眼科学是一门需要掌握显微操作的学科,因而对于学生的显微技能培训是眼科教学中不可或缺的重要部分.但由于现今大环境的影响,住院医师的动手机会越来越少,因而WetLab实验室的构建显得更加重要.我们通过WetLab实验室对住院医师进行显微操作技能的培训,同时围绕WetLab为中心,采用多方位联合培训的方法,如加强显微手术理论学习,优秀手术录像实况转播和教学,循序渐进的目标训练,建立了操作实时转播和录像系统,国外团队带教手术教学,严格的定期考核,增加实战经验等,将各种新的教学手段融入教学过程中,并借鉴国外著名眼科中心临床教学的一些方法加以改进和完善,在临床中取得了良好的教学效果.

目的 探讨利用Pentacam和KR-1W像差仪测量超声乳化白内障联合IOL植入术手术前后角膜前、后表面高阶像差的变化,比较两种仪器测量角膜前表面像差的差异.方法 收集年龄相关性白内障患者60例98眼行超声乳化联合IOL植入术,利用Pentacam系统于术前和术后1个月测量角膜前、后表面高阶像差,同时利用KR-1W像差仪测量角膜前表面高阶像差,记录总高阶像差、球差、彗差、三叶草、四叶草以及总三阶、四阶像差的测量值,观察手术前、后角膜前、后表面像差的变化.结果 术前测量结果:Pentacam测量各类像差值均比KR-1W偏大,其中总高阶像差、球差、四叶草差和总四阶像差之间差异有统计学意义(P分别为0.001、0.001、0.002和0.003).术后测量结果:两种仪器测量角膜前表面像差均比术前增加,其中Pentacam测量术后角膜前表面总高阶像差、彗差、三叶草差、三阶和四阶像差与术前差异有统计学意义(P分别为0.001、0.014、0.005、0.003和0.001);KR-1W测量术后角膜前表面总高阶像差、三叶草差、三阶和四阶像差与术前差异有统计学意义(P分别为0.004、0.019、0.023和0.001).Pentacam测量角膜后表面总高阶像差、彗差、三叶草差、四叶草差、三阶和四阶像差术后均比术前轻度增加,但差异无统计学上的意义(P均>0.05).结论 小切口超声乳化白内障吸除联合IOL植入术后角膜前、后表面高阶像差均有不同程度增加(除外球差),可能影响术后视觉质量,Pentacam测量角膜前表面像差值比KR-1W测量值偏大.

At this point in time, the importance of medical humanities education has not been fully understood during the standardized training of residents in China. The study of medical humanities is an important facet of ophthalmology residency that needs to be strengthened. During the standardized training of ophthalmology residents, not only the medical sciences should be strengthened, but also the nature and practice of medical humanities knowledge should be enhanced in multiple aspects. Offering medically-relevant literature, history, philosophy and other courses, simulating real medical activities, being enthusiastic in popular medical science and increasing the contents of the examination in medical humanities would all be areas that would further advance the ophthalmology residency. Along with medical science education, residents will be led and trained on medical humanities as to build good medical humanistic spirit of patient care so that they may better serve patients.

Background/Aims: Age-related cataract (ARC) remains the leading cause of visual impairment among the elderly population. Long non-coding RNAs (lncRNAs) have emerged as potential regulators in many ocular diseases. However, the role of lncRNAs in nuclear ARC, a subtype of ARC, requires further elucidation. Methods: LncRNA sequencing was performed to identify differentially expressed lncRNAs between the capsules of transparent and nuclear ARC lenses. Expression validation was confirmed by qRT-PCR. MTT assay, Calcein-AM and propidium iodide double staining, Rhodamine 123 and Hoechst double staining, EdU and transwell assay were used to determine the role of H19 or miR-675 in the viability, apoptosis, proliferation and migration of primary cultured human lens epithelial cells (HLECs). Bioinformatics and luciferase reporter assays were used to identify the binding target of miR-675. Results: Sixty-three lncRNAs are differentially expressed between the capsules of transparent and nuclear ARC lenses. One top abundantly expressed lncRNA, H19, is significantly up-regulated in the nuclear ARC lens capsules and positively associated with nuclear ARC grade. H19 knockdown accelerates apoptosis development and reduces the proliferation and migration of HLECs upon oxidative stress. H19 is the precursor of miR-675, and a reduction of H19 inhibits miR-675 expression. miR-675 regulates CRYAA expression by targeting the binding site within the 3’UTR. Moreover, miR-675 increases the proliferation and migration while decreasing the apoptosis of HLECs upon oxidative stress. Conclusion: H19 regulates HLECs function through miR-675-mediated CRYAA expression. This finding would provide a novel insight into the pathogenesis of nuclear ARC.

Objective: To evaluate the postoperative complications and additional surgeries of limbal and pars plana approaches using microincision vitrectomy (25G/23G) for removal of congenital cataracts. Methods: In this retrospective cohort study, patients with a congenital cataract were referred to the Eye & ENT Hospital of Fudan University from March 2009 to December 2013. There, they underwent cataract surgeries through either the limbal approach or the pars plana approach. All of the surgeries were performed by one surgeon. For patients older than 1 year, primary intraocular lens implantation was performed. For patients younger than 1 year, secondary intraocular lens implantation was performed during follow-up after the initial cataract surgery. Complications and additional surgeries were recorded. Logistic regression was used to test the influence of potential risk factors on the incidence of postoperative complications. Fisher exact test was used to compare the incidence of postoperative complication between the different surgical approaches. Results: Of the 67 patients, 99 eyes with congenital cataract were included. The mean follow-up time was 4.4 years (range 0.9-8.3 years). Postoperative complications that required additional surgeries occurred 15 times in 11 eyes. These included 5 times of visual axis opacification in 5 eyes, 4 times of intraocular lens (IOL) pupillary capture in 3 eyes, 1 time of dislocation of IOL in vitreous in 1 eye, 2 times of retained cortex in 2 eyes, 2 times of pupillary membrane in 2 eyes, and 1 time of retinal detachment in 1 eye. Surgery at less than 1 year of age and surgery through the limbal approach were risk factors of complication requiring additional surgery (OR=17.9, P=0.009; OR=7.9, P=0.041; respectively). There was no statistical significance in the type of postoperative complications between the limbal approach and the pars plana approach (P>0.05). Conclusions: Age at surgery of less than 1 year and surgery through the limbal approach are the risk factors for postoperative complications requiring additional surgeries in patients with congenital cataract. The distribution of postoperative complications is not correlated with either of the two surgical approaches.

Objective To investigate the crystalline expression change induced by ultraviolet (UV) exposure in human lens epithelial cells (LECs).Methods LECs (including cells from primary culture and cell line) were exposed to UVC at the wavelength of 254 nm for certain time and were collected for the following assays:①apoptosis detection by propidium iodide (PI) staining and mitochondrial membrane potential evaluation;②quantitative PCR (qPCR) for measuring the expression of crystallin coding genes CYRAA,CRYAB and CRYBB2;③Immunofluorescence staining of CRYAA;④pyrosequencing analysis of the promoter region of CRYAA to evaluated the methylation status.Results LECs exposed to UVC at the intensity of 25 μW/cm2 for 0,10,20 and 30 min showed an increasing apoptosis rate by immediate propidium iodide (PI) staining at 0,7％,33％ and 100％.LECs exposed to UVC for 10 seconds or longer died at 100％ after 24 hours,whereas LECs exposed to UVC for 5 seconds died partially after 24 hours;the CRYAA gene expression showed a significant increase after 24 hours.The pyrosequencing of CRYAA promoter showed that the methylation status did not change in the UVC-treated cells.Conclusions The exposure to UVC for longer than 10 seconds would 100％ kill the cultured LECs.A 5 seconds-exposure to UVC would induce an increase in CRYAA expression,and the up-regulation is not the result from demethylation.

In the phacorefractive age , surgical image-guided system provides precise multifunctional platform for cataract surgery .Continuous , automated and real-time eyeball tracking and navigation , and intraoperative marking without a trace could be achieved .Alignment of toric intraocular lens ( IOL ) and centrality of multifocal IOL were improved.Intraoperative real-time measurement of the operated eye could improve the accuracy of IOL power calculation after keratorefractive surgery .Therefore, precise position of functional IOLs were achieved .CALLISTO eye image-guided system possesses the functons of view superimposed assistance , incision assistant , continuous curvilinear capsulorhex assistant , Z ALIGN-Toric IOL assistant and seamless connection with Forum big data management platform .VERION image-guided system possesses the functions of reference image tracking , surgery planning and navigation .Both image-guided systems have its characteristics and advantages and could help with individualized phacorefractive surgery design .

Postoperative glaucoma is one of the most common complications after congenital cataract surgery and an important cause of unsatisfactory long-term visual acuity rehabilitation. Recently, the diagnostic criteria of glaucoma after congenital cataract surgery have been gradually complemented; the measurement of intraocular pressure is improved and the follow-up is standardized. The risk factors of glaucoma after congenital cataract surgery include age at surgery, ocular abnormalities and central corneal thickness, some of which still remain controversial. The main treatment of postoperative glaucoma is surgery, while some patients need adjuvant medications in addition to surgery. (Chin J Ophthalmol, 2017, 53: 863-867).

随着显微手术技术的进步,白内障摘除联合微创前段玻璃体切除及人工晶状体(IOL)植入术已经成为治疗先天性白内障的主要方法.2岁以下儿童一期植入IOL已经成为一种趋势.对眼轴长度、角膜曲率及屈光度变化的准确估计,IOL度数选择的综合考虑,积极规范的弱视训练和长期随访对于获得良好的视觉重建结果尤为重要.本文对这一领域近5年的研究进展进行综述.

Cornea curvature and aberrations will change after corneal refractive surgery.Hyperopic error still exists and the increase of higher-order aberrations also affects the visual quality after cataract surgery in such patients.Therefore,the new IOL power calculation methods have emerged to reduce refractive predictive error.Aspheric IOL selection according to cornea spherical aberration before cataract surgery can reduce the whole eye aberrations and patient' s visual symptoms such as glare,decreased night vision and improve the visual quality.

Row data of qRT-PCR for CRYAA after Zebularine treatment, Experiment 3. It is the rata data of the third experiment described above. (XLS 2630Â kb)

PURPOSE:To study the prevalence of age-related cataract (ARC), cataract surgery, and visual outcomes in a Chinese adult population in Taizhou, China.METHODS:A population-based, cross-sectional study was conducted using a random cluster sampling method. We evaluated 10,234 eligible subjects 45 years or older (response rate 78.1%) in the Taizhou Eye Study. We conducted a detailed eye examination in all participants, including presenting visual acuity (PVA), best-corrected visual acuity (BCVA), slit-lamp assessment of lens opacities using the Lens Opacities Classification System III (LOCS III), and fundus examination.RESULTS:The standardized prevalences of cortical, nuclear, and posterior subcapsular cataract (PSC) were 28.6%, 24.3%, and 4.4%, respectively, and combined nuclear and cortical cataract was the most common cataract type (40.0%). According to the US visual impairment (VI) criteria and World Health Organization VI criteria, 40.6% and 21.8% of PSC participants had binocular VI, respectively; these values were higher than the VI rates in cortical and nuclear cataract (all P < 0.001). Of 148 patients (3.5%) who had cataract surgeries, 41.2% had PVA <20/63, and 19.6% had PVA <20/200. The main causes of poor visual outcome after cataract surgery were ocular comorbidities (41.3%), uncorrected refractive error (30.0%), surgical complications (15.0%), and posterior capsular opacification (PCO; 13.7%).CONCLUSIONS:The high prevalence of cataract and high rate of VI from ARC in the adult Chinese population remains a severe public health problem. Cataract surgery remains insufficient in mainland China and poor visual outcomes were frequent. Surgical complications and PCO were important avoidable causes that attributed to poor visual outcomes after cataract surgeries.

Age-related cataract (ARC) is the leading cause of visual impairment worldwide, and α-crystallin (CRYAA) is the predominant structural protein involved in the maintenance of lens clarity and refractive properties. We previously demonstrated that CRYAA genes undergo epigenetic repression in the lens epithelia in ARC. We further analyze the underlying mechanism in the current study.

DNA methylation is a major event of epigenetic modifications. In the presence of DNA methyltransferases (DNMT), the addition of methyl groups from cytosines can impact gene expression and alter cell and organism function. Methyl groups of CpG sites in the promoter can directly interfere with binding of transcription factors to their recognition cis elements or, on the other side, can facilitate interaction with a family of methyl-binding proteins and result in gene silencing. Analysis of DNA methylation includes genome-wide DNA methylation assessment, analysis of gene-specific DNA methylation and finding of new DNA methylation sites. The implication of DNA methylation has been suggested with the pathogenesis of retinoblastoma, uveal tract melanoma and ocular surface tumor. We focus on the progresses of DNA methylation on ocular tumors in this article.

Standardization of residency training aims to improve the overall quality of residents and bring up high-quality medical students.Research capabilities and innovative spirit of young physicians play important roles in the sustainable development of hospitals.This article describes the experience in strengthening research training in the United States residency program,provides recommendations to resolve the problems of our residency standardized training and new ideas for the domestic medical institutions to strengthen the young physicians' sense of innovation and scientific research ability.

Purpose: To identify proteins interacting with alpha A-crystallin (CRYAA) and to investigate the potential role that these protein interactions play in the function of CRYAA using a human proteome (HuProt) microarray.Methods: The active full-length CRYAA protein corresponding to amino acids 1-173 of CRYAA was recombined. A HuProt microarray composed of 17,225 human full-length proteins with N-terminal glutathione S-transferase (GST) tags was used to identify protein-protein interactions. The probes were considered detectable when the signal to noise ratio (SNR) was over 1.2. The identified proteins were subjected to subsequent bioinformatics analysis using the DAVID database.Results: The HuProt microarray results showed that the signals of 343 proteins were higher in the recombinant CRYAA group than in the control group. The SNR of 127 proteins was >= 1.2. The SNR of the following eight proteins was > 3.0: hematopoietic cell-specific Lyn substrate 1 (HCLS1), Kelch domain-containing 6 (KLHDC6), sarcoglycan delta (SGCD), KIAA1706 protein (KIAA1706), RNA guanylyltransferase and 5'-phosphatase (RNGTT), chromosome 10 open reading frame 57 (C10orf57), chromosome 9 open reading frame 52 (C9orf52), and plasminogen activator, urokinase receptor (PLAUR). The bioinformatics analysis revealed 127 proteins associated with phosphoproteins, alternative splicing, acetylation, DNA binding, the nuclear lumen, ribonucleotide binding, the cell cycle, WD40 repeats, protein transport, transcription factor activity, GTP binding, and cellular response to stress. Functional annotation clustering showed that they belong to cell cycle, organelle or nuclear lumen, protein transport, and DNA binding and repair clusters. CRYAA interacted with these proteins to maintain their solubility and decrease the accumulation of denatured target proteins. The protein-protein interactions may help CRYAA carry out multifaceted functions.Conclusions: One-hundred and twenty-seven of 17,225 human full-length proteins were identified that interact with CRYAA. The advent of microarray analysis enables a better understanding of the functions of CRYAA as a molecular chaperone.

Objective. To evaluate the postoperative visual quality of cataract patients with extreme myopia after implantation of aspheric intraocular lenses (IOLs). Methods. Thirty-three eyes were enrolled in this prospectivestudy. Eighteen eyes with an axial length longer than 28 mm were included in the extreme myopia group, and the other 15 eyes were included in the nonextreme myopia group. Phacoemulsification and aspheric IOL implantation were performed. Six months after cataract surgery, best-corrected visual acuity (BCVA), contrast sensitivity, and wavefront aberrations were measured, and subjective visual quality was assessed. Results. The BCVA improved significantly after surgery for both groups, and patients in the nonextreme myopia group achieved better postoperative BCVA due to better retinal status of the eyes. The evaluation of contrast sensitivity without glare was the same in both groups, whereas patients in the nonextreme myopia group performed better at intermediate spatial frequencies under glare conditions. The two groups did not show a significant difference in high-order aberrations. With regard to subjective visual quality, the composite scores of both groups did not differ significantly. Conclusions. Aspheric IOLs provided good visual outcomes in cataract patients with extreme myopia. These patients should undergo careful evaluation to determine the maculopathy severity level before surgery.

Objective To evaluate the safety and efficacy of a 23-gauge transconjunctival sutureless vitrectomy system for the management of traumatic cataract in children and to determine the short-term outcome and complications.Methods This retrospective study involved a consecutive series of 32 children (32 eyes) who suffered from traumatic cataract from March 2009 to September 2011.Each eye underwent anterior capsulotomy,lentectomy,posterior capsulotomy,and anterior vitrectomy through a superior limbal incision using a 23-gauge vitrectomy cutter.A limbal port incision was used to introduce an infusion micro cannula to maintain the anterior chamber with balance salt solution.The superior limbal incision was enlarged to 2.75 mm by a diamond knife.An intraocular lens (IOL) was implanted in the bag or sulcus.The enlarged incision was closed with one or two 10-0 nylon suture.Refraction correction with spectacles and amblyopic training began 1 week postoperatively.The mean follow-up period was 17.1±8.2 months.Results All the surgical procedures were successfully performed in all 32 eyes.No intraoperative complication was noted.The mean postoperative intraocular pressure (IOP) was 12.9±2.4 mmHg.Postoperative inflammation was mild.No fibrin reactions,vitreous escape or incarceration were noted in the anterior chamber.Neither significant aqueous flare nor aqueous cell was observed 1 week after surgery.Five eyes (15.6％) had mild posterior synechiae.All eyes had primary IOL implantation.IOL was implanted in the bag in 22 eyes (68.7％) and in the sulcus in 10 eyes (31.3％).The mean axial length of the 32 eyes was 22.36±1.03 mm at the time of operation and the mean IOL power was +22.97±1.89 D.Four eyes (12.5％) developed visual axis opacification (VAO) and required capsulotomy by YAG laser.IOL pigmentation was noted in 5 eyes (15.6％).No cases of ocular hypertension,glaucoma,choroidal detachment or retinal detachment were observed.The mean logMAR best corrected visual acuity (BCVA) was 2.37±1.16 preoperatively and 0.39±0.48 at the last follow-up,BCVA was significantly improved (t=10.916,P＜0.01).BCVA was improved in 29 eyes postoperatively.The predictors of good visual outcomes (BCVA≥20/40) included metal as the object causing injury,cataract operation within 3 month after injury and good amblyopic treatment (Fisher=O.028,0.047,0.000,respectively.P＜0.05).Conclusion Management of traumatic cataract in children via an anterior approach using the 23-gauge transconjunctival sutureless vitrectomy system appears safe and effective.Advantages include a more precise capsulotomy and more sufficient lensectomy and anterior vitrectomy,stable intraoperative IOP,and reduced surgical trauma and inflammation.

Uveitis is one of the common sight-threatening eye diseases, which is usually recurrent and refractory to treatment. It is generally considered that the development of uveitis is closely related to the autoimmune response of uvea. Tumor necrosis factor (TNF)-α is one of the key cytokines involved in the emergence and progression of uveitis. Blocking the production or inhibiting the activity of TNF-α can inhibit the development or progression of uveitis. Presently, the commercially available TNF-α blockers include infliximab, adalimumab, etanercept, and golimumab. This review describes the clinical studies and adverse effects of TNF-α blockers in the treatment of uveitis, and discusses the principle for clinical use of TNF-α blockers in synergy with other immunosuppressive agents.

小儿先天性白内障,是指眼睛的晶状体在出生时或在出生1年内发生部分或全部混浊,是导致儿童失明和弱视的常见眼病.调查显示,每250个新生儿中就有1个患有先天性白内障.而儿童致盲原因,约22％～30％为先天性白内障导致. 成人白内障常常因为视力减退而就诊,但是婴幼儿往往不善表达,特别是单眼发病的患儿,症状更加隐匿,难以早期发现,往往错失了最佳治疗时机.其实小儿先天性白内障如果能做到早期发现,早期诊断,早期治疗,大部分孩子的视功能仍能得到良好的发育.那么小儿先天性白内障有哪些征兆呢?