Varicella-zoster virus as a causative agent of acute retinal necrosis in younger patients / 中华医学杂志(英文版)

BACKGROUND@#Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have found that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients.@*METHODS@#A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN.@*RESULTS@#Final best visual acuity (BCVA) improved significantly from 1.36 ± 0.95 (median 20/400) to 0.95 ± 0.82 (median 20/100) (t = 2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2 ± 5.2 years) and 12 of the 13 samples in the senior group (53.6 ± 4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1.@*CONCLUSIONS@#This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.

Inverted Internal Limiting Membrane Flap Technique for Repair of Large Macular Holes: A Short-term Follow-up of Anatomical and Functional Outcomes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inverted internal limiting membrane (ILM) flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes (MHs) with fair MH closure rates as well as gains in visual acuity. In the current study, longitudinal changes in multi-focal electroretinogram (mfERG) responses, best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated in eyes with large MHs managed by this technique.</p><p><b>METHODS</b>A prospective noncontrolled interventional study of eight patients (eight eyes) with large MHs (minimum diameter >400 μm) was conducted. All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique. SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up.</p><p><b>RESULTS</b>All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure. Partial microstructural reconstruction, demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone, was observed in all cases as early as 1 month after surgery. Functionally, as compared to baseline, all patients showed improvements in BCVA and all but one in mfERG response during follow-up. However, Pearson's test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point.</p><p><b>CONCLUSIONS</b>Inverted ILM flap technique appears to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results. Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response, of which the latter might be a supplement for the former in postoperative functional follow-up.</p>

Measurement and comparison of retinal nerve fiber layer thickness in different stages of diabetic retinopathy patient with type 2 diabetes / 中华实验眼科杂志

Background Diabetic retinopathy (DR) is one of the leading causes that result in adult irreversible blindness in many countries.Recent researches suggest that neurodegeneration is an important component of DR.To realize the disease process of retinal neutron is very important for prevention and treatment on DR.Objective This study was to investigate the change of retinal nerve fiber layer thickness in patients with type 2 diabetes mellitus.Methods Ninety-six eyes of 48 patients with type 2 diabetes mellitus were enrolled in Peking Union Medical College Hospital.The patients were assigned into non-diabetic retinopathy (NDR) group,background diabetic retinopathy(BDR) group,proliferative diabetic retinopathy (PDR) group and panretinal photocoagulation (PRP) group based on the fundus finding and fundus fluorescein angiography(FFA),and 24 normal subjects with matched age were included as control group.RNFL thickness was measured by GDxVCC system,including temporal,superior,nasal,inferior,total,(TSNIT) average,superior average,inferior average,TSNIT standard deviation and nerve fiber indication.The datas of the RNFL thickness were analyzed and comparison among different groups by one-way analysis of variance and Student Newman Keuls test.Results The TSNIT averages of the NDR group,BDR group,PDR group and PRP group were(56.54±5.28),(56.92±6.49),(53.04±6.14) and(53.17±9.30) μm,respectively,while that of the control group was (59.04±4.37) μm.The TSNIT average,superior average,inferior average,TSNIT standard deviation of the PDR group and PRP group compared with control group were significantly decreased,and the nerve fiber indication of the PDR group and PRP group was significantly increased (P =0.002,0.000,0.002,0.000,0.001 ;P =0.002,0.000,0.001,0.000,0.000).Compared with the control group,the TSNIT average,superior average,inferior average,TSNIT standard deviation were insignificantly decreased,and the nerve fiber indication was insignificantly increased in the NDR group and BDR group (P =0.187,0.235,0.333,0.106,0.202 ;P=0.262,0.063,0.072,0.098,0.062).Conclusions The decline of the RNFL thickness appears prior to DR findings.The RNFL thinning of PDR and PRP patients suggests the degeneration of neurons and atrophy of axonal.The neurodegeneration is an important component of DR.

Treatment and analysis of risk factors of suprachoroidal hemorrhage induced by intraocular surgery / 中华实验眼科杂志

Background Suprachoroidal hemorrhage (SCH)is a rare but devastating complication of ophthalmic surgery,and it is crucial to be aware of the risk factors and select effective treatment. Objective Present study was to assess the treatment and risk factors of SCH induced by intraocular surgery. Methods Retrospective case series were carried out to investigate the clinical data of 15 eyes from 15 patients with SCH at Peking Union Medical College Hospital.The risk factors of SCH were analyzed.Written informed consent was obtained before any medical examination and treatment.SCH was occurred in 10 eyes during intraocular surgery,while the SCH was diagnosed in other 5 eyes 1-3 days after operation.Surgical drainage was carried out in 8 eyes,of which 3 eyes combined with vitrectomy besides surgical drainage and other 5 eyes were treated with medication alone.Results SCH was completely removed and absorbed in 12 eyes.The visual acuity was improved in 6 eyes,unchanged in 6 eyes and decreased in 3 eyes.Nine eyes complicated with retinal detachment and reattached in 6 eyes after treatment.Seven eyes combined with hypermyopia,6 eyes combined with glaucoma,and 1 eye was aphakia.Four patients combined with hypertension,and 2 patients had diabetes mellitus. Conclusions SCH induced by intraocular surgery develops rapidly and violently,and it can result in vision loss without effective treatment.Suturing surgical incision immediately,applying hypertonic agents and sclerotomy drainage are the urgent approaches to treat SCH.Medicines and/or sclerotomy could be optional according to the amount of bleeding and other ocular complication.The risk factors of SCH include myopia,glaucoma and the instantly dropping of intraocular pressure.

Cytomegalovirus retinitis associated with acquired immunodeficiency syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cytomegalovirus (CMV) retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome (AIDS). This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS.</p><p><b>METHODS</b>It was a retrospective case series. CMV retinitis was present in 39 eyes (25 patients). Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography (FFA) and CD4(+) T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir (400 µg) were performed in 4 eyes (2 patients).</p><p><b>RESULTS</b>Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque. Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium (RPE) atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4(+) T-lymphocyte count in peripheral blood of the patients with CMV retinitis was (30.6 ± 25.3) × 10(6)/L (range, (0 - 85) × 10(6)/L). After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed.</p><p><b>CONCLUSIONS</b>CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus (HIV) serology should be performed. Routine eye examination is also indicated in HIV positive patients.</p>

Change of serum high sensitive C-reactive protein level in patients with pathologic myopia / 中华实验眼科杂志

Background Pathologic myopia is one of the common blinding eye diseases.Recent research suggests that immune response participates in the pathogenesis of pathologic myopia,and inflammation is an important factor that influent immune status.Objective Present study was to observe the change of high sensitive C-reactive protein(hs-CRP) in serum in the patients with pathologic myopia and explore the role of inflammation in the development of pathologic myopia. Methods Serum hs-CRP was measured from 30 patients with pathologic myopia,30 patients with simple myopia and 30 normal controls with Nephelometric Turbidity in the OLYMPUS AU5400 automatic biochemical analyzer.Written informed consent was obmined from each subject before medical examination.Results The mean age was(30+10) years in pathologic myopia group,and(32+8)years in simple myopia group and(32+9)years in normal control group.The range of preoperative spherical equivalent refraction was (-6.00--22.00) D in pathologic myopia group,(-1.00--6.00) D in simple myopia group and(-1.00-+1.00) D in normal control group.The level of hs-CRP in serum was(3.68±1.15)mmol/L in the patients with pathologic myopia and was significantly higher than that of simple myopia group(1.99±0.68 mmol/L)and normal controls (2.11±O.66 mmol/L)(q=10.69,P＜0.01;q=9.91,P＜0.01),respectively.No significant correlation was found between hs-CRP level and myopic degrees in pathologic myopia group(R2=0.037,P＞0.05). Conclusion Hs-CRP may play rule in the inflammatory reaction during the pathogenesis of pathologic myopia.

Expressions of collagen , matrix metalloproteases-2, and tissue inhibitor of matrix metalloproteinase-2 in the posterior sclera of newborn guinea pigs with negative lens-defocused myopia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the expressions of the collagen , matrix metalloproteases-2 (MMP-2), and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) in the posterior sclera of newborn guinea pigs with negative lens-defocused myopia.</p><p><b>METHODS</b>Newborn guinea pigs were monocularly defocused by -10D lens. After 4 weeks of defocus, the eyes were removed to provide posterior scleral samples for detection. Expression of collagen was detected by immunohistochemistry on frozen sections of guinea pig sclera, and the protein levels of MMP-2 and TIMP-2 were evaluated by Western blot.</p><p><b>RESULTS</b>Immunohistochemical analysis indicated that the expressions of collagen and TIMP-2 were significantly lower and the expression of MMP-2 was significantly higher in the posterior sclera in the defocused eyes than in the contralateral eyes (all P < 0.01). However, all these indicators were not significantly different between the contralateral eyes and normal control eyes (all P > 0.05). In the defocused animals, the refraction of defocused eyes was positively correlated with the expression levels of collagen (r = 0.79, P < 0.01) and TIMP-2 (r = 0.74, P < 0.05) and was negatively correlated with the expression level of MMP-2 (r = -0.78, P < 0.01) in posterior sclera.</p><p><b>CONCLUSION</b>Alteration of extracellular matrix in the posterior sclera, probably participated by MMP-2, may exist during the development of defocus-induced myopia.</p>

Relationship between cataract extraction with intraocular lens implantation surgery and age-related macula degeneration / 中国医学科学院学报

Cataract extraction with intraocular lens (IOL) implantation surgery may result in the remarked increase in the prevalence of age-related macular degeneration (AMD). Researches have shown that the postoperative retina is much more easily exposed to blue light, which can induce the retina to produce reactive oxygen species (ROS) and finally damage the retina. Therefore, cataract surgery should not be recommended at early stage; alternatively, to lower the incidence of AMD, blue-light filtering IOL may be implanted to avoid the ocular exposure to more blue light in the postoperative patients.

Myopic and retinopathy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the incidence of myopic retinopathy and its risk factors.</p><p><b>METHODS</b>The fundus of 1449 patients (2879 eyes) with myopia were retrospectively examined. The clinical relationship between myopic retinopathy and diopter, age, and sex was analyzed.</p><p><b>RESULTS</b>Myopic retinopathy was detected in 413 eyes (14.35%). Posterior pole retinal lesions were detected in 22 eyes (0.76%). Peripheral retinal lesions were found in 396 eyes (13.75%). According to their diopters, the myopic patients were divided into four groups: low, medium, high and super high myopia The incidence of peripheral retinal lesions was 4.18%, 8.72%, 19.18%, and 37.44% in these four groups, which significantly different (chi2 = 178.594, P<0.001). By age these patients were divided into three groups: I group, age <25; II group, age 25-34; III group, age >34. The incidences of peripheral retinal lesions in these three groups were 8.11%, 15.34%, and 24.59%, which were significantly different (chi2 = 76.090, P<0.001). The incidence of retinal lesion in male and female was 9.32% and 16.07%, respectively, which was significantly different (chi2 = 24.886, P<0.001). Posteriorpole retinal lesions were only detected in the highly or super highly myopic patients, all of them were more than 25 years. The incidence of posteriorpole retinal lesions in the highly and super highly myopia group was 0.86% and 6.67% respectively, which was significantly different (chi2 = 31.898, P<0.001). The incidence of posteriorpole retinal lesions in group II and group III was 0.55% and 3.55% respectively, which was significantly different (chi2 = 22.523, P<0.001).</p><p><b>CONCLUSIONS</b>The prevalence of retinal lesions in myopic patients is higher than that of emmetropia. The incidence of peripheral retinal lesions increases in patients with deeper diopters. Posterior pole retinal lesions usually occur in the myopic patients whose age are more than 25 years and diopter more than - 6.00 D. Careful examination of fundus is essential for early detection and timely treatment.</p>

Modified dacryocystorhinostomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To introduce a novelty-modified dacryocystorhinostomy.</p><p><b>METHODS</b>With the innovated scalpels, 11 patients (13 eyes) suffering from chronic dacryocystitis were performed with the newly modified surgical procedures derived from traditional dacryocystorhinostomy. The efficacy, efficiency, and complications were observed.</p><p><b>RESULTS</b>Thirteen operations for 11 patients were performed successfully and efficiently. The wound was during operation neat and with a slight hemorrhage which could be stanched easily. No serious complications were observed intra-operatively. The average time of follow-up was 7.8 months (6-12 months). All the dacryocysto-rhinal canals remained unblocked.</p><p><b>CONCLUSIONS</b>The modified dacryocystorhinostomy with the help of innovated mucous scalpel has high success rate, high efficiency and low complications. It deserves wide application as the first choice for chronic dacryocystitis.</p>

Progress in the studies on cytomegalovirus retinitis / 中国医学科学院学报

Cytomegalovirus retinitis (CMVR) is the commonest opportunistic ocular infection in patients with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), typically occurs when CD4+ T cell counts fall below 50/mm3. CMVR accounts for the majority of the vision loss associated with HIV-related eye diseases. However progress in the studies on CMVR, including the prevalence, clinical features, differential diagnosis and recent advances in the management of CMVR is reviewed.