Changes to central visual fields in cases of severe myopia in a Chinese population.

BACKGROUND: Severe myopia (SM) is commonly defined as a refractive error that exceeds -10.0 diopters (D). To date, however, studies focusing on visual field changes in eyes affected by SM remain scarce. The present study aims to characterize changes to central visual fields in the presence of SM among Chinese individuals and to provide evidence for enabling early diagnosis of primary open-angle glaucoma (POAG) in cases of SM. METHODS: The data of 26 cases (44 eyes) involving Chinese individuals with SM were collected using a Humphrey Visual Field Analyzer 750i. The following aspects were identified: types of visual field defects in the probability map of pattern standard deviation, the features of patterns in visual field defects in four quadrants, the frequencies of scotomas, and the proportions of relative scotomas. RESULTS: (I) Among all visual field defects, 95.45% were found to be relevant to selected ocular fundus changes; (II) the proportion of relative scotomas was 65.02%. The two major types of visual field scotomas were the enlargement of the physiologic blind spot (43.20%) and central scotoma (38.64%), while additional types included nasal step defects (18.18%), paracentral scotomas (13.64%), and temporal sector-shaped defects (9.09%). The proportions for scotomas in the four quadrants were: 38.74% (superior temporal quadrant), 25.87% (inferior temporal quadrant), 19.32% (superior nasal quadrant), and 16.07% (inferior nasal quadrant). CONCLUSIONS: (I) Visual field analysis should be conducted alongside consideration of fundus changes. The bulk of visual field defects were found to be relative scotomas. (II) Scotomas in SM patients were mainly due to the enlargement of a physiological blind spot and central scotomas, and nasal arch-shaped scotomas presented as arc-shaped damage. (III) Abnormal scotomas were detected most frequently in the inferior temporal quadrant.

Toxic effects of combination of Aconiti Lateralis Radix Praeparata with Trichosanthis Fructus on inflammatory response and myocardial fibrosis in pressure overload rats based on β2-AR/PKA signal / 中国中药杂志

To study the effects of combination of Aconiti Lateralis Radix Praeparata( Fuzi) with Trichosanthis Fructus( Gualou) on cardiac function,electrocardiogram,inflammatory response and myocardial fibrosis in pressure overload( PO) rats,and further explore the mechanism based on β2-AR/PKA signaling. PO rat model was established by constricting the abdominal aorta. Twelve weeks after the operation,these rats were randomly divided into model goup( PO),low dose Fuzi group( FL,5. 4 g·kg-1·d-1),Gualou group( GL,5. 4 g·kg-1·d-1),Fuzi and Gualou combination group( FG,5. 4 g·kg-1·d-1+5. 4 g·kg-1·d-1) and high dose Fuzi group( FH,10. 8 g·kg-1·d-1). At the same time,sham operation group was set. After intervention for 6 weeks,carotid blood pressure,cardiac function,electrocardiogram and heart mass index were measured. HE staining was used to observe the inflammatory response in the rat heart and kidney. Masson staining was used to determine the myocardial fibrosis. Western blot was used to detect the protein expression of β2-AR and PKA. As compared with sham operation group,the blood pressure and heart mass index were obviously increased in PO model group,but there was no significant difference in various treatment groups in the above indexes. As compared with PO model group,FH treatment significantly increased the ejection fraction( EF) and GL treatment effectively enhanced the cardiac output( CO),but other treatment groups had no significant effect on these parameters. Moreover,FG treatment can synergistically attenuate QT and QTc internal prolongation,but it also aggravated inflammatory response in the heart and kidney tissues and promoted myocardial fibrosis as compared to FZ or GL alone treatment,with toxic effects equivalent to FH treatment group. Following FG and FH treatment,simultaneously,β2-AR and PKA protein levels were significantly elevated,indicating that the increasing toxicity of FG could be associated with activation of β2-AR/PKA signaling. These results suggested that combination of FZ and GL could synergistically enhance toxicity of FZ in special pathological states such as pressure overload,and caution should be taken in clinical application.

Longitudinal Cohort Study on the Incidence of Primary Open-Angle Glaucoma in Bai Chinese.

PURPOSE: The prevalence of primary open-angle glaucoma (POAG) in China has been reported previously, and was lower than that in white and black populations. However, the incidence of POAG in China has not been reported. Therefore, a longitudinal study was conducted to determine the 5-year cumulative incidence and predictors of POAG in China. DESIGN: Population-based cohort study. METHODS: A total of 1520 participants (71.3% of the subjects in the baseline survey) of Bai ethnicity were examined and followed for 5 years. Glaucoma was defined based on the International Society of Geographical and Epidemiological Ophthalmology Classification criteria. Multivariable logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: A total of 19 new cases of POAG were detected. The 5-year cumulative incidence of POAG was 1.3% (95% CI, 0.7-1.9). In multivariate analyses, incident POAG was associated with baseline variables including increased age (OR, 4.3; 95% CI, 1.4-13.8; P = .02; 70 years or older vs 50-59 years), elevated IOP (OR, 3.5; 95% CI, 2.0-5.9; P < .001; per 10 mm Hg increase), lower education level (OR, 0.3; 95% CI, 0.1-0.8; P = .02; post-primary education vs no formal education), and the presence of myopia (OR, 3.4; 95% CI, 1.3-8.6; P < .01). CONCLUSIONS: The average annual incidence of POAG in Bai Chinese was lower than that in populations of African descent and white race. The results are important to elucidate the racial/ethnic difference in POAG incidence and for the clinical management and health resource allocation in China.

c-Jun N-terminal kinase 3 expression in the retina of ocular hypertension mice: a possible target to reduce ganglion cell apoptosis.

Glaucoma, a type of optic neuropathy, is characterized by the loss of retinal ganglion cells. It remains controversial whether c-Jun N-terminal kinase (JNK) participates in the apoptosis of retinal ganglion cells in glaucoma. This study sought to explore a possible mechanism of action of JNK signaling pathway in glaucoma-induced retinal optic nerve damage. We established a mouse model of chronic ocular hypertension by reducing the aqueous humor followed by photocoagulation using the laser ignition method. Results showed significant pathological changes in the ocular tissues after the injury. Apoptosis of retinal ganglion cells increased with increased intraocular pressure, as did JNK3 mRNA expression in the retina. These data indicated that the increased expression of JNK3 mRNA was strongly associated with the increase in intraocular pressure in the retina, and correlated positively with the apoptosis of retinal ganglion cells.

[Prevalence and causes of blindness and moderate and severe visual impairment among adults aged 50 years or above in Luxi County of Yunnan Province: the China Nine-Province survey].

OBJECTIVE: To investigate the prevalence and causes of blindness and moderate and severe visual impairment among adults aged ≥ 50 years in Luxi County of Yunnan Province, China. METHODS: It was a population-based cross-section study. Geographically defined cluster sampling was used in randomly selecting 5575 individuals aged ≥ 50 years in Luxi County. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out. All participants were enumerated through village registers followed door-to-door visits.Eligible individuals were invited to receive visual acuity measurement and eye examination. Prevalence of blindness and moderate and severe visual impairment was calculated according to different age, gender or education. And the reasons of blindness were analyzed.Statistical analyses were performed using Stata/SE Statistical Software, release 9.0. Chi-square test was used to investigate the association of age, gender and education with presenting and best corrected visual acuity. RESULTS: Five thousands five hundreds and seventy-five individuals were enumerated and 5151 persons were examined, the response rate was 92.39%. Based on the criteria of World Health Organization visual impairment classification in 1973, the prevalence of blindness and moderate and severe visual impairment defined as best corrected visual acuity was 4.95% (255/5151) and 9.51% (490/5151) , respectively. The prevalence of blindness and moderate and severe visual impairment defined as presenting visual acuity was 5.40% (278/5151) and 15.84% (816/5151) , respectively. The prevalence of blindness and moderate and severe visual impairment was higher in aged (χ(2) = 1349.21, P = 0.000) , illiterate (χ(2) = 203.55, P = 0.000) persons. Cataract was still the first leading cause of blindness and visual impairment. CONCLUSIONS: The prevalence of blindness and moderate and severe visual impairment is highest in China Nine-Province Survey among older adults aged ≥ 50 years in Luxi County. The first leading cause of blindness and visual impairment is still cataract.

[Current approach on various methods of detection glaucomatous visual field progression].

Visual field is critical to evaluation of glaucoma progression. Various methods of detection of progression were used in clinical practice, but none of them is received as an ideal standard. It is very difficult to choose a method to distinguish progressive glaucomatous visual field loss from test variability. To help analysis visual field progression and identify real progressive loss, benefits and drawbacks of most commonly used methods were reviewed in present article.

[Surgical management of coexisting glaucoma and cataract].

Coexisting glaucoma and cataract is a common eye disorder in elderly population. Recent advances in the management of patients with coexisting cataract and glaucoma offer a promising alternative in patients with uncontrolled glaucoma and a cataract and provide an individualized treatment depending upon patient's characteristics and intraocular pressure (IOP). Based on many significant studies that have been conducted in the combining cataract extraction with a glaucoma surgery in recent years, present article reviews the different surgical options on the control of their postoperative IOP level in the different stages of glaucoma and the surgical strategies for patients with combined cataract and glaucoma.

[Changes of opsin expression in experimental form-deprivation and defocus myopia in guinea pig].

OBJECTIVE: To investigate the opsin expression in form-deprived and defocus myopia in guinea pig and to study the relationship between the opsin expression and the experimental myopia. METHODS: Fifty guinea pigs were randomized into form-deprived group, defocus group (n = 20 in each group) and normal group (n = 10). Guinea pigs in form-deprived group wore a diffuser RGP on one eye since one week after birth. Those in defocus group wore -4.00 D RGP on one eye. The contralateral eyes wore 0 D RGP were used as the control. Refraction, axial length and depth of vitreous cavity were measured after 1 and 2 weeks. Animals were sacrificed and the retina were dissected at 10:00 - 12:00 AM. The level of opsin and its mRNA were measured by Western-blot and real-time PCR, respectively. RESULTS: Two weeks after the experiment, the refraction in form-deprived group and defocus group were (-4.00 ± 0.87) and (-2.00 ± 1.17) D respectively, which were significant different compared with contralateral eyes or normal control group (F = 203.98, 88.66, P < 0.05). These also accompany with increase of axial length and depth of vitreous cavity in form-deprived group and defocus group. Expression of S-opsin mRNA were increased both in form-deprived and defocus groups and the ratios of S-opsin mRNA/ß-actin expression were 0.752 ± 0.05 and 1.117 ± 0.13 in two weeks treatment, which were significant different from contralateral eyes (the ratios of S-opsin mRNA/ß-actin expression were 0.536 ± 0.04 and 0.772 ± 0.10.t = 6.10, 6.28, P < 0.05). Similar findings were also demonstrated in the expression of L-opsin mRNA, which were increased in form-deprived group and defocus group (the ratios of L-opsin mRNA/ß-actin expression were 0.42 ± 0.01) compared with contralateral eyes (the ratios were 0.24 ± 0.0 and 0.34 ± 0.04. t = 6.30, 4.93, P < 0.05) after two weeks experiment. The western-blot results also indicated the high expression of S-opsin and L-opsin level compared to contralateral eyes in form-deprived and defocus groups. CONCLUSIONS: Cone might be the detector receiving the signal of form-deprivation and defocus. Changes of opsin expression might play a role in the occurrence of experimental myopia in guinea pig.

[Characteristics of visual field defects in primary angle-closure glaucoma].

OBJECTIVE: To determine the difference of visual field defects between acute angle-closure glaucoma (AACG) and chronic angle-closure glaucoma (CACG) and to analyze the difference in the changes of visual field between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). METHODS: This retrospective case series study consisted of 53 patients with CACG,42 with AACG, and 42 with POAG. Visual field tests were examined using the 30-2 threshold program of the Humphrey Visual Field Analyzer. All cases with eligible visual fields were scored from 1 to 11 with the modified criterion used by Advanced Glaucoma Intervention Study (AGIS scores, mild groups: 1-5 and moderate groups: 6-11). An upper hemifields, lower hemifields, nasal area and overall field, mean defect (MD) and pattern standard deviation (PSD) were calculated and compared among the three glaucoma groups. The difference in central 10 degrees (12 points) of visual field damage, the nasal area, and the most defect quadrant of static visual field in each groups were evaluated. All analyses were performed with SAS 9. 1 software. The factor analysis was used to analyze significant differences in mean defect (MD), pattern standard deviation (PSD), VF scores of nasal area and overall field among the three glaucoma groups. Analysis of variance were assessed differences between VF scores of the superior hemifield and the inferior hemifield. The differences in central 10 degrees of visual field damage, the nasal area and the most defect quadrant of static visual field in each groups were examined using a chi-square test. P < 0.05 were considered to be statistically significant. RESULTS: (1) VF scores with inferior hemifield in POAG were lower than in CACG (t = 4.24, P = 0.0000) and in AACG (t = 3.28, P = 0.0013); There were no significant differences of VF scores between the superior hemifield and the inferior hemifield in CACG (t = 1.35, P = 0.1808) and AACG (t = 0.55, P = 0.5824). There was found a significant differences of VF scores between the superior hemifield and the inferior hemifield in POAG (t = 6.52, P = 0.0000). The CACG cases had a significantly greater amount of PSD than acute angle-closure glaucoma (P < 0.05). (2) There was found a significant differences in the number of patients with central visual field damage among the three glaucoma groups (chi2 = 10.385, P = 0.006). The POAG cases had the greatest rate of central visual field damage (52.38%), followed by acute angle-closure glaucoma (47.62%), the central visual field of CACG is the least suffered (22. 64%). (3) The nasal area was the most commonly involved area in the early stage of glaucoma. There were no significant differences among three groups (chi2 = 2.518, P = 0.641). There were no different distribution in the most defect quadrant of static visual field in different types of glaucoma (chi2 = 1.573, P = 0.954). CONCLUSIONS: Using AGIS scores, AACG had more diffused visual field damage than CACG and had more severe defect of the central visual field, while the damage of superior and the inferior hemifield in PACG are similar to POAG.

[Pigment epithelium-derived factor expression in the retina in response to hypobaric hypoxia].

OBJECTIVE: The present study was undertaken to examine the expression of pigment epithelium-derived factor (PEDF) in the retina of adult rat following hypobaric hypoxic exposures. METHODS: Forty-eight adult Wistar rats were divided into 6 groups randomly (8 rats in each group), of which 5 groups (40 rats) were subjected to hypobaric hypoxia for 2 hours following which expression of PEDF in the retina was investigated from 3 hours to 14 days by real time RT-PCR, western blotting and immunohistochemistry. RESULTS: PEDF mRNA and protein expression in the retina was decreased at 3 hours to 14 days following exposure to hypoxia. Compared with normal control group (1.00+/-0.00), PEDF mRNA expression decreased to 0.83+/-0.05 at 3 hours, 0.72+/-0.04 at 24 hours, 0.56+/-0.04 at 3 days, 0.54+/-0.05 at 7 days and 0.49+/-0.05 at 14 days respectively; Compared with normal control group (1.90+/-0.02), PEDF protein expression decreased to 1.49+/-0.02 at 3 hours, 1.19+/-0.05 at 24 hours, 1.15+/-0.05 at 3 days, 1.09+/-0.06 at 7 days and 1.07+/-0.03 at 14 days respectively. CONCLUSIONS: The findings of this study indicate hypoxia can downregulate PEDF in adult retina.

[Visual field analysis after laser in situ keratomileusis].

OBJECTIVE: To evaluate the effects of laser in situ keratomileusis (LASIK) on the patients' visual field. METHODS: 92 eyes of 46 patients with mild, moderate, and high degrees of myopia were undergone LASIK. Perimetry was performed before and 1 day, 1 month, 3 months, 6 months after LASIK surgery by Humphrey II-750 visual field analysis. The central 30 - 2 fast threshold program was used to examine the change in central 30 degree. Mean defect (MD) and pattern standard deviation (PSD) were record. All operations were performed by an experienced surgeon. Statistical analyses were performed by SPSS using the randomized complete block design ANOVA (two factors analysis of variance). Differences among variables were evaluated by q-test (Student-Newman-Kueuls method). RESULTS: 93.5% patients obtained estimated best correct visual acuity or better at six months after LASIK. No complications were found in the subjects. No difference was found in fundus examinations before and after surgery. Intraocular pressure was normal at all preoperative and postoperative examinations. MD was significant differences among preoperative and postoperative values (P < 0.05, for all comparisons) and was correlated with visual acuity post-LASIK significantly (P < 0.05). While PSD did not show significant differences before and after LASIK (P > 0.05) and was not correlated with visual acuity post-LASIK. The indexes of visual field were not correlated with the degree of myopia and the other surgical parameters (P > 0.05). CONCLUSION: In current research, no significant visual field change was demonstrated pre-LASIK and post-LASIK after 6 months follow-up. The study suggests that LASIK does not affect the retinal physiological functions.

[The expression of heat shock protein 27 in retinal ganglion cells in the rat glaucoma model].

OBJECTIVE: To observe the expression of heat shock protein 27 (HSP27) in retinal ganglion cells in experimental rat glaucoma model and to study the relationship between HSP27 expression and hypertension using serum autoantibodies. METHODS: Forty nine Wistar rats were randomly divided into ocular hypertension group, sham control group and normal control group. Intraocular pressure (IOP) was elevated by electrocoagulation of at least 3 episcleral and limbal veins in the right eye of each rat. Contralateral eyes were used as the controls. Serum immunoreactivity against HSP27 was examined in these three groups by means of enzyme-linked immunosorbent assay (ELISA). Immunohistochemical staining for HSP27 was performed in 49 rats (98 eyes) for studying the distribution of the target gene products in retinal ganglion cells and retinal nerve fiber layer. RESULTS: Electrocoagulation treatment caused a significant increase of IOP and was maintained for 8 weeks (P < 0.01), which was greater than that in the contralateral eyes, sham control eyes and normal eyes. The baseline IOP was (15.69 +/- 3.20) mm Hg (1 mm Hg = 0.133 kPa). IOP was increased to (27.52 +/- 6.63) mm Hg (3 days after the operation), (31.42 +/- 6.18) mm Hg (1 week after the operation) and stabilized thereafter for 8 weeks. Serum ELISA titers of HSP27 antibody were higher in ocular hypertension group as compared to the control groups in both sham and normal group at 2 weeks after operation (P < 0.01) and 3 weeks after operation (P < 0.05). The expression of HSP27 was significantly enhanced in RGCs with IOP elevated and sustained. It was also significantly increased in retinal nerve fiber layers (RNFL). CONCLUSION: Enhanced expression of endogenous HSP27 might play an important role in the development of glaucomatous optic neuropathy.