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Objective To compare the dosimetric difference among plans designed by 4-field,6-field TomoDirect and TomoHelical techniques in Tomotherapy system for left-breast cancer patients with radiotherapy after breast-conserving surgery.Method A total of 16 patients with left-breast cancer following breast-conserving surgery and intensity-modulated radiation therapy were enrolled in this retrospective study.The 4-field TomoDirect (TD4),6-field TomoDirect (TD6),and TomoHelical (TH) techniques were applied to design simulation plans in tomotherapy system for each patient,respectively.The differences of dose distribution and treatment parameters were analyzed in this study.Results Three plans all met the clinical requirement.Thereinto,TD4 was superior to TH in the dose limitation of organs at risk (OARs),especially the max dose of cord and right-breast,thc 5 Gy radiation volume of lung,and the mean dose of heart(F =595.60,129.24,60.44,65.37,P ＜ 0.05),but inferior to TH in dose homogeneity (HI) and conformity (CI) (F =2.78,60.93,P ＜ 0.05).However,TD6 improved TD4's HI and CI when delivered the lower OARs dose compared to TH.Meanwhile,the number of monitor units was less in TD technique and reduced the treatment times (F =24.89,3.75,P ＜ O.05).Conclusions For the radiotherapy of left-breast cancer patients after breast-conserving surgery,TD6 technique appeared to be superior,with the lower radiation dose of OARs compared to TH technique,and the better target's HI and CI in comparison with TD4 technique,especially in patients with early stage breast cancer.
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Background Neovascular glaucoma (NVG) often occurs secondary to ocular ischemic diseases.Intravitreal injection of bevacizumab or ranibizumab as an adjunct therapy or NVG is safe and efficient.However,the efficacy of intravitreal injection of conbercept for NVG is still under exploration.Objective This study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for NVG.Methods A prospective,interventional case series study was performed.Twenty-six patients (27 eyes) who were diagnosed with NVG in Tianjin Eye Hospital were included.Twenty-five eyes were initially injected with conbercept into vitreous,then trabeculectomy and panretinal photocoagulation were performed,the best corrected visual acuity (LogMAR),intraocular pressure and treatment-related indexes were examined before and after treatment,the intraoperative and postoperative complications were evaluated.Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue.Enucleation was performed on 2 eyes,and the surgically excised tissue was taken as the histopathological controls.Results At six monthes after surgery,the intraocular pressure of the 25 patients with intravitreal injection of conbercept were decreased from (48.8 ± 10.2) mmHg to (18.0±4.3) mmHg,the number of anti-glaucoma medications were decreased from 3.0 (3.0,4.0) to 0.0 (0.0,1.0) (both at P＜0.05).Best corrected visual acuity (LogMAR) was increased from 2.0± 0.9 to 1.5 ± 1.4 (P＞0.05).Twenty-one eyes displayed controlled intraocular pressure (≤ 21 mmHg) after treatment.Regression of neovasculariztion in the surface of iris and thin-walled vessels in the iris stroma in specimens with intravitreal injection of conbercept were revealed by light microscopy.New vessels decreased,endothelial cell degeneration and vascular occlusion or cavity in the iris stroma in the conbercept-treatment specimens were revealed by transmission electron microscopy.Conclusions A comprehensive therapy for NVG can regress iris neovascularization,reduce postoperative complication,effectively control intraocular pressure and preserve visual function by intravitreal injection of conbercept,anti-glaucoma surgery and panretinal photocoagulation.
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Background Persistent hyperplastic primary vitreous (PHPV) is a congenital eye disease of children,because its clinical manifestations are nonspecific,it is easy to be misdiagnosed as congenital cataract and the prognosis is poor.There has been more researches on PHPV clinical characteristics than its histopathological feature and immunochemistry.Objective This study was to investigate the clinical characteristics of PHPV and the pathological characteristics of retrolental membranes secondary to PHPV.Methods The clinical data of 6 PHPV eyes from 6 patients during May 2005 to December 2014 were retrospectively analyzed.All the PHPV eyes received a combinating procedure of cataract extraction and anterior vitrectomy.The retrolental membranes were collected during surgery for the histopathological examination by hematoxylin & eosin staining and periodic acid-Schiff (PAS)staining.Immunochemistry was used to detect the expression of Vimentin,smooth muscle actin (SMA),S-100,glial fibrillary acidic protein (GFAP),neuron specific enolase (NSE),epithelial membrane antigen (EMA),CD34 and proliferating cell nuclear antigen (PCNA) in the retrolental membranes.Results Monocular PHPV was found in 6 cases since born,with the main clinical manifestation of similar to congenital cataract.The ocular axial was shorter in 5 PHPV eyes than that of the contralateral eye by A-sonography,and 1 eye accompanied by eye nystagmus,strabismus and small cornea.The retrolental membranes were seen during the surgery in all cases,and the white band through the vitreous in 2 eyes.Pathological examination showed that the retrolental membrane was mainly composed of loose or myxoid connective tissue fibers,the capillaries and small veins.PAS positive tissue,residual transparent artery and differentiated adipocytes were exhibited in some specimens.Immunohistochemistry indicated that spindle-shape cells in the retrolental membranes presented the characteristics of mesenchymal cells,and some cells appeared the myofibroblast characteristics with the low proliferation activity.The development of the lens and the ciliary body was abnormal because of the stretching of retrolental membranes into the lens capsule in 1 PHPV eye.The follow-up was performed for 6-9 years in 4 eyes,with the best corrected visual acuity (BCVA) for 0.06,light perception,0.05 and 0.07 respectively.The intraocular pressure was normal in all the eyes.Conclusions PHPV is usually misdiagnosed as congenital cataract and shows a poor postoperative BCVA.PHPV occurs mainly due to an incomplete regression of the embryonic vitreous and hyaloid vasculature and eventual abnormality of lens.
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Background The primary reason to trabeculectomy failure is fibrosis of conjunctiva and episclera because of progressive fibroblast proliferation and collagen deposition of the filtration bleb.Conventional methods of inhibiting bleb scarring was intraoperative application of mitomycin C (MMC),but many complications occured after surgery.Researches showed that bevacizumab was an antifibrotic agent,and whether it can suppress scarring of filtering bleb after trabeculectomy is concerned.Objective The aim of this study was to evaluate the antifibrotic efficacy of bevacizumab after trabeculectomy in rabbits.Methods Forty New Zealand rabbits were randomly divided into four groups.Trabeculectomy was performed on the right eyes of each rabbits.The rabbits received subconjunctival injection of 0.05 ml bevacizumab (25 mg/ml) at the end of operation in the bevacizumab single injection group.The same dose of bevacizumab was respectively injected at the end of operation as well as 3 days and 7 days after operation in the bevacizumab repitition injection group,and 0.05 ml normal saline solution was used in the same way in the normal saline group.In the MMC group,MMC cotton patch with 0.2 mg/ml was placed under the Tenon caplsule and scleral flap for 3 minutes during operation.The intraocular pressure (IOP),bleb area and shape were evaluated during the 28-day period.The animals were sacrificed on postoperative day 14 and 28,respectively for the histopathologic examination of bleb.The expression of CD31 in the bleb was detected by immunohistochemistry for the calculation of microvessels.All experiments were performed in accordance with the ethics code for animal experimentation and approved by the Institutional Review Board of Tianjin Eye Hospital.Results No significant difference was found in the postoperative IOP among the groups (F =0.88,P =0.47).Compared with the bevacizumab single injection group,MMC group and normal saline group,the shape of bleb was higher and much diffuse with sparse vessels 7 days after operation in the bevacizumab repitition injection group.The survival time of bleb was 27 days,19 days and 13 days in the bevacizumab repitition injection group,the bevacizumab single injection group,MMC group and normal saline group,respectively.The percentage of collagen deposition area was (49.18±1.54)％,(26.41±1.23)％,(50.68±1.87)％ and (70.63±1.81)％ at day 14 postoperative in the bevacizumab single injection group,bevacizumab repitition injection group,MMC group and normal saline group,respectively,with the largest area in the normal saline group,and percentage of collagen deposition area was significantly reduced in the bevacizumab repitition injection group compared with the bevacizumab single injection group (all at P＜0.05).The percentage of collagen deposition area was (66.82±1.53)％ at day 28 postoperative in the bevacizumab repitition injection group,while complete scarring was seen in other 3 groups.The number of microvessels was least at postoperative day 14 in the bevacizumab repitition injection group compared with the bevacizumab single injection group,MMC group and normal saline group (all at P ＜ 0.05).The number of microvessels was more in postoperative day 28 in the bevacizumab repitition injection group (3.51 ±0.31) compared with other groups (all at P ＜ 0.05).Conclusions Subconjunctival injection of bevacizumab following trabeculectomy can improve the successful rate of surgery by remaining the survival time of filtering bleb,inhibiting the bleb scarring in rabbits.
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Background Primary iris stromal cysts is a rare clinical disease.In recent years,the pathological findings of primary iris stromal cysts are different from previous literature reports.It is very important to understand the pathological characteristics of primary iris stromal cysts for illuminating its pathogenesis and accurate treatment.Objective This study was to analyze the pathological types and clinical manifestations of primary iris stromal cysts.Methods Histopathological sections of 14 patients with primary iris stromal cysts from January 1979 to December 2012 in Tianjin Eye Hospital were retrospectively analyzed.The primary iris stromal cysts were typed based on the hematoxylin-eosin staining,periodic acid-Schiff (PAS) staining and immunochemistry, and the clinical chacteristics upon different types were evaluated.Results In 14 specimens of primary iris stromal cysts,squamous epithelial type was found in 9 specimens,lens epithelial type in 3 specimens and ciliary body epithelial type in 2 specimens.The primary iris stromal cysts of squamous epithelial type were constituted of non-cuticular stratified squamous epithelium cells,and sporadic goblet cells were found in some specimens.The primary iris stromal cysts of lens epithelial type were consisted of lens epithelium cells and lens capsular analogic tissue and the cysts were tightly adherent to the lens.Crystalline lens dysplasia were seen in 2 specimens.The primary iris stromal cysts of ciliary body epithelial type showed single or stratified ciliary body like epithelium cells.Iris-ciliary dysplasia or anterior chamber angle abnormality was displayed in 1 specimen in this type of cysts.Under the slit lamp microscope,superior-temporal clear cysts were often seen in the primary iris stromal cysts of squamous epithelial type, and translucent cysts or diffuse swelling cysts were exhibited in the lens epithelial type and might be accompanied with lens dysplasia and cataract.Diffuse swelling was found in the cysts of ciliary body epithelial type which were often associated with chamber dysplasia and infantile glaucoma.Conclusions Primary iris stromal cysts are pathologically classified into squamous epithelial type, lens epithelial type and ciliary body epithelial type and present with different clinical appearances.
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Background The extraocular muscles (EOMs) Pulley in primate is related to the function of EOMs,but there are arguments about that.The location of rabbit's eyes is different from the primate.Study on the structure of the extraocular muscle connective tissue in rabbit may play a role to analyze the function of the EOMs Pulley.Objective The structure of the connective tissue around EOMs in rabbit was studied,the difference between this structure in rabbit and homan' s EOMs Pulley in past reports was analyzed,and then,the role of EOMs Pulley to ocular movement was investigated.Methods Five adult rabbits were involved.The gross anatomy of an orbit in each rabbit was observed.The other orbit was processed with paraffin imbedding and coronal serial sections.A murine monocolonal antibody to α-smooth muscle actin(α-SMA) was used to show the smooth muscle,while Weigert stain was used to show muscle and collagen,and Masson trichrome stain to show the elastin.Results An encircling ring of collagen circled every EOM.The collagen ring was thin and connected to the orbital layer muscle fiber loosely.Collagen tissues coupled to adjacent EOMs.Less elastin fibers and scanty the smooth muscle cells were embedded in the collagen.Conclusions The connective tissue around rectus in rabbit is different from that in human with developed binocular ocular movements.It shows that connective tissue around EOMs may be related to the function of ocular movements.
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Background Endoscopic cyclophotocoagulation(ECP) is a new approach to treat refractory glaucoma.But,the histopathological change of ciliary body after ECP has not been reported yet.ObjectivePurpose of the present study is to explore the histopathologic change of ciliary body after ECP and investigate the mechanism of lowing intraocular pressure(IOP) of ECP and compared with trans-scleral cyclophotocoagulation (TSCP).MethodECP was performed on the right eyes of 30 adult pigmented rabbits and TSCP was taken in the fellow eyes.Other two normal pigmented rabbits were as control group.The clinical examinations were performed in day 1,3,5,7,14,28,42 and 56 after operation under the slim lamp to evaluate the inflammatory reactions of conjunctiva,sclera and cornea,and the IOP was detected in the same time points.The animals were sacrificed and the eyeballs were extracted for the examination of structure of ciliary body under the light microscope in day 7,14,28,42 and 56 after surgery respectively.ResultsThe mild inflammatory response and local opacity of lens were seen under the slim lamp in the eyes after ECP,and severe inflammatory reaction was in the eyes received TSCP.No opacity of lens was found after TSCP through the observing period.The lowing-IOP extent was significantly higher in ECP group than TSCP group after operation(P＜0.01).The structure of ciliary body epithelium was normal in normal rabbit eyes.The disruption of ciliary body epithelium,especially for non-pigment epithelial layer,edema of ciliary process were seen in the early period after ECP.Fourty-two days later,the irregulation of ciliary body epithelium and atrophy of ciliary process were exhibited under the light microscope.In TSCP group,the edema,blooding and damage of ciliary process were seen,but slight inflammatory response was in the ciliary epithelium.After 42 days of surgery,atrophy of ciliary body,irregular proliferation of pigmental and non-pigmental epithelial cells,thinness of sclera and scarring of ciliary stroma were revealed.ConclusionCompared with TSCP,ECP can selectively destroy ciliary epithelium effectively and thoroughly and therefore reduce IOP.The adverse effect of ECP is the opacity of lens.Less damage of adjacent tissue is found in ECP compared with TSCP.
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Objective To observe the classification,clinical and pathological features of ciliary body tumors. Methods The clinical and pathological data of 11 cases of primary ciliary body tumors were analysed retrospectively. Results By pathological examination,the tumors of these cases were devided into malignant melanoma (2 cases), benign melanocytoma (3 cases),leiomyoma (2 cases), and angio- leiomyoma, neurilemoma, non-special granuloma and medulloepithelioma (1 case respectively). Both of the benign and malignant tumors of ciliary body tended to grow and enlarge progressively. The cardinal clinical manifestations of this series of 11 cases were as follows: elevation of intraocular pressure in 7, local scleral vascular dilatation in 5, secondary exudative retinal detachment in 5,and the signs of anterior uveitis in the early stage of tumor growth in 4. Conclusion The histopathological types of cilliary tumors are manifold,and the tumors are prone to enlarge progressively in developement either in benign or malignant ones, so that the rates of clinical misdiagnosis are relatively high.