A modified 3D stereophotogrammetry-based distraction test for assessing lower eyelid tension.

AIM: To investigate the reliability of a modified three-dimensional distraction test (3D-DT) and three-dimensional pinch test (3D-PT) for assessing lower eyelid tension (LET). METHODS: A cross-sectional study was conducted among 97 volunteers including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each participant, including two photographs obtained in a neutral position (NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT. RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively; technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively; and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients (ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1; the ICCs of all the measurements obtained in all the positions (NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80. CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre- and postoperative clinical evaluation.

Severe absence of intra-orbital fat in a patient with orbital venous malformation: A case report.

BACKGROUND: The orbital venous malformation is quite common in orbital diseases. Clinically, it is usually characterized by proptosis. However, among patients with distensible venous malformations, if the lesions continuously progress, they may induce enlargement of the orbital bone or orbital lipoatrophy, which in turn leads to enophthalmos. CASE SUMMARY: Here, we report a patient who presented with enophthalmos and had a severe absence of intra-orbital fat secondary to orbital venous malformation. The patient was a 66-year-old female with a 20-year history of enophthalmos. Hertel exophthalmometry readings in a relaxed upright position were 4 mm OD and 13 mm OS with a 97 mm base. It was determined that she had positional "proptosis". Physical examination also revealed a bulging mass on her hard palate. Computed tomographic scan and magnetic resonance imaging showed an expansion of the right orbit with local bony defects and multiple soft-tissue masses. CONCLUSION: Long-term lack of awareness about the presence of orbital venous malformations, persistent venous congestion could lead to compression of the orbital fat, which in turn induces atrophy or the absence of intra-orbital fat.

Absolute ethanol embolization of arteriovenous malformations in the periorbital region.

OBJECTIVE: Arteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment. METHODS: Transcatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals. RESULTS: During the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76-99 % in 7 patients, and 50-75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases. CONCLUSION: Ethanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

Beta-blockers versus corticosteroids in the treatment of infantile hemangioma: an evidence-based systematic review.

BACKGROUND: The efficacy and safety of beta-blockers versus corticosteroids in the treatment of infantile hemangiomas (IHs) is controversial. This study aimed to summarize evidence described in the literature and to assess the quality of studies involving beta-blockers and corticosteroids for the treatment of cutaneous IHs. METHODS: Comparative studies were collected from 15 online electronic databases, including OVID Medline, PubMed, ISI Web of Science, CENTRAL, CNKI, ChiCTR, JPCTR, CTRIndia, IranCTR, SLCTR, ISRCTRN, NLCTR, GCTR, ANCTR, ClinicalTrial. gov, and associated references. Studies without a control group were excluded, and the remaining studies were assessed by two reviewers independently using the Downs & Black scale for reported quality. The main areas assessed in the included studies were volume changes, overall improvement in appearance, eye function, and adverse events. RESULTS: Ten comparative studies were included with a total of 419 children. A meta-analysis was not performed due to the considerable heterogeneity across studies. Some evidence showed that beta-blockers are superior to steroids in reducing volume and improving the overall appearance of IHs, such as lightening of the color and flattening of the surface. Conclusions regarding improved eye function and adverse events were divided, and no consensus has been reached on the superiority of one treatment over another. No episodes of severe-onset asthma, hypotension, or bradycardia occurred in the beta-blocker treatment due to the rigorous exclusion of patients with contraindications. CONCLUSIONS: Available studies indicate that beta-blockers are an alternative option to corticosteroids for IH treatment with respect to volume shrinkage and improvement in appearance. No evidence has shown a significant difference in improved eye function and adverse events between beta-blockers and corticosteroids in the treatment of IH; indeed, there is a lack of well-designed, high-quality randomized control trials.

[Continuous funding of National Natural Science Foundation of China has boosted the development of the discipline of ophthalmology over the past 25 years].

OBJECTIVE: To analyze the role of National Natural Science Foundation of China (NSFC) on the development of the discipline of Ophthalmology from 1986 to 2010. METHODS: Data on the total number of projects and funding of NSFC allocated to Ophthalmology, as well as papers published, awards, personnel training, subject construction were collected, and the role of NSFC on other sources of funding was evaluated. RESULTS: From 1986 to 2010, NSFC supported a total of 593 scientific research projects of Ophthalmology, funding a total amount of 152.44 million Yuan, among which were 371 free application projects, 156 Young Scientist Funds, 9 Key Programs, 5 National Science Fund for Distinguished Young Scholars, 3 Major international (regional) joint research programs, 1 Science Fund for Creative Research Group and 48 other projects. Over the past 25 years, the number of NSFC projects received by Ophthalmology has been an overall upward trend in the share in the Department of Life (Health) Sciences. Take the projects (186 of 292, 63.7%) as examples completed between 2002 and 2010, a total 262 papers were published in Science Citation Index (SCI) included journals and 442 papers were published in Chinese journals. Meanwhile, 8 Second prizes of National Science and Technology Progress Award and 1 State Technological Invention Award were received. As of 2010, the training of a total of more than 40 postdoctoral, more than 400 doctoral students and more than 600 graduate students have been completed. 5 national key disciplines and 1 national key laboratory have been built. Moreover, 2 "973" programs from Ministry of Science and Technology and 1 project of special fund in the public interest from Ministry of Public Health were obtained. 2 scholars were among the list of Yangtze Fund Scholars granted by Ministry of Education. CONCLUSIONS: Over the past 25 years, a full range of continuous funding from NSFC has led to fruitful results and a strong impetus to the progress of discipline of Ophthalmology.

[Clinical features and treatment of lateral orbital wall blow-in fracture].

OBJECTIVE: To analyze the clinical features of lateral orbital wall blow-in fracture and summarize the points of treatment. METHODS: A retrospective analysis of 12 patients with lateral orbital wall blow-in fracture treated in the Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from January 2007 to January 2010 was investigated. Clinical records and results of follow-up were analyzed. RESULTS: Twelve cases of the lateral orbital wall blow-in fracture with the frontal process of the zygoma impacted into the orbit were confirmed. Globe rupture occurred in 1 case, 4 cases had traumatic optic neuropathy. 1 case suffered exophthalmos, 8 cases had enophthalmos. Diplopia was found in 5 cases and eyeball movement disturbance in 5 cases.3 cases had upper eyelid deformity, 1 case had ptosis, 3 cases had telecanthus accompanied with lacrimal ducts obstruction. 11 cases suffered orbital floor fracture, 9 cases had zygomatic arc fracture, 6 cases had orbital medial wall fracture, and 3 cases had naso-orbito-ethmoid fracture. Surgical treatment was performed by different combination of approaches according to the extents of injury; Osteotomy was performed in patients whose blow-in fracture was malformation. Orbital reconstructive surgery was performed in 11 patients and fractures were completely restored. CONCLUSIONS: The lateral orbital wall blow-in fracture could cause serious impairment to the ocular components, better outcomes could be achieved by timely and proper treatment with improving recognition of this type of fracture.

[Small interference RNA targeting vascular endothelial growth factor inhibits rat corneal neovascularization].

OBJECTIVE: To test the effects of VEGF-siRNA-transfected corneal epithelium on corneal neovascularization (CNV). METHODS: It was an experimental study. Cultured rat corneal epithelial cells and keratocytes were transfected with synthesize VEGF siRNA by lipofectamine 2000. The level of VEGF mRNA was analyzed by real time PCR, and the protein levels were determined by enzyme-linked immunosorbent assay (ELISA). CNV was induced by cauterization with 1 mol/L sodium hydroxide in rat corneas. The VEGF-siRNA-transfected-corneal epithelium cells were transplanted to the CNV lesions. Immediately after transplantation, the VEGF-siRNA combined with lipofectamine 2000 were directly transfected rat cornea through injecting into the anterior chamber. After surgery, the surface areas occupied by new vessels were measured, and VEGF protein was localized by immunohistochemistry. RESULTS: The levels of VEGF expression at both mRNA and protein in the VEGF-siRNA transfected corneal epithelial cells and keratocytes were significantly lower than those of control cells. VEGF siRNA could inhibit the expression of VEGF mRNA in corneal epithelial cells and keratocytes to 57% - 85% and 59% - 78%, respectively. The VEGF-siRNA-transfected-corneal epithelium transplantation significantly decreased the surface areas occupied by new vessels. VEGF expression level in interference groups was lower than that in the control group. CONCLUSIONS: The development of CNV is markedly suppressed by VEGF-siRNA transfection in vivo.

[Emphasis on pathology and hemodynamics based classification of orbital vascular lesions].

Orbital vascular lesions, mainly including hemangioma and vascular malformation, are the most common disorders among orbital diseases. Vascular lesions of the orbit have clinically complicated presentations and are very hard to deal with. Selection of therapeutic modality on orbital vascular lesions requires an appropriate classification of them. An improved classification of these lesions has been proposed by the Orbital Society based on the pathological types and hemodynamic features and has been extensively used in developed countries. However, orbital vascular lesions are still being classified based on morphology in China. This classification system does not represent the pathological difference between hemangioma and vascular malformation of the orbit, nor the hemodynamic characteristics among different vascular malformations of the orbit. Morphology based classification has hampered scientific dialogue and confused clinicians, with occasionally serious consequences for patients. Thus, the use of a pathology and hemodynamics based classification of orbital vascular lesions should be highly advocated. We can expect that the use of appropriate classification can improve the management of these lesions in our country.

[Treatment of orbital venous malformation using surgical procedure combined with Nd:YAG laser].

OBJECTIVE: To evaluate the security and efficacy of surgical procedure combined with Nd:YAG laser in the management of orbital venous malformation. METHODS: A total of 17 successive patients with orbital venous malformation were treated with surgical excision in conjunction with Nd:YAG laser from July 2003 to June 2005. General anesthesia was performed in all patients. Appropriate approach was used according to the location and size of the lesion as well as its relation with adjacent tissues. Surgical procedure and laser coagulation were performed alternatively. Intermittent or continuous photocoagulation aimed at minor and deep lesions or large and superficial lesions was administrated, respectively, when indicated. Laser power of these two procedures was set at 60 to 90 J/cm2 or less than 100 J/cm2, respectively. Cold saline solution was used to cool the targeted region immediately after photocoagulation in case of damage to surrounding normal tissues. RESULTS: Seventeen patients were followed-up for 12 to 26 months. Notable lesion regression was found in 15 cases and fair reduction of the lesion in 2 cases. Vision acuity decrease did not occur and vision acuity increase was found in 2 patients. Exophthalmos was completely corrected, enophthalmos was found in 4 patients, the movement of the eyeballs was markedly improved. Complications consisted of superior oblique muscle paralysis (1 case) and ptosis (1 case). Relapse or aggravation of residual lesion was not found during the whole follow-up period. CONCLUSIONS: Surgical procedure combined with Nd:YAG laser is a safe and effective procedure in managing patients with orbital venous malformation. Laser treatment can decrease the hemorrhage during operation, make the surgical procedure easier, reduce the risk of operation and improve the results of surgical treatment.

[bFGF siRNA expression plasmid inhibits growth of human LEC-B3 cells].

OBJECTIVE: Basic fibroblast growth factor (bFGF) has been thought to play an important role during the development of posterior capsule opacification (PCO) by promoting the growth of lens epithelial cells (LECs). In the present study, we sought to explore the inhibition effect on LEC-B3 cells growth by plasmid-based RNA interference (RNAi) targeting bFGF. METHOD: It is a prospective study. LEC-B3 cells, an immortal human lens capsule epithelial cell line, were identified as human lens epithelium by immunohistochemical assay of alphaB-crystalline. Both bFGF and bFGF receptor 1 (FGFR1) mRNA expressions of LEC-B3 cells were determined by reverse transcription polymerase chain reaction (RT-PCR). Based on the identification of bFGF expression, plasmid-based RNA interference (RNAi) was used to inhibit bFGF mRNA expression of LEC-B3 cells by stable transfection. bFGF mRNA and protein levels were examined by real time PCR and western blot, respectively. Then the flow cytometry (FCM) was performed to evaluate proliferation cell nuclear antigen (PCNA) expression. PCNA level in bFGF-interfered LEC-B3 cells was compared to that of the control. P < 0.05 was regarded as statistically different. RESULTS: bFGF and FGFR1 mRNAs were abundantly expressed in LEC-B3 cells. bFGF mRNA and protein levels were both down-regulated by stable transfection of bFGF siRNA expression plasmid. PCNA expression was significantly decreased by inhibiting bFGF expression (t = -5.0011, P = 0.0005). CONCLUSIONS: bFGF and FGFR1 mRNA are extensively expressed in LEC-B3 cells. Plasmid-based RNAi targeting bFGF can lead to potent inhibition of LEC-B3 cells growth, which may play a part in dealing with the development of PCO.

[Inhibition of VEGF expression by plasmid-based RNA interference in the retinoblastoma cells].

OBJECTIVE: To explore the inhibition effect of small hairpin RNA (shRNA) expression plasmid targeting vascular endothelial growth factor (VEGF) on VEGF expression in cultured retinoblastoma (RB) cells. METHODS: VEGF shRNA plasmid p4.1CMV-VEGF was constructed and transfected into retinoblastoma cell lines SO-RB50 and HXO-RB44. Using neomycin G418 in conjunction with gradient dilution, p4.1CMV-VEGF shRNA positive single clone of RB cells was selected and subsequently enriched. Real-time polymerase chain reaction (PCR) was applied to detect VEGF mRNA levels of RB cells. VEGF protein concentration in culture supernatants of RB cells were determined by enzyme-linked immunosorbent assay (ELISA). Plasmid p4.1CMV-Neg shRNA, which expressed shRNA lacking significant sequence identity to human and mouse genome databases, was transfected into RB cells as negative control. Cells without any treatment were used as blank controls. RESULTS: p4.1CMV-VEGF shRNA was constructed successfully and VEGF shRNA construct positive clone of RB cells was developed. VEGF mRNA level of SO-RB50 (HXO-RB44) cells in negative control and blank control was 5.02 (5.70) folds and 6.32 (4.86) folds greater than that in p4.1CMV-VEGF shRNA treated SO-RB50 (HXO-RB44) cells. VEGF protein concentration in culture supernatants of p4.1CMV-VEGF shRNA treated SO-RB50 cells (187.69 +/- 83.89) microg/L was significantly lower than that of negative control (822.98 +/- 187.98) microg/L and blank control (865.76 +/- 170.33) microg/L (P < 0.01). There was also significant difference of VEGF protein concentration between p4.1CMV-VEGF shRNA treated HXO-RB44 cells (162.20 +/- 66.33) microg/L and controls (764.33 +/- 164.79) microg/L in negative control and (828.22 +/- 145.94) microg/L in blank control (P < 0.01). CONCLUSIONS: Stable transfection of VEGF shRNA expression plasmid can potently suppress VEGF expression in RB cells. RNA interference (RNAi) targeting VEGF promises to be a substantial tool for the study of the treatment of RB.

[Reduction of tumorigenicity of SMMC7721 hepatoma cell line by VEGF siRNA].

In this study the small interfering RNA(siRNA) targeting human VEGF effectively inhibited the expression of VEGF in human hepatoma cell line, SMMC7721, and could dramatically decrease the tumorigenicity of SMMC7721 s.c. xenograft tumor. Chemically synthesized siRNA targeting VEGF was transiently transfected into SMMC7721 cells by lipofectamine, RT-PCR and Elisa analysis suggested that the expression of VEGF mRNA and secreted protein in SMMC7721 cells with VEGF siRNA transfection were suppressed with inhibition rates of 76.16% and 96.28% respectively compared with negative control, but the growth rate of SMMC 7721 cells with VEGF siRNA transfection was the same as the control cells. In vivo test, siRNA was injected directly into implanted tumors and the tumors volume were calculated at different time interval. Result showed that VEGF siRNA greatly inhibited the growth of tumors tissues, which was consistent with decrease of VEGF mRNA and protein compared with control. In addition, the VEGF siRNA-treated group exhibited obvious signs of necrosis compared with control.