Yokoyama procedure for cyclic strabismus with axial high myopia:a case report.

BACKGROUND: It is a very rare form of ocular motility characterized by alternating strabismus and orthotropia. We report a patient with a 48-h cycle of esohypotropia associated with axial high myopia that resolved by Yokoyama procedure. CASE PRESENTATION: A 43-year-old female patient who underwent left medial rectus muscle recession and lateral rectus muscle resection elsewhere due to highly myopic strabismus 2 years ago. The patient experienced a recurrence of left esohypotropia 12 months after undergoing surgery, exhibiting a 48-hour cycle. The cycle is one full day of esohypotropia and one day of orthotropia. The patient exhibited a case of high myopia in the left eye, characterized by a diopter measurement of -24.00DS and an eye axis measurement of 28.43 mm. Orbital CT showed supertemporal dislocation of the posterior portion of the elongated globe out from the muscle cone. Based on these observations, we performed Yokoyama procedure by uniting the muscle bellies of the superior rectus(SR) and lateral rectus (LR) muscles to restoring the dislocated globe back into the muscle cone. CONCLUSIONS: When cyclic strabismus is combined with axial high myopia, the Yokoyama procedure was effective and cycles are successfully terminated without overcorrection on no squint days. The purpose of this procedure is to put the dislocated globe back into its muscle cone by uniting the muscle bellies of the superior rectus and lateral rectus.

Pachymic Acid Ameliorates Pulmonary Hypertension by Regulating Nrf2-Keap1-ARE Pathway.

OBJECTIVE: Pulmonary hypertension (PH) is a severe pulmonary vascular disease that eventually leads to right ventricular failure and death. The purpose of this study was to investigate the mechanism by which pachymic acid (PA) pretreatment affects PH and pulmonary vascular remodeling in rats. METHODS: PH was induced via hypoxia exposure and administration of PA (5 mg/kg per day) in male Sprague-Dawley rats. Hemodynamic parameters were measured using a right ventricular floating catheter and pulmonary vascular morphometry was measured by hematoxylin-eosin (HE), α-SMA and Masson staining. MTT assays and EdU staining were used to detect cell proliferation, and apoptosis was analyzed by TUNEL staining. Western blotting and immunohistochemistry were used to detect the expression of proteins related to the Nrf2-Keap1-ARE pathway. RESULTS: PA significantly alleviated hypoxic PH and reversed right ventricular hypertrophy and pulmonary vascular remodeling. In addition, PA effectively inhibited proliferation and promoted apoptosis in hypoxia-induced pulmonary artery smooth muscle cells (PASMCs). Moreover, PA pretreatment inhibited the expression of peroxy-related factor (MDA) and promoted the expression of antioxidant-related factors (GSH-PX and SOD). Furthermore, hypoxia inhibited the Nrf2-Keap1-ARE signaling pathway, while PA effectively activated this pathway. Most importantly, addition of the Nrf2 inhibitor ML385 reversed the inhibitory effects of PA on ROS generation, proliferation, and apoptosis tolerance in hypoxia-induced PASMCs. CONCLUSION: Our study suggests that PA may reverse PH by regulating the Nrf2-Keap1-ARE signaling pathway.

Meta-analysis of best corrected visual acuity after treatment for myopic choroidal neovascularisation.

AIM: To compare the best corrected visual acuity (BCVA) between Verteporfin with photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in patients with myopic choroidal neovascularization (CNV). METHOD: Published literature from Medline, Premedline, Embase and the Cochrane Library from inception until November 2013 were retrieved. All studies evaluating the BCVA between Verteporfin with PDT and intravitreal anti-VEGF for myopic CNV were included. The results were pooled using mean difference (MD), a corresponding 95% confidence interval (CI). RESULTS: Finally, five studies enrolled 349 eyes were included in the meta-analysis. We inferred that the BCVA of myopic CNV after the treatment of anti-VEGF was significantly better compared with Verteporfin with PDT (MD=0.25, 95%CI:0.17-0.33, Z=5.97, P<0.00001). CONCLUSION: This meta-analysis suggests that intravitreal anti-VEGF could have a better BCVA after treatment than Verteporfin with PDT for myopic CNV.

TGFBI and CHST6 gene analysis in Chinese stromal corneal dystrophies.

AIM: To investigate whether mutations in TGFBI gene or CHST6 gene correlated with stromal corneal dystrophies (CD) in 8 Chinese probands. METHODS: Eight unrelated patients with stromal corneal dystrophies were recruited in this study; all affected members were assessed by completely ophthalmologic examinations. Genomic DNA was extracted from peripheral leukocytes, 17 exons of TGFBI gene and the exon of CHST6 gene were amplified by polymerase chain reaction (PCR), sequenced directly and compared with the reference database. RESULTS: Three heterozygous mutations in TGFBI gene were identified in six patients: c. 370C>T (p.Arg124Cys) was found in exon 4 of TGFBI gene in three members, c. 371G>A (p.Arg124His) was found in one patient; c. 1663C>T (p.Arg555Trp) was found in exon 12 in other two members. In addition, four polymorphisms with the nucleotide changes rs1442, rs1054124, rs4669, and rs35151677 were found in TGFBI gene. Mutations were not identified in the rest of 2 affected individuals in TGFBI gene or CHST6 gene. CONCLUSION: Within these patients, R124C, R124H and R555W mutations were co-segregated with the disease phenotypes and were specific mutations for lattice corneal dystrophy type I (LCD I), Avellino corneal dystrophy (ACD, GCD II), granular corneal dystrophy type I (GCD I), respectively. Our study highlights the prevalence of codon 124 and codon 555 mutations in the TGFBI gene among the Chinese stromal corneal dystrophies patients.

Hypopyon in patients with fungal keratitis.

BACKGROUND: Hypopyon is common in eyes with fungal keratitis. The evaluation of the clinical features, culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions. METHODS: The medical records of 1066 inpatients (1069 eyes) with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features, risk factors, clinical characteristics, laboratory findings and treatment outcomes. The incidence of hypopyon, the fungal culture positivity for hypopyon, risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined. RESULTS: We identified 1069 eyes with fungal keratitis. Of the 850 fungal culture-positive eyes, the Fusarium species was the most frequent (73.6%), followed by Alternaria (10.0%) and Aspergillus (9.0%). Upon admission, 562 (52.6%) eyes with hypopyon were identified. The hypopyon of 66 eyes was evaluated via fungal culturing, and 31 eyes (47.0%) were positive. A total of 194 eyes had ocular hypertension, and 172 (88.7%) of these eyes had hypopyon (P < 0.001). Risk factors for incident hypopyon included long duration of symptoms (P < 0.001), large lesion size (P < 0.001) and infection caused by the Fusarium and Aspergillus species (P < 0.001). The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size. Surgical intervention was more common in cases with hypopyon (P < 0.001). Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation (P = 0.002). CONCLUSIONS: Hypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension. About half of the hypopyon cases were positive based on fungal culture. Long duration of symptoms, large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon. The presence of hypopyon increases the likelihood of surgical intervention.

[Research of the change tendency of corneal transplantation indications from 2000 to 2009].

OBJECTIVE: To analyzed retrospectively the indications of corneal transplantations, including penetrating keratoplasty (PKP), lamellar keratoplasty (LKP) and corneal transplantation combined with anterior and posterior segment surgery in Qingdao Eye Hospital, Shandong Eye Institute. And compare the changes of the indications between the first five years and the last five years. METHODS: The patients who received PKP, LKP and corneal transplantation combined with anterior and posterior segment surgeries in Qingdao Eye Hospital, Shandong Eye Institute between January 2000 and December 2009 were reviewed retrospectively. From 2000 to 2009, 3649 cases (3741 eyes) of corneal transplantations have complete data, including male 2518 cases (2582 eyes), female 1131 cases (1159 eyes); PKP 2594 cases (2667 eyes), LKP 1055 cases (1074 eyes). Compare and analysis the indications and its changes between 2000 - 2004 and 2005 - 2009 two periods. RESULTS: During the first period, the leading indications for PKP, in order of decreasing frequency, were purulent keratitis (440 cases, 442 eyes), keratoconus (241 cases, 274 eyes), herpes simplex keratitis (HSK) (229 cases, 229 eyes), the leading indications for LKP were purulent keratitis (221 cases, 221 eyes), corneal burn (including thermal and chemical burn) (106 cases, 106 eyes), others (mainly refers to the phlyctenular keratitis, interstitial keratitis, et al) (79 cases, 79 eyes), the ratio of PKP and LKP is 2.5 to 1.0. During the second period the leading indications for PKP, in order of decreasing frequency, were purulent keratitis (330 cases, 330 eyes), HSK (124 cases, 124 eyes), keratoconus (99 cases, 105 eyes), the leading indications for LKP were purulent keratitis (230 cases, 236 eyes), keratoconus (97 cases, 101 eyes), corneal dystrophy and degeneration (42 cases, 49 eyes), the ratio of PKP and LKP is 1.7 to 1.0. CONCLUSIONS: Purulent keratitis is the main indication of corneal transplantation, the choice of LKP significantly increase. LKP has become the first surgical choice of purulent keratitis and keratoconus.

[Infectious keratitis in China during the past two decades: a bibliometric analysis].

OBJECTIVE: To gain insights into the construction and content of literature on infectious keratitis in China during the past two decades. METHODS: Through VIP-VMIS, SinoMed and PubMed databases for the period of 1989 to 2008, the literature regarding infectious keratitis published in domestic and foreign journals by China authors was retrieved. Numbers, types, time, journal distribution of documents published and provincial distribution of authors were recorded. Meanwhile the subject content was roughly analyzed. RESULTS: There were 1982 Chinese articles on infectious keratitis during the past two decades, of which 629 were pertaining to traditional Chinese medicine. In the remaining 1353 of Western medicine articles, 704 were published in kernel journals, 78 in serial journals of Chinese Medical Association and 443 as original research articles (including 160 basic research papers). Moreover, 30 articles regarding epidemiology and etiology of infectious keratitis were retrieved from VIP-VMIS. And 31 papers published in foreign journals were retrieved from PubMed database. CONCLUSIONS: During the past two decades, the China oculists have made great progress in research works on infectious keratitis. However more attention should be devoted to the basic researches, epidemiologic survey and etiologic analysis.

Trends in the indications for penetrating keratoplasty in Shandong, 2005-2010.

AIM: To identify the current indications and the trend shifts for penetrating keratoplasty (PKP) in Shandong. METHODS: The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1, 2005 to May 31, 2010 were analysed retrospectively. RESULTS: A total of 875 patients (875 eyes) received PKP in this 5-year period, accounting for 61.6% of all corneal transplantation surgeries. The leading indications for PKP were infectious keratitis (37.1%), HSK (19.1%), keratoconus (11.2%), bullous keratopathy (8.5%), regrafting (6.7%) and corneal scarring (4.8%). The percentage of PKP for keratoconus declined year by year, whereas the percentage of bullous keratopathy had a mild annual increase. Fungal infections accounted for 65.2% of the infectious keratitis cases, remaining the leading cause of corneal infection. In addition, 54.1% of bullous keratopathy cases were associated with cataract surgery. The leading initial diagnoses associated with regrafting were infectious keratitis (38.9%), HSK (18.6%) and corneal burn (16.9%). The major causes of regrafting included graft endothelial dysfunction (39.0%), graft ulcer (28.8%) and primary disease recurrence (15.3%). CONCLUSION: Infectious keratitis remained the leading indication for PKP in Shandong, and fungal infections were still the major cause of corneal infections. There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus. Even with a decline in the overall proportion among all corneal transplantation surgeries, PKP is still the major corneal transplant choice in Shandong.