 0.05). Postoperative LogMAR BCVA was positively correlated with the FVD in the DCP (p < 0.05).CONCLUSIONS:Idiopathic macular epiretinal membrane (iERM) eyes of different grades have significant differences in microvasculature features. According to OCTA, eyes with higher grades have more serious microvascular changes. Grading plays a part in predicting postoperative microvascular characteristics, and grade 1 iERM eyes have a better visual outcome compared with grade 2 iERM eyes.
Objective:To objectively evaluate the postoperative efficacy and rotational stability of two common types of toric intraocular lenses (IOLs), and perform vector analysis of postoperative residual astigmatism.Methods:A cohort study was performed.A total of 80 cases (80 eyes) of age-related cataract combined with corneal regular astigmatism patients who underwent phacoemulsification combined with toric IOL implantation in Ningbo Aier Guangming Eye Hospital from January 2019 to October 2021 were selected.The astigmatic corrected IOL was implanted according to the patients' wishes.Among them, 39 cases (39 eyes) implanted with Tecnis ? ZCT IOL were classified as Tecnis group, and 41 cases (41 eyes) implanted with AcrySof ? IQ Toric IOL were classified as AcrySof group.The uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), and residual astigmatism of subjective refraction were observed 1 week, 1 month, and 3 months after operation.After mydriasis, OPD-Scan Ⅲ was used to measure the toric IOL axial position, and the IOL axial deviation (LAD) was calculated.Vector analysis of preoperative corneal astigmatism, expected residual astigmatism and postoperative residual astigmatism was performed using the astigmatism double-angle map.The study protocol was approved by the Ethics Committee of Ningbo Aier Guangming Eye Hospital (No.2019-001). Results:There was no significant difference in the overall comparisons of UCDVA and BCDVA between the two groups ( Hgroup=2.503, P=0.113; Hgroup=0.399, P=0.527), while there were statistically significant differences between before and different time points after operation ( Htime=147.535, P<0.001; Htime=146.808, P<0.001). Postoperative UCDVA and BCDVA were significantly improved compared to preoperative, and the difference was statistically significant (all at P<0.001). There were statistically significant differences in the overall comparison of astigmatism between the two groups before and at different time points after operation ( Hgroup=5.489, P=0.019; Htime=171.070, P<0.001). The residual astigmatism was significantly higher in AcrySof group than in Tecnis group 1 month after operation ( P=0.016), and the residual astigmatism after operation in both groups decreased compared to before operation, showing statistically significant differences (both at P<0.001). There was no statistically significant difference in IOL LAD between the two groups at different time points after operation ( Hgroup=3.013, P=0.083; Htime=1.689, P=0.430). Vector analysis of astigmatism showed that residual astigmatism was significantly reduced in both groups at 3 months after operation compared to before operation, and the 95% confidence ellipses were significantly reduced.There were differences in the mean and centroid values of residual astigmatism prediction errors between the two groups 3 months after operation, but there was no significant difference in the 95% confidence ellipse.The percentage of eyes with residual astigmatism prediction error ≤1.0 D in Tecnis group and AcrySof group was 82%(32/39) and 90%(37/41), respectively, showing no statistically significant difference ( χ2=1.131, P=0.288). Conclusions:Both Tecnis ? ZCT IOL and AcrySof ? IQ Toric IOL can effectively improve postoperative visual acuity of patients with cataract and corneal astigmatism, reduce postoperative residual astigmatism and have good rotational stability.The online calculators of the two types of toric IOLs have good performance in the prediction of postoperative residual astigmatism.
With the popularity of electronic devices and the increasing environmental light pollution, more attention has been paid to the damage caused by retinal light irradiation and its pathogenic effects in retinal pigment degeneration, age-related macular degeneration and other diseases.The types of light-retinal tissue reaction are mainly photothermal and photochemical, and the photochemical reaction produced by visible light is closely related to retinal diseases.The parameters of light irradiation include wavelength, energy density and duration, etc.The effect of light irradiation on retinal cells can be influenced by many external factors under different parameters.Many in vitro models of light irradiation on retinal cells have been established to study the mechanism of light irradiation, especially blue light on retinal pigment epithelial cells, photoreceptor cells and nerve cells.Light irradiation can cause oxidative stress, endoplasmic reticulum stress and mitochondrial damage in retinal cells, which activates autophagy and regulates apoptosis.Inflammasome activation and exosomes are also involved in the regulation of light-induced damage to retinal pigment epithelial cells.There are also studies on the potential therapeutic effect of different wavelength light sources on cells.This review discusses the differences in cellular and light irradiation parameters between different models with respect to experimental models of retinal light irradiation in terms of types of light-retinal tissue responses, light irradiation parameters commonly used in biological studies, and retinal pigment epithelium light irradiation models, retinal photoreceptor light irradiation models, and retinal ganglion cell light irradiation models.
Objective:To investigate the efficacy of intense pulsed light (IPL) combined with meibomian gland expression for moderate to severe dry eye associated with meibomian gland dysfunction (MGD) in cataract patients during the perioperative period.Methods:A non-randomized controlled study was conducted.Forty patients (40 eyes) with moderate to severe dry eye associated with MGD who planned to undergo binocular cataract extraction combined with intraocular lens (IOL) implantation at Beijing Tongren Hospital, Capital Medical University were enrolled from October 2020 to December 2021.One eye of each patient was randomly included using Excel RAND function.All patients received artificial tears regularly to treat dry eye symptoms, and meibomian gland expression was performed as needed.Patients were divided into a treatment group (20 patients, 20 eyes) and a control group (20 patients, 20 eyes) according to whether they wished to receive IPL therapy.The treatment group received IPL therapy 3 times before surgery, with a 2-week interval between each therapy, and phacoemulsification combined with IOL implantation at least 2 weeks after the last treatment.The two groups were evaluated at baseline, 1 day before surgery (i.e.2 weeks after the last IPL treatment for the treatment group), 1 week after surgery and 1 month after surgery.Outcome measures included Ocular Surface Disease Index (OSDI), corneal fluorescence staining, Schirmer Ⅰ test (SⅠt), tear break-up time (TBUT), meniscus height, the number of eyes with different scores of meibomian gland atrophy and the number of eyes with different scores of meibomian gland excretion capacity.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2017-063). Written informed consent was obtained from each subject.Results:Baseline, 1-day preoperative, 1-week postoperative, 1-month postoperative OSDI scores were (47.83±10.17), (47.50±10.75), (66.08±12.68), (67.92±16.51) points in control group, and (62.50±12.04), (20.05±4.65), (24.75±5.98), (12.65±3.01) points in treatment group, respectively.There were significant differences in the overall comparison of OSDI scores between the two groups at different time points ( Fgroup=119.351, P<0.01; Ftime=86.219, P<0.01). The 1-day preoperative, 1-week postoperative and 1-month postoperative OSDI scores were lower and the baseline OSDI score was higher in the treatment group than in the control group, showing statistically significant differences (all at P<0.05). In the treatment group, the OSDI score 1 day before surgery was significantly lower than baseline, and 1 week after surgery was significantly higher than 1 day before surgery, but significantly lower than baseline, and decreased significantly again at 1 month after surgery (all at P<0.05). In the control group, the OSDI score was significantly higher at 1 week and 1 month after surgery than at 1 day before surgery and at baseline (all at P<0.05). The number of eyes with corneal fluorescence staining 1 day before surgery, 1 week after surgery and 1 month after surgery was significantly lower in the treatment group than in the control group (all at P<0.01). The SⅠt values 1 day before surgery, 1 week after surgery and 1 month after surgery were higher in the treatment group than in the control group but significantly higher than the baseline value, and the differences were statistically significant (all at P<0.05). The SⅠt value 1 month after surgery was significantly higher in the treatment group than before surgery and 1 week after surgery (both at P<0.05). The TBUT values 1 day before surgery, 1 week after surgery and 1 month after surgery were greater in the treatment group than in the control group and at baseline, and the 1-month postoperative TBUT of the treatment group was significantly higher than the 1-week postoperative TBUT (all at P<0.05). Meniscus height 1 day before surgery, 1 week after surgery and 1 month after surgery was greater in the treatment group than in the control group and at baseline, and the differences were statistically significant (all at P<0.05). There was no statistically significant difference in the number of eyes with different scores of meibomian gland atrophy between the two groups at different time points (all at Z=-0.628, P=0.530). There was no statistically significant difference in the number of eyes with different scores of meibomian gland excretion capacity between the control and treatment groups at baseline, 1 day before surgery, 1 week after surgery and 1 month after surgery (all at P>0.05). Conclusions:IPL is effective for treating dry eye associated with MGD in cataract patients during the perioperative period, and it can effectively improve dry eye symptoms and signs in patients after cataract surgery.
Objective:To investigate the mechanism of curcumin in the treatment of diabetic retinopathy (DR) by network pharmacology and molecular docking.Methods:The compounds targets of curcumin were predicted by SEA and SwissTargetPrediction databases, and the DR target genes were obtained by CTD database.The different genes were mapped and matched by Venny database to screen their intersections.The intersecting genes were submitted to GeneMANIA database to construct a protein-protein interaction network.WebGestalt database was used to conduct enrichment analysis and AutoDock Vina was used to perform molecular docking of the core targets.Results:A total of 52 targets of curcumin, 1 599 targets of DR and 48 intersecting targets were detected.The core targets were serine/threonine-protein kinase 1 (AKT1), tumor necrosis factor-α (TNF-α), epidermal growth factor receptor (EGFR), signal transduction and activator of transcription 3 (STAT3) and heat shock protein 90 alpha family class A member 1 (HSP90AA1). Enrichment analysis suggested that these targets were mainly associated with signaling pathways, including the EGFR tyrosine kinase inhibitor resistance signaling pathway, hypoxia-inducible factor-1 (HIF-1) signaling pathway, interleukin (IL)-17 signaling pathway and advanced glycosylation end product-the receptor of advanced glycosylation end product (AGE-RAGE) signaling pathway.Conclusions:Curcumin may play an important role in the treatment of DR by regulating multiple signaling pathways to inhibit the inflammatory response and combat oxidative stress.
With the widespread application of laser vision correction in clinical treatment, it has become one of the important treatment methods for the correction of refractive errors, such as myopia and presbyopia, and provides important technical support for the treatment for refractive errors in Chinese adults.At present, continuously improving the visual acuity and quality of life is still the ultimate goal pursued by refractive surgeons.Accurate preoperative refraction and simulation of monocular vision are important procedures to ensure surgical effectiveness, achieve optimal visual quality, and achieve postoperative comfort for patients.However, up to now, there is no prefer practice pattern for refraction in China, standardized preoperative examination or effective consultations with patients before surgery.In order to standardize the preoperative examination for clinical researchers and practitioners engaged in laser vision correction, the Division of Refractive Surgery Branch of Ophthalmology, China National Health Association organized experts to review evidence-based literature nationally and internationally, summarize the clinical problems that need to be solved in clinical practice.After discussion, the experts develop the Expert consensus on preoperative refraction and simulation of monocular vision for laser vision correction in China (2023) and provide recommendations on clinical issues such as subjective refraction, objective refraction, subjective combined with objective refraction, dominant eye evaluation, binocular visual function examination, and monocular vision simulation before laser vision correction.The aim of this consensus is to improve the accuracy of preoperative refraction and monocular vision test for laser vision correction, and to make laser vision correction more standardized, personalized and humanistic in China.
Aging is a degenerative process that leads to dysfunction and abnormalities of tissues and cells in vivo.In the retinal neural degenerative diseases associated with aging, retinal ganglion cells (RGCs) are injured and lose their function.Through interacting ways including energy generation disorders, oxidative stress damage, mitochondrial mutation accumulation, protein misfolding and aggregation, immune inflammatory response, lack of neurotrophic factors, insufficient blood flow, increased pressure difference across lamina cribrosa and sclerosis of connective tissues, the sensitivity of RGCs to damage factor might be increased, which plays an important role in the process of optic nerve injury and degeneration.Rejuvenation of RGCs is supposed to be the key to the treatment of neurodegenerative diseases such as glaucoma, which can reduce or even reverse the damage caused by aging and promote the regeneration of RGCs, providing new targets for protecting visual function.Therefore, the research on the role of aging in RGCs injury will provide a new direction for optic nerve protection strategies.From aging and RGCs damage as well as new ideas of RGCs rejuvenation, this paper reviews the role and significance of aging in RGCs damage.
Objective:To evaluate the long-term impact of three different outdoor activity intervention strategies on the prevalence of myopia among school-aged children in China.Methods:Cross-sectional data from the Refractive Error Study in Children (RESC) on the baseline prevalence of myopia and 10-year longitudinal data from the Guangzhou Twin Eye Study (GTES) on the baseline incidence of myopia were utilized.The effect size of outdoor activity intervention was derived from longitudinal data of the Guangzhou Outdoor Activity Longitudinal Study (GOALS). Three intervention strategies were proposed: intervention for children in grades 1 to 6 (Strategy A), intervention for children in grades 1 to 3 (Strategy B), and intervention for children from the last year of kindergarten to grade 3 (Strategy C). Outdoor activity interventions across all strategies included an extra 40 minutes of daily outdoor activity time.Simulated analyses assumed that the prevalence of myopia would decrease with declining incidence and increasing school grade, and the degree of myopia among highly myopic children would decrease with delayed myopia onset.This study was approved by the Ethics Committee of Zhongshan Ophthalmic Center (No.2006-5).Results:With prolonged intervention time, the overall prevalence of myopia in children showed a significant declining trend.After 5 years of implementation, Strategy A resulted in a decrease in myopia prevalence from 34.67% to 25.71%, which decreased to 24.89% after 10 years, with an average annual reduction of 0.98%.Strategies B and C had similar long-term effects, with myopia prevalence after 10 years being 26.00% and 26.20% respectively, with an average annual reductions of 0.87% and 0.85%.Strategy A yielded the greatest reduction in myopia severity, with a decrease of -5.94 D after 5 years and -5.88 D after 10 years in the initial 15-year-old highly myopic individuals.Strategy B followed with -6.08 D and -6.02 D after 5 and 10 years, respectively.Conclusions:Implementing intensified outdoor activity intervention among children in grades 1 to 6 may be the recommended strategy to reduce the overall prevalence of myopia in regions with high rates of myopia among school-aged children.
Primary open-angle glaucoma (POAG) is an irreversible blinding eye disease that severely threatens and damages the optic nerve and visual pathways.Due to the diversity of causes and factors influencing its pathogenesis, the study of its pathogenesis has been a hot spot for research in this field.In recent years, metabolomics, as an emerging method, has been mainly applied in the prediction, diagnosis and prognosis assessment of ophthalmic diseases, providing characteristic metabolites with clinical guidance.Untargeted, targeted and widely targeted metabolomics methods based on nuclear magnetic resonance spectroscopy and mass spectrometry platforms have been applied to screen a large number of highly selective, sensitive and specific biometabolite products and biomarkers, and systems and technical platforms for metabolomics have been developed to track biological changes at all levels in POAG research, providing a foundation for further application of metabolomics in POAG clinical research in the future.This article reviews metabolomics and its clinical implications, advances in animal model-based metabolomics research, and advances in clinical metabolomics research in patients with POAG.
Long-term use of topical intraocular pressure-lowering medications, particularly those containing preservatives, may cause or worsen ocular surface diseases, which may ultimately reduce patient tolerance and compliance, increase surgical risk, and compromise treatment efficacy.Therefore, long-term management of glaucoma requires the consideration of various factors such as efficacy, safety, and cost-effectiveness.Recently, the use of preservative-free (PF) intraocular pressure-lowering drugs has been gaining considerable attention in research as a means to avoid the toxicity of preservatives on ocular health.These drugs have similar pharmacokinetic properties and bioequivalence to their corresponding preservative-containing drugs.In addition, the manufacturing process of PF medications can reduce the incidence of ocular surface diseases, improve patient symptoms, and increase treatment effectiveness, indicating extensive potential applications.This review focuses on the development and clinical use of PF intraocular pressure-lowering drugs, aiming to deepen clinicians' understanding of their use.
Objective:To investigate the inhibitory effect of indocyanine green (ICG) on biological behavior and transdifferentiation of human lens epithelial cells (HLECs) and its mechanism.Methods:HLECs were divided into blank control group, 5% glucose solution (GS) group and 0.5% ICG group, 1.5% ICG group and 2.5% ICG group, which were treated with balanced salt solution, 5% GS and 0.5%, 1.5% and 2.5% ICG solutions for 3 minutes, respectively, and then were incubated in fresh medium for 24 hours.The apoptosis level of HLECs was detected by flow cytometry.The expression levels of apoptosis-related proteins, Bcl-2-associated X protein (Bax), B-cell lymphoma-2 (Bcl-2), caspase-3 and caspase-9 were detected by Western blot.Cell proliferation was detected via the cell counting kit-8 (CCK-8) assay and 5-ethynyl-2'-deoxyuridine (EdU) incorporation assay.The migration ability of HLECs was detected by cell scratch assay.Cell migration and invasion were determined by Transwell assays.The expression levels transdifferentiation-related proteins, α-smooth muscle actin (α-SMA), nerve calcium adhesion protein (N-cadherin), fibronectin (FN) and vimentin were assessed by Western blot.Results:The apoptosis rates of blank control group, 5% GS group, 0.5% ICG group, 1.5% ICG group and 2.5% ICG group were (4.35±0.60)%, (4.63±0.19)%, (8.17±0.69)%, (13.90±0.33)% and (23.08±1.12)%, with a statistically significant difference in the overall comparison ( F=412.74, P<0.05). The apoptosis rate was significantly higher in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group (all at P<0.05). The relative expressions of caspase-3, caspase-9 and Bax proteins were significantly higher in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the relative expression of Bcl-2 protein was lower in 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the differences were statistically significant (all at P<0.05). The rate of EdU-positive cells was significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG groups than in blank control group and 5% GS group (all at P<0.05). The survival rate of cells was significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group (all at P<0.05). The migration rates of scratch cells were significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the differences were statistically significant (all P<0.05). The number of migrating cells and the number of invading cells were significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group (all at P<0.05). The relative expressions of α-SMA, N-cadherin and FN were significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the relative expression of vimentin was lower in 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the differences were statistically significant (all at P<0.05). Conclusions:ICG can promote HLECs apoptosis and inhibit HLECs proliferation, migration, invasion and transdifferentiation in a concentration-dependent manner.
Choroidal thickness is susceptible to age, sex and hormone levels under normal physiological conditions.In addition, under pathological conditions, the choroid is also vulnerable to ocular and systemic inflammatory reactions, resulting in the corresponding vascular reactivity changes, so that hemodynamic disorders will occur.When the normal physiological function of choroid is disrupted, imaging examination will show abnormal choroidal thickness.Optical coherence tomography can directly measure the changes in choroidal thickness, and its non-invasive detection method is convenient for patient follow-up and provides the basis for evaluating the progression of the disease.In recent years, researchers in various fields have proposed that the changes in choroidal thickness can become a new potential inflammatory index to evaluate ocular inflammatory diseases and systemic inflammatory diseases.In the long-term chronic inflammatory reaction, such as recurrent uveitis, systemic lupus erythematosus, rheumatoid arthritis and other diseases, the choroidal thickness is significantly lower than the normal value.But in the acute inflammatory response, such as the acute phase of sympathetic ophthalmia and the acute phase of posterior scleritis, the choroidal thickness will increase significantly compared with the normal value, and with the control of the inflammatory response, the thickened choroid will also decrease.However, the changing pattern of choroidal thickness is not the same, for example, the choroid is thickened in keratoconus, diabetic retinopathy, ankylosing spondylitis and other chronic inflammatory reactions.This article reviews the changes in choroidal thickness in ocular and systemic inflammation and its potential as a marker of inflammation.
随着国内医疗水平的提升、玻璃体切割手术设备及显微设备的更新，玻璃体切割手术逐渐在我国县级医院开展。玻璃体视网膜手术后，部分患眼需填充硅油以提高手术成功率和改善预后。待术后视网膜病情稳定，作为玻璃体腔填充物的硅油需及时取出，否则会继发青光眼、角膜变形、视敏度下降等并发症 [1]。目前临床上有几种硅油取出方法的报道，包括经巩膜两通道切口取油、输液皮条连接23G通道取油、F4H5辅助硅油取出以及本课题组报道的经瞳孔硅油取出等 [2,3,4,5]。无论何种取油方式，维持术中及术后眼压的平稳至关重要，过低的眼压会引发脉络膜渗漏，甚至出血、感染 [6]。在临床教学中，我们发现经验不足的手术医师存在缝合巩膜切口不密闭的现象，为此，我们改良了硅油取出术中的灌注模式，使得术中及术后眼压维持较好。现报告改良的硅油取出术与既往硅油取出术在眼压维持等安全性方面的优劣。
Objective:To compare the efficacy and safety of low-intensity illumination 3D heads-up system-assisted pars plana vitrectomy (PPV) and traditional microscope eyepiece system-assisted PPV for proliferative diabetic retinopathy (PDR).Methods:A randomized controlled study was conducted.Forty patients (40 eyes) who were diagnosed as PDR and met the PPV standard were included in Xuzhou First People's Hospital from June to December 2022.The patients were randomly divided into 3D group and eyepiece group using a random number table method, with 20 eyes in each group.The eyes in 3D group underwent 3D heads-up system-assisted PPV, and the eyes in eyepiece group received traditional microscope eyepiece system-assisted PPV.The intravitreal injection of 0.5 mg(0.05 ml) ranibizumab was performed 6 or 7 days prior to three-channel 25G PPV for all the eyes.The brightness of endoilluminator was adjusted to minimum level during the surgical procedure, and the brightness of the optical fiber and chandelier in 3D group was set to 20%, while that in eyepiece group was 32% and 46%, respectively, and was further matched to the actual requirements of the surgery.The light intensity of optical fiber and chandelier was measured at 5 mm and 10 mm with a digital photometer.Best corrected visual acuity (BCVA) was measured before surgery and 7 days, 1 month and 3 months after surgery.Electroretinogram (ERG) was recorded by the Retiscan before surgery and 1 month after surgery to evaluate retinal function.Intraocular pressure and postoperative complications in both groups were compared.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (No.xyy11[2022]027). Written informed consent was obtained from each subject prior to entering the cohort.Results:The BCVA was 2.21±1.13, 1.99±1.07, 1.26±0.86 and 0.98±0.65 in 3D group, and 1.89±0.95, 1.94±0.79, 1.42±0.80 and 1.31±0.79 in eyepiece group at before surgery and 7 days, 1 month, and 3 months after surgery, respectively.There was no significantly intergroup difference in BCVA ( Fgroup=0.022, P=0.884). The BCVA was significantly different at various time points before and after surgery ( Ftime=18.765, P<0.001). The BCVA was significantly improved at 1 and 3 months after surgery in 3D group and at 3 months after surgery in eyepiece group in comparison with before surgery, showing statistically significant differences (all at P<0.05). There were significant differences in the latency of dark-adapted 3.0 a-wave before and after surgery between two groups ( Htime=3.983, P=0.046), and the latency of dark-adapted 3.0 a-wave was shorter after surgery than before surgery in both groups (all at P<0.05). The light intensities of optical fiber and chandelier at 5 mm and 10 mm during surgery were lower in 3D group than in eyepiece group, and the differences were statistically significant (all at P<0.001). There was no significant difference in intraocular pressure between the two groups at different time points ( Fgroup=0.980, P=0.328; Ftime=2.706, P=0.062). There was no significant difference in the number of postoperative vitreous hemorrhage between the two groups ( χ2=0.960, P=0.327). Conclusions:Low-intensity illumination 3D heads-up system-assisted PPV has the same outcome as traditional microscope eyepiece system-assisted PPV for PDR.However, compared with the traditional microscope eyepiece system, the light intensity on the retina from low-intensity illumination 3D heads-up system is lower on the retina during surgery and therefore produce less light damage to retinal function of patients.
Objective:To compare the fitting effect between rig gas-permeable contact lens (RGPCL) and scleral lenses (SLs) in moderate and severe keratoconus eyes.Methods:A cross-sectional study was performed.Fifty-two eyes of 42 keratoconus patients were recruited in Henan Eye Hospital from September 2022 to September 2023.Based on steep keratometry (Ks) value, patients were divided into moderate stage (48 D≤Ks<55 D, 28 eyes) and severe stage (Ks≥55 D, 24 eyes). RGPCL and SLs were fitted normatively in all eyes.Fluorescein staining and anterior segment optical coherence tomography were performed under a slit lamp.The distance between the central and lateral centers of the lenses and the cornea, the centering of the lenses, the mobility of the lenses and the peripheral fit of the lenses were observed.Best corrected visual acuity (BCVA) converted to logarithmic minimum angle of resolution, comfort score, wetness score and clarity score were recorded.Differences in the above parameters of each patient between RGPCL and SLs wear were compared.The improvement of the above parameters after RGPCL and SLs wear was compared in moderate and severe patients.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[5]-04). Written informed consent was obtained from each patient before any medical examination.Results:After RGPCL wear, the mean BCVA, comfort, wetness, and clarity score were 0.19(0.10, 0.30), 5.5(3.0, 7.0) points, 7.0(5.0, 8.0) points and 7.0(4.0, 8.0) points, respectively.After SLs wear, the mean BCVA, comfort score, wetness score and clarity score were 0.10(0.00, 0.10), 8.0(8.0, 9.0) points, 8.0(8.0, 9.0) points and 8.0(6.0, 9.0) points, respectively.Compared with RGPCL wear, the BCVA, comfort score, wetness score and clarity score of SLs were significantly improved ( Z=-5.887, -6.064, -5.705, -5.516; all at P<0.001). There was a moderate positive correlation between BCVA and Kmax after SLs wearing ( rs=0.519, P<0.001), and had a moderate negative correlation with TCT ( rs=-0.535, P<0.001). There was a moderate positive correlation between the clarity score of the SLs and TCT ( rs=0.303, P=0.029). In the moderate and severe subgroup analysis, BCVA, comfort score, wetness score and clarity score were significantly improved after SLs wear compared to RGPCL (all at P<0.05). In addition, the clarity score was significantly improved in severe keratoconus compared to moderate keratoconus ( Z=-3.100, P=0.002). Conclusions:In patients with moderate to severe keratoconus, RGPCL can improve BCVA to a limited extent.SLs can significantly improve patients' comfort, wetness and visual clarity while improving their BCVA.
Objective:To investigate influencing factors of persistent diplopia after orbital floor blowout fracture reconstruction surgery.Methods:A case control study was conducted.Data of 146 eyes of 146 orbital floor blowout fracture patients with diplopia occurring 1 day after operation were collected in Henan Eye Hospital from July 2011 to July 2020.The patients were divided into two groups, persistent diplopia group (14 cases 14 eyes) and disappeared diplopia group (132 cases 132 eyes), according to the persistence of diplopia in the follow-up.Differences in sex, right or left eye, age, preoperative course of disease, preoperative intraorbital soft tissue hernia, operation methods, operation approach, postoperative eyeball rotation exercise compliance, the number of eyes with postoperative inferior rectus muscle damage level were compared between the two groups to select factors with P<0.05 for multifactor logistic regression analysis.This study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2021[15]). Results:All eyes were successfully operated and no complications such as infection or dislocation of the orbital implant occurred in any of the eyes during the postoperative follow-up period.There were statistically significant differences in age, preoperative course of disease, preoperative intraorbital soft tissue hernia, operation methods, postoperative eyeball rotation exercise compliance and postoperative inferior rectus muscle injury between the two groups ( χ 2=9.443, P=0.002; χ 2=29.041, P<0.001; H=53.943, P<0.001; H=34.583, P<0.001; χ 2=46.041, P<0.001; H=101.438, P<0.001). The multiple logistic regression analysis indicated that the long preoperative course of disease ( OR=8.678, 95% CI=1.013-74.304, P=0.031), preoperative intraorbital soft tissue hernia (Severe: OR=32.963, 95% CI=7.647-142.084, P<0.001.Moderate: OR=11.852, 95% CI=2.679-52.436, P=0.001), and postoperative inferior rectus muscle injury (Severe: OR=511.000, 95% CI=42.815-6 110.808, P<0.001.Moderate: OR=132.000, 95% CI=12.442-1 400.458, P<0.001) were independent risk factors for postoperative persistent diplopia.Advanced operation methods (Individualized shaped titanium mesh method: OR=0.020, 95% CI=0.002-0.127, P<0.001.Manufacturers prefabricated titanium mesh method: OR=0.031, 95% CI=0.004-0.257, P=0.001), and the postoperative eyeball rotation exercise ( OR=0.015, 95% CI=0.001-0.197, P<0.001) were independent protective factors for postoperative persistent diplopia. Conclusions:Severe preoperative intraorbital soft tissue hernia and postoperative inferior rectus muscle injury are the main risk factors for persistent postoperative diplopia after orbital floor blowout fracture repair surgery.Shortening the preoperative course of disease, improving the operation methods, and enhancing postoperative ocular functional exercises may reduce the incidence of postoperative persistent diplopia.
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system, primarily affecting the optic nerve and spinal cord.In addition to aquaporin 4 antibody, more and more studies have shown that interleukins (IL) also play an important role in the progression of NMOSD.For example, among the most common CD4 + T cells, Th17 cells can destroy the blood-brain barrier to invade the central nervous system and then affect autoimmunity; Th2-mediated IL-4 and IL-10 regulate immune activities by activating macrophages; Tregs can suppress the immune response by restricting various immune cell functions.The levels of related IL in the cerebrospinal fluid and blood of NMOSD patients vary at different stages of the disease course.This article mainly reviews the role and a change characteristics of interleukins related to NMOSD, which helps us to understand its pathogenic mechanism in-depth, and discusses whether IL can be used as immunophysiological markers to diagnose NMOSD.
Objective:To investigate the influencing factors of secondary retinal detachment (RD) in patients with acute retinal necrosis syndrome (ARN).Methods:A case control study was conducted.A total of 57 patients (64 eyes) with initial diagnosis of ARN not accompanied by RD were enrolled in Qingdao Eye Hospital of Shandong First Medical University from March 2013 to April 2021.Among them, 36 cases (40 eyes) were male and 21 cases (24 eyes) were female, with an average age of (51.72±9.73) years.All patients received topical ophthalmic, systemic intravenous and oral antiviral and anti-inflammatory medications, as well as intravitreal injection of ganciclovir according to the patient's condition and willingness.The RD group was divided into RD group and RD-free group according to whether RD occurred during the 1-year follow-up, of which 23 cases and 23 eyes (35.94%) in the RD group occurred from 27 to 160 days after the onset of the disease, with a mean of 45(30, 83) days.The degree of anterior chamber inflammation was evaluated and graded.The scope of retinal necrosis was evaluated by nine-directional fundus color photographs or ultra-wide angle laser scanning ophthalmoscopy without pupil dilation combined with fundus fluorescein angiography.Retinal hemorrhage was divided into three types, no or little scattered patchy hemorrhage, patchy retinal hemorrhage with >1 papillary diameter (PD) and frost-branch retinal hemorrhage.Baseline systemic parameters included sex, age, course of disease, etc.Ocular parameters included best corrected visual acuity, intraocular pressure, anterior segment inflammatory response, retinal hemorrhage, as well as invasion degree and scope of retinal necrosis.Therapy parameters included duration of systemic antiviral drug treatment, with or without intravitreal injection of ganciclovir and the injection frequency as independent variables, and RD occurred whether or not as dependent variables for multivariate logistic regression analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Qingdao Eye Hospital (No.2020-15).Results:Four eyes with severe vitreous opacity were excluded.In the fundus image analysis of the other 60 eyes, the necrotic lesion involved retina reaching 1 to 4 quadrants were in 14, 9, 17 and 20 eyes, respectively.Necrotic lesion affected 13, 23 and 24 eyes in zone 3, zone 2 and zone 1, respectively.Before treatment, frost-like retinal hemorrhage occurred in 26 eyes (43.33%), retinal hemorrhage with >1 PD in 25 eyes (41.67%). Compared with RD-free group, the RD group had a longer course of disease, worse baseline visual acuity, larger necrotic lesions, more eyes with more invasion areas close to the macular area, and more eyes with frost-branch retinal hemorrhage, with statistically significant differences (all at P <0.05). There were no significant differences in age, intraocular pressure, anterior segment inflammatory response, duration of intravenous antiviral drug injection, with or without intrvitreal injection of antiviral drug and injection frequency between the two groups (all at P>0.05). Multivariate logistic regression analysis showed that the occurrence of frost branch-retinal hemorrhage was a high risk factor for RD (odds ratio=9.14, 95% confidence interval: 1.10-82.44, P=0.049). There were no significant differences between the two groups in age, intraocular pressure, anterior inflammatory response, time of intravenous antiviral drug injection, whether or not antiviral drug was injected into vitreous cavity and frequency at the time of initial diagnosis (all at P>0.05). Conclusions:Frost-branch retinal hemorrhage is a risk factor for retinal detachment in ARN.
Objective:To investigate the effect of tumor necrosis factor-α (TNF-α) on the differentiation of orbital fibroblasts (OF) in thyroid-associated ophthalmopathy (TAO) and its regulation mechanism.Methods:Six patients (six eyes) diagnosed with TAO were collected in Tianjin Medical University Eye Hospital from December 2019 to August 2020.Adipose connective tissue was collected during the orbital decompression surgery.OF was isolated and cultured using the tissue block method and vimentin was identified by immunofluorescence.Lipogenic differentiation of OF was induced and identified by oil red O staining.Complete culture medium containing 0, 0.1, 1.0 and 10.0 μg/L TNF-α was used to induce the dedifferentiation of orbital mature adipocytes.Primary culturing cells, 14-day differentiation cells and 20-day dedifferentiation cells were collected.The relative mRNA expression levels of peroxisomal proliferation-activated receptor (PPARγ), extracellular regulatory protein kinase1 (ERK1), ERK2 and fat-coated protein1 (perilipin1) were detected by real-time fluorescent quantitative PCR.The relative protein expression levels of PPARγ, P-ERK1/2 and perilipin1 were detected by Western blot.Results:Human TAO-derived OF were successfully cultured in vitro, spindle-shaped or polygonal, tightly arranged in a vortex pattern, and immunofluorescence staining for vimentin was positive.After OF adipogenic differentiation, lipid droplet structures could be seen in the cytoplasm of some cells, and the stained lipid droplet structures in the cytoplasm could be seen by oil red O staining, which confirmed that the cells obtained after differentiation were adipocytes.Dedifferentiation of adipocytes was induced by 0.1, 1.0, and 10.0 μg/L TNF-α.With the extension of induction time, the volume of lipid droplets in the cytoplasm and the number of cells containing lipid droplets decreased.Lipid droplets disappeared in the cytoplasm on the 20th day of dedifferentiation, and the cells became long spindle-shaped and tightly arranged, dedifferentiated into fibroblast-like cells.Real-time fluorescence quantitative PCR detection results showed that the relative expression levels of PPARγ, ERK1, ERK2 and perilipin1 mRNA in 14-day differentiation group were 4.26±0.09, 2.01±0.09, 3.23±0.10 and 8.69±0.33, respectively, which were significantly higher than 1.00±0.09, 1.05±0.19, 1.00±0.10 and 1.05±0.07 in primary group, and 1.06±0.03, 1.15±0.11 and 6.27±0.09 in 20-day dedifferentiation group (all at P<0.05). Western blot analysis showed that the expression levels of PPARγ, ERK1/2 and perilipin1 proteins in 14-day differentiation group were 1.07±0.03, 1.00±0.03 and 1.13±0.02, respectively, which were significantly higher than 0.37±0.02, 0.29±0.02 and 0.00±0.00 in primary group, and 0.20±0.02, 0.38±0.06 and 0.00±0.00 in 20-day dedifferentiation group (all at P<0.001). Conclusions:TNF-α has a dedifferentiation effect on TAO orbital adipocytes.The mechanism may be related to the downregulation of ERK1/2-PPARγ-perilipin1 signaling pathway.
