Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes.

BACKGROUND: Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis. METHODS: We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed. RESULTS: Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes. CONCLUSIONS: Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

Protective Effects of Anthocyanins Extracted from Vaccinium Uliginosum on 661W Cells Against Microwave-Induced Retinal Damage.

OBJECTIVE: To study the protective effect of anthocyanins extracted from Vaccinium Uliginosum (VU) on retinal 661W cells against microwave radiation induced retinal injury. METHODS: 661W cells were divided into 6 groups, including control, model [661W cells radiated by microwave (30 mW/cm2, 1 h)] and VU groups [661W cells pretreated with anthocyanins extracted from VU (25, 50, 100 and 200 µg/mL, respectively) for 48 h, and radiated by microwave 30 mW/cm2, 1 h]. After treatment with different interventions, the cell apoptosis index (AI) was determined using Heochst staining; contents of malonaldehyde (MDA), glutataione (GSH), and activity of superoxide dismutase (SOD) were measured. mRNA expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1(HO-1) were detected by real time quantitative polymerase chain reaction, and the expression of HO-1 protein was examined by Western blot analysis. Nucleus and cytoplasm were separated and Nrf2 protein expression was further verified by Western blot analysis. RESULTS: There was significant difference in AI among the groups (F=322.83, P<;0.05). Compared with the control group, AI was significantly higher in the model group and was lower in 4 VU-pretreated groups (P<;0.05). Linear regression analysis showed the decline of AI was in a dose-dependent manner with VU treatment (r=0.8419, P<;0.05). The MDA and GSH contents of 661W cells in VU-treated groups were significantly lower than the model group (P<;0.05). Compared with the model group, the SOD activity in the VU-treated groups (50, 100 and 200 µg/mL) was significantly higher (all P<;0.05). The Nrf2 and HO-1 mRNA expressions were slightly increased after irradiation, and obviously increased in 100 µg/mL VU-treated group. After irradiation, the relative expressions of HO-1 and Nrf2 proteins in nucleus were slightly increased (P<;0.05), and the changes in cytoplasm were not obvious, whereas it was significantly increased in both nucleus and cytoplasm in the VU treatment groups. CONCLUSIONS: Anthocyanins extracted from VU could reduce apoptosis, stabilize cell membrane, and alleviate oxidant injury of mouse retinal photoreceptor 661W cells. The mechanism might be through activating Nrf2/HO-1 signal pathway and inducing HO-1 transcription and translation.

An online diabetic retinopathy screening tool for patients with type 2 diabetes.

AIM: To develop a useful diabetic retinopathy (DR) screening tool for patients with type 2 diabetes mellitus (T2DM). METHODS: A DR prediction model based on the Logistic regression algorithm was established on the development dataset containing 778 samples (randomly assigned to the training dataset and the internal validation dataset at a ratio of 7:3). The generalization capability of the model was assessed using an external validation dataset containing 128 samples. The DR risk calculator was developed through WeChat Developer Tools using JavaScript, which was embedded in the WeChat Mini Program. RESULTS: The model revealed risk factors (duration of diabetes, diabetic nephropathy, and creatinine level) and protective factors (annual DR screening and hyperlipidemia) for DR. In the internal and external validation, the recall ratios of the model were 0.92 and 0.89, respectively, and the area under the curve values were 0.82 and 0.70, respectively. CONCLUSION: The DR screening tool integrates education, risk prediction, and medical advice function, which could help clinicians in conducting DR risk assessments and providing recommendations for ophthalmic referral to increase the DR screening rate among patients with T2DM.

A new perspective for analyzing clinical characteristics of idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome.

PURPOSE: We aimed to analyze the clinical characteristics of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Furthermore, we aimed to correlate the number and location of retinal aneurysms with the size of retinal non-perfusion area and neovascularization. METHODS: Six patients with IRVAN syndrome (1 male and 5 females, age 5-38 years) were enrolled in this study. Fundus fluorescein angiography (FFA) was used to determine the total number of retinal aneurysms, number of aneurysms within the first branch of the retinal artery, minimum distance between the non-perfusion margin and the optic disc, and the number of retinal aneurysms in each quadrant, as well as the type of neovascularization. RESULTS: The size of the non-perfusion area was positively correlated with the total number of retinal aneurysms, the number of aneurysms within the first branch of the retinal artery, and the number of retinal aneurysms in each quadrant (P < 0.05). During the 5-year follow-up, one patient exhibited a dynamic change in the number and location of retinal aneurysms. CONCLUSIONS: In IRVAN syndrome, the number and location of retinal aneurysms correlate with the size of retinal non-perfusion area and type of neovascularization.

Research Advances in Biomarkers for Demyelinating Optic Neuritis.

Optic neuritis refers to all inflammatory diseases in the optic nerve. The most common type is demyelinating optic neuritis. Biomarkers can indicate its pathophysiological process and thus are useful in disease diagnosis and treatment. This article reviews the known biomarkers for demyelinating optic neuritis.

Removal of the eye in a tertiary care center of China: a retrospective study on 573 cases in 20 years.

AIM: To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration. METHODS: A retrospective study of 573 eyes removed (573 inpatients) at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed. RESULTS: Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14%) being enucleated and 406 (70.86%) eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62%) in original protopathies followed by neoplasm (13.44%) and ocular infections (5.76%). Phthisis bulbi (45.20%) was the most common direct indication, succeeded by malignant tumor (12.57%), loss/unreconstructed of intraocular tissues due to trauma (11.00%), untreatable inflammation (9.60%), intractable glaucoma (8.55%) and sclerocorneal staphyloma (5.24%). Exenteration was underwent in 20 (25.97%) cases (40% for recurrent carcinoma). Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%. CONCLUSION: Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be focused on.

Correlation of in vivo and in vitro methods in measuring choroidal vascularization volumes using a subretinal injection induced choroidal neovascularization model.

BACKGROUND: In vivo quantification of choroidal neovascularization (CNV) based on noninvasive optical coherence tomography (OCT) examination and in vitro choroidal flatmount immunohistochemistry stained of CNV currently were used to evaluate the process and severity of age-related macular degeneration (AMD) both in human and animal studies. This study aimed to investigate the correlation between these two methods in murine CNV models induced by subretinal injection. METHODS: CNV was developed in 20 C57BL6/j mice by subretinal injection of adeno-associated viral delivery of a short hairpin RNA targeting sFLT-1 (AAV.shRNA.sFLT-1), as reported previously. After 4 weeks, CNV was imaged by OCT and fluorescence angiography. The scaling factors for each dimension, x, y, and z (µm/pixel) were recorded, and the corneal curvature standard was adjusted from human (7.7) to mice (1.4). The volume of each OCT image stack was calculated and then normalized by multiplying the number of voxels by the scaling factors for each dimension in Seg3D software (University of Utah Scientific Computing and Imaging Institute, available at http://www.sci.utah.edu/cibc-software/seg3d.html). Eighteen mice were prepared for choroidal flatmounts and stained by CD31. The CNV volumes were calculated using scanning laser confocal microscopy after immunohistochemistry staining. Two mice were stained by Hematoxylin and Eosin for observing the CNV morphology. RESULTS: The CNV volume calculated using OCT was, on average, 2.6 times larger than the volume calculated using the laser confocal microscopy. The correlation statistical analysis showed OCT measuring of CNV correlated significantly with the in vitro method (R 2 =0.448, P = 0.001, n = 18). The correlation coefficient for CNV quantification using OCT and confocal microscopy was 0.693 (n = 18, P = 0.001). CONCLUSIONS: There is a fair linear correlation on CNV volumes between in vivo and in vitro methods in CNV models induced by subretinal injection. The result might provide a useful evaluation of CNV both for the studies using CNV models induced by subretinal injection and human AMD studies.

The involvement of high mobility group 1 cytokine and phospholipases A2 in diabetic retinopathy.

BACKGROUND: Diabetic retinopathy, the main microvascular complications of diabetes and one of the leading causes of blindness worldwide. Interesting reports on the role of inflammatory/proangiogenic high mobility group 1 (HMGB-1) cytokine and phospholipases A2 (PLA2) in neovascularization have diverted our concentration to reveal whether HMGB-1 and PLA2 plays role in diabetic retinopathy. METHODS: We performed our study in streptozotocin (STZ)-induced diabetic rat model. The expression levels of the cytokines, chemokines, and cell adhesion molecules in retinal tissues were evaluated by quantitative RT-PCR. HMGB-1 and PLA2 protein levels along with VEGF, TNF-α, IL-1ß and ICAM-1 levels were also measured. RESULTS: We observed the retinal pericytes, endothelial injury/death and breakdown of blood-retinal barrier (BRB). The protein expression of HMGB-1, PLA2 and IL-1ß were significantly increased in micro vessels from retina of diabetic rats. Diabetic rats had also high retinal levels of VEGF, ICAM-1 and TNF-α. Further investigation revealed that pericyte death is mediated by HMGB-1-induced cytotoxic activity of glial cells, while HMGB-1 can directly mediate endothelial cell death. Similarly, increased expression of PLA2 represents the diabetic mediated alteration of BRB, perhaps up regulating the VEGF. CONCLUSIONS: Our data suggest that HMGB-1 and PLA2 involved in retinal pericyte and endothelial injury and cell death in diabetic retinopathy. From this study, we suggest that HMGB-1 and PLA2 may be interesting targets in managing diabetic retinopathy.

A new classification for epidemiological study of mechanical eye injuries.

OBJECTIVE: Considering the difficulty in classifying some cases with eye trauma by Birmingham Eye Trauma Terminology (BETT) in our epidemiological study, we introduce a new classification for epidemiological study of mechanical eye injuries based on BETT. METHODS: A retrospective investigation was carried out in 31 hospitals from January 2005 to December 2010. All medical records of inpatients with eye injuries were reviewed. A total of 10 718 patients (11 227 eyes) were diagnosed as mechanical eye injuries. All mechanical eye injuries were tried to be classified using BETT. While some eye injuries were difficult to categorize. We recorded the injury type and case number. A new classification based on BETT was also used for the same project. RESULTS: Of 10 718 patients (11 227 eyes) with mechanical eye injuries, the following cases cannot be classified by BETT: 1 488 patients (1 559 eyes) with merely orbital or ocular adnexa injury, 1 961 (2 054) globe injuries associated with orbital or ocular adnexa injury, 271 (284) ocular surface foreign body (OSFB) or ocular wall foreign body (OWFB), 77 (89) contusion, 9 (11) lamellar laceration associated with OSFB or OWFB, 29 (30) rupture associated with OSFB, OWFB or intraocular foreign body and 60 (62) lace- ration associated with OSFB or OWFB. While according to our new classification, all eye injuries can be categorized without any difficulty. CONCLUSION: Difficulty in classifying some eye injuries in epidemiological study by BETT brings some trouble to our study, which can be solved by our new eye injury classification to some extent. It is hoped that other ophthalmologists present better ones to make the classification more perfect.

Comparative study of modified and conventional secondary hydroxyapatite orbital implantations.

AIM: To compare the clinical effects of the modified and conventional secondary hydroxyapatite orbital implantations. METHODS: A total of 40 patients who had received eye enucleation were equally randomized into the modified and conventional groups. Twenty patients were treated by conventional method. The four rectus muscles were separated, and then an orbital implant wrapped with xenogenous sclera was implanted. Twenty patients were treated by modified method. An implant unwrapped with xenogenous sclera was directly implanted into the muscle pyramid. The operating time, costs, clinical effects, and complications of the two groups were compared. RESULTS: The average operating time of the modified group was 20.5±5.6min, whereas that of the conventional group was 56.8±14.6min (P<0.01). The average cost of the modified group was 7 800±340RMB (1 274±55.6USD), whereas that of the conventional group was 9 800±660RMB (1 601±107.8USD) (P<0.01). The two groups did not show significant difference in orbital implant mobility or postoperative complications. CONCLUSION: The modified secondary hydroxyapatite orbital implantation has advantages in operating time, surgery cost, and complication reducing. It is worthy for wide clinical application and further study.

[Clinical characteristics of paraneoplastic retinopathy and optic neuropathy].

OBJECTIVE: To analyze the clinical characteristics of paraneoplastic retinopathy and optic neuropathy(PRON). METHODS: Case series study. Eight patients were enrolled from October 2006 to March 2012 visited in ophthalmology department, the People Liberation Army General Hospital. The patients were underwent a series of examinations, including fundus photography, visual electrophysiology, fundus fluorescein angiography, optic coherent tomography,fundus autofluorescent imaging, perimetry, ultrasonography, magnetic resonance imaging, spinal tap and cerebrospinal fluid test, paraneoplastic syndrome (PNS) antibody test. The patients were followed up in outpatient department and(or) by phone. The clinical manifestation,entity types, and treatment were analyzed. RESULTS: Of the eight patients, there were cancer associated retinopathy(CAR) 3 cases, bilateral diffuse uveal melanocytic proliferation (BDUMP) 2 cases and paraneoplastic optic neuropathy(PON) 3 cases. Five patients were detected the PNS antibodies and revealed three patients with positive results. As for the primary malignancy,four of the eight patients were lung carcinoma,others included invasive thymoma, kidney cancer, acute lymphocytic leukemia and cervical cancer, each for one case. All the patients complained vision blurring or progressive visual decrease. Other complaints included dark shadow in two patients, shimmering, dazzling, double vision and eye pain, each in one patient. One patient complained progressive decreased vision in both eyes prior to the diagnosis of lung cancer. Of the 16 eyes of the eight patients, there were six patients with no light perception vision, five from light perception to 0.05, and other five with no less than 0.4 vision, in the end of the follow up. Five patients were treated with steroid with unsatisfactory efficacy. CONCLUSIONS: Each entity of PRON has its own clinical characteristics. PRON especially BDUMP may be a pre-metastatic disease.

Cyclopexy versus vitrectomy combined with intraocular tamponade for treatment of cyclodialysis.

AIM: To compare the effects and complications of direct cyclopexy (DC) versus vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade (VEE) treatment in patients with cyclodialysis and persistent hypotony. METHODS: This is a prospective, comparative, nonrandomized clinical trial which includes 52 patients with cyclodialysis and persisting hypotony. Fifty-two patients suffering from cyclodialysis and persistent hypotony in one eye were divided into 2 groups (groups DC and VEE) and treated, respectively, with direct cyclopexy or vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade. The patients were followed up for 12 months. Assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV) and subjective rating of the pain caused by the treatments. RESULTS: After a follow-up of 12 months, significant improvement was seen in postoperative mean BCVA, IOP, ACD and ACV in both treatment groups (which were not significantly different from each other). The success rates for the treatments were not significantly different (DC: 50.0% vs VEE: 62.5%, P=0.383). Postoperative morbidity of cataract and subjective pain rating were significantly higher in the VEE group vs the DC group (P= 0.003 and P<0.001 respectively). CONCLUSION: DC and VEE were effective surgical procedures in treating patients with cyclodialysis and persistent hypotony. Patients had better tolerance to DC treatment and VEE was more likely lead to cataract complications. Taking into consideration the ease of the operation, success rate, and patient comfort, DC treatment seems preferable to VEE treatment in patients with simple cyclodialysis. While VEE has the advantage of treating patients with cyclodialysis combined with vitreous hemorrhage.

[Characteristics of color discrimination changes in diabetic patients without diabetic retinopathy].

OBJECTIVE: To detect the color discrimination changes in early-stage diabetic patients. METHODS: Retrospective series case study. A total of 78 type 2 diabetic patients (126 eyes) without diabetic retinopathy were enrolled. Another 64 healthy individuals were selected as the normal control. Total error scores (TES) and each error score (ES) in distinguishing the red, green and blue colors were measured via the Farnsworth-Munsell 100 hue tester. The TES origin scores and their square roots were used for statistical analysis. The results of the two groups were compared. The influence of gender, age, duration of diabetic mellitus and application time of insulin on TES and each color's ES values was investigated. The t, t' or u-test was adopted to compare the mean of TES and ES values between these two groups; the Spearman rank correlation analysis was used to analyze the relationship between TES and ES values and age, duration and duration of insulin usage; the t test was employed to analyze the relationship between TES and ES values vs. gender; the number of superior, average, low discrimination eyes were analyzed via the χ(2) test. Wilcoxon rank sum analysis was adopted in determining the color discrimination ability between these three groups. RESULTS: The TES and its square root values in the diabetic and normal groups were 63.80 ± 34.19, 30.39 ± 4.57 and 7.69 ± 2.17, 5.50 ± 0.42, respectively. There were differences in both values between these two groups (t = 4.87, 4.91; P < 0.05). The error scores and its square root values in distinguishing the red, green, blue colors in the diabetic group were 9.39 ± 8.61, 12.67 ± 9.71, 12.39 ± 8.05 and 2.62 ± 1.60, 3.23 ± 1.51, 3.28 ± 1.27, respectively, and the values were 5.13 ± 3.59, 7.00 ± 1.84, 6.81 ± 2.70 and 1.95 ± 1.17, 2.62 ± 0.36, 2.52 ± 0.68, respectively, in the normal group. There were differences between these two groups (u = 3.62, 4.94, 5.40 and 2.40, 3.32, 4.03; P < 0.05). Differences existed in discriminating the three colors between two groups (u = 4.071, P < 0.05). Except for age (r = 0.38, P < 0.05), there was no relationship between color vision defects and age, duration (r = -0.02 ∼ 0.23, P > 0.05), gender (r = 0.32 ∼ 0.39, P > 0.05) or duration of insulin usage (r = -0.03 ∼ 0.11, P > 0.05). CONCLUSIONS: Color vision defects appear in early-stage diabetic patients. Color discrimination can play an important role in the evaluation of color perception damage and visual function in diabetic patients.

Complement factor B polymorphism (rs641153) and susceptibility to age-related macular degeneration: evidence from published studies.

AIM: To determine whether single nucleotide polymorphism (SNP) rs641153 is associated with the risk of age-related macular degeneration (AMD), we performed a systematic meta-analysis of 15 eligible studies. SNP in the complement factor B (CFB) gene is considered to have significant association with AMD susceptibility, but there is great discrepancy in these results. METHODS: The eligible studies were identified by searching the databases of PubMed, EMBASE, and Web of Science. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the association. All data were analyzed using Stata software. RESULTS: The association between rs641153 and AMD risk was statistically significant under the homozygous model (AA vs GG:OR=0.26, 95%CI=0.15-0.45, P h=0.973, I (2)=0.0%, fixed effects), dominant model (AA+GA vs GG:OR=0.49, 95%CI=0.40-0.59, P h=0.004, I (2)=56.4%, random effects) and recessive model (AA vs GA+GG:OR=0.30, 95%CI=0.17-0.51, P h=0.983, I (2)=0.0%, fixed effects). The same results were also observed in the stratified analyses by ethnicity, source of control and sample size. CONCLUSION: Our meta-analysis suggests that rs641153 in the CFB gene may play a protective role in AMD susceptibility, the late AMD in particular, both in Caucasians and in Asians.

[Characters of contrast sensitivity in diabetic patients without diabetic retinopathy].

OBJECTIVE: To explore the change of contrast sensitivity (CS) in diabetic patients without diabetic retinopathy. METHODS: It was a case-control study. We screened and tested 52 type 2 diabetic patients (89 eyes) and 47 healthy persons (68 eyes). OPTEC 6500 contrast sensitivity tester was used to examine near and distance CS values on 1.5, 3.0, 6.0, 12.0, 18.0 cycles/degree (c/d) respectively. We kept strict inclusion criteria on subjects, no retinopathy was found and best corrected vision acuity was above 1.0. The difference of CS values between these two groups was investigated, and the influence of gender, age, duration of diabetic mellitus and application time of insulin on CS values, respectively. T-test or u-test was used to compare the means of CS values between these two groups, near and distance CS values in each group. Simple linear correlation and multiple regression analysis were used to analyze the single factor and multiple factors correlation between CS values and age, duration, gender, and application time of insulin, respectively. RESULTS: The maximum CS values in both distance and near were 112.67 ± 43.97, 85.85 ± 41.83 and 83.68 ± 35.91, 55.20 ± 24.14, both appeared in 6.0 c/d. The minimum CS values in both distance and near were 26.19 ± 17.69, 12.69 ± 7.09 and 18.68 ± 11.81, 8.22 ± 5.68, respectively, both appeared in 18.0 c/d. Distance and near CS values in diabetic group and control group had very significant differences at these five spatial frequencies (From 1.5 to 18.0 c/d, the test values on distance, t = 3.11, 3.38, 2.77, 3.48, 3.86; P < 0.05; the test values on near, u = 3.70, 3.22; t' = 3.69, 3.88, 4.25; P < 0.05). Abnormal rate in diabetic group on high, medium, low and all frequencies were higher than control group, regardless of distance or near CS values (in near χ(2) = 11.86, 8.17, 9.14, 5.81; P < 0.05; on 4 combinations in distance χ(2) = 13.27, 6.70, 4.01, 4.50; P < 0.05). In diabetic group, gender related with 3.0 and 6.0 c/d CS values on near-distance (r = 0.26, 0.28; P < 0.05); age related with high-frequencies on near (r = -0.45, -0.28; P < 0.05); duration of diabetic mellitus related with high-frequencies on near (r = -0.25, -0.39; P < 0.05), and related with medium, high frequencies on distance (r = -0.26, -0.28, -0.30, -0.34; P < 0.05); application time of insulin related with high-frequencies on distance (r = -0.30, -0.31; P < 0.05). CONCLUSIONS: There exists important sense of CS value on showing visual function changes accurately in early-stage of diabetes mellitus. The high frequencies on distance is the sensitive index in vision impairment. Duration of diabetes closely relates with changes of retinal function ultimately, can be classified as the most important risk factor of CS values decline in early-stage diabetic patients.

Laser in situ keratomileusis surgery is not safe for military personnel.

OBJECTIVE: To investigate the relationship between eye injury and laser in-situ keratomileusis (LASIK) surgery in military personnel. METHODS: This retrospective study collected the data from 27 evacuation hospitals of Chinese army. All medical records of eye injuries in military personnel admitted to the 27 hospitals between January 2006 and December 2010 were reviewed. Patients'detailed information was analyzed, including the injury time, place, type, cause, as well as examination, treatment and outcome. RESULTS: There were 72 eye-injured patients who had been treated by LASIK before. The incidence was rising year by year. Among them, 69 patients were diagnosed with mechanical ocular injury and 3 with non-mechanical ocular injury; 29 patients had traumatic flap-related complications and 21 patients need surgery. There was statistical difference when compared with those having no refractive surgery history. Visual acuity recovered well at discharge. CONCLUSION: There is a high risk of potential traumatic flap problems after LASIK and it is not recommended in army service.

The effect of Vaccinium uliginosum on rabbit retinal structure and light-induced function damage.

OBJECTIVE: To study the effect of Vaccinium uliginosum L., (VU) on the electroretinogram (ERG) and retinal pathological changes in rabbits after light-induced damage. METHODS: Twenty-eight Chinchilla rabbits were randomly divided into four groups: administration beforehand (A), administration after injury (B), light injury without administration (C), and blank (D) groups. After a 4-week administration of VU homogenate at 4.8 g/(kg·d) once a day in group A, ERG in groups A, B and C were recorded according to the standards set by the International Society for Clinical Electrophysiology of Vision (ISCEV). Except for group D, the groups were then exposed to strong light. Just after that, group A stopped receiving VU treatment and group B started to receive it. Then ERGs in all groups were recorded after 1 day, 1 week, and 2 weeks. Throughout the whole process groups which were not fed with VU were fed with normal saline. Finally, the tissues and structures of all the groups were observed and the thickness of the outer nuclear layers (ONL) was measured. RESULTS: (1) After 4-week feeding with VU, the latency time of ERG in group A became shorter than those in the other groups and the amplitude increased. After being exposed to strong light, the latency time lengthened and amplitude decreased in all the injury groups, but comparing at each time point, the measured values in group A were better than those in group C. With the accumulation of VU, the ERG in group B improved, and finally, all of the detected values became better than those in group C. (2) Retinae in group D were normal in histology and the layers were in order but those in group C became disarranged. The injuries in groups A and B were minor compared with those in group C. The thickness of the ONL in group C was significantly thinner than in the other groups (P=0.000), and that in groups A and B was thicker than that in group C, although thinner than in group D. That in group A was thicker than in group B. CONCLUSIONS: VU can relieve the injury to rabbit retinae exposed to normal day and night rhythm, alleviate the harm caused by light when used beforehand, and repair the light damage to the retina.

Protective Effects of Adeno-associated Virus Mediated Brain-derived Neurotrophic Factor Expression on Retinal Ganglion Cells in Diabetic Rats.

Adeno-associated virus vector plasmid carrying the expression cassette of brain-derived neurotrophic factor (BDNF), pAAV-BDNF, was constructed and packaged into recombinant adeno-associated virus (rAAV-BDNF). The rAAV-BDNF was intravitreally injected into streptzotocin (STZ)-induced diabetic Sprague-Dawley (SD) Rats. Data showed that over-expression of BDNF could increase alive retinal ganglion cell (RGC) number and improve its function in streptzotocin(STZ)-induced diabetic rats, which might be a new method to treat diabetic neuropathy and retinopathy.

Epidemiology of eye injuries sustained by military personnel in China.

OBJECTIVE: To investigate the epidemiological characteristics of eye injuries sustained by military personnel in Chinese army. METHODS: Eleven military evacuation hospitals located in different regions were selected for this study. We reviewed all the medical records of eye injuries sustained by military personnel between January 2005 and December 2009. Patients'information was collected. All data were put into database and analyzed statistically. RESULTS: Totally there were 415 inpatients with eye injuries (442 eyes) and their mean age was 24.40 years. Eye injury accounts for 13.51% of all eye diseases in this study. From 2006 to 2009, the number of eye injury increased gradually. Among them, 175 (42.17%) were injured in leisure time, and 145 (34.94%) in working time. Twenty-two (5.30%) patients had an eye surgery or history of eye disease before injury. In all, 246 patients (59.28%) were sent to evacuation hospital within 24 hours and 64 (56.64%) underwent surgeries in 24 hours after injury. There were 389 patients (93.73%) hospitalized for 1 time. Visual acuities of 187 eyes (42.31%) were grade 1 (larger than or equal to 20/40) after injury. When discharge, 349 eyes (78.96%) obtained a visual acuity of grade 1. CONCLUSION: Eye injury has a very frequent incidence in Chinese army and much more attention should be paid to prevent it.

The survey of the causes of eye injury of various services in China.

The cause of eye injury in various services may be different. Preventing the injury according to the cause would be more effective. We investigated 502 (549 eyes) cases of ocular injury in 21 military hospitals in China. Sports-related injury was the first cause of ocular injury (181/502, 36.1%), and it was more often seen in navy and air force personnel. A total of 69.1% of sports-related ocular injuries were caused by playing basketball and 18.8% by playing football. Work-related injury was the second cause (140/502). The highest ratio of work-related injury was in the surface warship force (31/67, 46.3%). The ratios of military training-related injury in the army and armed police were 21.4% and 21.3%, respectively, but it is only 4.4% in the navy. The analysis of training subjects showed that about 49.2% of injuries occured during skill training, such as parachuting and operating firearms, and 29.5% occurred during physical exercise or counter-acting exercises. We also found that the ratio of sports-related injury increased and military training-related injury decreased with the level of education.