Use of cataract surgery in urban Beijing: a post screening follow-up of the elderly with visual impairment due to age-related cataract / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing.</p><p><b>METHODS</b>From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery.</p><p><b>RESULTS</b>At the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery.</p><p><b>CONCLUSIONS</b>The data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.</p>

Gonioscopy and ultrasound biomicroscopy in the detection of angle closure in patients with shallow anterior chamber / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the agreement between gonioscopy and ultrasound biomicroscopy (UBM) in detecting angle closure in Chinese patients with shallow anterior chamber.</p><p><b>METHODS</b>An observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded.</p><p><b>RESULTS</b>85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor (Κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber (P=0.005) or plateau iris configuration tended to produce different results (P=0.075) in the 2 methods.</p><p><b>CONCLUSION</b>Gonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.</p>

Comparison between ophthalmologists and community health workers in screening of shallow anterior chamber with oblique flashlight test / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To study the agreement between ophthalmologists and community health workers in detecting shallow anterior chamber with oblique flashlight test.</p><p><b>METHODS</b>Totally 425 subjects were given an eye examination in a community health center. The anterior chamber depth of each subject was examined by one ophthalmologist and two trained community health workers (one nurse and one non-professional health worker) using oblique flashlight test. Inter-observer agreement was determined using the weighted kappa statistic.</p><p><b>RESULTS</b>Among the enrolled subjects, 148 (35%) were male and 277 (65%) were female. Good agreement was noted in all the three observers. The comparison between the ophthalmologist and the nurse showed a kappa statistic of 0.42 for both eyes (P < 0.001). The kappa statistic was 0.54 and 0.52 for right and left eyes respectively between the ophthalmologist and the non-professional health worker (P<0.001). As for agreement between the nurse and the non-professional health, worker, the kappa statistic was 0.49 and 0.38 for right and left eyes, respectively (P < 0.001).</p><p><b>CONCLUSION</b>The oblique flashlight test may be used as an applicable tool by trained community health workers for screening of shallow anterior chamber and play a role in blindness prevention in community.</p>

Expression of interleukin-6 in rat model of doxorubicin-induced nephropathy / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The pathogenesis of minimal change nephrotic syndrome (MCNS) remains unclear. This study aimed to investigate the expression of interleukin-6 (IL-6) in rats with doxorubicin-induced nephropathy and its possible roles in the pathogenesis of MCNS.</p><p><b>METHODS</b>Eighty-three male Wistar rats were randomly assigned into a control group (n=32) and a nephropathy group (n=51). Nephropathy was induced by a single tail vein injection of doxorubicin (5 mg/kg). The control group was injected with normal saline. Twenty-four-hour urinary protein excretion was measured 7, 14, 28 and 42 days after doxorubicin injection. IL-6 expression in urine and renal tissues was determined using ELISA 7, 14, 28 and 42 days after doxorubicin injection.</p><p><b>RESULTS</b>The urinary protein excretion increased significantly in the nephropathy group 7, 14, 28 and 42 days after doxorubicin injection compared with that in the control group (P<0.01). IL-6 expression in urine and renal tissues increased significantly 7, 14, 28 and 42 days after doxorubicin injection compared with that in the control group (P<0.01). IL-6 expression in urine and renal tissues was positively correlated with 24-hour urinary protein excretion in the nephropathy group (r=0.794, P<0.01; r= 0.870, P<0.01). IL-6 expression in urine was positively correlated with that in renal tissues (r=0.739, P<0.01).</p><p><b>CONCLUSIONS</b>IL-6 expression in the urine and renal tissues is increased in MCNS rats. IL-6 might play an important role in the pathogenesis of MCNS.</p>

An epidemiological study of visual disability and visual rehabilitation in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the status of visual disability and the demands for visual rehabilitation services in Beijing.</p><p><b>METHODS</b>Five hundred and fifty-five persons with visual disability in Beijing from the Second National Survey on Disability of China were involved in this study. Their visual disability and demands for rehabilitation were evaluated.</p><p><b>RESULTS</b>About three fourth of the visual disabled persons were over 60 years of age. Cataract, retinal and choroidal diseases, and glaucoma were the three leading causes of the visual impairment. Medical service was the number one (82.0%) demand for the persons with visual disability, although 89.4% of them had previously received some kinds of medial services. People who had received visual aid devices or rehabilitation training were 26.7% and 5.8%, respectively, while more people showed their demand for these service (36.6% and 11.9%, respectively). The demand for visual rehabilitation varied in different groups of age and severity of disability.</p><p><b>CONCLUSION</b>Accessibility of high quality medical services for preventable blindness diseases should be further promoted. Public health education on visual rehabilitation is also needed.</p>

Effects of enantiomers(R,R)-XY and(S,S)-XY on ocular blood flow in rabbits / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the effects of two series of enantiomers [(R, R)-XY-1 through (R, R)-XY-12 and (S,S)-XY-1 through (S, S)-XY-12] on ocular blood flow in rabbits.·METHODS; Colored microsphere technique was used for in vivo experiments to determine the ocular blood flow in various tissues of ocular hypertensive (40mmHg) rabbit eyes.·RESULTS; Of the twelve compounds of ( R, R)-XY series examined, four increased choroidal blood flow at 10g/L, 50uL instilled into eyes. All compounds of (S, S)-XY series were not effective on ocular blood flow.·CONCLUSION; Some compounds of (R, R)-XY series increased the ocular blood flow, which might be useful for the prevention and treatment of ocular blood flow related eye diseases. Among all twenty-four compounds, (R, R)-XY-1and (R, R)-XY-9 seem to be the most potent ones.KEYWORDS; ocular blood flow; ischemia; enantiomer

Effects of ZX-5 and its optical isomers on ocular blood flow in rabbits and retinal function recovery in rats / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: The effects of ZX-5, as nitric oxide (NO) donor, on ocular blood flow has been investigated using colored microsphere technique in previous study. The relationship between the production of NO by ZX-5 and ocular blood flow has been evaluated. ZX-5 has been shown to have strong positive effect on increasing choroidal blood flow. However,the effect of ZX-5 on retinal function recovery, the effects of its optical isomers, (R, R)-ZX-5 and (S, S)-ZX-5, on choroidal blood flow and retinal function recovery have not been studied and merit investigation.METHODS: Colored microsphere technique was used for in vivo experiments to determine choroidal blood flow of ocular hypertension (40mmHg) in rabbit eyes. Electroretinography was used to measure the b-wave recovery as an indication of retinal function recovery.RESULTS: (R, R)-ZX-5 increased choroidal blood flow at 10g/L, 50μL instillation into eyes at all time points (P＜0.05).(S, S)-ZX-5 was not effective in increasing choroidal blood flow. ZX-5 and (R, R)-ZX-5 showed significant effects in retinal function recovery after ischemia of the retina at all time points (P＜0.05); whereas (S, S)-ZX-5 did not show significant effect on recovery of b-wave after ischemia at most time points except at 120 and 240 minutes.CONCLUSION: ZX-5 and (R, R)-ZX-5 have high potency in increasing the choroidal blood flow and improving the retinal function recovery. It is hoped that they could be used for the prevention/treatment of ocular blood flow related eye diseases.

The effect of D-Timolol and L-Timolol on rat experimental choroidal neovascularization vivo and endothelial cells in vitro / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: Impairment of choroidal perfusion was found in AMD patients. We postulated that vasoactive agents,which can reduce choroidal blood flow resistance, might prevent the development of choroidal neovascularization (CNV). D-Timolol and L-Timolol are hypotensive agents used in cardiovascular and glaucoma therapy. Their effects on laser-induced experimental CNV rat model and human umbilical vein endothelial cells (HUVEC) were thus evaluated.·METHODS: Male Brown Norway rats were anesthetized to receive Nd:YAG laser to break the Bruch's membrane. D-Timolol and L-Timolol were given once daily through intraperitoneal injection after laser treatment for 4wk. Fluorescein angiography was performed on 2wk and 4wk. HUVEC were tested by proliferation assay and adhesion assay with D-Timolol and L-Timolol at different concentrations.· RESULTS: D-Timolol reduced the fluorescein leakage to 83% of the control group in laser-induced rat's CNV model at a dosage of 15mg/(kg·d). L-Timolol had no effect on CNV formation even at a higher dosage of 20mg/(kg·d). D-Timolol inhibited the endothelial cells proliferation significantly by 300mg/L. L-Timolol also significantly inhibited the cell proliferation at 1 000mg/L. But at a lower dose such as 300mg/L, no significant inhibitory effect was found. Both drugs showed no effect on cell adhesion function in cell culture experiments.· CONCLUSION: D-Timolol was found to prevent CNV development in laser-induced model in vivo and inhibit vascular endothelial cells proliferation in vitro. L-Timolol had no effect on cell proliferation at the same dose, and neither on rat CNV model. The results indicate these two isomers have different functions on rat's CNV prevention and on HUVEC cell proliferation.

Pharmacological therapy in age-related macular degeneration (AMD) / 国际眼科杂志(Guoji Yanke Zazhi)

· Age-related macular degeneration (AMD) is the leading cause of legal blindness in individuals aged over 65 in the United States and other industrialized nations. Till now, we have limited choices of treatment for this kind of disease. Treatment available can be grouped into two major categories: physical and pharmacological therapies. The former received extensive attention with little success whereas the latter attract new attention with great hope of success. The pharmacological therapies indude photodynamic therapy (PDT), steroids, vascular endothelial growth factor (VEGF) inhibitors, extracellular matrix (ECM) modifiers, gene therapy, nutrition supplements, choroidal blood flow facilitators and the like. PDT treatment is the only available effective treatment for certain forms of neovascular AMD. Anecortave acetate,as a synthetic derivative of cortisol, might stabilize vision in patients with predominantly classic subfoveal choroidal neovascularization (CNV) for up to 6mo through subtenon juxtascleral depot application. Intravitreous injection of VEGF aptamer stabilized or improved vision in 87.5% of patients with subfoveal CNV 3mo after treatment. Malfunction of choroidal blood flow is found in early stage of AMD. Elevation of intravascular pressure is the crucial hemodynamic factor in age-related macular degeneration, resulting in a decrease of the blood flow of choriocapillaries. Chain reactions are triggered which lead to retinal pigment epithelium (RPE) degeneration,Bruch's membrane breakdown, CNV formation, AMD and blindness in the end. Therefore, specific drugs that can increase the choroidal blood flow could be very useful to prevent the AMD from developing and worsening. Although most of them are still in the experimental stage,it is hopeful to find a way to treat AMD at the early stage and to prevent the disease to be triggered and developed.

Visual fields changes in chronic angle closure glaucoma patients after their intraocular pressures were well controlled / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the progression of visual field loss and to explore the prognosis of glaucomatous optic neuropathy in patients with chronic angle-closure glaucoma (CACG) after their intraocular pressures were well controlled under 21 mmHg.</p><p><b>METHODS</b>Forty-seven eyes of 29 patients in the Department of Ophthalmology in PUMC Hospital were included. All the patients had at least two separate tests of visual fields using the 24-2 program of the Humphery Visual Field Analyzer after their intraocular pressure were well controlled under 21 mmHg after sugery. The visual fields of patients were followed routinely for at least 1 year. In addition, all patients were divided into 2 groups according to follow-up period: 1-2 years group and over 2 years group. Visual field scores were calculated with the Advanced Glaucoma Intervention Study (AGIS) method. The visual fields were divided 5 sections and the sensitivity and defect depth of each section were calculated.</p><p><b>RESULT</b>No statistically significant differences were found in terms of AGIS scores, localized sensitivities and localized defects within the time interval of the observation.</p><p><b>CONCLUSION</b>Glaucomatous optic neuropathy is not likely to progressively deteriorate in CACG cases once their intraocular pressure are well controlled under 21 mmHg.</p>