Table of Content

22 February 2019, Volume 43 Issue 1

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Application of digital imaging of telemedicine on diabetic retinopathy screening

Song Linlin，Li Zhiqing，Ma Wenjiang

2019, 43(1):  2-7.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.002

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Diabetic retinopathy (DR) has become one of the main causes of acquired blindness. Early detection, diagnosis and timely treatment of DR have long been considered as a means to significantly reduce the visual loss caused by diabetes. Telemedicine based on digital imaging plays a crucial role in the early detection and diagnosis of DR, and its accuracy and reliability research is increasingly improved, which is also one of the rapid detection methods in the early screening of DR. With the development of digital imaging of telemedicine, using artificial intelligence to assist DR diagnosis has become the future development direction.

Recent advances in pathological myopia

Xu Jie, Xu Liang

2019, 43(1):  8-13.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.003

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Pathological myopia has become the leading cause of blindness in Chinese. Typical fundus changing of pathological myopia includes fundus tessellation, lacquer cracks, diffuse chorioretinal atrophy, patchy chorioretinal atrophy, choroidal neovascularization,  macular atrophy, and posterior scleral staphyloma. Posterior staphyloma and eye deformity are important causes of developing vision\|threatening complications. Monitoring the parapapillary, chorioretinal atrophic lesions or lacquer cracks is of great significance as an early assessment method of pathological myopia. Environmental factors such as increased educational pressure and near work are the main pathogenic factors. Local atropine therapy and increased outdoor activity time are effective prevention method. For patients with high myopia, posterior scleral reinforcement and scleral collagen cross\|linking are possible and effective means to delay progression.

Artificial intelligence in ophthalmology

Zhu Guyu, Zhang Jingshang, Wan Xiuhua

2019, 43(1):  14-18.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.004

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Artificial Intelligence (AI) is a comprehensive interdisciplinary subject. It is a new subject with new ideas, new theories and new technologies. At present, artificial intelligence has been widely used in many fields, including medical fields, such as AI\|assisted medical image interpretation. The accuracy of diagnosis in some diseases can be compared with medical experts. At present, most of the common ophthalmic diseases such as diabetic retinopathy, age\|related macular degeneration, glaucoma, cataract and so on are the starting points. Medical image interpretation of artificial intelligence can help preliminary screening and assistant diagnosis, but it also faces the challenge of one\|sided diagnosis and accuracy to be improved.

Advances of detection for the progression of glaucoma

Liu Bo, Xiao Dan, Zhang Xinpei, Zhang Chun

2019, 43(1):  19-24.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.005

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Glaucoma is a group of progressive diseases characterized by apoptosis of retinal ganglion cells, and it is the most common cause of irreversible blindness. Currently, there are no single method to accurately and sensitively detect the progression of glaucoma. To compare the advantages and disadvantages of various monitoring methods and providing the possible direction for the application of new technologies, this review will list some of the clinical examination methods such as fundus photography, optic coherence tomography (OCT), optic coherence tomography angiography (OCTA), adaptive optical microscope, standard automated perimetry (SAP) and other methods including both structure and function. Besides, we will enumerate new evaluation indicators in stead of traditional indicators to prospect the future of feasible monitoring technology. The ideal monitoring method should not only accurately determine the progression of glaucoma, but also give the probability of deterioration and estimate the rate of deterioration. In the future, improving the accuracy of monitoring methods and exploring more sensitive testing methods will be a great challenge, and it is also significant to combine both structural and functional aspects to comprehensively assess the condition, in order to achieve the purpose of guiding treatment and improving prognosis.

Research situation of retinal prostheses

Qian Jiangyuan

2019, 43(1):  25-29.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.006

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With the advances in biotechnology, material science and understanding of visual and retinal neuroscience, there are two kinds of retinal prostheses in clinical practice now: Argus II and alpha\|IMS. The retinal prostheses can partly rebuild the function of outer retinal by image capture, image translation, and inner retina activation, from where visual information can be relayed to the visual cortex by the optic nerve.

Application of in vivo confocal microscopy on the diagnosis of corneal dystrophy

Shen Yunzhi, Sun Song

2019, 43(1):  30-36.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.007

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In vivo confocal microscopy (IVCM) makes it possible to observe the physiological and pathological changes of ocular surface tissue and cell structure in vivo. It has a relatively standardized application in the diagnosis and treatment of infectious keratitis, ocular surface assessment of dry eye, evaluation of the efficacy of ophthalmic surgery and early screening of diabetes. In recent years, many studies have used it to observe corneal dystrophy. IVCM can help diagnose corneal dystrophy, monitor its progression, evaluate therapeutic effects and study its pathophysiological changes and origins.

Application of corneal collagen cross-linking in post-LASIK ectasia

Huang Jing， Du Zhiyu， Yao Hao

2019, 43(1):  37-41.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.008

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Corneal collagen cross-linking (CXL) is mainly used to treat the corneal ectasia diseases like keratoconus and post\|laser in situ keratomileusis (LASIK) ectasia.  This paper aims to review the causes, risk factors and treatment of post-LASIK ectasia, and the principle and clinical application of CXL in the treatment of post\|LASIK ectasia．It is suggested that CXL alone or combined with other surgical methods could used to treat post-LASIK ectasia, which might preserve vision, arrest the progression of the ectatic conditions and prevent or delay the future need for keratoplast. In addition, the prophylactic use of CXL during LASIK in patients with high risk factors can effectively prevent postoperative refractive regression and corneal ectasia after LASIK in the short term, but the long\|term effect needs further confirmation.

Progress in corneal collagen cross\|linking with different cross-linking agentia

Yang Lei1, Tian Lei2, Zhang Haixia3

2019, 43(1):  42-46.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.009

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Corneal collagen cross-linking(CXL) is one of the effective methods for treating keratoconus, which enhances corneal strength with CXL agentia and light irradiation. CXL with riboflavin and ultraviolet\|A has been widely adopted in clinical for many years, which has preferable efficacy and safety. Based on traditional UVA and different cross\|linking agentia, there are more and more innovative techniques appear constantly, including transepithelial, rapid-CXL, Rose Bengal with green light, Genipin, Glyceraldehyde CXL and so on. These new techniques are aiming to increase the treatment effect and reduce patient malaise, and they provide a theoretical and clinical basis for the selection of appropriate CXL treatment of keratoconus.

Adcances on immunologic pathogenesis of thyroid\|associated ophthalmopathy

Yan Jie, Hu Zhulin

2019, 43(1):  47-52.  doi:10.3760/cma.j.issn.1673\|5803.2019.01.010

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Graves’ disease is always accompanied by thyroid-associated ophthalmopathy (TAO), and both of them shared the same pathophysiological characteristics, as it has been proved that thyroid\|stimulating hormone receptor (TSHR) plays an essential role not only in the pathogenesis of Graves’ disease but also in that of TAO. TSHR expresses on orbital fibroblasts in the procedure of TAO, in which many factors such as cellular and humeral immunity, thyrotropin stimulating immunoglobulin (TSI), thyroid\|stimulating hormone (TSH), platelet derived growth factor (PDGF) and other thyroid antibodies synergistically initiate the disease via TSHR. The activation of helper T cells recognizing TSHR peptides and ligation of TSHR by TRAb lead to the secretion of inflammatory cytokines and chemokines, and enhanced hyaluronic acid (HA) production and adipogenesis. The resulting connective tissue remodeling results in varying degrees extraocular muscle enlargement and orbital fat expansion. In addition to TSHR, orbital fibroblasts from patients with TAO express high levels of insulin-like growth factors\|1 receptor (IGF-1R). Stimulatory autoantibodies direct against the insulin-like growth factor-1 receptor have been proposed to contribute to orbital fibroblast activation in TAO.

Relationship between expression regulation of matrix metalloproteinases and diabetic retinopathy

Li Yu, Xue Liping

2019, 43(1):  53-57.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.011

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The exact molecular mechanism of diabetic retinopathy (DR) remains unclear. Hyperglycemia in DR can increase the expression of matrix metalloproteinases (MMPs). MMPs are a family of zinc\|dependent endopeptidases that can collectively degrade almost all components of the extracellular matrix. They are involved in the process of apoptosis and angiogenesis in DR. Their enzymatic activity is tightly regulated under physiological conditions. Primary modes of enzyme regulation include transcriptional control, zymogen activation and tissue inhibitors of MMPs. Among which transcriptional control is the most important regulatory mechanism.

Application of subthreshold micropulse laser on treatment of macular disorders

Liao Dan, Li Linrui, Yang Xiaoli

2019, 43(1):  58-61.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.012

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Subthreshold micropulse laser treatment consists of short, repetitive pulses of laser, and has shown efficacy in multiple retinal conditions. In contrast to the conventional laser, the therapeutic effect of the subthreshold micropulse laser is not accompanied by thermal retinal damage. This fact is of particular importance when a treatment near the fovea is required. Micropulse treatment is applied in indications such as diabetic macular edema (DME), macular edema due to retinal vein occlusion (RVO), or central serous chorioretinopathy (CSC) and proved effective.

Research progress of Fuchsu veitis

Wang Bingsong, Wang Tao

2019, 43(1):  62-67.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.013

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Fuchs uveitis (FU) is a chronic, low\|grade inflammatory disorder involving the uvea. Evidence accumulates that there is no doubt that rubella virus infection have been implicated in the pathogenesis of the disease. FU is also named Fuchs’ heterochromic iridocyclitis. But heterochromia is variable depending on amount of pigment in the iris pigmented epithelium and the intensity of the anterior iris atrophy. The diagnosis might often be delayed due to the absence of heterochromia. In addition, recent researches showed that FU might be an inflammatory condition involving the whole uveal tunic. Progression of the disease is associated with cataract formation and glaucoma. Recently, phacoemulsification combined with intracapsular intraocular lens implantation has been widely reported in the treatment of complicated cataract.Although the complications of angle hemorrhage and anterior chamber inflammation are higher than those of conventional cataract surgery, most of the patients have good postoperative visual acuity.Therapy for glaucoma associated to FU is often more challenging because of its poor response to drugs, lasers and surgical treatment than other types of glaucoma. If trabeculectomy is used, intraoperative use of antimetabolic drugs can increase the success rate of surgery. Some researchers have used new combined glaucoma and cataract surgery to treat the complications of the disease recently, and the long\|term results need to be observed.

Treatment of retinal artery occlusion

Chen Jiabao1, Li Jinying2

2019, 43(1):  68-72.  doi:10.3760/ cma.j.issn.1673\|5803.2019.01.014

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Retinal artery occlusion, causing irretrievably visual loss due to the retinal hypoxic\|ischemic apoptosis, is also called eye stroke. The conservative treatment is wildly use in clinic, including ocular massage, anterior chamber paracentesis, vasodilator and lower intraocular pressure. Studies indicated that the conservative treatments have no effective to improve the vision, some of them might be harmful. As for the aggressive treatment, which consist of intravenous/intra\|arterial thrombolysis, surgery and YAG\|laser treatment, the studies showed a certain degree of effect, particularly thrombolysis, whereas exist sorts of complication. The traditional Chinese medicine treatment is needed to be scientifically evaluated. Evaluating the patient’s condition scientifically and choosing the most suitable treatment to get the best outcome is important.