Preliminary research of the clinical pathways of glaucomatous optic nerve damage in cases with glaucomatocyclitic crisis: A retrospective study.

To investigate the clinical pathways via which the glaucomatous optic nerve damage (GOND) occurred in cases with glaucomatocyclitic crisis (also called Posner-Schlossman syndrome, PSS). A retrospective study was conducted, 59 PSS patients with confirmed GOND were screened out from 190 PSS cases and followed up for a period of 5 ±â€…3.3 years. Clinical data were retrospectively analyzed systematically and dynamically, including intraocular pressure and its dynamic change, appearance of fundus, visual field and the state of anterior chamber angle in initial and later period during the episodes and intermission of PSS. Based on the clinical data, a classification and standard for the clinical pathways of GOND were established, and the clinical pathway of GOND in each patient was classified accordingly. There are at least 4 clinical pathways of GOND in PSS patients, namely: Type A: GOND was simply caused by the accumulation effect of high IOP during many attacks of PSS itself. Type B: GOND was resulted from the combined action of PSS itself and another type of secondary open-angle glaucoma. The recurrent inflammation during the episodes of PSS damaged the trabecular meshwork, which can cause elevation of IOP during the intermission of PSS. Type C: PSS combined with primary open angle glaucoma (POAG). Type D: PSS combined with primary angle-closure glaucoma (PACG). Base on the clinical gateways of GOND classification above, the cases of type A, B, C, and D were 27, 6, 19, and 7 respectively. The staging of visual field damage in cases with GOND from different clinical pathways showed a significant difference (Person chi-square χ2 test, χ2 = 7.211, P = .007). There are at least 4 clinical pathways of GOND in PSS patients, and each clinical pathway corresponds to different clinical features and different treatment principles. It is extremely important to correctly discriminate the pathways of GOND in PSS patients.

Clinicopathological features of corneal invasion by filtering bleb.

PURPOSE: To describe the clinicopathological characteristics and explore the possible etiology of cornea invasion by filtering bleb (CIFB) after filtering surgery. METHODS: We reviewed 22 patients treated for CIFB between March 2005 and March 2022. The patients were followed up for more than 1 year. Slit-lamp examination, optical coherence tomography (OCT), ultrasound biomicroscopy, and histopathological examination were performed to observe the morphology of the bleb and depth of corneal invasion. Depending on the severity of the lesion, treatments consisting of local massage, acupuncture separation, or surgical resection were administered. RESULTS: The mean age of the patients was 56.3 ± 8.8 years. All patients underwent filtering surgery in the moderate or advanced stage of glaucoma. The filtering bleb was closely connected with the cornea, and its posterior boundary was locally adhered. Forward displacement of the internal opening of the filtering bleb was found in 4 of 7 surgically treated patients. OCT and pathological examination showed that the filtering blebs invaded the corneal stroma. Removal of the adhesion of the posterior boundary of the filtering bleb by different treatment methods successfully improved the patients' conditions. CONCLUSION: Filtering blebs can invade the corneal stroma. Adhesion of the posterior boundary and forward displacement of the internal opening of the filtering bleb are the possible causes of CIFB. Removal of the adhesion of the posterior boundary of the filtering bleb can halt the progression of CIFB.

Preliminary clinical report of alternate episodes of Posner-Schlossman syndrome and viral keratitis.

Posner-Schlossman syndrome (PSS) and viral keratitis have a shared pathogen and are common diseases in China, but there are few case reports on whether these two diseases occur concurrently or alternately. After long-term clinical observations, six patients with alternating episodes of PSS and viral keratitis were confirmed at our hospital in the past 10 years. Of the six patients, three were female and three were male. Four patients had monocular PSS with ipsilateral monocular viral keratitis, one had monocular PSS with bilateral viral keratitis, and one had bilateral PSS with bilateral viral keratitis. Of the six cases, three had epithelial viral keratitis and three had endothelial viral keratitis. In four cases, the interval between the onset of the two diseases ranged from 8 days to 3 years, and two cases showed overlapping manifestations of the two diseases in 3 to 6 days, both with incomplete absorption of keratic precipitates. The six cases had intermittent episodes of both diseases and significant loss of corneal sensation during the onset of viral keratitis, and were effectively treated with antiviral therapy. PSS and viral keratitis may alternate episodically, and clinical attention should be paid to these conditions. The mechanism of the alternate episodes might be associated with viral infection and the use of glucocorticoids.

Anterior chamber parameters in cataract surgery candidates from middle China.

To determine the distribution of the anterior chamber parameters and associated factors in cataractous adults from middle China. In this cross-sectional study, axial length, anterior chamber depth (ACD) and lens thickness (LT) were measured with IOLMaster 700. The Pentacam HR was designed to measure the anterior chamber volume (ACV) and anterior chamber angle (ACA). Patients' data were collected and analyzed between 2020 and 2022. A total of 157 eyes of 157 Chinese adults (mean age: 64.43 ±â€…12.16 years) with a cataract were enrolled in this study. The mean values measured were as follows: axial length, 24.10 ±â€…2.44mm; ACD, 2.99 ±â€…0.52 mm; LT, 4.51 ±â€…0.48 mm; ACV, 113.98 ±â€…45.12 mm3; ACA, 32.33 ±â€…7.66 degrees. The ACD and ACV were statistically significantly greater in men than in women and had a decrease trend as age and LT increased. In the simulated linear equation of age with ACD and LT the absolute slope coefficients of equations were the same; however, the directions were opposite. The mean ACV was <100 mm3 when the patients were over 60 years. In the multivariate regression analysis of ACD, ACV and ACA there was a reasonable prediction with adjusted R2 = 0.878, 0.847 and 0.564, respectively. This study may provide normative data for cataract patients. The profile of anterior chamber can help improve the knowledge of the risk of angle closure in cataract candidates.

Influence of glaucoma surgery on the ocular surface using oculus keratograph.

PURPOSE: To investigate the influence of trabeculectomy and phacotrabeculectomy on the ocular surface. DESIGN: Retrospective, case-control study. METHODS: Eighty-one samples without dry eyes were recruited and divided into three groups, including phacoemulsification group (N = 30) as control group, trabeculectomy group (N = 27) and phacotrabeculectomy group (N = 24) as study groups. Ocular surface parameters, including noninvasive keratograph first (NifBUT) and average (NiaBUT) tear film breakup time, tear meniscus height (TMH) and corneal fluorescein stain (CFS), were estimated preoperatively, at 3 days, 1 month and 3 months postoperatively using oculus keratograph. RESULTS: No significant difference was observed in ocular surface parameters at baseline among three groups (p > 0.05). The magnitude of NifBUT and NiaBUT was reduced at 3 days and 1 month postoperatively in phacotrabeculectomy group, but greater than that in the other two groups (All p < 0.001). In all the groups, both the NifBUT and NiaBUT tended to recover at 1 and 3 months postoperatively, whereas both of them did not recover to baseline at 3 months postoperatively in trabeculectomy (NifBUT, p = 0.001; NiaBUT, p < 0.001) and phacotrabeculectomy group (NifBUT, p < 0.001; NiaBUT, p = 0.020). TMH was raised at 3 days postoperatively and restored to the baseline level at 1 and 3 months postoperatively for three groups (p > 0.05). CFS was elevated at 3 days postoperatively and different in recovery at 1 and 3 months postoperatively for three groups. CONCLUSIONS: The influence of phacotrabeculectomy on ocular surface is worse than that of trabeculectomy for the short run and is not distinct different for a long time.

The characteristic of intraocular pressure dynamic change in patients with glaucomatocyclitic crisis.

PURPOSE: To investigate the characteristic of intraocular pressure (IOP) dynamic change from episode to intermittent period in patients with Posner-Schlossman syndrome (PSS). PATIENTS AND METHODS: Seventeen cases of typical PSS were collected in this study. Both their random IOP in episodes/intermittent period and 24-h IOP in intermittent period were measured. The mean IOP as well as the peak and the valley value of 24-h IOP were calculated. Those data were statistically analyzed. RESULTS: The IOP in affected eye in episodes is higher than that of the contralateral eye statistically; while in intermittent period the mean IOP (p = 0.001), the peak (p = 0.029) and the valley (p = 0.004) value of 24-h IOP in affected eye are statistically different with that of the contralateral eye. All of these parameters of the affected eye in intermittent period are lower than that of the contralateral eye obviously. CONCLUSION: The dynamic observations of IOP in episodes and intermittent period confirmed the IOP crossover phenomenon inpatients with typical PSS and this observation may be important in the differential diagnosis of PSS.

The selective cysteinyl leukotriene receptor 1 (CysLT1R) antagonist montelukast regulates extracellular matrix remodeling.

Scar formation after filtration surgery of glaucoma is mainly caused by excessive synthesis of new extracellular matrix (ECM) and contraction of subconjunctival tissue mediated by human Tenon fibroblasts (HTFs) and the transforming growth factor (TGF-ß1). Montelukast, a potent and specific cysteinyl leukotriene receptor 1 (cysLT1R) antagonist, is a licensed drug clinically used for the treatment of bronchial asthma. In this study, we investigated the effects of montelukast on the contractility of HTFs cultured in a three-dimensional collagen gel. We found that cysLT1R was expressed in HTFs. Interestingly, the expression of cysLT1R was increased in response to TGF-ß1 in a dose dependent manner, suggesting its potential role in TGF-ß1 induced fibrosis. Importantly, we found that montelukast inhibited TGF-ß1-induced collagen gel contraction mediated by HTFs in a concentration- and time-dependent manner. In addition, TGF-ß1-induced expression of MMP-1 and MMP-3, generation of fibronectin and type I collagen production, focal adhesion kinase (FAK) and paxillin phosphorylation in HTFs were also ameliorated by montelukast in a dose dependent manner. These results suggested that montelukast might provide therapeutic possibilities for inhibition of scar formation after such surgery.

A novel technique for staining bulk grids bearing ultrathin sections.

This article proposes a technique for staining bulk grids bearing ultrathin sections with a silicone device consisting of a base plate and a depression bar. Specifically, bulk grids were loaded into the holes on the base plate in order, and then the depression bar was inserted into the slot of the plate to fix the inner edges of the grids and thereby form several separated cells to facilitate the subsequent staining and washing procedures. The results showed that the proposed technique can improve handling efficiency, safety and identification of grids during staining courses.

Self-retaining contact lens simplifies intravitreal injection course in rats.

BACKGROUND: The aim of this study was to design a self-retaining rat contact lens to simplify intravitreous injection in rats. MATERIAL/METHODS: A self-retaining, plane-concave prism contact lens customized for rats was designed. Forty diabetic rats were randomly divided into 2 groups and received the intravitreous injection of 10 µl of a cell suspension containing bone marrow-derived stroma cell (BMSC). Group A: used a microsyringe and a rat contact lens (n=20). Group B: used the same microsyringe and a traditional cover-slip (n=20).The duration of the intravitreous injection course and the success rate of intravitreous injection were observed. RESULTS: With the use of a self-retaining rat contact lens, a clear and stable view of the rat fundus was provided and the intravitreous injection course of rats quickly achieved, averaging 4.65±0.53 min in Group A and 12.33±2.79 min in Group B. The difference was statistically significant, and the time saved averaged 7.68 min. None of the Group A rats had retinal bleeding or lens injury; whereas 2 of 20 Group B rats had bleeding and 1 of 20 had lens injury. There was no significant difference between the rats in Group A and Group B. CONCLUSIONS: A self-retaining rat contact lens is a potentially powerful instrument that allows high-quality observation of the rat fundus and simplifies the course of intravitreal injection.