Table of Content

22 August 2012, Volume 36 Issue 4

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Impaired vision and falls in the elderly people

SUN Bao-chen, HU Ai-lian, ZHENG Yuan-yuan, CUI Tong-tong, YANG Xiao-hui

2012, 36(4):  217-221.  doi:10 3760/ cma. j. issn. 16735803 2012 04 001

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Falls are  the major public health issues in the elderly population. Every year accidental falls occur in 30% to 40% of those aged more than 65 years, with 20% to 30% of those falls resulting in serious injury (such as hip fractures and brain damages) in our country. After the falls, 60% of the elderly suffered from psychological disorders, limited mobility and decreased quality of life. Falls account for approximately half of all accidentrelated deaths. Visual impairment is the most important risk factor for falls in the elderly people. This article introduces the consequences  and the intervention stragegies of falls in visually impaired older people. The purpose is to arouse our attention and concern on the ungency and seriousness of the falls in the elderly people with visual impairment.

The neuroprotective role of Sirt1 in retinal and optic nerve diseases

ZHUGE Chun-chun, XU Guo-tong, XU Jing-ying

2012, 36(4):  222-227.  doi:103760/ cma.j.issn.16735803201204002

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Besides involved in metabolism process, cell cycle control and immune response, Sirtuin1 (Sirt1), a member of Class III Histone deacetylase (HDAC), also demonstrated neuroprotective effects on the retinal cells in several retinal and optic nerve diseases. The roles of Sirt1 in the development of retina diseases were reviewed and summarized in this article. The main points included: in diabetic retinopathy models, Sirt1 could inhibit the retinal chronic inflammation, attenuate the retinal neovascularization and cleavage the metabolic memory of retina cells; in optic neuritis and glaucoma models, Sirt1 protected retinal ganglion cells (RGCs) from apoptosis; in agerelated macular degeneration (AMD) study, Sirt1 had been proved to be able to rescue the viability and function of retinal pigment epithelium (RPE) cells in vitro, and decrease the complement factor (CF) Hinduced retinal autoimmunity. On the other hand, Sirt1, as a possible angiogenesis factor, may promote choroidal neovascularization, which needs further confirmation. Sirt1 might be a potential therapeutic target in retinal diseases.

Clinical research progress of antiVEGF agents for diabetic retinopathy

ZHAI Yi, ZHU Ya-nan, YAO Ke

2012, 36(4):  228-234.  doi:10 3760/ cma. j. issn. 16735803 2012 04 003

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Diabetes mellitus can pathologically elevate ocular vascular endothelial growth factor (VEGE)  level, which causes the angiogenesis and edema in eyes. The extensive use of antiVEGF agents for the agerelated macular degeneration (AMD) has prompted research into the application of antiVEGF drugs for the diabetic retinopathy (DR). Pegaptanib and ranibizumab, which are approved for intravitreal injection, have shown shortterm effect on visual acuity improvement. And offlabel intravitreal use of bevacizumab has shown shortterm positive effects on both visual acuity improvement and central retinal thickness. Aflibercept has also been regarded as an effective treatment to DR, which is supported by trials. The growing evidence indicates that antiVEGF agents are beneficial for the DR treatment, especially the one with diabetic macular edema (DME). Still, physicians expect the results of large, controlled trials to substantiate the longterm efficacy and safety of antiVEGF drugs for DR.

Soluble vascular endothelial growth factor receptor 2 and its inhibitory effects on ocular neovascularization

LI Mei-li, ZOU Hai-dong

2012, 36(4):  235-238.  doi:10 3760/ cma. j. issn. 16735803 2012 04 004

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Angiogenesis is the main pathologic change in many important ocular diseases，and vascular endothelial growth factor (VEGF) is the crucial angiogenic stimulator. In recent years, soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) has been proved to be a native inhibitor of the angiogenesis and signal transduction pathways induced by VEGF. Studies indicated that sVEGFR2 had intimate connection with the occurance and progression of ocular angiogenesis, and could be regarded as an inhibitory factor as well as surrogate marker of neovascular eye diseases, which implies a potential clinical practice. This review focuses on the recent advances of the inhibitory effects of sVEGFR-2 on the ocular neovascularization.

Clinical application of lacrimal plug

WU Zhi-yong, YAN Man-ni, LI Xia, ZHU Zhi-zhong

2012, 36(4):  239-244.  doi:103760/ cma.j.issn.16735803201204005

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One of the effective methods for dry eye is to reduce the lost of tear with lacrimal plug.  There are two sorts of lacrimal plugs: absorbable and nonabsorbable. Generally, we may try to find the causes of dry eye, and to relieve the dry eye symptoms with artificial tear. However, these methods would not work well for some severe dry eyes. So lacrimal plug will be chosen. We always select absorbable plug at first, and then nonabsorbable one should be apply while no complications happened. It is important to avoid complications such as canaliculitis, epiphora, displacement of plug, etc.. The lacrimal plug with controlledrelease medicine  has a wonderful  prospect.

Drug-induced dry eye

YANG Yong-sheng, ZHANG Shou-kang, XIE Li-ke

2012, 36(4):  245-250.  doi:103760/ cma.j.issn.16735803201204006

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Drug-induced dry eye is gradually recognized by ophthalmologists in recent years. It has been found that more than 10 categories and hundreds of drugs can induce dry eye, which include anticholinergic receptor drugs, antihistamines, antidepressant drugs, antipsychotic drugs, hormone drugs, antiglaucoma drugs, and so on. The main mechanisms include the influence of drugs on the parasympathetic/sympathetic system so that the secretion pathway of lacrimal gland blocked, or tear film instability and ocular surface abnormalities caused by eye drops or ointments. Preventions and treatments are mainly to stop or change the drugs, etiological treatment and symptomatic treatment.

The treatment of meibomian gland dysfunction

DONG Xue-qing, GAO Ying-ying

2012, 36(4):  251-255.  doi:10 3760/ cma. j. issn. 16735803 2012 04 007

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Meibomian gland dysfunction (MGD) is the general term that describes a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction or/and qualitative and quantitative changes in the meibom secretion. It may result in instability of the tear film, inflammation in the lid margin, lipid tear deficiency(LTD) dry eye and other ocular surface diseases. Previously, MGD treatment includes the eyelids cleaning, warm massage, nutritional therapy, hormone and antibiotic applications. In recent years，physical therapy, immune regulation, and environmental regulation, as well as the study of the mechanism of antibiotic application, has a lot of new progresses.

Cause analysis, diagnosis and treatment of dry eye after cataract extraction

WANG Yong, JIA Hui

2012, 36(4):  256-259.  doi:10 3760/ cma. j. issn. 16735803 2012 04 008

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As the generally developing of cataract phacoemulsification, the complaints of dry eye, such as dry sensation, foreign body sensation, burning sensation and so on, were complained by some of the patients after cataract extraction. The operation time, the length and location of incision, and the medicines using in the perioperation period significantly affect the function of tear film. Oculists should pay more attention to the causes and characteristics. Maintaining the normal structure of tear film, shortening the operation time, and reducing the mechanical injury to the cornea and conjunctiva during the operations, treating timely and exactly after the operations are helpful to the patients getting better surgical outcomes and quality of life.

The variation characteristics of  cornea biomechanical properties after corneal refractive surgery

WU Di, WANG Yan

2012, 36(4):  260-265.  doi:10 3760/ cma. j. issn. 16735803 2012 04 009

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Corneal biomechanics is the science that investigates and analyzes the properties of cornea, such as viscosity resistance and overall resistance. The biomechanical property of corneal is one of the most important factors effecting the predictability and stability of corneal refractive surgery, and which related to the different operative method and ablation depth. For example, lamellar ablation has more effects on corneal resistance than surface ablation. Both corneal hysteresis and corneal resistance factor decrease significantly after thick flap creation. And deeper ablation may result in obvious corneal resistance factor reduction. These changes are highly related to some complications like keratectasia and regression, etc.

Cytokines in scar regulation after glaucoma filtration surgery

LI Wei-na, CHENG Jin-wei, WEI Rui-li

2012, 36(4):  266-270.  doi:10 3760/ cma. j. issn. 16735803 2012 04 010

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Following all types of glaucoma filtration surgery, scarring still poses the major threat to longterm success. Many cytokines, such as transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), connective tissue growth factor (CTGF), interleukin (IL) and interferon (INF), are associated with the scarring progress after filtration surgery. Recently, many promising new agents were used therapeutically by binding to these molecular targets among scar regulation after glaucoma surgery. In this review, we discuss our current understanding of cytokines in the wound healing process after glaucoma surgery and promising new treatment modalities.

Primary intraocular lens implantation after extraction of congenital cataract in infants

LIU Xin, LUO Yi

2012, 36(4):  271-275.  doi:103760/ cma.j.issn.16735803201204011

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Primary intraocular lens (IOL) implantation after extraction of congenital cataract in infants has been accepted and gradually applied to clinic by an increasing number of ophthalmologists in recent years. Incidence of postoperative complications has largely reduced after application of the 25gauge vitrectomy system in cataract surgery in infants. Accuracy of IOL power calculation has been increased because of the developments of new generation of IOL power calculation formula and prediction formula of myopia shift. Visual rehabilitation has improved due to the developments of the infants suitable IOLs and the means of amblyopia training.

Biocompatibility evaluation of intraocular lens materials

WANG Zi-yang, ZHU Si-quan

2012, 36(4):  276-280.  doi:10 3760/ cma. j. issn. 16735803 2012 04 012

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Phacoemulsification cataract extraction and intraocular lens (IOL) implantation is the most effective method for cataract patients. As the implanted biomaterials, IOL can initiate a series of biological reactions. IOL biocompatibility evaluation follows two major principles, which are bio-safety and bio-function principles. Biosafety evaluation includes cytotoxicity tests, genetic toxicity tests, irritation and sensitization test, as well as implantation test. Biofunction evaluation includes the evaluations of uveal biocompatibility and capsular biocompatibility.

The causes and interventions of dysphotopsia after intraocular lens implantation

GUO Ya-wen, LI Jun

2012, 36(4):  281-284.  doi:10 3760/ cma. j. issn. 16735803 2012 04 013

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The dysphotopsia is the common complication after intraocular lens (IOL) implantation, which includes positive dysphotopsia and negative dysphotopsia. After IOL implantation the light from outside generates bright images on the retina. This is called positive dysphotopsia. The negative dysphotopsia is that the blind spot and shadow on the retina after IOL implantation because of the photorefraction through the square edge of the IOL. The posterior capsular opacification, the material and the edge design of the  IOL,  the diameter of IOL optical component, the position of incision and the irisoptic distance are the important influential factors that cause the dysphotopsia. Some patients after IOL implantation suffer from dysphotopsia. It effects their qualities of life. In this article, the reasons, influential factors,  treatment  and the newly developed examination methods of the dysphotopsia were reviewed.

Pathological changes of thyroidassociated ophthalmpathy

HU Yi-bo, AI Li-kun

2012, 36(4):  285-288.  doi:10 3760/ cma. j. issn. 16735803 2012 04 014

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Thyroidassociated ophthalmopathy is the common orbital disease. Although the mechanism is not fully understood, it has been confirmed that thyroidassociated ophthalmopathy is a kind of autoimmune disease. The pathological changes of extraocular muscle, connective tissue, and eye conjunctiva tissue in thyroidassociated ophthalmopathy were reviewed in this paper in order to provide some clues for further revealling the pathogenesis of thyroidassociated ophthalmopathy, to present more reasonable explanation for some clinical phenomenon of the restrictive strabismus, and to expect some guiding for clinical treatment.