Annular electrode lacrimal duct reconstruction for improving the safety and efficacy of lacrimal stent implantation: a randomized clinical trial / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of annular electrode lacrimal duct reconstruction in improving the safety and efficacy of nasolacrimal duct stent implantation for treatment of nasolacrimal duct obstruction.</p><p><b>METHODS</b>This randomized clinical trial was performed to compare the efficacy, success rate of intubation, time used for stent implantation, intraoperative pain, and extubation-assciated complications between nasolacrimal stent implantation with and without annular electrode lacrimal duct reconstruction.</p><p><b>RESULTS</b>A total of 119 eligible patients were enrolled in this trial. The total curative rate at 6 months of follow up after extubation was 70.9% (83/117) in these patients, and was significnatly higher in pateinets with lacrimal duct reconstruction than in those without [80.6% (54/67) vs 58.0% (29/50); χ(2)=7.093, P<0.05]. The total success rate of stent implantation was 98.3% (117/119) in all the patients initially enrolled, and two patients experienced failure of stent implantation and were excluded; the success rate was signfiicantly higher in patients initially enrolled in the lacrimal duct reconstruction group (χ(2)=6.282, P<0.05). The median time required for intubation was shorter in lacrimal duct reconstruction group (12 s vs 33 s; Z=-36.722, P<0.05). The intendity of intraoperative pain was comparable between the two groups (t=0.833, P=0.405). The total rate of puncta injury was 43.6% (51/117) in these patients and similar between the two groups (χ(2)=1.459, P=0.227). The total rate of extubation difficulty was 9.4% (11/117) in all the patients, and was lower in lacrimal duct reconstruction group [4.5% (3/67) vs 16% (8/50); χ(2)=4.463, P<0.05]. Stent breakage in extubation occurred in 4.3% (11/117) of the patients with similar rates between the two groups (χ(2)=2.964, P=0.085). Spearman bivariate correlation analysis showed that the time required for intubation was inversely correlated with the treatment efficacy (r=-0.584, P<0.05) and positively with the occurrence of extubation difficulty (r=0.491, P<0.05); extubation difficulty was inversely correlated with the curative effect (r=-0.511, P<0.05).</p><p><b>CONCLUSION</b>Annular electrode nasolacrimal duct reconstruction can increase the safety and efficacy of nasolacrimal duct stent implantation for treatment of nasolacrimal duct obstruction.</p>

Analysis of risk factors of diabetic retinopathy inpatients with type 2 diabetes in the city of Dongguan / 中华实验眼科杂志

Background Diabetic retinopathy (DR) has become the main cause of blindness in the world,But the etiology of DR is still not clear,and the results of the studies on the risk factors of DR are not completely consistent.Fully understanding the risk factors of DR has an important clinical value for the prevention and treatment of DR.Objective This study was to analyze the prevalence rate and risk factors of DR inpatients with type 2 diabetes and provide a basis for the establishment of ophthalmic intervention programs and measures for diabetic inpatients.Methods Cross sectional study was performed.Four hundred and seventy three patients with type 2 diabetes in the department of endocrinology,Dongguan People's Hospital from July 2011 to July 2012 were included.The patients were divided into DR group and non diabetic retinopathy (NDR) group.The DR group was subdivided into mild,moderate and severe non-proliferative DR (NPDR) group and proliferative DR (PDR) group.The sex and age of patients,course of diabetes,body mass index (BMI),systolic blood pressure,diastolic blood pressure,fasting blood glucose (FBG),2 hours postprandial blood glucose (2 h PBG),glycosylated hemoglobin (HbA1 c),fasting insulin,2 hours postprandial insulin,high density lipoprotein cholesterol,low density lipoprotein cholesterol,apolipoprotein A1 (APOA1),APOB,alpha lipoprotein,total cholesterol,three glycerol,urea nitrogen,creatinine,uric acid,percentage of neutrophil,24 hours urinary albumin total (ALBU-24 h) and ALBU were detected.Logistic regression was used to analyze the relationship between DR and various factors,and the risk factors of DR were screened out.Results The prevalence of DR inpatients with type 2 diabetes was 28.33％,the prevalence of mild,moderate and severe NPDR were 2.54％,16.28％ and 4.23％,respectively,the prevalence of PDR was 5.29％.The prevalence of DME was 10.36％ in the DR patients.The course of diabetes,the levels of serum lipoprotein,creatinine,ALBU-24 h and ALBU were statistically significant between DR group and NDR group (all at P＜0.05).By stepwise Logistic regression analysis,the course of disease,FBG were identified as the independent risk factors of DR (course of disease:odds ratio [OR] =1.155,95 ％ confidence interval [CI]:1.067-1.251;FBG:OR =1.313,95％ CI:1.071-1.610).Conclusions The course of diabetes,lipoprotein,creatinine,ALBU-24h,ALBU are closely related to the occurrence and development of DR.The course of diabetes and FBG are the independent risk factors of DR.

Long-term changes of corneal endothelial cells following Artisan phakic intraocular lens implantation / 中华实验眼科杂志

Background Artisan phakic intraocular lens (pIOL) implantation was demonstrated to be safe and effective for the correction of high myopia in short-term.However,long-term corneal endothelium status after operation should be concerned.Objective This study was to investigate the long-term changes of corneal endothelial cell density (ECD) and morphology following Artisan pIOL implantation for the correction of high myopia.Methods Fifty-one eyes of 27 patients who received Artisan PIOL implantation for high myopia from January 2005 to December 2008 were retrospectively analyzed.The central corneal ECDs were detected by corneal endothelial cell counter before surgery and 6 months and 1 year,2,3,4,5,6 years after surgery,and the coefficient of variation (CV) and standard deviation (SD) of cellular area were evaluated.ECD loss rate with time lapse was calculated ([preoperative ECD-postoperative ECD]/preoperative ECD× 100％).Results Six years after surgery,there were 34 eyes with BCVA ≥ 1.0,14 eyes with BCVA higher than preoperative and 8 eyes with BCVA lower than preoperative.The mean intraocular pressure was (14.23±2.14)mmHg 6 years postoperative.The preoperative mean ECD was (3 184.05±233.55)/mm2,and the ECD was gradually reduced over time with the cell loss 2.34％ in 6 months,5.32％ in 1 year,6.32％ in 2 years,8.06％ in 3 years,12.59％ in 4 years,15.63％ in 5 years and 19.49％ in 6 years after operation.Before surgery,The mean CV of cellular area was 37.17±7.12,and the SD of cellular area was 118.77±21.39,and those 6 years after surgery were 32.24 ±4.62 and 125.60± 18.49,respectively.The mean CV and SD of cellular area were significantly different among different time points (P =0.000,0.036).Eight eyes with localized iris depigmentation,6 eyes with IOL dyssymmetry,3 eyes with transient high intraocular pressure and 2 eyes with Macular hemorrhage were obtained after surgery.Conclusions Corneal endothelial cells appear obvious changes in both number and morphology after Artisan pIOL implantation in high myopia.ECD is gradually reduced with time lapse,and the shape of the cells occur remodeling during 6-year fellow-up duration.Overall,endothelial specular microscopy is mandatory before and after surgery for a long term.

Phenotypes,distribution, and morphological features of antigen-presenting cells in the normal murine iris / 中华实验眼科杂志

Background The conventional study of antigen-presenting cells(APCs)in eye relies on in vitro histoimmunochemistry,but its outcome is influenced by many factors.The anterior chamber injection of fluoresceinmarked antibody was used as a new approach before,however,it is liable to lead to injury of cornea.The intravitreal injection of fluorescein-labeled antibody may be important for the in vivo study of the phenotype features of APCs in iris,which is significant for evaluating the function of APCs in immune homeostasis.Objective This study was to investigate the phenotype characters,distribution and morphology of different types of APCs in the normal murine iris.Methods Fifty-one SPF female BALB/c mice(from 6-to 8-week old)were randomized into 17 groups according to the injection of different antibodies.Alexa Fluor 594 or Alexa Fluor 488-tagged ovalbumin (OVA),CD11 c,major histocompatibility complex Ⅱ (MHC-Ⅱ),F4/80,B7-1 and B7-2 monoclonal antibodies or mixtures of two antibodies (2.0 μl)were intravitreally injected at 0.5 mm far from corneal limbus with microneedle under the biomicroscope.The iris tissues were isolated 24 hours after injection.The phenotype characters,precise distribution and morphology of different types of APCs were identified by epifluorescence microscope and laser confocal microscope.In vitro staining was also performed to validate the in vivo staining results.Results After in vivo staining via intravitreal injection,the cell positive for OVA as well as MHC-Ⅱ,F4/80,CD11 c,B7-1 and B7-2 were exhibited with the regular networkline appearance throughout the normal murine iris.Positive cells tagged with Alexa Fluor 594 or Alexa Fluor 488 presented the red or green fluorescence.Double-fluorescein staining showed that about 90％ of F4/80+ cells were OVA+,and MHC-Ⅱ was expressed in about 60％ of F4/80+ cells and CD11c+cells,and about 35％ of F4/80+ cells and CD1 1 c+ cells expressed B7-1 and B7-2 simultaneously,and over 70％ of OVA+ cells were positive to MHC-Ⅱ.These labeled cells were identified as two populations based on their shape.One type was dendritiform cell (DC) with a small cell body and many long dendrites,including OVA+,CD1 1 c+,F4/80+ cells and MHC-Ⅱ + cells ; and the other types were polymorphic population being round,pleomorphic or irregular shape with a large cell body and a few short dendrities,including B7-1 + and B7-2+ cells.Conclusions In vivo intravitreal injection of labeled antibodies can be adapted to visualize the labeled cells in the murine iris.APCs with distinct morphologies,phenotypes and distribution may contribute to the immunologically privileged feature and inflammation of the eye.

Comparison of different methods for the measurement of central and paracentral corneal thickness in post-LASIK eyes / 中华实验眼科杂志

Background Accurate measurement of corneal thickness is very important during the pre-and post-operative management of corneal surgical procedures,especially laser-assisted in-situ keratomileusis (LASIK),which is the most popular approach to the correction of refractive errors currently.This may be particularly important for the patients who have undergone previous laser refractive surgery with suboptimal outcomes and are being considered for an enhancement procedure.Objective This study was to compare the measuring outcomes of corneal thickness by slit-scanning pachymetry,non-contact specular microscope,anterior segment optical coherence tomography (AS-OCT)and ultrasound pachymetry,with a focus on central and midperipheral (from the central 3.0 mm) region of cornea in post-LASIK eyes.Methods Sixty-four right eyes of 64 patients who received LASIK were collected in Henan Eye Institute,Henan Eye Hospital from March to June 2011 with the equivalent spherical diopter of (-4.75±2.38)D and horizontal corneal diameter of (11.36±0.32)mm.Central corneal thickness was measured on each eye by using non-contact specular microscope (Topcon SP-3000P),slit-scanning pachymetry (Orbscan Ⅱ),AS-OCT and A-type ultrasound pachymetry,respectively,and the paracentral corneal thickness including 12:00,2:00,6:00 and 10:00 meridian was measured using Orbscan Ⅱ,non-contact specular microscope and AS-OCT.The measuring values and the agreement from different instruments were compared and evaluated.Results The mean central corneal thickness was (467.12±31.10)tμm for AS-OCT,(466.67±30.99)μm for ultrasound pachymetry,(441.84 ± 33.65) μm for specular microscopy and (422.51 ± 44.09) μm for Orbsan Ⅱ,respectively,showing a significant difference among the four methods (F =23.730,P =0.000).The central thickness value of the A-type ultrasound pachymetry was significantly higher than that of Orbsan Ⅱ or non-contact specular microscope (q =6.940,6.720,both at P =0.000).Compared with Orbscan Ⅱ,the measuring values of non-contact specular microscope and AS-OCT were significantly higher (q =-5.54,6.940,both at P =0.000),and the measuring value of AS-OCT was significantly higher that of non-contact specular microscope (q =6.800,P =0.000).The lowest difference value (25.3 μm)and the best agreement was found between the ultrasound pachymetry and AS-OCT.The paracentral corneal thickness values in 12:00,2:00,10:00,6:00 meridians were highest for Orbsan Ⅱ and the next for AS-OCT,and non-contact specular microscope had the lowest values,with significantly differences among them (F =5.020,22.950,67.890,18.850,all at P ＜ 0.01).Conclusions The corneal thickness values vary with the different instruments.Orbsan Ⅱ underestimates the central corneal thickness and overestimates the midperipheral corneal thickness,and non-contact specular microscope underestimates both the central and midperipheral corneal thickness.The measuring outcome from AS-OCT has a good agreement with ultrasound pachymetry and therefore they can be used interchangeably.

Pay close attention to the advances of epigenetics in lens / 中华实验眼科杂志

Epigenetics is a branch of conventional genetics and is an emerging research field in biomedicine.Epigenetic factors regulate gene function and phenotype by the modulation of DNA methylation,histone modification,non-coding RNA such as microRNA expression instead of changing the DNA sequence.Therefore,it is thought to be a discipline associated with life science.Epigenetics is opening new means for understanding ocular development and ocular diseases related to aging and environment,and relevant study is increasingly emphasized because epigenetic inheritance is considered to be a reversible process.Like other ocular tissues,the growth,differentiation,senescence and epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) are modulated by epigenetic inheritance.Epigenetic inheritance participates in the regulation of gene phenotype,chromatin structure,non-coding RNAs,and cellular differentiation and potential influent in lens diseases such as cataracts.Therefore it may provide new insight of the pathogenesis of cataracts and development of novel treatment options by vigorously carrying lens research on epigenetics.Domestic ophthalmologists should keep watchful eye to these studies.

Focusing on the signal pathway of diabetic retinopathy and guiding the target therapy of diabetic retinopathy / 中华实验眼科杂志

Diabetic retinopathy (DR) is one of common causes of vision loss.Recent years,progress has been made on the signal pathway in DR which provides more theoretical basis for clinical therapies and more chance for developing targeted therapeutic drugs.Understanding the biological function of the signal pathway in DR is helpful for physicians to selectively control its biological activities,make medical decisions and optimize new approaches to the treatment of DR.How to closely combine the study of signal pathway and targeted therapy in practice is a key link of improving the therapeutic effect of DR.Therefore,we should pay attention to translational medicine and reinforce targeted therapy in DR.

Advances on heme oxygenase-1 on angiogenesis of tumors / 国际肿瘤学杂志

Studies show that heme oxygenase-1 (HO-1) can promote the tumor neovascularization via interacting with angiogenic factors,such as vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1.On the other hand,HO-1 may suppress angiogenesis in tumors via inhibiting the transcription of NF-кB.In a word,HO-1 may participate in the pathophysiological process of tumor angiogenesis,and may be a new target for cancer treatment.

Detection of Toric intraocular lens misalignment by digital photograph / 眼科研究

Background Toric intraocular lens (Toric IOL) is a well accepted method of correct of corneal astigmatism.Axial misalignment,including the error of intraocular lens alignment during surgery and rotation of Toric IOL,is the main barrier to the precise alignment of Toric intraocular lenses.Therefore,the angle of axial misalignment is a main index to evaluate the effectiveness of Toric IOL implantation.Objective The present study is to describe a method of precisely detecting Toric IOL misalignment using postoperative digital photograph.Methods A measuring template (polar coordinates) was constructed using Adobe Photoshop software.Minimum graduate to detect the Toric axis was 1° (maximum error 0.5°).The clinical data of 24 eyes undergone Toric IOL implantation was retrospectively analyzed.Corneal astigmatism was detected by rotating Scheimpflug camera (Pentacam) or slit scan (Orbscan).Digital retro illumination picture was photographed after mydriasis.The picture was analyzed by our derived template.The steepest corneal axis and the axis of Toric IOL were then determined.The misalignment of Toric IOL was determined as the angle between the steepest corneal axis and the axis of Toric IOL.Misalignment of Toric IOL and its distribution were analyzed by statistical means.Results A method using polar coordinates and digital photo to precisely detect Toric IOL misalignment was derived.Mean Toric IOL misalignment was 10.93±6.90 degrees (0-24 degrees) in the 24 cases.The axial misalignment in all of cases were within 25 degrees,including clockwise in 14 eyes(58.33%),anticlockwise in 10 eyes (41.67%).In this study,the misalignment angle of 4 eyes were within 5 degrees;11 eyes were 5 to 10 degrees;1 eye was 10 to 15 degrees;6 eyes were 15 to 20 degrees;2 eyes were 20 to 25 degrees.Conclusion The method is feasible to the direction of Toric IOL misalignment in clinic.

Progress in the gene-related study on autosomal retinitis pigmentosa / 眼科研究

Retinitis pigmentosa (RP) is a common sight-threatening eye disease.RP is characterized by highly genetical and phenotypical heterogeneity.Identification of the causative genes of RP is the first step toward the understand of the molecular basis of RP and,subsequently,toward the prevention and treatment of RP.In recent years,there have been new progress in the study on RP.This review mainly focuses on recent advances in the gene-related studies of autosomal dominant RP (adRP) and autosomal recessive RP (arRP) with emphasis on the roles of common genes,as well as their possible mechanisms in RP in order to provide the essential reference for the genetics research of RP.

Clinical analysis of phacoemulsification and intraocular lenses implantation on 546 patients / 眼科新进展

Objective　To analyze the therapeutic effects of phacoemulsification with intraocular lens in several kinds of cataract.Methods　The surgery was performed under topical anesthesia on 672 eyes of 546 patients with senile ,complicated ,congenital and traumatic cataracts through different incision.Results　Postoperatively, the visual acuities with spherical correction or without correction were 0.5 or better in 83.0%, 88.9% of the eyes three hours later and in one day; and 1.0 or better in 27.2%, 28.7% in one week and one month. The mean postoperative astigmatism was all under +1.0D which was not found preoperatively in only 35 patients. There was no significant difference of the visual acuities between every two kinds of different cataract.Conclusion　The phacoemulcification with intraocular lens implantation can be widely used in treating different kinds of cataract.

Comparison of higher-order aberrations between implantations of aspherical intraocular lens and spherical intraocular lens / 眼科

Objective To compare intraindividual higher-order aberrations(HOA)after implantation of aspherical and spherical intraocular lenses(IOL).Design Prospective,case-controlled study.Participants 33 patients(66 eyes)were between 50 and 76 years of ages.The patients with bilateral senile cataracts were operated with phacoemulsification and IOL implantation.All the patients had no other ocular pathologies and no previous ophthalmic surgery.Patients with keratometric astigmatism higher than-2.0 diopters(D)were excluded from the study.Methods Wavefront aberration measurements of 33 patients(66 eyes)after implantation of a spherical IOL(Canon Staar KS-3)in one eye and an aspherical IOL(Cannon Staar KS-3Ai)in the contralateral eye were analyzed.The eyes were randomly assigned to groups of the spherical IOL or the aspherical IOL.Third-order,4th-order,5th-order,total HOA root-mean-squares(RMS),and 4th-order spherical aberrations(Z40)were compared 3 months after surgery.Main Outcome Measures Visual acuity(VA),the best corrected visual acuity(BCVA),the centrality of IOL,refraction data,diameter of pupil size,3rd-order,4th-order,5th-order and total HOA RMS,and 4th-order spherical aberration(Z40)RMS were measured.Results Fourth-order aberration RMS(0.193?0.098?m),Z40 RMS(0.037?0.099?m),total HOA RMS(0.498?0.072?m)in the aspherical IOL group were lower than those with the spherical IOL(0.403?0.155?m,0.381?0.142?m,0.737?0.164?m,respectively)at 6mm pupil diameter.For 3rd-and 5th-order RMS at 6mm pupil diameter,total HOA RMS(at 5mm pupil diameter),no significant difference was found in both IOLs.Under mesopic conditions,ten patients(30%)with an aspheric IOL had better contrast sensitivity.The average myopic shift were(-0.29?0.09)D and(-0.87?0.16)D in the aspherical and spherical IOL groups at 6mm pupil diameter(P