[Treatment of patients with rhegmatogenous retina detachment combined with non-secondary glaucoma].

OBJECTIVE: To discuss the cause of disease, treatment and therapeutic effect in patients with rhegmatogenous retina detachment (RRD) combined with non-secondary glaucoma. METHODS: Clinical data of 28 patients with RRD combined with primary or congenital glaucoma were retrospectively analyzed. RESULTS: Twenty-five out of the 28 patients succeeded with one operation (89.3%). The intraocular pressure of post-operation:on the 1st day was 10 approximately 46 (28.1+/-6.5) mmHg, on the 7th day was (18.9+/-7.2) mmHg, and on the last re-examination day was (17.6+/-6.2) mmHg. Anti-glaucoma operation was performed in 10 patients after the retinal operation. Chroidal hemorrhage was found in 2 patients and 2 chroidal exudations were found after the retinal operation. CONCLUSION: The proportion of primary open angle glaucoma is higher than that of primary angle closure glaucoma, and trauma or surgery before the retinal operation is an important cause in glaucoma patients with RRD. There is no obvious difference in the ratio of surgical success between non-secondary glaucoma with RRD and those RRD patients without glaucoma. Vitreotomy+ silicon oil injection or drainage of subretinal fluid+air injection+cryocoagulation+explants is recommended. Chroid is easily involved. It is important to control the intraocular pressure during and after the surgery. The final visual acuity is rather poor, which may be related to the glaucoma and intraocular pressure.

[The effects of caspase-3 in apoptosis of cultured retinal microvascular pericytes induced by advanced glycation end products].

OBJECTIVE: One of the earliest changes observed in the development of diabetic retinopathy (DR) is the selective loss of pericytes and acellular capillaries. We tested the hypothesis that advanced glycation end products (AGE) might be involved in the disappearance of retinal pericytes by apoptosis and further investigated the activity and effect of caspase-3 at the same time. METHODS: Cultured bovine retinal microvascular pericytes (BRPs) were exposed to various concentrations of advanced glycation end products-bovine serum albumin (AGE, 0.47, 1.88, 7.50 micromol/L) for 4 days. We assayed the degree of pericytes apoptosis by fluorescence activated cell sorting, and further measured the caspase-3 activity and the effect of selective caspase-3 inhibitor Z-DEVD-fmk on apoptosis and the of ratio Bcl-2/Bax expression. RESULTS: The results showed that AGE could induce significantly the apoptosis of BRPs in a dose-dependent manner compared with controls (r = 0.867, P < 0.01), associated with an increase in intracellular caspase-3 activity. Selective caspase-3 inhibitor Z-DEVD-fmk inhibited pericyte apoptosis induced by AGE. CONCLUSION: These data suggest that the pericyte loss in DR involves an apoptotic process, and that activation of caspase-3 are associated with apoptotic process, which can provide new therapeutic perspectives in diabetic retinopathy.

Advanced glycation end-products induce apoptosis involving the signaling pathways of oxidative stress in bovine retinal pericytes.

One of the histopathologic hallmarks of early diabetic retinopathy is the selective loss of pericytes. Evidences suggest that the pericyte loss in vivo is mediated by apoptosis. However, the underlying cause of pericyte apoptosis is not fully understood. This study investigated the effect of advanced glycation end products (AGEs) on apoptotic cell death in bovine retinal pericytes (BRPs). After incubation of BRPs with 0.47, 1.88, 7.5, 30 microM of AGE-bovine serum albumin (BSA) for 4 days, we assayed the pericytes apoptosis by FACS (fluorescence activated cell sorting), and further measured the signaling pathway involved. The results showed that AGE-BSA could induce significantly the apoptosis of BRPs in a dose-dependent manner compared with controls, associated with an increase in intracellular malondialdehyde level and caspase-3 activity; a decrease in intracellular catalase, SOD activities and Bcl-2/Bax ratio. SOD and selective caspase-3 inhibitor Z-DEVD-fmk can inhibit pericyte apoptosis induced by AGE-BSA. These data suggest that the pericyte loss in diabetic retinopathy involves an apoptotic process, and that elevated AGE observed in diabetes may cause apoptosis in BRPs through an oxidative stress mechanism. The decreased Bcl-2/Bax ratio and activation of caspase-3 are associated with apoptotic process.

[Splicing site mutation of D19S418 in PRPF-31 gene and its phenotypic characters with autosomal dominant retinitis pigmentosa].

OBJECTIVE: To evaluate the disease-causing gene and phenotypic characters of a large family with autosomal dominant retinitis pigmentosa (adRP). METHODS: Disease status and associated ocular abnormalities of eight patients and six unaffected members who represent different generations of this family were assessed by measurement of visual psychophysics, full-field and multifocal electrophysiology (ERG and mfERG) and funds fluorescent angiography (FFA). The DNA samples of nineteen patients and fifteen unaffected individuals in this family were examined by Genome scanning, linkage analysis and mutation detection to identify coding sequence changes. RESULTS: A case with variable, early onset night blindness before 10 years and visual field loss in their teens was found. Macular dystrophy, progressing to a retinitis pigmentosa phenotype was demonstrated in most adult cases. Both a-wave and b-wave amplitudes of photopic and scotopic full-field ERG were marked reduced and nearly non-detectable, demonstrating severe damage of photoreceptor systems. There were two obligate gene carriers in the family which remained asymptomatic in the clinical. But one of them was found with a minimal RP characteristic and the other was normal by examination of fundus and ERG. An unreported splicing site mutation (IVS5-1G > A) was identified in intron 5- acceptor site of PRPF-31 gene on chromosome 19. ERG and molecular genetic findings were consistent with the reclassification of this disease as an autosomal dominant RP. CONCLUSION: It is a novel splicing site mutation that IVS5-1G > A of D19S418 site in PRFP31, the relative phenotypes by which main displayed type I/diffuse has variable expressivity and complex phenotype.

[Corneal combined amniotic membrane transplantation for early severe alkali chemical injury of the eye].

OBJECTIVE: To investigate the effect of lamella corneal transplantation combined amniotic membrane transplantation for the early severe alkali burns of eyes. METHODS: Twenty-three eyes with an over second-degree acute corneal alkali injury in 2 weeks were treated by lamella corneal transplantation combined amniotic membrane transplantation. After the operation the patients were treated with an intense and prolonged regimen of topical steroids and topical and systemic vitamin C. All patients were followed up for 6-12 months. RESULTS: Seven eyes were cornea transparent, 10 semi-transparent, and 6 opaque in the 23 eyes, respectively. The visual acuity of 3 eyes was better than 0.3, that of 5 eyes was between 0.25 to 0.1, and that of the other 15 eyes was below 0.1. No eye was enucleated due to the corneoscleral melting. CONCLUSION: Lamella corneal transplantation combined amniotic membrane transplantation may clear away the necrotic tissues and cells of corneal or conjunctiva, prevent and reduce the complication, and improve the prognosis of the patients.

[Modification of silicone oil removal via limbus of corneal with aphakia].

OBJECTIVE: To introduce a simplified method to remove silicone oil via limbus of corneal after previous lensectomy-vitrectomy. METHODS: Fifty-one eyes received the modified procedures to eliminate silicone oil via one pars plana or limbus incision after previous lensectomy-vitrectomy. Local anesthesia was performed with 25G syringe needle through pars plana or corneal limbus infusion and super limbus incisions to eliminate silicone oil. RESULTS: All operations were primarily successful in eliminating silicone oil. The complications occurred in all the patients with the early low intraocular pressure, in 4 (4/51, 7.8%) eyes with retinal detachment, and in 2 (2/51, 3.9%) eyes with less bleeding at the point of puncture. The visual acuity was significantly improved after the procedure (P < 0.05) in patients with stable retinal reattachment. CONCLUSION: The procedure via one pars plana and limbus or limbus incision after previous lensectomy-vitrectomy is useful in removing the silicone oil tamponade in aphakic eyes because of its simplicity, good curative effect, and fewer complications.

[Transplantation of amniotic membrane and amniotic membrane combined with limbal autograft for patients with complicated pterygium].

OBJECTIVE: To evaluate the curative effects of amniotic membrane transplantation and amniotic membrane combined with limbal autograft on patients of complicated pterygium. METHODS: Forty-two cases (48 eyes) of recurrent pterygium or pseudopterygium were operated on with human amniotic membrane transplantation (20 cases 22 eyes) and amniotic membrane combined with limbal autograft (22 cases 26 eyes). All cases were followed up for 6-12 months. RESULTS: In 2 week postoperation, corneal wound recovered quickly and cured by epithelium except two eyes in amniotic membrane combined with limbal autograft group, but 8 eyes were not cured in amniotic membrane transplantation group. There was significant difference between two groups (P < 0.05). In the terms of follow-up, no rejection or recurrence were found in amniotic membrane with limbal autograft group, but 3 eyes recurred a relapse in amniotic membrane transplantation group. CONCLUSION: Amniotic membrane combined with limbal autograft is more effective in the treatment of recurrence or pseudopterygium than amniotic membrane transplantation, and is able to inhibit fibrosis, reconstruct the ocular surface and promote the epithelial recovery, so as to improve the curative effect and decrease the recurrence.

[Analysis of misdiagnostic causes of Coats disease].

OBJECTIVE: To analyze the clinical features and misdiagnostic causes of Coats disease. METHODS: The clinical data were retrospectively analyzed in 69 eyes of 68 patients with Coats disease. RESULTS: Misdiagnostic histories to a varying degree occurred in 11 of the 68 cases with a misdiagnosis rate of 16.18% and misdiagnostic mean time of 7.5 months. CONCLUSION: Lack of knowledge on pathogenic characteristics of Coats disease, lack of typical manifestations, no timely accessory examinations, and advanced cases are the main causes of misdiagnosis.

[Advanced glycation end products induce apoptosis and expression of apoptotic genes in cultured bovine retinal capillary pericytes].

OBJECTIVE: The purpose of the present study was to examine whether advanced glycation end products (AGE) contribute to the development of apoptosis and expression of apoptotic genes in cultured bovine retinal capillary pericytes (BRPs), in order to investigate retinal microvascular pathologic process during early stage of diabetic retinopathy. METHODS: After a 4 day incubation with various concentrations of AGE (8, 32, 125, 500, 2,000 mg/L) which were prepared in vitro by incubating bovine serum albumin (BSA) with glucose, we studied the degree of apoptosis and the expressions of apoptotic genes (Bax and bcl-2) in BRPs by staining with the Annexin V-FITC and propidium iodide (PI), terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) and immunohistochemistry. RESULTS: (1) After a 4 day incubation with various concentrations of AGE, BRPs showed typical changes of apoptosis, i.e. shrunken cell size, nuclear condensation associated with DNA fragmentation, a relatively intact cell membrane, and loss of cell viability eventually. (2) AGE could induce significant apoptosis of BRPs in a dose-dependent manner as compared with normal cultures or the albumin group not treated by glucose (r = 0.878, P < 0.01). (3) After a 4 day incubation, the level of pro-apoptotic gene Bax was upregulated (r = 0.855, P < 0.01), whereas the level of pro-survival gene bcl-2 was downregulated by AGE in a dose-dependent manner (r = -0.850, P < 0.01). (4) There was a positive correlation between apoptotic rate and Bax-bcl-2 ratio of BRPs induced by AGE (r = 0.808,P < 0.01). CONCLUSIONS: AGE can induce a significant apoptosis of BRPs in a dose-dependent manner and the rate of apoptosis was determined by the Bax/bcl-2 ratio. These results suggest that the selective loss of pericytes in diabetic retinopathy involves an apoptotic process.

[Cyclosporin A combined with dexamethasone in preventing and treating immune rejection after penetrating keratoplasty].

OBJECTIVE: To evaluate the efficacy of topical 1% cyclosporin A (CsA), 0.1% dexamethasone or 1% CsA combined with 0.1% dexamethasone in preventing and treating immune rejection after penetrating keratoplasty (PKP). METHODS: Eighty-six eyes from 86 PKP patients were randomly divided into 3 groups: (1) Thirty-one eyes were treated with 1% CsA and dexamethasone for 3 months. (2) Twenty-nine eyes were treated with 1% CsA for 3 months; (3) Twenty-six eyes were treated with 0.1% dexamethasone for 3 months. The rejected eyes of postoperation were given with the dexamethasone injection under conjunctiva and increased the frequency of CsA and dexamethasone eye drops. All patients were followed up for 1 to approximately 2 years. RESULTS: There was a statistical difference in the 3 groups in the postoperative immune rejection which occurred in 5 out of 29 (17.3% ) eyes treated with 1% CsA, 7 out of 26 (26.9%) treated with 0.1% dexamathasone, and 3 out of 31 (9.7%) with 1% CsA and dexamethasone. The immune rejection after PKP occurred in 15 eyes and 13 eyes were cured by sub-conjunctiva injection of dexamethasone combined with eye drops of 1% CsA and 0. 1% dexamethasone. CONCLUSION: The efficacy of CsA combined with dexamethasone topically is better than that of 1% CsA or 0.1% dexamethasone alone in preventing rejection episodes. It is effective to cure the graft rejection after PKP with sub-conjunctiva injection of dexamethasone combined with the eye drop of 1% CsA and 0.1% dexamethasone.