Acute acquired concomitant esotropia (AACE) causes diplopia and asthenopia, severely affecting quality of life. This study aimed to explore the association between dry eye (DE) tear film biomarkers and Type III AACE. We enrolled 52 patients (52 eyes) with Type III AACE and 50 controls (50 eyes). Assessments included tear meniscus height (TMH), tear film non-invasive break-up time (NIBUT), corneal fluorescein staining (CFS), Schirmer's test (ST), and the Dry Eye-Related Quality of Life Score (DEQS). Tear samples were analyzed for cytokine levels using a multiplex immunoassay. Logistic regression analyses identified risk factors, and a random forest classifier evaluated predictive performance. Patients with Type III AACE without DE showed significantly reduced NIBUT and elevated levels of cytokines (e.g., MMP-2, MMP-13, and IFN-γ) compared to normal controls (all P < 0.05). Near-distance work duration showed a moderate positive correlation with Galectin-3 (r = 0.64, P < 0.05). MMP-2, MMP-13, and IFN-γ were identified as independent risk factors (arear under the curve (AUC): 0.91, 0.91, 0.94). The random forest model achieved an AUC of 1.00. Elevated tear levels of MMP-2, MMP-13, and IFN-γ were strongly associated with Type III AACE, highlighting their potential as predictive biomarkers.

This retrospective study aimed to evaluate the efficacy of the prism and Maddox rod test (PMT) in determining surgical targets for small-angle acute acquired concomitant esotropia (AACE). Thirty-three patients with small-angle AACE who underwent surgical treatment at the First Affiliated Hospital of Fujian Medical University from June 2017 to May 2023 were included. All patients underwent various tests, including the Hirschberg test (HT), PMT, and prism and alternative cover test (PACT). PACT measured the minimum value (PACTmin) and the maximum value (PACTmax) based on different interpretation criteria for examination endpoint. PMT results were used as the surgical target. Unilateral medial rectus recession (MRrec) was performed on all patients, and postoperative follow-up lasted up to 6 months to evaluate deviation angle and binocular vision. Both near and distance measurements from PMT were 23.67 ± 5.44 PD and 24.82 ± 5.49 PD, respectively, which were comparable to PACTmax (23.06 ± 2.65 PD and 23.58 ± 2.35 PD) and significantly higher than PACTmin (15.18 ± 5.12 PD and 15.24 ± 5.06 PD; P < 0.001). Post-surgery, the mean deviation angles for distance and near viewing were reduced to 0.73 ± 1.69 PD and 0.61 ± 1.35 PD (PMT and PACTmin, respectively). All patients achieved excellent surgical outcomes, with no noticeable deviation angles, diplopia disappearance, and restoration of normal binocular vision. Our study demonstrates that PMT serves as a reliable and practical method for determining surgical targets in patients with small-angle AACE. The results highlight its accuracy and consistency in measuring deviation angles, which can effectively guide unilateral MRrec.

Purpose:To investigate the risk factors and surgical design for type III acute acquired concomitant esotropia (AACE). Methods:In this retrospective, matched, case-control study, 51 patients developed type III AACE between March 2018 and September 2020, and the control group consisted of 60 patients matched by age and refractive power during the same period. A history of the duration of near work per day and the use of glasses were reviewed, and the refractive power of both eyes, deviation angles at both near and far vision, visual function, and treatment options were analyzed. Additionally, the distance from medial rectus insertion to the limbus was measured in surgical patients. The data were analyzed by logistic regression analysis. Results:We found that 99.96% of the patients and 91.67% of the controls had myopia. Of these, 60.8% and 20.0%, respectively, did not wear glasses for near work. Twelve patients were treated with a prism and 39 were treated surgically. The average time devoted to near work per day was 7.24 and 3.7 h by the patients and controls, respectively. Univariate logistic regression analysis showed that increased hours of near work per day and near work without the use of spectacles were associated with the incidence of type III AACE. Multiple logistic regression analysis revealed that increased hours of near work per day and near work without the use of glasses were independent risk factors for AACE. Conclusion:Increased hours of near work per day and uncorrected myopia in near work are independent risk factors for type III AACE.

Concomitant exotropia have obvious symptoms of eye discomfort in adults, and the presence of ocular surface inflammation in patients may be important mediators between concomitant exotropia and dry eye. Oculus Keratograph eye comprehensive analyzer was performed to detect noninvasive tear break time, noninvasive tear height, and eye red index, while the ocular surface disease index and schirmer I testing were made. The levels of IL-6, IL-10, IL-17A, IL-12P70, INF-γ, and TNF-α were detected in tears in patients with concomitant exotropia and healthy controls matched by age and gender through the Simoa technology. IL-6 was significantly higher in patients with concomitant exotropia (4.683 ± 1.329) pg/mL than that in normal group (1.455 ± 0.391) pg/mL, p = 0.0304. TNF-α was also significantly higher in patients (0.2095 ± 0.0703) pg/mL than normal group (0.0513 ± 0.0149) pg/mL, p = 0.0397. The levels of inflammatory factors in strabismic patients vs. normal controls were as follows: IL-17A (0.1551 pg/mL︰0.0793 pg/mL), IL-10 (0.3358 pg/mL︰0.0513 pg/mL), IL-12p70 (0.0253 pg/mL︰0.0099 pg/mL), and INF-γ (0.0284 pg/mL︰0.009 pg/mL) were detected, and the median of them in concomitant strabismus was 1.96-6.55-fold as much as the control group. High levels of inflammatory cytokines in tears of patients with concomitant exotropia, which may be a potentially factor promoted the occurrence of dry eye in the patients with concomitant exotropia.

Diabetic retinopathy (DR) is a common condition of diabetes, and approaches to detecting early DR using the unique characteristics of the retinal pigment epithelium-Bruch's membrane complex (RBC) have increasingly attracted attention. A diabetic model was established in Sprague-Dawley rats via streptozocin (STZ) injection for 1 (DM1) and 6 months (DM6), confirmed by weekly blood glucose measurement. Serum and retinal tissue-based advanced glycation endproducts (AGE) levels significantly elevated in diabetic rats, and RBC was evaluated by transmission electron microscopy and Raman spectroscopy. The results showed that whole Raman spectra and all marked band intensities could respectively achieve almost equal and accurate discrimination of all animal groups, along with the determination of important molecules from the band data. Further quantitative analyses indicated series of metabolic disturbance due to hyperglycemia were involved while the body self-regulation mechanism still played a role with different effects during the disease progression. Given this, Raman spectroscopy can reliably distinguish the early characterization of DR in addition to providing intrinsic key molecules that is sensitive to identify the early disease progression.

BACKGROUND: Our study aimed to determine whether the expression concentration of inflammatory cytokines in ocular surface tears was increased in patients with concomitant strabismus.METHODS: In this study, the concentration of inflammatory cytokines interleukin-6 (IL-6), interleukin-17A (IL-17A), interleukin-10 (IL-10), interleukin-12p70 (IL-12P70), interferon gamma (INF-γ), and tumor necrosis factor- α (TNF-α) were detected in tears in patients with concomitant strabismus and healthy controls matched by age and gender.RESULTS: Our results showed that the concentration of IL-6 and TNF-α were significantly higher in the experimental group compared to the normal group. The concentration of IL-17A, IL-10, IL-12p70, and INF-γ in patients with concomitant strabismus were higher than those in the control group, but not reached the statistically significant.CONCLUSIONS: Our results suggested that most of concomitant strabismus patients have higher concentration of inflammatory cytokines in tears.

AIM:To investigate the effect of small incision non-phacoemulsification cataract surgery on corneal endothelial cell.METHODS:Totally 140 cataract patients (152 eyes) treated in our hospital from August 2013 to March 2016 were selected.All of the patients underwent small incision non-phacoemulsification cataract surgery.Before surgery and at 1wk, 1mo and 3mo after surgery, we measured the corneal endothelium of upper cornea, the central cornea and the lower part of cornea.The proportion and density of hexagonal cells, loss rate and cell area in corneal endothelial cells were calculated and compared.RESULTS:Postoperatively 36 eyes had posterior elastic layer folds, aqueous flare, which disappeared after treatment.After surgery, corneal incision was found to have mild corneal edema.No other complications were found.A total of 128 patients (137 eyes) were followed up for a total of up to 3mo, with a loss of follow-up in 12 patients (15 eyes).After surgery, corneal endothelial cell density of the upper part of the cornea, the central cornea and the lower part of cornea, was statistically significantly different with each other (F=3.526, P=0.031), the difference in different time points was statistically significant (F=4.111, P=0.018).The postoperative corneal endothelial cell loss rate was statistically significant different between the three groups (F=3.526, P=0.031), at different time pionts (F=4.111, P=0.018).There was statistical significance of percentage of hexagonal cells between the three groups (F=4.348, P=0.014), the difference was significantly different between different time points (F=4.964, P=0.008).There was statistical significance of corneal endothelial cell area between the three groups (F=3.180, P=0.044), the difference was significantly different between the time points (F=3.511, P=0.032).CONCLUSION:After small incision non-phacoemulsification cataract surgery, corneal endothelial cell density decreased, hexagonal cell proportion decreased, corneal cell area expanded.

Objective To investigate the role of miR-34a in retinal pigment epithelium (RPE) cells with high glucose metabolic memory and explore new strategy for the prevention and treatment of diabetic retinopathy.Methods RPE cells were cultured under various conditions.The high glucose metabolic memory model of diabetes mellitus was simulated through culturing cells in high glucose for 4 days followed by 4 days in normal glucose medium.The expression of miR-34a was measured by quantitative real-time PCR (qRT-PCR).The level of histone deacetylase Sirtuin 1 (SIRT1) was evaluated using immunocytochemistry and Western blot.Apoptotic cells were detected by flow cytometry using Annexin V/Propidium iodide double staining.Results qRT-PCR showed that miR-34a expression in RPE cells was significantly increased in high glucose and metabolic memory groups.Its expression in RPE cells with metabolic memory could be further modulated,e.g.up-regulated by MiR-34a mimic or down-regulated by inhibitor.Immuno-cytochemistry staining showed that STRT1 expression in RPE cells was significantly decreased in high glucose culture and metabolic memory groups.Overexpressing miR-34a further down-regulated STRT1 in metabolic memory RPE cells,while miR-34a inhibitor partially abolished the inhibitory effects mediated by metabolic memory.Flow cytometry showed that apoptotic RPE cells significantly increased in high-glucose culture and metabolic memory groups,which could be further increased by miR-34a overexpression but reduced by miR-34a inhibitor in RPE cells with metabolic memory.Conclusion MiR-34a inhibitor can partially reverse high glucose metabolic memory effect in RPE cells and prevent diabetic retinopathy likely through reducing SIRT1 expression and apoptosis.

目的:探究丹酚酸B抗氧化应激对糖尿病大鼠角膜的保护作用.方法:健康雄性SD大鼠25只,随机选取5只作为正常对照组;其余20只采用一次性腹腔注射链脲佐菌素(STZ,60mg/kg)诱导糖尿病大鼠模型,建模成功(血糖＞16.7mmol/L)后应用随机数字表法分为糖尿病对照组、0.01％丹酚酸B凝胶治疗组、0.05％丹酚酸B凝胶治疗组、0.1％丹酚酸B凝胶治疗组,丹酚酸B治疗组和糖尿病对照组每天分别给予自制相应浓度的丹酚酸B凝胶及空白凝胶点眼,每次1滴,每日3次;检测大鼠的血糖和体质量,观察角膜知觉和透明度,每周1次;造模成功后的第12wk取材,观察角膜组织结构改变,以及大鼠眼组织中丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性情况.结果:所有大鼠血糖处在高水平(＞ 16.7mmol/L),体质量早期上升后期有明显下降.在糖尿病对照组,角膜的知觉和透明度降低,各丹酚酸B凝胶治疗组与糖尿病对照组相比较,角膜知觉明显改善,各丹酚酸B治疗组角膜保持透明度与正常组无明显差异,角膜组织中的MDA含量明显减少,角膜组织中SOD的活性明显增加(P＜0.05).结论:丹酚酸B可以减缓糖尿病大鼠角膜病变,其机制可能与丹酚酸B能清除超氧阴离子的抗氧化应激作用有关.

糖尿病视网膜病变(Diabetic retinopathy,DR)是糖尿病引起的微血管并发症之一,是致盲的主要原因之一.高糖引起DR的机制包括糖基化终末产物(AGEs)的生成、氧化应激以及炎症反应等.目前DR的发病机制尚未明确,治疗DR仍然面临严峻的挑战.最近研究显示,过氧化物酶体增殖物激活受体-γ(PPAR-γ)及其激动剂噻唑烷二酮类药物(TZDs)具有增强胰岛素敏感性、拮抗AGEs生成、抗氧化、抗炎以及抗血管生成等作用,可能成为治疗由高糖引起视网膜损害的一种新方法.该文就PPAR-γ防治DR的作用机制进行综述.

Purpose. To evaluate the efficacy of a combination of intrastromal and intracameral injections of amphotericin B in the treatment of severe recalcitrant fungal keratitis. Methods. Patients with severe fungal keratitis who were resistant to conventional antifungal medical treatments and needed potential surgical intervention were recruited at the First Affiliated Hospital of Fujian Medical University between January 2012 and July 2013. The patients were treated with a combination of intrastromal and intracameral injections of amphotericin B (25 μg/mL and 50 μg/mL, resp.). Selectively repeated injections were performed as necessary. The efficacy, complications, and outcome were evaluated. Results. Nine patients (9 eyes) were involved in this study. All 9 cases responded favorably, and the clinical appearance of serious corneal damage and intraocular extension was resolved after the treatment. Four eyes required only 1 injection, and 5 eyes required repeated injections. Seven corneal ulcers healed with leucoma, and 2 healed with adherent leucoma. All of our cases had a marked increase in the anterior chamber reaction and pain immediately after the injection. There was no obvious clinical evidence of corneal or lenticular toxicity in any patient. Conclusions. A combination of intrastromal and intracameral injections of amphotericin B may be safe and effective for the treatment of severe fungal keratitis that is resistant to conventional therapy.

Objective To investigate the potential of the treatment of growth-associated protein 43 (GAP43) gene-modified bone marrow-derived mesenchymal stem cells (BMSCs) for retinitis pigmentosa (RP). Methods BMSCs were isolated and cultured by adherence method. By transfecting GAP43 gene into BMSCs via a lentivirus vector, we got GAP43 gene-modified BMSCs. Sixty-three Royal College of Surgeons (RCS) rats were randomly divided into three groups: experimental group, negative control group and blank control group. The experimental rats received subretinal injection of GAP43 gene-modified BMSCs. The negative control rats received subretinal injection of BMSCs. The control rats received subretinal injection of PBS. Thirty days after transplanting, the retinal thickness was detected by optical coherence tomography (OCT), and the expression of rhodopsin in RCS rat retinas was examined by Western blotting. Results Compared with the blank control group and the negative control group, 30 days after GAP43 gene-modified BMSC transplantation, the retinal thickness of the experimental group remarkably increased and the expression of rhodopsin significantly rose. Conclusion GAP43 gene-modified BMSC transplantation can increase survival photoreceptor cells and delay retinal degeneration.

Objective To observe the expression of glutamate (Glu) and γ-aminobutyric acid (GABA) in the retina of diabetic rats which were intervened later by insulin intensive therapy, and to investigate the mechanism of metabolic memory of hyperglycemia which induced the retina neuropathy in diabetic rats.Methods 60 Brown Norway rats were randomly divided into normal control (NC) group, diabetes mellitus (DM) group (6 weeks at DM1,12 weeks at DM2) and metabolic memory (MM) group, 15 rats in each group.Diabetes was induced by intraperitoneal injection of streptozocin.After 6 weeks, MM group was treated with insulin intensive therapy for 6 weeks.DM1 group was sacrificed at the end of 6 weeks and other groups were sacrificed at the end of 12 weeks.High performance liquid chromatography was used to detect the amount of Glu and GABA in the rat retina.Real-time polymerase chain reaction was applied to quantify the mRNA expressions of Glutamate decarboxylase (GAD).TdT mediated dUTP nick ending labelling was used to detect cell apoptosis.Results The concentration of Glu (t=6.963), GABA (t=4.385) and the ratio of Glu/GABA (t =4.163) in MM group were significantly higher than DM1 group, but the concentration of Glu (t=3.411) and GABA (t=3.709) were significantly lower than DM2 group (P＜0.05).And there was no significant difference in the ratio of Glu/GABA between MM and DM2 groups (t=1.199 ,P＞0.05).The level of expressions of GAD mRNA in MM group was significantly lower than DM1 group (t=3.496, P＜0.05), but higher than DM2 group (t=8.613, P＜0.05).The number of nerve cells apoptosis in MM group was significantly higher than DM1 group (t=2.584, P＜0.05), but lower than DM2 group (t-3.531, P＜0.05).Conclusions Intensive therapy later by insulin can partially reduce the content of Glu and GABA and the rate of nerve cells apoptosis, which cannot return to normal levels, and has no effect on the rise in the ratio of Glu/GABA caused by the hyperglycemia.The disorders of Glu and GABA may participate in the metabolic memory of hyperglycemia.

目的 观察吡哆胺对糖尿病大鼠视皮质高级糖基化终末产物(AGE)及其受体(RAGE)表达的影响,探讨吡哆胺对视皮质的保护作用.方法 健康SD大鼠随机分为正常对照组(NC组)、糖尿病未治疗组(DM组)、糖尿病吡哆胺治疗组(PM组)和氨基胍治疗对照组(AG组)各20只,用链脲佐菌素(STZ)建立糖尿病模型,PM组和AG组分别于造模成功后第二天开始予吡哆胺和氨基胍灌胃.各组于治疗4w和12w后取材,用酶联免疫吸附(ELISA)法定量检测大鼠视皮质中AGEs含量,荧光免疫组化及图像分析半定量检测各组视皮质RAGE的表达.结果 糖尿病治疗组和未治疗组血糖无显著性差异.4w时各组AGEs含量无明显差异,12w时PM组视皮质中AGEs含量与AG组、NC组比较差异无统计学意义,与DM组相比显著降低,差异具有统计学意义(P＜0.05).PM组视皮质中RAGE表达比DM组显著减少,差异具有统计学意义(P＜0.05),但高于NC组(P＜0.05).结论 糖尿病大鼠12w后视皮质中AGEs含量和RAGE的表达高于正常对照组,吡哆胺类似氨基胍可减少AGEs的堆积,还能抑制RAGE的表达,减轻AGEs-RAGE通路作用导致的组织损伤,对视皮质具有一定的保护作用.

Objective To study the effect of advanced glycosylation end products (AGEs) on human retinal pigment epithelium (RPE) cells.Methods Human primary RPE cells were cultured in basal and different concentrations of AGEs with different times.The cells were divided into several groups as follows:group C (control):bovine serum albumin 0.1 g/L,24 hours (C1) and 48 hours (C2); group NC (normal control):basal culture medium with 5.6 mmol/L of glucose,24 hours (NC1) and 48 hours (NC2) ; group A (AGEs):0.1 g/L,24 hours and 48 hours,A1 and A4 ; 0.2 g/L,24 hours and 48 hours,A2 and A5 ; 0.4 g/L,24 hours and 48 hours,A3 and A6.Immunohistochemistry analysis was used to study the protein expression of receptor for AGEs (RAGE),peroxisome proliferative-activated receptor-gamma coactivator-1 alpha (PCG -1α) and vascular endothelial growth factor (VEGF) protein.The activation of nuclear factor-kappa B (NF-κB) was detected by confocal microscope.Software IPP6.0 and SPSS 17.0 were used to analyze the quantitation data.Results Immunohistochemistry analysis showed that RAGE protein,PGC-lα protein and VEGF protein were basally secreted in RPE cells,but AGEs can obviously increases the expression level of these proteins (F =294.5,228.3,241.5; P ＜ 0.05).Confocal microscope demonstrated that AGEs increased the activation of NF-κB significantly.Conclusion Accumulation of AGEs can stimulate the expression of RAGE protein,PGC-1α protein and VEGF protein,activation of NF-κB and induce apoptosis of RPE cells.

Objective To evaluate surgically induced astigmatism and corneal endothelium after sutureless small incision extracapsular cataract extraction. Methods After sutureless small incision extracapsular cataract extraction,astigmatism of 122 cases (139 eyes) were measured pre-operatively,1 week,1 month and 3 months post-operatively.Surgically induced astigmatism was calculated using Vector Analysis method.Corneal endothelium density and loss rate were calculated by specular microscopy. Results Astigmatism were significantly different between the groups before surgery and 1week,1 month after surgery (P ＜0.05).There was no significantly different between the groups before surgery and 3 months after surgery (P ＞0.05).SIA were significantly different between the groups 3 months and 1 week,1 month after surgery (P ＜0.05).There was statistically significant difference in corneal endothelial cell density between the groups before surgery and after surgery (P ＞0.05).The differences in corneal endothelium loss rate between 1 month and 3 months after surgery were not statistically significant (P ＞0.05). Conclusions Sutureless small incision extracapsular cataract extraction cause low rates of astigmatism induced by surgery and endothelial cell loss.

Objective To investigate the effect of small incision nonphacoemulsification cataract surgery on corneal endothelial cells. Methods One hundred and twenty-three cataract patients (136eyes) were collected from January 2010 to June 2011 in our hospital.Small incision nonphacoemulsification cataract extraction was performed by the same physician.The corneal endothelial cells on the upper,the central and the lower corneal were measured by using corneal endothelial microscope preoperative and 1 week,1 month and 3 months postoperative.The comeal endothelial cells density,loss rate,hexagonal cell ratio and cell area were calculated. Results The differences among the upper,the central and the lower cornea of comcal endothelial cells density,hexagonal cell ratio and cell area were no statistical significances (all P ＞0.05) before operation.The comeal endothelial cells density decreased,the hexagonal cells ratio decreased and the cell area increased after operation.The differences among the upper,the central and the lower cornea of corneal endothelial cells density,hexagonal cell ratio and cell area were the largest at 1 week after operation and were statistical significances (all P ＜0.01).The differences among the upper,the central and the lower cornea of corneal endothelial cells density,hexagonal cell ratio and cell area were statistical significances at 1month after operation (all P ＜0.05).The differences among the upper,the central and the lower corneal of corneal endothelial cells density,hexagonal cell ratio and cell area were no statistical significances at 3 months after operation (all P ＞0.05). Conclusions Small incision nonphacoemulsification cataract extraction has a small amount of damage on corneal endothelial cells,and the damage position is mainly at the incision on the upper part of corneal. Key words: Cataract; Surgery; Small incision nonphacoemulsification cataract extraction; Corneal endothelial cells

Metabolic memory was demonstrated in some clinical trials that diabetic complications continued even though a successful control of blood glucose at later stages.This phenomenon has recently been defined as "metabolic memory”.It is still elusive how "hyperglycemic memory" influence diabetic retinopathy(DR).Among the assumed mechanisms,oxidative stress is thought to have a key role.Hyperglycemia induces dysfunction and destruction of mitochondria in retinal cells,so reactive oxygen species are constantly released and activate downstream pathways,which lead to the "metabolic memory" effect on the retina and the progression of DR.Furthermore,other mechanisms such as advanced glycation end products,epigenetic changes,as well as inflammation and apoptosis factors may also be implicated in this process.

Objective To evaluate the application of ultrasound biomicroscopy (UBM) in the diagnose of slight lens dislocation.Methods Seventy-three patients with ocular contusion and clinical suspicion of lens dislocation were performed UBM direct examination and UBM indirect examination by two technicians for detecting the rupture o'clock position of suspensory ligament of lens.The time required for examination was calculated.Results Among 73 cases with clinical suspicion of lens dislocation,49 cases could cooperate with UBM direct examination.The completion rate was 67.35％.All cases could cooperate with UBM indirect examination.The completion rate was 100％.The difference was statistical significance (P ＜0.01).Thirty-seven cases were final diagnosis of lens dislocation by UBM direct examination.Thirty-eight cases were prompted diagnosis of lens dislocation by UBM indirect examination.UBM indirect examination sensitivity was 97.29％,specificity 90.91％,false positive rate 16.67％,false negative rate 2.70％,the correct index 88.21％,positive predictive value 94.74％,negative predictive value 90.91％.The time required for UBM direct examination was 30.9min± 8.7min.The time required for UBM indirect examination was 9.2min± 1.1min.The difference was statistical significance (t =20.034,P ＜0.01).The rupture o'clock positions of suspensory ligament of lens detected by UBM direct examination were close to the position detected by UBM indirect examination.The difference was no statistical significance (t =0.495,P =0.624).Conclusions UBM direct and UBM indirect combined examination is a fast,effective way for the final diagnosis of slight lens dislocation.