Table of Content

22 February 2016, Volume 40 Issue 1

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APELIN/APJ system：a new target of anti intraocular neovascularization

LIU Shuai, JIN Hai-ying

2016, 40(1):  1-6.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.001

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Retinal neovascularization is a common complication of proliferative diabetic retinopathy (PDR), retinopathy of prematurity (ROP) and ischemic central retinal vein occlusion and other retinal diseases, which is leading cause of blindness to these diseases. Studies have shown that multiple factors involve in the angiogenesis, such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), etc. APELIN is an endogenous ligand for the G protein-coupled receptor of  APJ, and widely distributes in various tissues, with a variety of biological functions. Recently, studies show that APELIN is a novel angiogenic factor, which has an important role in physiological and pathological angiogenesis, will provide a new target to anti-neovascularization.

Recent advances in signal pathways related to choroidal neovascularization

WANG Ying, CHEN Hui

2016, 40(1):  7-12.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.002

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Choroidal neovascularization (CNV) occurred in many ocular fundus diseases and has become one of the main cause of visual disability. The abnormal regulation of many intracellular signal transduction pathways are involved in the occurrence and development of CNV. Recently many researches have shown that many signaling pathways including PI3K/Akt, Wnt, STAT3, Notch, etc. play the essential roles in the development of CNV. Researches on these signaling pathways in CNV may contribute to the illumination of pathogenic mechanism of CNV and the searches for new therapeutic targets.

Autophagy and its relationship with atrophic age-related macular degeneration

ZHANG Yao, FENG Le, WANG Fang

2016, 40(1):  13-18.  doi: 10.3760/ cma.j.issn.1673-5803.2016.01.003

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Age-related macular degeneration is the main cause of blindness of elderly patients and its prevalence has been increasing worldwide. Despite close attention was paid on AMD, its pathogenesis is still not fully understood and the research has been regarded as an essential project in vision science. Autophagy refers to the process which targeted proteins and organelles were packaged and transported for degradation in lysosome，which is a major catabolic pathway involved in maintaining intracellular homeostasis. Mutiple researches suggested that autophagy also has a close relationship with AMD-related pathogenesis such as oxidative stress, inflammation and retinal pigment epithelium disorders,which may present some ideas of autophagic treatment for AMD.

T helper cell and Th-correlation cytokines in the pathogenesis of dry eye

CHANG Kun, ZHENG Xiao-fen

2016, 40(1):  18-22.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.004

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Dry eye is a multiple factor disease characterized by chronic and persistent inflammation on the ocular surface, which is due to the disruption of normal immunoregulatory mechanism of the lacrimal functional unit (LFU), which composed of tear film, corneal and conjunctival epithelium, meibomian gland, lacrimal gland and their related nerve tract. Studies show that T helper cells (Th cells)  subsets-derived pro-inflammatory cytokines and chemokines play crucial role in the ocular surface inflammation. Anti-inflammatory treatments aim at reconstructing the ocuar immunohomeostasis by inhibiting inflammatory cytokines in both clinical trials and animal models are effective in treating dry eye.

Ocular manifestations of familial amyloidosis polyneuropathy

LAI Jie, ZHANG Yu, WANG Qing-ping

2016, 40(1):  23-26.  doi: 10.3760/ cma.j.issn.1673-5803.2016.01.005

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Familial amyloid polyneuropathies (FAP) are a group of life-threatening multisystem disorders transmitted as an autosomal dominant trait, and the TTR Val30Met mutation is the most common type. TTR FAP typically causes a nerve length-dependent polyneuropathy, along with autonomic dysfunction leading to cachexia and death within 10 years on average. Tissue biopsy was seen in Congo red affinity staining with a characteristic yellow-green birefringence under polarised light. The disease can be involved in the eyes, amyloid deposition in the pupil, trabecular, vitreous, causing secondary glaucoma and vitreous opacity. Vitrectomy can significantly improve the visual acuity of patients with vitreous opacity, with the risk of recurrence after surgery. A secondary glaucoma trabeculectomy with mitomycin infiltration is operated to control of intraocular pressure. High risk family members should carry out genetic testing, DNA testing provides predictive diagnosis for those without any symptom.

Pathology, ophthalmic manifestations, and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis

MA Xue-yan 2,3, GAO Hua1

2016, 40(1):  27-30.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.006

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)  are two kinds of severe drugs adverse reactions,  which can seriously threaten the life of the patients. The clinical symptoms of the two diseases are very similar, and they are cross sometimes in clinic. The common symptoms of the two diseses are general malaise, high fever, skin herpes and spot, and often accompanied by mucosal damage and eye injury. Clinical treatment of the eye injury caused by SJS and TEN is difficult, blindness and poor prognosis are common if there is no timely treatment. The main pathogenesis is the interaction between Fas receptors and soluble Fas ligands secreted by mononuclear cells in the peripheral blood, so that the apoptosis of keratinocytes is rapidly and the  epidermal cells is damaged, and the clinical symptoms are obvious. The clinical treatment methods include general treatment (system support treatment, skin and mucosal secretions or pseudo membrane cleaning, and Tacrolimus) and specific treatment (corticosteroids, cyclophosphamide) and the treatment of eye damage (depending on the condition to give amniotic membrane transplantation and conjunctival flap covering, corneal transplantation, artificial cornea and ocular surface reconstruction surgery).

Clinical application and surgical technic of Descemet’s membrane endothelial keratoplasty

CHEN Lu-xia, TANG Xin

2016, 40(1):  31-35.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.007

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Endothelial keratoplasty (EK) is a new surgical treatment for endothelial diseases. Descemet’s membrane endothelial keratoplasty (DMEK) is the most advanced technique which provides an anatomically exact replacement of dysfunctional host endothelium and now provides better vision with lower risk of immunologic rejection. Therefore, this new technique has received high attention. However, DMEK required more challenging dissection, advanced techniques of excision of host posterior stoma tissue and need long learning curve. Initially，the biggest challenges were tissue loss in preparation and ensuring attachment. Recently, some eye banks have prepared grafts of donor tissue that may help the surgeon avoid the risk of tissue loss. Furthermore, a new bimanual technique for insertion and positioning of the grafts in DMEK that may prevent the risk happening. Now DMEK has been widely applied in developed countries. In China, there are still no reports of DMEK because of the lack of donor tissue.

Management of postpenetrating keratoplasty astigmatism

LIU Yang, ZHAO Shao-zhen, YANG Rui-bo

2016, 40(1):  36-40.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.008

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Penetrating keratoplasty (PKP) can restore vision or control the development of corneal disease. A successful corneal graft requires both clarity and an acceptable refraction. After PKP, astigmatism remains a challenge for corneal refractive surgeons, it is a limiting factor in the visual rehabilitation of otherwise successful corneal grafts. The management of postkeratoplasty astigmatism include two stages: in the first stage, it managed by suture manipulation: suture removal along the steep meridian of astigmatism and suture adjustment, which can change the corneal curvature, and decrease the corneal astigmatism. If significant astigmatism remains after suture removal, it can be corrected by optical means or surgical procedures. The optical means include spectacles and contact lenses. The doctors usually use rigid gas-permeable contact lenses and scleral contact lenses. The surgical procedures include traditional incisional keratotomy, wedge resection and modern intrastromal corneal ring segments, laser refractive surgery, intraocular lens implantation and so on. Femtosecond laser (FSL) technology has been recently introduced in the clinical practice, it can increase the safety and efficacy, otherwise it also can decrease the complication.

Using optical coherence tomography to diagnose polypoidal choroidal vasculopathy

SUN Di，LI Yi-bin

2016, 40(1):  41-44.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.009

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Polypoidal choroidal vasculopathy (PCV) is recently known as a fundus disease,which is characterised as a peculiar form of choroidal vascular abnormality associated with hemorrhagic or serous detachment of pigmented epithelium in the macula. Indocyanine green angiography(ICGA)is seen as the gold standard of diagnosing PCV. With the development of optical coherence tomography (OCT), from the time-domain-OCT characteristics of double-layer sign to a change in spectral-domain-OCT  clearly presenting abnormal vascular network (BVN) and polyps, and then to OCT angiography which can presents the expansion of the choroidal vascular and polypoidal structure’s reflected signal changes, this non-invasive diagnosis method provides a more and moer reliable way in diagnosing PCV.

Application of aspheric IOL implantation in  cataract patients with previous corneal refractive surgery

YUSUFU Maierhaba，FAN Fan, LUO Yi

2016, 40(1):  45-48.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.010

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Cornea curvature and aberrations will change after corneal refractive surgery. Hyperopic error still exists and the increase of higher-order aberrations also affects the visual quality after cataract surgery in such patients. Therefore, the new IOL power calculation methods have emerged to reduce refractive predictive error. Aspheric IOL selection according to cornea spherical aberration before cataract surgery can reduce the whole eye aberrations and patient’s visual symptoms such as glare, decreased night vision and improve the visual quality.

Application of phototherapeutic keratectomy on superficial corneal diseases

DUAN Jia-huan, GUO Xiu-jin

2016, 40(1):  49-53.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.011

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Phototherapeutic keratectomy (PTK) use excimer laser to ablate lesions, gaining a regular and smooth corneal surface without damaging surrounding healthy tissue. PTK has many advantages such as high precision, good security, easy to manipulate and little adverse effects. Now it is widely applied in many superficial corneal diseases, such as corneal degeneration, corneal dystrophy, bullous keratopathy, recurrent corneal erosion etc. PTK is an effective treatment method to improve vision and relieve symptoms in superficial corneal diseases, and it is often successful in delaying or avoiding keratoplasty. In order to obtain satisfied efficacy and improve the quality of life, the indications and limitations of PTK should be mastered strictly, and different surgical skills should be used for different pathologic features.

Posterior staphyloma in pathological myopia

HUANG Wei-lin, DUAN An-li

2016, 40(1):  54-58.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.012

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In China, more than 300 million patients suffer from myopia, where in over 10 million patients have high myopia, and a large part of high myopia belong to pathologic myopia (PM). Its correlated ocular fundus retinopathy has become the first reason causing irreversible blindness. Posterior staphyloma (PS) is the most basic disease in the series of pathological degeneration of myopia, and its causes are still unconcluded. The thinning sclera, resulting from the continuous axial lengthening, synthesis and decomposition disorder of collagen in sclera, cannot resist the intraocular pressure, which may be the main cause of PS. At present, the only treatment measure is posterior scleral reinforcement surgery. Regular observation is needed for PS with no clinical symptoms or with complications. The surgery timing still requires a large number of clinical studies to assess.

Treatment of congenital subluxated lens

WANG An-jian, FAN Qi, LU Yi

2016, 40(1):  59-63.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.013

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Congenital subluxation of the lens is a complicated disease in ophthalmology. At present, the treatment of congenital dislocation of the lens is still dominated by surgical management. However, the choice of surgical approach and timing is still in dispute. The complexity of the operation is far greater than that of the common cataract surgery, and postoperative complications are more complicated. Nowadays, in order to get better postoperative prognosis and the least postoperative complications, a variety of surgical techniques and new surgical tools are constantly improving. The trans-scleral suture-fixed posterior chamber intraocular lens(IOL) is the most classic surgery. Meanwhile, the implantations of suture-fixed capsular tension ring/segment are used more and more, due to little complications during long-term follow-up. Some surgeons favor iris-claw or iris-fixed IOL alternatively. Each surgical method has its own merits and faults. According to the indications and complications of each method, surgeons should choose the personalized medical therapies tailored to individual patients based on their condition. Furthermore, constantly development of new technologies will provide a better prognosis to the congenital lens subluxation patients.

Surgical treatment for pediatric cataract

ZHANG Jing-shang, WAN Xiu-hua

2016, 40(1):  64-69.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.014

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Pediatric cataract is the main reason for children avoidable blindness. Surgery is still the main treatment method for the pediatric cataract. For the complete cataract, the surgery should be carried on as soon as possible after 3 months old, and refractive correction  should be timely given postoperatively. When the eyes further developed in 1~2 years old,  the intraocular lens (IOL)  can be implanted. For the incomplete cataract, the  surgery  can be carried on and  the IOL implanted at the same time according to the eyesight of children. In pediatric cataract surgery, resection of the posterior capsule and anterior vitreous can effectively prevent posterior capsule opacification. The follow up is very important after cataract surgery in children, because the postoperative complications such as glaucoma, can be timely treated and controlled,  the ametropia can be timely found and fully corrected, and the amblyopia can be effective training. Especially nowadays, through the medical databases and mobile network platform, parents of children with follow-up reminder can be stressed of strict follow-up. Establishing a database of pediatric cataract is conducive to further optimize and improve the surgical  managment and follow-up of pediatric cataract, so as to achieve the best therapeutic effect.

Status and progress of neonatal eye disease screening in China

LIU Li-li, ZHAO Jun-yang

2016, 40(1):  69-72.  doi:10.3760/ cma.j.issn.1673-5803.2016.01.015

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In order to minimize avoidable blindness and visual impairment, early intervention for children's eyes became very importent. Eye disease screening for newborn need to be attentioned by doctors. The earliest eye disease screening for children in China began in 2005. The screening objects gradually changed from high-risk  and premature babies to all the newborn; the check methods developed from the light stimulating,   anterior segment and red reflex examination gradually extended to the anterior segment combined with the retinal disease screening under indirect ophthalmoscope, to  carring out the wide-area digital fundus retinal photographic imaging system inspection, which considered as a new important tool of neonatal eye disease screening and reported higher positive detection rate. But at the moment,  relevant data of how many eye diseases can be treated in eye disease screening for a newborn are lack. The screening for newborn requires rules, standards, and scientific methods and procedures, committed to the effective preventing of blindness of children in China.