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AIM:To evaluate the application and effect of bandage contact lens in pterygium excision combined with conjunctival transplantation (CAT).METHODS:In a prospective, randomized, controlled clinical study, 110 patients (110 eyes) diagnosed with primary pterygium were collected in PLA NO.474 Hospital from January 2015 to January 2016.The 110 patients enrolled in the study in turn, and divided into two groups by the odd and even number.The odd number divided into bandage contact lens group (CAT + bandage contact lens, n=55), while the even number divided into control group (CAT, n=55).Visual analog scale (VAS) and corneal irritation were evaluated on 1, 3 and 7d after operation.Cornea fluorescent staining testing was carried out on 3d after operation.Following-up all the patients with 1a at least observed the recurrence of pterygium.RESULTS:The score of VAS in bandage contact lens group less than that in control group on 1d (4.13±2.06 vs 5.80±1.93, t=4.391, P<0.001) and 3d (2.09±1.36 vs 3.65±1.65, t=5.422, P<0.001) after operation, while there was no significant difference between two groups on 7d (t=1.295, P=0.198) after operation.The corneal irritation in bandage contact lens group less than that in control group on 1d and 3d after operation (P<0.05), while there was no significant difference between two groups on 7d after operation (P=0.052).Cornea fluorescent staining testing area in bandage contact lens group was less than that in control group on 7d after operation (0.33±0.37mm2 vs 2.73±2.21mm2, t=7.921, P<0.01).There was no significant difference in recurrence rate between two groups after 1a operation (P=1.000).CONCLUSION:Bandage contact lens could significantly release pain and corneal irritation, promote the healing of the corneal epitheliums in the defected area, and increase the postoperative comfort level in patients after operation.
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AIM: To investigate and analyze the changes of corneal biomechanics of normal eyes,forme frusta keratoconus eyes,subclinical keratoconus eyes and clinical keratoconus eyes by Corneal visualization Scheimpflug technology (Corvis ST),and provide clinical basis for early diagnosis of keratoconus.METHODS: Case-control study.We randomly selected 40 normal eyes as normal group,15 forme frusta keratoconus eyes as forme frusta keratoconus group,23 subclinical keratoconus eyes as subclinical keratoconus group,and 40 clinical keratoconus eyes as keratoconus group.The biomechanical parameters of each group were measured by Corvis ST.The receiver operating characteristic(ROC) curves was plotted to distinguish keratoconus from the normal cornea.RESULTS: There was no significant difference in the parameters of biomechanics between normal group and forme frusta keratoconus group (P>0.05).Compared to normal group and subclinical keratoconus group,the parameters second applanation length(AL2),first velocity of applanation (AV1),central curvature radius at highest concavity (HC-radius),deformation amplitude (DA) were revealed statistically significant differences(P<0.05).The biomechanical parameters of the keratoconic group were significantly different from those of normal group except for the second velocity of applanation (AV2),time from the start until the highest concavity(HC-time),peak distance (PD).ROC curve showed that the DA(area under the curve:0.891±0.028) was the best predictive parameter to distinguish keratoconus from the normal eyes.CONCLUSION: The corneal biomechanical parameters of forme frusta keratoconus group are not changed compared with normal group.The changes between normal group and subclinical keratoconus group should combine with other technology to further improve subclinical keratoconic screening.Compared with normal corneas,keratoconus has a great change in biomechanics,which DA diagnosis of the highest efficiency.
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?AIM: To discuss the effect of laser exposure on visual acuity and macula.?METHODS: Retrospective and consecutive case series. A retrospective analysis of 11 patients (11 eyes) with laser retinal injury was carried out from January 2014 to June 2015 in Ophthalmology Department of No. 474 Hospital of Chinese PLA. All individuals underwent visual acuity, best corrected visual acuity ( BCVA ) , and spectral-domain optical coherence tomography ( SD-OCT) for macular at first visit, and fundus fluorescein angiography ( FFA ) , visual field, and multifocal electroretinogram ( mf ERG ) were perform if necessary. Symptomatic therapies, supportive therapies and pars plana vitrectomy ( PPV ) were performed depended on the patient’s condition. The patients were followed-up at 1, 3 and 6mo after the first visit, and patients were undertaken visual acuity, BCVA, macular SD-OCT and so on.?RESULTS: Eight patients ( 73%) were under 18 years old and all patients were young males, who were injured by laser pointers when playing. Three patients ( 27%) over 18 years old were injured accidentally at work. Ten (91%) patients’ BCVA were ≤0. 3, while one ( 9%) patient’s BCVA was higher ≥0. 3. Full-thickness macular holes ( the diameter 224-519 μm ) were detected in 10 patients (91%), while sub-foveal RPE changes and IS/OS injury in 1 patient ( 9%) . Macular hole with traction or cystoid edema in 6 eyes (55%) were received PPV, while the other 5 eyes ( 4 eyes with stable macular hole and 1 eyes with RPE injury ) received conservative treatment. Macular hole closed successfully in 1 eye ( 17%) after PPV, while macular hole in the other 5 eyes ( 83%) were stable after PPV of which the cystoid edema faded. The 4 patients with macular hole and 1 patient with RPE injury were stable during follow-up period. However, the BCVA in all patients had no significant improvement at end.?CONCLUSION: Exposure to laser devices could lead to severe macula injury that could reduce central vision, which is permanent.
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AIM: To compare the safety and efficacy of conjunctival autograft transplant ( CAT ) and limbal - conjunctival autograft transplant (LCAT) for primary pterygium. METHODS: In this prospective, randomized and controlled clinical study, 120 patients ( 120 eyes ) diagnosed with primary pterygium were collected in NO. 474 Hospital of Chinese PLA from January 2014 to January 2015. The 120 patients enrolled in the study in turn, and divided into two group by the odd and even number. The odd number underwent CAT and the even number underwent LCAT. RESULTS:One hundred and seven patients (107 eyes) completed the follow-up of 1a, including 54 patients (54 eyes) from the CAT group and 53 patients (53 eyes) from the LCAT group. Four patients (4 eyes, recurrence rate 7. 4%) in the CAT group and 2 patients ( 2 eyes, recurrence rate 3. 8%) in the LCAT group developed recurrence. However, there were no significant in recurrence rate between CAT group and LCAT group (P =0. 678). CONCLUSION: CAT and LCAT might be both effective treatment for primary pterygium for reducing the recurrence rate of pterygium. However, LCAT is the optimal surgical method for primary pterygium.
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AlM: To demonstrate the effect of comprehensive treatments for meibomian gland dysfunctional dry eye. METHODS:Totally, 86 cases (172 eyes) in our hospital, who suffered from meibomian gland dysfunctional dry eye, were measured by BUT, CFS, the machine of infrared meibomian gland function and testing meibomian gland after extrusion. The scores of meibomian gland function missing and secretions were observed, which as a diagnosis, and assessed the effectiveness of treatment, after took comprehensive treatments in different stages ( comprehensive treatments including cleaning, hot covering, massaging, TobraDex, Pranoprofen and Lubricant, etc. ) . RESULTS:All patients were treated and observed for 3wk, in which 46 cases (92 eyes) of cured, 29 cases (58 eyes) effective, 11 cases (22 eyes) ineffective, the total effective rate was 87. 2%. After 6wk, 68 cases (136 eyes) of cured, 13 cases (26 eyes) effective, 5 cases (10 eyes) ineffective, the total effective rate was 94. 2%, not appeared adverse ocular and systemic reactions in the process of treatment. CONCLUSlON: Taken comprehensive treatments for meibomian gland dysfunctional dry eye could effectively shorten the course of the disease, quickly remove meibomian gland tube obstruction, restore the meibomian gland secretion and stable the lipid layer, and could reduce the discomfort of patients with dry eye positively and effectively.
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AIM: To evaluate the safety, efficacy and stability of posterior chamber phakic intraocular lens ( ICL ) implanation and clear lens extraction for the correction of high myopia. METHODS: The study enrolled 56 cases ( 100 eyes ) of high myopia. Group I comprised 32 cases ( 58 eyes ) receiving ICL implantation and Group II comprised 24 cases (42 eyes) undergoing clear lens extraction. In this study, we evaluated the two groups of subject's the visual and refractive results, intraocular pressure ( IOP ) , endothelial cell density ( ECD ) , anterior chamber depth ( ACD) , lens transparency, the surgical complications as well as visual adverse symptoms before and after surgery. RESULTS: The postoperative subjects in group I and group II were followed, uncorrected vision acuity ( UCVA)>0. 5 were 69. 0% in group I and 71. 4% in group II after 3mo. UCVA>0. 5 were 72. 4% in group I and 73. 8% in group II after 1a. Predictability of the manifest spherical equivalent refraction within±1. 00D was achieved in 62. 1%of eyes in group I and 57. 1% in group II after 1a. The central vault of the ICL ( distance from posterior surface of ICL to the crystalline lens ) measured with anterior segment optical coherence tomography ( AS-OCT ) was 0. 35-0. 54 (0. 40±0. 16) mm. Twelve point one percent of eyes in group I and 7. 1% of eyes in group II had transient mild increase in IOP. Here were statistically significant differences between preoperative and postoperative ECD (PCONCLUSION: ICL implantation and clear lens extraction are effective, safe and predictable surgical option for the management of high myopia. No severe complications occurred, but its long time effect and safety still need more time to prove.
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Background Vitretomy and lenstomy with silicone oil tamponade is an effective method for complicated vitreous retinopathy.The severe anisometropia after silicone retention is usually treated by two-point transscleral suture fixation for posterior chamber intraocular lens(IOL)implantation.In order to reduce the number and difficulty and complication of the operation,the surgical method should be improved.Objective The goal of this study was to observe the resuh of silicone oil removal combined with four-point trans-scleral suture fixation of posterior chamber IOL after vitrectomy.Methods A retrospective case-observational study design was adopted.Twenty eyes with silicone oil tamponade from 20 patients without lens and posterior capsule after vitrectomy were included in this study.Silicone oil removal with four-point trans-scleral suture fixation of posterior chamber IOL was performed.The anterior ocular inflammatory response,intraocular pressure,uncorrected and corrected acuities before and after operation,corneal endothelial cell counting and postoperative complications were observed and analyzed.Written informed consent was obtained from all patients prior to the operation.Results All of the operative eyes in this study showed improvement of visual acuity after operation.Of the 20 eyes,a visual acuity of ≥0.8 was seen in 2 eyes,0.6-0.7 in 6 eyes,0.3-0.5 in 8 eyes and 0.05-0.2 in 4 eyes 3 months after the removal of silicone oil.The uncorrected acuity postoperation was significantly improved in comparison with preoperation(H=10.147,P＜0.01),but no significant difference was found in the corrected acuity between preoperation and postoperation(X =2.089,P＜ 0.01).The number of the corneal endothelial cells was(2064±329)cells/mm2 before operation,and that after operation was(1987±269)cells/mm2,showing an insignificant change between them(t =1.660,P ＞ 0.05).No abnormality of IOL position was found in all 20 operated eyes.There was not serious postoperative complication in all 20 patients.Conclusions The combination of silicon oil extraction with four-point transscleral suture fixation IOL is effective in eyes without posterior capsule or lens after vitrectomy.It can reduce the operation time and improve the postoperative acuity and the quality of life of patients.
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Background Optic neuritis is closely associated with multiple sclerosis (MS).Its pathogenesis is uncompletely clear,and less basic researches are carried out at home and abroad. Objective This study was to reveal the expression of myelin basic protein (MBP) in the optic nerve of rat with experimental allergic encephalomyelitis (EAE) and to provide a theoretical evidence for the research of the relationship of optic neuritis with MS. Methods Fifty clean Wistar rats were randomized into the control group and immune 8,12,18 and 25 days groups.Myelencephalon was collected from 5 guinea pigs to prepare the homogenate and mixed with the isovolumetric complete Freud' s adjuvant (CFA).The 0.5 ml mixed antigen emulsifier was subcutancously injected into the 4 maps together with Bordetella pertussis 0.2 ml under the cutancous of dorsalis pedis at 0 and 48 hours to induce the EAE.Behavior of the rats was evaluated to score the neurological function.The optical nerve sections were prepared 8,12,18 and 25 days after immunology for the histopathological examination,and immunochemistry and Western blot were used to detect the expression of MBP in optic nerve.The use of the animals complied with the Regulation for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission. Results The disorder of motor nerve was seen 12 days following the immune,and the clinical neural functional scores were significantly higher 12 day and peaked on 18 days myelination and then gradually reduced.The histopathological examination showed that the irregular alignment of neural fiber was found at 12 days,and changes of cellular structure,edema of neural shaft bunch were observed at 18 days.However,the abnormal cells were significantly less 25 days following the immune.Immunochemistry showed that the MBP was expressed mainly in the myelination of optic nerve fibers.The numbers of positive cells for MBP were (115.75±26.49)cells/5 fields at the 12th day,showing a significant lowing in comparison with (167.44±22.49)cells/5 fields of control group (t=4.537,P＜0.05 ).The positive cells were lest at the 18th day with the values ( 75.57 ± 34.54) cells/5 fields ( t =6.362,P＜0.01 ).At the 25th day,positive cells increased to ( 117.63 ± 13.78) cells/5 fields,which still was lower than those of the control group ( t =4.068,P＜0.05 ).Western blot assay illuminated that with the prolong of immune time,MBP/β-actin ratio in optic nerve was gradually reduced and followed the same pattern at the 12th day( t =4.639,P＜0.05 ).At 18 days after immune in comparison with the control group,the expression of MBP/β-actin ratio in optic nerve was the least (t=8.427,P＜0.01). Conclusions MBP can be degraded in rat optic nerve.This is a further evidence that optic neuritis is a severe demyelination disease.It is clearly related to MS.
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Background At present,researches about retinitis and acquired immunodeficiency syndrome (AIDS) mainly focus on observation and analysis of the cytomegalovirus (CMV)-induced ocular complication.To screen the effective drugs is very important for the treatment of AIDS-related CMV-induced retinitis.Objective This study was to describe the clinical features,diagnosis and treatment outcome of CMV-induced retinitis with BAY 38-4766 and evaluate the relationship between CMV retinitis and AIDS.Methods This was a case observational study.A total of 154 eyes of 84 patients with CMV retinitis and AIDS were enrolled in this study.Before the definitive diagnosis of CMV retinitis,the AIDS course of these patients were 4-26 months.In the initial examination,the visual acuity ranged from finger counting to 0.4,and the number of CD4+ T-lymphocyte was 0-30 cells/μl.The survival time in the patients ranged from 3 weeks to 18 months.BAY 38-4766 was used in 117 eyes of 62 patients,and 102 eyes of 53 patients showed the srinked of retinal lesion and improvement of vision (0.1-0.7).BAY 38-4766 was used to treat the CMV retinitis in 117 eyes of 62 patients with the initial intravenous dose of 5 mg/kg,twice per day for consecutive 2 weeks and followed by oral dose 1 gram per day.The follow-up duration was 2 weeks to 18 months.The fundus feature,visual acuity and CD4+ T-lymphocyte counts were analyzed.This study proposal was approved by Ethic Committee of the 474th Hospital of PLA,and written informed consent was obtained from each patient prior to entering this study.Results The numbers of CD4+T-lymphocytes increased to 12-402 eells/μl after administration of BAY 38-4766.The CMV retinitis aggravated and the vision decreased in the untreated 22 patients with the CD4+T-lymphocytes 0-30 cells/μl.Conclusions CMV retinitis is the most common intraocular complication in patients with AIDS.Diagnosis of CMV retinitis is based on the characteristics of necrotizing retinitis,which is typically associated with retinal hemorrhage and vasculitis.BAY 38-4766 is an effective drug for the treatment of CMV retinitis.
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Background Choroidal neovascularization (CNV) is a main cause of visual impairment in many retinal diseases.To create an ideal CNV animal model is very important for the experimental and clinical study of CNV.The assessment method of repeatable and reliable for CNV model is still seldom.Objective This experiment was to explore the label value of fluorescent antibody for visualizing and quantifying the morphologic changes associated with laser-induced CNV.Methods Laser-induced CNV models were created in 30 eyes of 15 male SPF C57BL/6J mice by Krypton red laser irradiating fundus 2 spots around the optical disc with the wavelength 647.1nm,power 260 mW,spot diameter 50μm and exposure time 0.05 seconds.The CNV was evaluated at 5 minutes,4,7,14 and 28 days after laser injury by using fundus photography and fundus fluorescein angiography (FFA),and the successful models were identified as the rupture of Bruch's membrane.The mice were then immediately sacrificed and the eyeballs were enucleated to prepare the choroidal flatmounts.The posterior eye cups were fluorescently labeled with markers of cell nuclei (DAPI,4',6'-diamino-2-phenylindole),endothelial cells (isolectin-B4),and filamentous actin (phalloidin).The CNV areas from specimens were measured by Image pro plus 6.0.Two eyes from one matched mouse without receiving photocoagulation were used as the controlls.This study followed the Standard of Association for Research in Vision and Ophthalmology.Results No any CNV was seen in photocoagulated eyes in 5 minutes and 4 days after laser irradiation.The first sign of CNV appeared at 7 days following photocoagulation.The incidence of fluorescein leakage was 76.47% (26/34),81.81% (18/22),50.00% (5/10) at 7,14 and 28 days,respectively.The fluomicroscope examination showed that in unphotocoagulated areas,retinal pigment epithelial (RPE) cells were visualized with a uniform hexagonal array.Immediately after laser exposure,a circular area devoid of fluorescent labeling was observed,indicating disruption of the choroid-Bruch membrane-RPE complex.On the fourth day,cellular debris and fragmented nuclei were presented and an autofluorescent ring was visible at the site of Bruch's membrane disruption.The number of CNV vessels increased exponentially during the next 3 days.At 7 days,a well-defined isolectin-B4 labeled CNV network was exhibited and lasted for 28 days.The CNV areas were (7.99±0.42)×103μm2,(16.89±3.77)×103μm2,(14.37±4.02)×103μm2 at 7,14 and 48 days after photocoagulation respectively,showing a significant difference among these three groups (F=17.340,P=0.000),and the CNV area was significantly increased in the photocoagulating eyes in 14 days and 28 days compared with 7 days (q=16.46,q=15.54,P＜0.01).Conclusion Fluorescent antibody labeling allows the well identification and measurement of laser-induced CNV lesions in mouse choroid/RPE flatmounts.This technique offers excellent morphologic detail and facilitates the study of critical early events in CNV.CNV complexes are labeled at an early stage,providing a more accurate preclinical evaluation of antiangiogenic molecule.
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Background More and more attentions are paid to the effect of matrix metalloproteinases (MMPs) in the process of wound healing after excimer laser.Objective The present study was to investigate the effects of GM6001,a matrix metalloproteinases inhibitor,on haze formation after excimer laser epithelial keratomileusis (LASIK).Methods LASEK of -10.00 diopter was bilaterally performed on 27 New Zealand white rabbits and then divided randomly into the GM6001 group,Fluorometholone (FML) group and normal control group.Corneal haze was graded under dim light at 2 weeks,4 weeks and 8 weeks after operation,and the number of eyes in different grades of haze were compared among the three groups.Six corneal samples were harvested in each group for confocal microscope examination at 2,4,8 weeks.The corneal histopathological examination was carried out with the optical microscope,and the ultrastructure of the cornea was examined under the transmission electron microscope.Results The numbers of eyes of different corneal grades of haze at 2,4 or 8 weeks after surgery were significantly different among the three groups (P＜0.05).Compared with the normal control group,the corneal haze grades in the GM6001 group and FML group were apparently lower (P＜0.01),but there was no significant difference in the numbers of eyes of different corneal grades of haze between the GM6001 group and FML group (P＞0.01).The numbers of keratocytes in the GM6001 group were apparently lower than those in the normal control group and FML group in 2,4 or 8 weeks after operation (P＜0.05).No significant difference in the keratocytes was seen between the normal control group and FML group at various time points (P＞0.05).Corneal epithelial cell morphology,disordered arrangement of collagen fibers in GM6001 group and in FML group were less pronounced than in the negative control group.Conclusion GM6001 has an inhibitory effect on the formation of corneal haze after LASEK which suppresses proliferation and production of keratocytye with the similar efficacy as FML.
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AIM To evaluate the anti-angiogenesis action of Bevacizumab on corneal neovascularization(CNV) in rats induced by alkali burns.·METHODS: 20 Health Wistar rats, aging from 6 to 8 weeks and weighting from 170g to 190g from 170g to 190g were prepared for CNV animal models. Both corneas of each animal in experimental were cauterized with alkali, then all rats were randomly divided into four groups (each group have 5 rats and 10 corneas), the both corneas of each rats were received subconjunctival Bevacizumab in different dosage (group 2, 0.5rag; group 3, 1.0mg; group 4, 2.0mg)and the group 1 received carrier solution. The occurrence and development ofCNVwereobservedbyslit-lamp microscope, and length and area of CNV were calculated. All rats were followeded up 16 days after alkali burns. The 40 corneas were taken for histopathological examination. Vascular endothelial growth factor (VEGF) were detected in all rat corneas by immunohistochemistry method. ·RESULTS: In the bevacizumabotreated eyes, the vascular area was lower than in the control eyes. The treated group was statistical differences compared with the control group; when vascular area were compared between the treated groups, no statistical differences were observed. The histopathological findings showed that the inflammation cells and the neovascularity in each treated group were significantly fewer than that in the control group. The expression of VEGF markedly increased in CNV control group compared with bevacizumab-injected group. ·CONCLUSION: Subconjunctival application of a certain concentrations Bevacizumab could inhibit angiogenesis in rats corneas induced by alkali burns.
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· AIM: To investigate the role of intercellular adhesion molecule-1 (ICAM-1) in the graft rejection of rabbit penetrating keratoplasty (PKP).· METHODS: Sutures were used to produce corneal neovascularization (CNV) on New Zealand white rabbits to make PKP model. Graft mean survival time and rejection index were determined. The levels of sICAM-1 in serum and aqueous humor were dynamically determined by enzyme-linked immunosorbent assay (ELISA).Immunohistochemical technique was used on cornea to get the evidence of expression and distribution of ICAM-1.· RESULTS: Graft mean survival time is (12.4±1.3) days.The mean sICAM-1 levels in aqueous humor and serum in the control animals that did not undergo surgery were (16.6±3.6)ng/L and (95.2±6.3) ng/L respectively. Levels in aqueous humor and serum for the graft rejection group increased postoperatively, continued to increase to (53.9±19.2)ng/Land (378.8±30.6)ng/L, compared to those in the other group (P ＜0.01). ICAM-1 positive cells were found in the graft rejection group.· CONCLUSION: ICAM-1 plays a critical role in initiating and maintaining corneal graft rejection. Sequential determination of serum sICAM-1 after operation may be of value in the prediction and diagnosis of acute rejection.