Table of Content

22 October 2014, Volume 38 Issue 5

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Intravitreal chemotherapy for retinoblastoma

2014, 38(5):  289-293.  doi:DOI: 10.3760/ cma. j. issn.1673-5803.2014.05.001

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Vitreous seeding is common in retinoblastoma. As vitreous is lack of blood supply, chemotherapy drugs can hardly reach the effective concentration in the eye. Intravenous chemotherapy and ophthalmic arterial chemotherapy have improved the salvage of the globe in patients with retinoblastoma. However, persistent or recurrent viable vitreous seeds become one of the most challenging conditions for eyepreservation therapy. In recent years, intravitreal injection therapy (IViT) has attracted great attention. Intravitreal injection of melphalan or other antitumor drugs has demonstrated success in the treatment of vitreous seeds with less side effects. To further reduce the risk of intraocular toxicity, we should use drugs at safe doses and improve the injection technique. Although IViC appears to offer a comparatively safe and efficient salvage option to refractory and recurrent vitreous seeds, its validation awaits the results of a prospective phase II clinical trial. In this review, we summarized the recent research progress in IViT for retinoblastoma with vitreous seeding in terms of its effectiveness, complications and safety improvement.  (Int Rev Ophthalmol, 2014, 38:   289-293)

Clinical application of aflibercept for the treatment of wet agerelated macular degeneration

GAO Fan, WANG Yu-sheng, HOU Hui-yuan.

2014, 38(5):  294-300.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.002

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Age-related macular degeneration(AMD) is a major cause of blindness in elderly populations. Wet AMD, which is characterized by choroidal neovascularization (CNV), is the leading cause of vision loss. AntiVEGF therapy is the current firstline treatment for wet AMD. Aflibercept (Eylea) is the latest member in the antiVEGF drugs for ophthalmic application. The dose interval of Aflibercept can be extended but yield stable therapeutic effect due to its wider binding range(VEGF\|A, VEGF\|B, placental growth factor), better affinity, as well as longer halflife. At present, quite a few clinical trials about Aflibercept application have completed or are undergoing. As further confirmation of its efficacy and safety goes on, Aflibercept, alone or in combination with other anti\|VEGF agents, could become a new therapeutic option for wet AMD.  (Int Rev Ophthalmol, 2014, 38:   294-300)

Anti-scarring application of bevacizumab in glaucoma filtration surgery

LIANG Pei, YANG Jin.

2014, 38(5):  300-304.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.003

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The success of glaucoma filtration surgery mainly depends on the scar reaction of filtration channel. The application of antimetabolites such as mitomycin C (MMC) and 5fluorouracil (5FU) can reduce filtration channel scar formation. But they still can result in a series of complications: widespread cell death and apoptosis, postoperative hypotony, thinwalled bleb, bleb leakage even endophthalmitis. How to improve the success rate of filtration surgery and reduce the postoperative complications are always concerned. Vascular endothelial growth factor (VEGF) plays an important role in promote angiogenesis, wound healing and scar formation. Recently, there are a lot of studies about using antiVEGF drug bevacizumab in the antifibotics for glaucoma surgery. This is a review about the characteristics of the VEGF, its effect on wound healing response, animal experiments and clinical studies of the application of bevacizumab alone or combines with MMC or 5FU by way of intravitreous, subconjuctival or eyedrops during glaucoma filtration surgery.  (Int Rev Ophthalmol, 2014, 38: 300-304)

Macular thickness assessment with optical coherence tomography for glaucoma early diagnosis

ZHANG Rong, CHEN Wei.

2014, 38(5):  305-308.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.004

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Optical coherence tomography (OCT) is a noncontact, good repeatability technique to obtain fastly highresolution images from the anterior and posterior segments of the eye, and it has been widely used in the field of ophthalmology. Previous studies have shown that the thickness of circumpapillary retinal nerve fibre layer (cpRNFL) and optic disc assessment with OCT are valuable in diagnosing glaucoma.Traditional time domain (TD) OCT can measure macular nerve epithelium thickness.However, spectraldomain(SD) OCT allows a higher image resolution and can measure the thickness of retinal ganglion cell complex, which has less variablity in normal subjects so to be used as better indicator for early diagnosis in glaucoma. In this paper, we review the macular thickness measurement with OCT in glaucoma early diagnosis.   (Int Rev Ophthalmol, 2014, 38:   305-308)

Clinical application of visual electrophysiology technique in glaucoma

AN Jing, ZHANG Zuo-ming.

2014, 38(5):  309-315.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.005

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The visual electrophysiological techniques, such as pattern electroretinogram (PERG), photopic negative response (PhNR), multifocal electroretinogram (mfERG) and multifocal visual evoked potential (mfVEP), scotopic threshold response (STR), were applied to evaluate changes in each stage of the course of glaucoma. And these methods could provide help for the early diagnosis of it. PERG, PhNR can directly reflect the function of retinal ganglion cells (RGC) and optic nerve. PERG is the most sensitive indicator, the response changes are detected in suspected glaucoma. Recently the evaluation of damage degree of RGC could be shown by PhNR. Secondorder kernel mfERG be used to evaluate the spatial distribution of RGC function, the response is similar to the result of visual field. MfVEP is a sensitive index for patients with visual field loss. STR requires rigorous stimulation conditions; the current results show that the STR is not a sensitive index to glaucoma patients compared with other visual electrophysiological techniques.  (Int Rev Ophthalmol, 2014, 38:   309-315)

Roles of meibomian lipids in dry eyes

YOU Yu-chen, LI Xue-min.

2014, 38(5):  316-319.  doi:10.3760/cma.j.issn.1673-5803.2014.05.006

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Both aqueous tear deficiency and increasing evaporation lead to dry eye. The outmost part of the tear film is the lipid layer secreted from the meibomian glands. The meibomian lipids maintain the stability and prevent evaporation of the tear film. The composition and construction of lipid layer influence the stability of itself. In the patients with meibomian gland dysfunction (MGD), the dysfunction of lipid layer leads to the reducing stability of tear film and destruction of ocular surface, and finally cause the overevaporation dry eye.   (Int Rev Ophthalmol, 2014, 38:    316-319)  

Visual quality after femtosecond laser corneal refractive surgery

CAI Jian-ru, ZHANG Wen-wen, CHEN Hui.

2014, 38(5):  320-325.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.007

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Currently, the femtosecond laser surgeries can been classified into two main groups by the application in corneal refractive field, the femtosecond laser in situ keratomileusis (FSLASIK) and allinone femtosecond laser refractive surgery. The latter one can be assorted into femtosecond lenticule extraction (FLEx) and small incision lenticule extraction (SMILE). This article reviews the differences of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), safety index and efficacy index between the FSLASIK and traditional LASIK, the influence of FSLASIK to the objective visual quality, such as contrast sensitivity and high order aberration and subjective visual quality, by comparison with FSLASIK, the effects of FLEx on subjective visual quality, such as UCVA, wavefront aberrations and objective satisfaction. Meanwhile, the safety, efficacy, prediction and the affection on the corneal sensitivity of the three surgeries are summarized.  (Int Rev Ophthalmol, 2014, 38:   320-325）

Controlling early postoperative elevated intraocular pressure: the first reason cited for postoperative inpatient hospitalization after diabetic vitrectomy

ZANG Si-wen, WANG Wei.

2014, 38(5):  325-329.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.008

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 Due to the complexity of proliferative diabetic retinopathy (PDR), some patients need to still stay in hospital after vitrectomy. Controlling the elevation of early postoperative intraocular pressure (IOP) is the first reason for the prolonged hospitalization. To investigate the occurrence time and incidence would contribute to monitoring the postoperative IOP after diabetic vitrectomy in time. The risk factors of postoperative elevated IOP are combined tractional retinal detachment, preoperative high IOP, 20gauge vitrectomy, the number of laser photocoagulation, use of expanding gas and silicone oil tamponade, fibrovascular frond removal, combined surgery, postoperative severe inflammation and postoperative vitreous hemorrhage. Through analyzing these factors, doctors could evaluate the occurrence of the early postoperative elevated IOP caused by PDR vitrectomy and administer individualized treatment, and also forecast the postoperative duration of hospitalization.  (Int Rev Ophthalmol, 2014, 38:   325-329)

Ocular manifestation and treatment in Lowe syndrome

TAN Jian-wen, LAI Yi-fan.

2014, 38(5):  330-333.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.009

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Lowe syndrome also known as oculocerebrorenal syndrome. The aetiology is related to mutation of OCRL1 (Oculocerebrorenal syndrome of Lowe)gene in the chromosome Xq261，reulting in a deficiency of OCRL1 protein or a reduction of phosphatase activity is responsibility for the disease. Lowe syndrome is a multisystem disorder characterised by anomalies affecting the eye, the nervous system and the kidney. Most of affected individuals is male, female carriers may be presence of bilateral cataract without other systemic abnormities. The common ocular disease in Lowe syndrome including bilateral congenital cataract, glaucoma, keloid, amblyopia and retinal atrophy. The mainly ocular treatments contain phacoemulsification, glaucoma filtering operation, topical medication.   (Int Rev Ophthalmol, 2014, 38:   330-333)  

New discoveries in molecular genetics of congenital cranial dysinnervation disorders

SHEN Tao, DENG Da-ming.

2014, 38(5):  333-340.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.010

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The congenital cranial dysinnervation disorders (CCDDs) is a set of congenital, nonprogressive abnormalities of ocular motility with or without associated systemic abnormalities, which is caused by dysplasia or completely deficiency of one or more cranial nerves, leads to dysinnervation of extraocular muscles. To date, several pathogenic genes have been found in CCDDs, including SALL4, CHN1, HOXA1, KIF21A, PHOX2A, TUBB3, TUBB2B, ROBO3, HOXB1, and so on. Our understanding of the CCDDs is broadening, but it has now become clear that phenotype dose not completely predict the genotype of certain CCDDs categories, and the genotype does not completely predict the phenotype. We reviewed the clinical manifestations and new discoveries in molecular genetics of different types of CCDDs.   (Int Rev Ophthalmol, 2014, 38:   333-340)  

Macular thickness changes and its possible mechanism after phacoemulsification without surgical complications

ZHANG Nan, XIAO Yi-qin, YE Wen.

2014, 38(5):  340-345.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.011

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Macular thickness is increased in patients after phacoemulsification with intraocular lens implantation. The increase in macular thickness may lead to visual impairment. The mechanisms of macular thickness increase are still unknown.  The relative factors that affect the macular thickness after cataract surgery include systemic factors, ocular factors, surgical factors and medical factors. Inflammation plays a major role in the mechanisms which causes the break drown of the bloodretinal barrier that leads to the increase in macular thickness. Medicine that focuses on its mechanisms may prevent SCME and treat SCME.  (Int Rev Ophthalmol, 2014, 38:   340-345)    

Application of induced pluripotent stem cells in treating retinal diseases

SUN Jian-guo1,2, LI Dan1, YU Xiao-bo1, WU Ji-hong1, SUN Xing-huai1

2014, 38(5):  346-351.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.012

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Induced pluripotent stem cells(iPSC) have made a remarkable influence on science, technology and medicine by providing an available source of human cells for basic research and clinical applications. The aim of this article was to review the recent research progresses of iPSC in treating ocular diseases, especially in the treaments of retina and optic nerve diseases. Here we mainly reviewed the current literatures on the cell replacement therapy of retina and optic nerve diseases based on iPSC induction and differentiation technology, including retinal pigment epithelium, photoreceptor and retinal ganglion cells. The security and the existing problems of iPSC technology have also been discussed. Plenty of significant advancements have been made using different methods and protocols to differentiate iPSC into target retinal cells and transplant cells into animal model with untreatable retinal diseases. However, many challenges remained in the road from iPSC research to clinical application.  (Int Rev Ophthalmol, 2014, 38:  346-351)

Intravitreous injection of Bevacizumab for the wet agerelated macular degeneration

LIU Wen-jie, GAO Lei.

2014, 38(5):  351-355.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.013

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Age-related macular degeneration(AMD) is the main disease in today's world of the elderly blind, often resulting in severe vision loss, due to wet AMD in macular choroidal neovascularization (CNV) for clinical characteristics. Vascular endothelial growth factor (VEGF) is known as one of the factors promoting neovascularization stimulated the main form. But VEGF inhibitors by antagonism. Inhibition of angiogenesis, reduce blood capillary permeability, promoting CNV exudate absorption. Although there are Bevacizumab off label use problem, it is still relatively good shortterm therapeutic effect and low treatment cost in the international community has been widely used in the field of ophthalmology. The scheme of intravitreal injection Bevacizumab (125 mg) once a month, continuous 3 times is better than the scheme after once injection, then according to the disease situation for again injection. After intravitreal injection Bevacizumab, both fundus anatomical structure and visual acuity were improved in patients with wet AMD.  (Int Rev Ophthalmol, 2014, 38:   351-355)

Inflammatory machenism in the pathogenesis of diabetic retinopathy

GUO Rong-hua, CHENG Hao.

2014, 38(5):  356-360.  doi:10.3760/ cma. j. issn.1673-5803.2014.05.014

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Diabetic retinopathy (DR) is the most common retinal vascular disease and one of the main blinding diseases for people over the age of 50 In recent years, studies have shown that the occurrence of DR is related with several hypothesis such as nonenzymatic glycosylation, activation of protein kinase C, immune or inflammation, polyol pathway, growth factors, oxidative stress/the renninangiotensin system and hemodynamic changes, but the exact mechanism has not been fully elucidated. Recently, the role of inflammatory factors in the development of DR has been attracting the attention of scholars both at domestic and abroad, particularlly the tumor necrosis factor alpha (TNFα), adhesion molecules,vascular endothelial growth factor(VEGF), pigment epitheliumderived factor (PEDF).This article reviews the current studies about the role of inflammatory factors and inflammatory related factors in the pathogenesis of DR.  (Int Rev Ophthalmol, 2014, 38:   356-Posterior I)