The clinical characters of tear film instability in diabetes patients / 中华实验眼科杂志

Background The current epidemiology study had shown the prevalence of age and sex adjusted dry eye was higher in patients with diabetes than population without diabetes.Further researches demonstrated that the tear film disturbance is common after the phacoemulsification or photocoagulation in the eyes of diabetic patients.Objective The aim of this study was to characterize the clinical features of tear film instability in diabetes patients.Methods One hundred and sixty-two patients with tear-film abnormality referred to Tongren Eye Center from January 1,2010 to September 1,2010 underwent questionnaire about diabetes and other diseases,BUT,Schirmer test.Tear film instability was diagnosed as abnormality of either Schirmer test or BUT and showed as M ( Q25,Q75 ).The right eyes of 162 dry eye patients meeting with the including criteria were enrolled.The patients were assigned to two groups according to with ( 80 patients) or without ( 82 patients) diabetes mellitum.DEQ questionnaire were scored.The percentage of cases with meibomain gland abnormal score ＞ 1 was calculated.Mann-Whitney U analysis and Chisquare analysis were used to compare the difference between the two groups.Results The Schirmer test in diabetic group was 8 ( qualities:5,9 )mm and was longer than 6 ( qualities:5,7 ) mm in non-diabetic patients ( U =2452,P =0.00).The result of BUT test was 3 ( qualities:2,4 ) seconds in diabetic patients and was shorter than 4 (qualities:3,5) seconds in non-diabetic patients( U=2104,P＜0.01 ).The DEQ score of diabetic patients was 15 ( qualities:1 0,19,which was less than21 ( qualities:19,23.25 ) in non-diabetic patients.51.2 ％ ( 41/80 ) diabetic participants and 32.9％ (27/82) nondiabetic participants appeared meibography ( grade larger than 1 ) (x2 =16.07,P=0.00).The percentages of dry eyes were 51.2％ (41/80) and 93.9％ (77/82) respectively in diabetes and nondiabetes groups(x2 =37.24,P＜0.01 ).No significant correlation was found between the diabetes course and DEQ score or meibography( r =0.16,P =0.16 ; r =0.10,P =0.36 ).Conclusions Diabetes patients with tear film instability have longer Schirmer test results,shorter BUT,more severe meibomain glands damage and lower DEQ scores.The dry eye symptom is lack in the diabetic patients though appearing the tear film and meibomain glands damage.Therefore,more attention should be given to ocular surface health in diabetes patients.

Management of blood vessels in the vascularized autogenous submandibular gland transfer for severe keratoconjunctivitis sicca / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To summarize the management of blood vessels in the transfer of vascularized autogenous submandibular gland.</p><p><b>METHODS</b>Sixty-eight cases of vascularized transfer of autogenous submandibular gland for severe keratoconjunctivitis sicca performed from August 1999 to April 2004 were reviewed. Data collected for each patient included general items, donor and recipient vessels, vessel crisis, salvage of the vessel thrombosis, and survival of transferred glands.</p><p><b>RESULTS</b>Among the 68 cases, all the donor and recipient arteries were facial artery and superficial temporal artery respectively. For donor veins, 55 were facial veins, 1 was vein near the duct, and 12 were venae comitantes of facial artery. For recipient veins, 62 were superficial temporary veins and five were veins in the upper neck, one was deep temporary vein. Vessel thromboses occurred in 10 cases, 9 were venous and 1 were arterial. The salvage rate was 10.0%, with the overall survival rate of 86.8% of transferred gland.</p><p><b>CONCLUSIONS</b>Variation in venous outflow is common in microvascular transfer of submandibular gland, and anastomosis between venae comitante of facial artery and superficial temporal vein is most dependable. Vessel anastomosis under microscope may reduce the vessel thrombosis rate after operation.</p>

Identification of BIGH3 gene mutations in the patients with two types of corneal dystrophies / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the mutations of BIGH3 gene in Chinese patients with corneal dystrophies.</p><p><b>METHODS</b>Polymerase chain reaction in exon 4, exon 12 and direct DNA sequencing of BIGH3 gene were performed in fifteen patients with corneal dystrophies and ten normal individuals as controls.</p><p><b>RESULTS</b>Mutations in BIGH3 gene were detected in all the patients with corneal dystrophies. BIGH3 gene mutations were not found in normal subjects. Twelve patients with Avellino corneal dystrophy had the missense mutation R124H in the BIGH3 gene. Three patients with granular corneal dystrophy had the missense mutation R555W in the BIGH3 gene.</p><p><b>CONCLUSION</b>R124H and R555W mutations in BIGH3 gene were found in the patients with Avellino and granular corneal dystrophies. Avellino corneal dystrophy associated with the R124H mutation is the most common form in the corneal dystrophies resulting from BIGH3 gene mutations. Condons 124 and 555 are also the hot spots for the mutations in the BIGH3 gene in the Chinese patients with corneal dystrophies.</p>

Stress on recognition of dry eye in children with ocular allergic disorders / 眼科

Most patients with allergic conjunctivitis in children are vernal keratoconjunctivitis.Dry eye accompanied with al- lergic conjunctivitis in children is correlated with the decline of tear film stability.However,tear film stability decline is correlated with eosinophilic activation and concomitant release of inflammatory mediators.Moreover,conjunctival epithelial,goblet cells and tear film are damaged,then dry eye occur.Main symptom of dry eye in children is twinkling frequency increasing,followed by eye itch,eye red and photophobia.When allergic conjunctivitis in children is diagnosed,dry eye should be considered at the same time.Proper manage- ment for those allergic conjunctivitis can decrease ocular surface damages.

Fourteen cases of rhenmatic diseases associated corneal melting / 眼科

Objectives To analyse the clinical feature,drug and surgical treatment and prognosis of rheumatic diseases associat- ed corneal melting.Design Retrospective case series.Participants 14 patients (22 eyes) with rheumatic diseases associated corneal melting.Methods The clinical data of patients were analysed,including history,visual acuity,slit-lamp microscopy examination,drug and surgical treatment and follow-up results.Main Outcome Measures The clinical feature,therapeutic effects and recurrence. Results The follow-up was 6～24 months.Rheumatic diseases associated corneal melting always firstly occurred from the upper corneal limbus.The marginal lesions of cornea included melting of the stroma,resulting in corneal thinning or even perforation,with neovascu- larization.The corneal lesions in 4 eyes were within 1 quadrant,10 eyes within 2 quadrants,6 eyes within 3 quadrants,and 2 eyes in 4 quadrants.Eight eyes of 5 cases,whose corneal lesions were thinner than 2/3 of normal corneal thickness,received 1% cyclosporine A and 0.5% heparin eyedrops.Among those,the lesions in 3 eyes of 2 cases progressed worse.Fourteen eyes of 9 cases,whose corneal lesions were thicker than 2/3 of normal corneal thickness,received marginal lamellar keratoplasty.Among those,recurrent signs were noted in 10 eyes of 6 cases.Conclusions Rheumatic diseases associated corneal melting has typical clinical features.Local cy- closporine A and heparin treatment are effective for patients in early stage.A high recurrent rate is found for patients in late stage re- ceived marginal lamellar keratoplasty.