Table of Content

22 October 2013, Volume 37 Issue 5

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The vital importance of postoperative management for longterm success of trabeculectomy

REN Ze-Qin

2013, 37(5):  289-291.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.001

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Trabeculectomy depends on both surgery itself and postoperative management for its longterm success. This article expounds the reason and basis why the postoperative management plays an important role on trabeculectomy success, and introduces the main contents and measures of the postoperative management.  (Int Rev Ophthalmol, 2013, 37: 289-291)

Measurement techniques for peripheral refraction

WU Jing-Jing, HUA Ning, LI Xiao-Rong

2013, 37(5):  292-296.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.002

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Myopia has gained increasing interest in recent years, particularly because of its increase in prevalence across populations worldwide. Previous study suggests that the refractive statue of the peripheral retina may influence the onset and development of central refractive errors. To better understand the association between peripheral refraction and myopia development, precious and rapid measurement of refraction over the visual field is fundamental for all the studies. This review compares several refractive techniques frequently used for offaxis measurement, introduces their advantages and limits, and provides demand for the perfect instrument specialized for peripheral refraction, which may be of help for the future research work.  (Int Rev Ophthalmol, 2013, 37: 292-296)

Mechanisms and measurement of glare in human eyes

CAI Xiao-Gu, QIAO Li-Ya, GUAN Zheng, WAN Xiu-Hua, WANG Ning-Li

2013, 37(5):  297-302.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.003

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Glare is typically regarded as a sensation produced by light which enters the eye in such a fashion as to inhibit distinct vision. However, there are discrepant definitions and terminology in different disciplines and specialties. Many clinical glare testers have been developed, but results have been variable and no widely accepted testing protocol exists. In clinical and research fields, caution is needed to identify the bias lead by different glare definition and measurement method in visual quality assessment. Due to its complex, multidisciplinary nature, comprehensive and effective countermeasures for glare is absent. In this review, through the integration of publications in ophthalmology, illumination engineering, neurology, and other relevant disciplines, we provide the definition, characteristics, mechanisms, assessments and countermeasures of common type of glare including disability glare, dysphotopsia glare, discomfort glare and photophobia.   (Int Rev Ophthalmol, 2013, 37: 297-302)

Diagnosis and treatment  of the blepharochalasis syndrome

KE Mei-Qing, ZHANG Xing-Ru, ZHAO Li, HAN Zhu-Mei, LI Qing-Song

2013, 37(5):  303-307.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.004

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Blepharochalasis syndrome is a rare eyelid disease that often presents in childhood or adolescence. It is characterized by idiopathic localized intermittent painless edema of upper and(or) lower eyelids, which would destroy the tissue structure of eyelid and lead to atrophic, wrinkled periorbital skin and the tortuous and dilated capillaries. Other clinical manifestations include proptosis, prolapse of orbital fat, and lacrimal tissue, etc. The etiology of the blepharochalasis syndrome has not yet to be fully elucidated. It still cannot exclude the participation of genetic factors. IgA and matrix metalloproteinases had been found in the periorbital tissues, which confirm that participation of the immuoreaction which might lead to elastolysis. Elastolysis may ruin the structure and the function of the lymphatic system. All these factors may play a substantial role in the pathogenesis of the disease. The treatment of blepharochalasis divided into the treatment of acute edema and stable period.  (Int Rev Ophthalmol, 2013, 37: 303-307)

Inflammatory mechanisms in the pathologic lesions of dry eye

NIU Liang-Liang, WANG Yan

2013, 37(5):  307-310.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.005

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Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to ocular surface. It is accompanied by increased osmolarity of tear film and inflammation of the ocular surface. Current studies have shown that inflammation may play an important role in the pathological damage of dry eye. This article reviews how inflammation in dry eye leads to potential damage to the tears and ocular surface. Evidence for inflammatory mechanisms accounting for potential damage to the tears and ocular surface will be provided from the following aspects: tear hyperosmolarity, altered expression of mucins, disruption of the structure and function on keratoconjunctival epithelium, lacrimal gland and meibomian gland.  (Int Rev Ophthalmol, 2013, 37: 307310)

Research advances of predicting and screening for the primary angle closure glaucoma

WU Ruo-Xin, LI Jin-Ying

2013, 37(5):  311-316.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.006

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If the highrisk groups of primary angle closure glaucoma can be screened before acute angle closure attacks or peripheral anterior synechia formation among anatomically narrow angle eyes, and proper prophylactic treatment can be performed in time, subsequent glaucomatous optic neuropathy can be prevented. Each of those methods, such as gonioscopy，ultrasound biomicroscopy，anterior segment optical coherence tomography and Scheimpflug photograph, has advantages and drawbacks. Latest research shows predicting and screening for PACG involved with fairly wide range of biometric measurements, including the parameters on anterior chamber，angle opening degree, iris, lens, volume change of iris, and uveal effusion as well. This article briefly reviews research advances in predicting and screening methods for high risk cases of the primary angle closure glaucoma.  (Int Rev Ophthalmol, 2013, 37: 311-316)

Application of novel auxiliary apparatus on the treatment of lenses subluxation

GUO Yue, GUO Xiao-Hong, ZHENG Dan-Ying

2013, 37(5):  317-321.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.007

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Due to the instability of capsular bag, it has been a great challenge for  ophthalmologists to implant posterior chamber intraocular lens (IOL) in bag with efficiency and safety to deal with patient with subluxated lenses. Thus, some disadvantages may affect the effect of operation. In recent years, the appearance and widely use of novel auxiliary apparatus including, capsular tension rings, modified capsular tension rings, capsular tension segments, iris retractors and capsular anchor, which could protect capsular by different mechanisms to stable the subluxated lens, reduce further damage of ligaments and occurrence of crack of capsular in surgery, as well as keep IOL in center, decrease the shrinkage of capsular to prevent opacity of posterior capsule after surgery. All in all, they offer more choices for lens subluxation surgery.   (Int Rev Ophthalmol, 2013, 37: 317-321)

The history and future of combined surgery in glaucoma and cataract

ZHU Wei, WANG Tao

2013, 37(5):  322-328.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.008

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Combined cataract and glaucoma surgery refers to the combination of  different types of cataract extraction operations and glaucoma operations. At present, it mainly refers to the phacoemulsification combined with filtering surgery especially trabeculectomy. Cataract surgeries include from intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), to the transparent corneal incision phacoemulsification with foldable intraocular lens implantation even if femtosecond laser cataract surgery. The techniques of trabeculectomy include scleral flap firmly sutured, anti-metabolism drugs (especially mitomycin) application and the controlled demolition of scleral flap sutures. Nowadays there are no unified standards of indication for combined surgery. Some authors have suggested that patients with goniosynechia ≥ 180°, numbers of anti-glaucoma drugs ≥3, existing indication of cataract surgery, corrected visual acuity < 10/20, can be chosen for combined surgery. In the future, non-penetrating trabecular operation, viscocanalostomy and shunt procedures (including I-sent, ExPRESS) and endoscopic cyclophotocoagulation will be incorporated into field of combined surgeries. (Int Rev Ophthalmol, 2013, 37: 322-328)

Research progress in combining phacoemulsification with endoscopic cyclophotocoagulation

ZHANG Yun-Jiang, YU Fang-Liang

2013, 37(5):  329-334.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.009

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 Glaucoma  coexisting cataract is common,  and there are a lot of  combined surgical methods for it．With the endoscope applications development in ophthalmology, cyclophotocoagulation endoscopic surgery as a new means of treating complicated glaucoma, and combined phacoemulsification and intraocular lens implantation for cataract and glaucoma have some advantages．In this article,   the progress of endoscopic cyclophotocoagulation combined with phacoemulsification surgery including its indications, effacacy, complications and comparison with other combined surgeries were summarized.  (Int Rev Ophthalmol, 2013, 37: 329-334)

Transforming growth factor-beta signaling pathway as a therapeutic target for prevention and treatment of posterior capsule opacification

JIANG Li-Li, MA Zhong-Xu-

2013, 37(5):  335-339.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.010

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Posterior capsular opacification (PCO) is a most common complication of modern cataract surgery. The prevention of PCO is the key to ensure longterm efficacy of cataract surgery. The proliferation, migration, and epithelial mesenchymal transition of intraoperative residual lens epithelial cells are cellular basis of PCO. Transforming growth factor β（TGF-β）participates in the development of PCO by regulating lens epithelial cells proliferation, migration, differentiation and apoptosis. It is envisaged that the regulation of TGF-β, TGF-β receptor and its downstream pathway (Smad proteins and matrix metalloproteinases) can prevent PCO. By the means of conjunctival sac daub and anterior chamber injection, TGF-β antibodies, matrix metalloproteinase inhibitors and connective tissue growth factor antisense oligonucleotides or specific antibodies may become the new ways of preventing PCO.   (Int Rev Ophthalmol, 2013, 37: 335-339)

Diagnois and treatment of viral anterior uveitis

ZHU Xue-Mei, ZHAO Ming-Wei

2013, 37(5):  340-345.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.011

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Viral anterior uveitis,  remains the predominant type of uveitis,  which is a major cause of visual impairment throughout the world. With complicated etiology,  unclear pathogenesis and wide spectrum of manifestation,  viral anterior uveitis may initially be misdiagnosed. It’s a great challenge to differentiate viral anterior uveitis from other forms of uveitis accurately and timely.  It could be aggravated or recurrent without appropriate treatment. This review presents the clinical features,  the newer diagnostic modalities and the treatment strategy of viral anterior uveitis,  including herpetic simple virus,  varicella zoster virus,  cytomegalovirus and rubella virus. The clinical manifestations of the different viral anterior uveitis are compared. The molecular techniques for diagnosis and the treatment strategy are highlighted.  (Int Rev Ophthalmol, 2013, 37: 340-345)

Risk factors and prevention of endophthalmitis after intravitreal injection

LI Yi-Feng, WEI Wen-Bin

2013, 37(5):  345-349.  doi:10.3706/ cma.j.issn.1673-5803.2013.05.012

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Intravitreal injections have been developed and applied rapidly in recent years, especially the intravitreal injection of vascular endothelial growth factor (VEGF), which has become one of the most common treatments in ophthalmology.  This underscores the need that the complications of such treatment ought to merit full attention.  Endophthalmitis is the most serious complication of intravitreal injections.  Studies showed that the occurrence rate for endophthalmitis after the injection of VEGF is in the range of 0.02%~0.09%, with risk factors involving those before the injection, such as active external ocular infection, pressing of the eyelid, thick needles, glaucoma, diabetes and other systemic diseases; those during the injection, such as droplet transmission and flawed aseptic technique; and those after the injection, such as multiinjections.  The effects of antibiotic treatments during perioperative period are not yet clear.   (Int Rev Ophthalmol, 2013, 37: 345-349)

Neuroprotective effects of minocycline on retinal ganglion cell

JIAO Xiao-Ling, YANG Liu

2013, 37(5):  349-354.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.013

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Retinal ganglion cells（RGCs） is the mainly damaged cells in glaucoma and retinal diseases.  As a part of central nervous system,RGCs death often leads to irreversible  damage of visual function.  Recently, neuroscience researchers focused on minocycline and its neuroprotective effect. Minocycline is a secondgeneration, semisynthetic tetracycline. Besides its broadspectrum antibacterial effect, minocycline was proved to have the ability to protect against neuron cell damage through mechanisms of antioxidation, antiapoptosis, and inhibition the activation of microglia. More and more studies suggested that minocycline can also protect RGCs and has treatment potential in optic nerve injury, glaucoma, and various retinal diseases. This article reviews the neuroprotective effect of  minocycline on RGCs and its mechanism.  (Int Rev Ophthalmol, 2013, 37: 349-354)

New insights into the microstructure of outer retina and its correlation with visual prognosis of retinal diseases

TIAN Hong-Ya, WANG Fang

2013, 37(5):  354-358.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.014

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 In recent years, the fastdeveloping optical coherence tomography (OCT) technology has provided us more details of the outer retina microstructure. The four hyperreflective lines in OCT images (external limiting membrane, ELM; inner segment/outer segment junction, IS/OS; cone outer segment tips, COST; retinal pigment epithelium, RPE) are associated with visual acuity and function in different retinal diseases, and are able to predict prognosis and clinical outcomes of retinal diseases. In the present review, the emerging knowledge about the microstructures of the outer retina and its relationship with visual function in different retinopathies will be discussed.  (Int Rev Ophthalmol, 2013, 37: 354-358)

The response of microglia in the diabetic retinopathy—To explore changes of microglia from the view of neurovascular unit

ZHANG Ai-Ping, CAO Wen-Jun

2013, 37(5):  358-II.  doi:10.3706/ cma. j. issn.1673-5803.2013.05.015

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Being one of the most serious microvascular complications of diabetes, diabetic retinopathy(DR) is the leading cause of new cases of blindness among adults. Though the pathogenesis of DR still remains to be completely elucidated, increasing evidences suggest that microglial cells play an important role in the occurrence and development of DR. This review expect to summary the changes of distribution, morphology, surface marker profile and function of microglial under physiological condition and diabetic background, and to further explore the physiological conditions of neurovascular unit in the function and regulation of  microglial and its possible mechanism involved in DR. (Int Rev Ophthalmol, 2013, 37: 358-Ⅱ)