Table of Content

22 December 2015, Volume 39 Issue 6

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Blindness and poverty

SUN Bao-chen, HU Ai-lian, WU Min, ZHANG Xu, YANG Xiao-hui, ZHENG Yuan-yuan

2015, 39(6):  361-367.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 001

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WHO estimates that  globally 90% of patients with visual impairment are living below the poverty line. The rate of blindness decreases with the increase of national income, and when the annual income is lower than 10,000 to 20,000 USD, the rate of blindness markedly rises. After cataract surgery, the poverty rate within patients significantly decreases, with the catastrophic health expenditures of the patient going down. Each year the global productive forces loss due to vision impairment and blindness caused by trachoma is as much as 5.3 billion USD. Vision impairment caused by uncorrected refractive errors can lead to a productive force loss of 268.8 billion Geary-Khamis Dollar. Patients relevant to eye diseases with poverty income ratio (PIR) lower than 1.5 have a significant poorer chance to receive an eye care than those who are with a PIR higher than 5. Patients with high school education or less have  markedly lower chance to receive an eye care or dilated eye examination than those who have college education or higher. Poverty and blindness are closely related. Poverty induces blindness, and blindness could also exacerbate poverty.   (Int Rev Ophthalmol,  2015,  39:     361-367)

Research progress of SPARC in aqueous humor outflow pathway

CONG Lin, ZHANG Yu-yan

2015, 39(6):  368-371.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 002

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Primary open-angle glaucoma(POAG) is one of  blindness-causing diseases. Although we have already found out multiple molecules and signaling pathways that interact with each other are involved, the exact pathogenesis that leads to the progression of POAG is poorly understood. Secreted protein, acidic and rich in cysteine (SPARC), defined as a matricellular protein, is distributed throughout the human ocular tissue. SPARC, which can modulate the synthesis of extracellular matrix (ECM) and affect cellular morphology and adhesions, plays an important role in the increase of outflow resistance in patients with POAG by modulating the morphology and structure of trabecular meshwork(TM).   (Int Rev Ophthalmol,  2015,  39:    368-371)

The influence of lens in the pathogenesis of primary angle closure glaucoma

PENG Xian-yao, LIANG Yuan-bo

2015, 39(6):  372-375.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 003

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Primary angle closure glaucoma（PACG）is featured with elevated intraocular pressure due to blocking outflow of aqueous humor by synechia or appositional angle closure. Lens factors, such as lens thickness, lens position and relative lens position, lens vault, lens thickness to axial length factor and lens curvature play a very important role in the pathogenesis of PACG. But the static anatomy factors alone are not enough to explain the specificity of PACG. The dynamic changes of lens  mainly present as lens position and lens thickness change, which is decided by the zonule. The function of the lens zonule may be associated with the occurrence of the angle closure.   (Int Rev Ophthalmol,  2015,  39:     372-375)

Adjuvant treatment of neovascular glaucoma with anti-VEGF

SHI Liu-kun, YANG Jin

2015, 39(6):  376-381.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 004

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Neovascular glaucoma (NVG) is a severe complication of ocular ischemia diseases. High concentration of vascular endothelial growth factor (VEGF) exists in anterior segment which leads to iris neovascularization. Aqueous humor outflow will be blocked. Anti-VEGF agent can combine with VEGF receptor and block VEGF,  and to a certain extent delay the appearance of iris neovascularization. Intravitreal or intracameral injection of anti-VEGF agents (such as bevacizumab, ranibizumab and so on) combined with the traditional treatment such as trabecutectomy, glaucoma valve implantation, vitrectomy, panretinal photocoagulation are good choices to treat neovascular glaucoma.  (Int Rev Ophthalmol,  2015,  39:     376-381)

Application  of diffusion tensor imaging in central nervous system changes induced by glaucoma

ZHAO Jin, ZHANG Yu-yan

2015, 39(6):  381-385.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 005

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The damage of the central nervous system in glaucoma have drawn great attention of the researchers recently.   As one of functional magnetic resonance imaging (fMRI), the diffusion tensor image (DTI) technique can non-invasively and effectively trace the nerve fibers. It can also sensitively evaluate the micro-structure of brain tissues and the pathological changes of nerve fibers. It is applied into every aspect of  glaucoma research, and already led to some achievements in researches about optic nerve, lateral geniculate body, optic radiation,   brain volume and differential diagnosis of different types of glaucoma. As a new tool, the advantage of DTI includes displaying the functionality change of nerve fiber, and the disadvantage is the low resolution and susceptibility to the trend of complicated nerve fibers. At present DTI is only applied in medical research, in the future it will be widerly used in the ophthalmological field.  (Int Rev Ophthalmol,  2015,  39:     381-385)

The advances in the treatment of fungal keratitis

LIU Xin1, ZENG Qing-yan1,2

2015, 39(6):  386-390.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 006

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Fungal keratitis is a serious blindness leading disease. In recent years, new    treatment included new medicines such as fourth generation azoles, poly hexamethylene biguanide, calcineurin inhibitors, and new dosage forms such as mucoadhesive gels and Clotrimazole-β-Cyclodextrin, new operation such as corneal collagen cross-linking, excimer laser phototherapeutic keratectomy, deep lamellar keratoplasty, etc.   (Int Rev Ophthalmol,  2015,  39:     386-390)

Application of Pentacam Anterior Segment Analysis System on diagnosis of keratoconus

XU Man1, SUN Li2, LIU Yong-zhen2, LU Di2, XU Yan-chun2, CHEN Lei2

2015, 39(6):  391-393.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 007

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 Pentacam Anterior Segment Analysis System shows a 3D image which synthesize from the front surface of the cornea to the post surface of the lens. Anterior and posterior corneal curvature, anterior and posterior corneal elevation, posterior refractive power, corneal astigmatism, corneal volume and corneal thickness measured by the Pentacam Anterior Segment Analysis System play the important roles in diagnosing keratoconus, particular in diagnosing early keratoconus.  (Int Rev Ophthalmol,  2015,  39:     391-393)

The diagnosis and treatment of keratoconjunctival tumors

HUANG Jing-jing, LIANG Qing-feng, LI Bin

2015, 39(6):  394-400.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 008

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Conjunctival tumors account for vast majority of keratoconjunctival tumors. The primary cornea  tumors are very rare. Common benign tumors are dermoid, melanocytic nevi, and dermolipoma. Common malignant tumors are squamous cell carcinoma, melanoma, and lymphoma. Histopathology examination is the "gold standard" for tumor diagnosis. In recent years, with the development and applications of in vivo confocal microscopy, it  can also provide a reference value for determining the nature of the lesion. Observation is a common  choice for  management of most benign, asymptomatic tumors. If  a  malignant transition tendency is observed, both surgery and histopathological examinations are needed as soon as possible. For clinical suspected malignant tummors, the most common treatment is local extended resection and cryotherapy. Sometimes, it may need to be combined with radiotherapy, chemotherapy, or even enucleation or evisceration to save the patient's life.   (Int Rev Ophthalmol,  2015,  39:     394-400)

High-altitude retinopathy

HU Li-ying, LI Zhi-qing, LI Xiao-rong, YU Rong-guo, YANG Jin, WANG Lin-ni

2015, 39(6):  401-405.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 009

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High-altitude retinopathy (HAR) is a manifestation of high altitude disease. Its etiology and pathogenesis is still not clear, and hypoxia is the most important factor. The predominant characteristic is retinal hemorrhage. According to the severity of hemorrhage, it can be divided into four levels. Early diagnosis and timely treatment critical for a good prognosis. The prevention is the key point for HAR. Rising altitude slowly and extending adaptation time properly are suggested. At the same time,  other high altitude diseases need to bear in mind are, such as acute mountain sickness(AMS), high-altitude pulmonary edema(HAPE) and high-altitude cerebral edema(HACE).   (Int Rev Ophthalmol,  2015,  39:     401-405)

Ocular decompression retinopathy

ZHANG Ying-jie, ZHU Dong-qing

2015, 39(6):  405-408.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 010

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Ocular decompression retinopathy (ODR), caused by sudden lowering of intraocular pressure (IOP), is a rare retinal hemorrhagic disease. It usually occurs following glaucoma and various glaucoma surgeries, also is found in other treatments with acute IOP reduction. Clinical findings reported in ODR include a spectrum of hemorrhages and optic nerve changes, but the visual outcomes are generally good. At present,  the etiopathogenesis of ODR is unclear. It is supposed that this disease may be related with high preoperative IOP, the application of antimetabolites, low postoperative IOP and the severe enlarged cup-disc ratio. Gradually lowering the  IOP might prevent this complication.  (Int Rev Ophthalmol,  2015,  39:     405-408)

Effects of systemic risk factors on the development of diabetic retinopathy

WANG Mo1，WANG Fang2

2015, 39(6):  409-413.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 011

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Diabetic retinopathy (DR) is one of the most common and severe microvascular complications of diabetes. The progress of the disease is slow, and affected by many factors. In addition to the change of blood glucose,  many other aspects such as blood pressure and cardiovascular risk factors were associated with DR.Controlling blood pressure and blood sugar can prevent and delay the occurrence and development of DR. Angiotensin converting enzyme inhibitory factor not only has the effect of reducing blood pressure, but also can delay the development of DR; The abnormality of lipid metabolism is generally considered to be associated with macular hard exudation and vision loss. The effect of smoking on DR is bidirectional. Pregnancy is correlated with DR,  good glycemic control before conception and during pregnancy will not have long-term effects on DR. Genetic studies will be benifit for the further understanding on DR.  (Int Rev Ophthalmol,  2015,  39:     409-413)

Accuracy research of intraocular lens power calculation in high myopia eyes

QIAN Su-qin1, LIU Jie-wei2, CHAI Fei-yan2, LIU Wen-jie2

2015, 39(6):  414-417.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 012

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 For long axial (high myopia) cataract eyes, the difference between real refraction and calculated refraction by commonly used formulas is relatively large, frequently leading to a  postoperative hyperopia. Several solutions have been suggested to address this problem, including using the specific IOL’s constants for long axial eyes, adjusting the axial lengths (ALs), and using new-generation formulas such as Holladay II, Olsen, and Barrett Universal II. These solutions have been reported to be superior to the standard formulas in terms of accuracy used in highly myopic eyes.   (Int Rev Ophthalmol,  2015,  39:     414-417)

Histopathology of ocular and adnexal lymphoma

LIU Yi-nan, WEI Wen-bin

2015, 39(6):  418-422.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 013

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Ocular and adnexal (including the orbit, eyelid, conjunctiva, lacrimal gland and lacrimal sac) lymphoma is a relatively rare ocular malignant tumor, of which the incidence worldwide tends to be gradually increasing lately. They are  the classification of non-Hodgkin's lymphoma at most times. And the most common subtype of ocular and adnexal lymphoma are the highly malignant diffuse large B cell lymphoma and low-grade malignant extranodal marginal zone B cell lymphoma. Most of the ocular and adnexal lymphoma cells are derived from B lymphocytes. Immunohistochemistry often shows that B cell markers (CD79a, CD20, PAX5) are positive. Ki-67 staining is used to test tumor cell growth factor levels, so as to evaluate the malignant degree of lymphoma.   (Int Rev Ophthalmol,  2015,  39:     418-422)

The diagnosis and treatment of primary vitreoretinal lymphoma

ZHOU Nan, WEI Wen-bin

2015, 39(6):  422-427.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 014

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Primary vitreoretinal lymphoma (PVRL) is a rare and fatal ocular malignancy. PVRL is a subset of primary central nervous system lymphoma (PCNSL), and lack of characteristic clinical manifestations of the disease. PVRL requires invasive procedures for tissue diagnosis. Cytology/pathology, molecular pathology, immunohistochemistry, biophysical technology (flow cytometry), and cytokine analysis (interleukine-10) are often required. The gold standard for diagnosis is cellular immune pathology examination. Approaches to treatment have centered on systemic methotrexate-based chemotherapy. Rituximab is a new  meidicine in the treatment of PVRL, especially in the targeted therapy. Despite these advances, prognosis remain poor, and few patients remains disease-free >4.5 years after treatment.   (Int Rev Ophthalmol,  2015,  39:     422-427)

Seronegative neuromyelitis optica spectrum disorder

CAO Shan-shan, WEI Shi-hui

2015, 39(6):  428-432.  doi:10. 3760/cma. j. issn. 1673-5803. 2015. 06. 015

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Neuromyelitis optica (NMO) is a severe demyelinating disease of the central nervous system. Approximately 90% of the patients with NMO and more than half of the patients with NMO spectrum disorders (NMODS) are positive for autoantibodies against aquaporin-4 (AQP4). The patients with AQP4 antibody-negative are  characterized by more prone to male, a predominant Caucasian ethnicity, and an overrepresentation of simultaneous bilateral optic neuritis and transverse myelitis at first episode. Moreover, they experienced a better visual acuity at last follow-up compared with seropositive NMO. AQP4 were mainly tested by cell-based assay, enzyme linked immunosorbent assay, immunohistochemistry, radio-immunoprecipitation assay.  (Int Rev Ophthalmol,  2015,  39:     428-432)