Table of Content

22 June 2020, Volume 44 Issue 3

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Glaucoma and biological rhythm

Zhang Jingxue, Wang Ningli

2020, 44(3):  145-149.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.001

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The intrinsically photosensitive retinal ganglion cells (ipRGCs) are the main photoreceptors of the non\|image\|forming visual functions, and are responsible for regulating biological rhythm activities, such as sleep awakening and hormone secretion. Glaucoma, as a type of disease that characteristically damages retinal ganglion cells, can also lead to the damage of the ipRGCs and related visual pathways, and affect the reception and entrainment of light signals. The proportion of patients with damaged non-|image\|forming visual functions which regulated by ipRGCs is significantly increased in glaucoma patients, including sleep disorders, abnormal hormone secretion and decreased pupillary light reflection function, etc. These findings of glaucoma and biological rhythm further enrich the understanding of clinical diagnosis and treatment of such diseases. (Int Rev Ophthalmol, 2020, 44:145-149)

Ultrasound cycloplasty for glaucoma

Pan Zheng1, Liu Ke1, Zhang Lurong1, Duan Xuanchu1, 2

2020, 44(3):  150-156.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.002

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Ultrasound cycloplasty (UCP) is an alternative treatment for refractory glaucoma, which is simple, easy\|learning and convenient. UCP has a dual antihypertensive mechanism. Based on high-intensity focused ultrasound (HIFU), it can reduce intraocular pressure by decreasing aqueous humour production of the ciliary body, and by increasing in aqueous outflow via the uveoscleral pathway. Therefore, it has an ideal therapeutic effect on various types of glaucoma with the characteristic of high safety.(Int Rev Ophthalmol, 2020, 44：150-156)

Research advance of high myopia with glaucoma

Zhang Lurong1, Ouyang Junyi2, Liu Ke 1, Duan Xuanchu 1，2

2020, 44(3):  157-162.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.003

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High myopia is an independent risk factor for primary open-angle glaucoma. The prevalence of high myopia in glaucoma is 16%. Optic disc tilt and rotation, choroidal atrophy, lamina cribrosa damage, nerve fiber layer defect and decreased perfusion of optic disc microcirculation in patients with high myopia accelerate the visual field damage of glaucoma and play an important role in the pathogenesis of glaucoma. In clinical work, we should pay close attention to the axial length, central corneal thickness, optic disc morphology, visual field change, retinal nerve fiber layer thickness, intraocular pressure fluctuation and the performance of OCTA in patients with high myopia, and detect early stage of glaucoma patients in high myopia.(Int Rev Ophthalmol, 2020, 44：157-162

Research progress in peripapillary atrophy

Sun Caixia, Yuan Yuanzhi

2020, 44(3):  163-169.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.004

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The peripapillary atrophy (PPA) is the atrophy of the retina and choroid adjacent to the optic disc. PPA is classified according to its clinical appearance into a central β zone and a peripheral α zone. According to the detailed anatomic figures revealed by SD-OCT, classic β zone PPA can further be divided into newly defined β zone PPA and newly defined γ zone PPA. The prevalence of PPA is related to the old age, the increase of intraocular pressure, the longer axis length and uveitis. Classic β zone PPA is a risk factor for the progression of glaucomatous neuropathy, the prevalence of myopic maculopathy and the worse prognosis of uveitis and Stargardt disease. The β zone PPA in SD-OCT is a risk factor for glaucomatous neuropathy, but its correlation with myopia is relatively weak. The γ zone PPA is related to the prolongation of the axis length, and it may be a protective factor for glaucomatous neuropathy. (Int Rev Ophthalmol, 2020, 44：  163-169)

Relationship between  genes related to eye development and primary angle closure glaucoma#br#

Chen Yunxia, Shi Haihong

2020, 44(3):  170-175.  doi:10.3760/cma.j.issn.1673-5803.2020.03.005

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Primary angle closure glaucoma (PACG) is a complex multifactorial disease, and heredity plays an important role in its occurrence and development. Anatomical features such as shallow anterior chamber, short eyeball, thick lens, small corneal diameter and hyperopia are important risk factors for the occurrence of PACG, so genes related to these phenotypes become candidate genes for PACG. Extracellular matrix metalloprotease (MMP) gene and MMP regulatory genes (HSP70, eNOS, MTHFR), nanophthalmos related genes (MFRP, PRSS56), axial length and diopter related genes (HGF, MYOC), and anterior chamber depth related gene (ABCC5) may be related to the susceptibility of PACG. However, the mechanisms of these genes are poorly understood. MMP affects the remodeling of the sclera extracellular matrix during eye development, resulting in changes in the ocular axis and refractive errors. Membrane frizzled-related protein (MFRP) is expressed in ciliary body epithelium and retinal pigment epithelium, which is related to scleral growth and differentiation. Up till now, there exists inconsistencies in different ethnic backgrounds of these candidate gene studies due to the small sample size. (Int Rev Ophthalmol, 2020, 44: 170-175)

Selection of methods for surgical therapy of cyclodialysis cleft

Lan Lina, Chen Jiahui, Jiang Yongxiang

2020, 44(3):  176-181.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.006

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Cyclodialysis cleft is usually treated with medical management, argon laser photocoagulation or surgical procedure. The earliest and most frequently used therapy to eliminate cyclodialysis is direct cyclopexy. Direct cyclopexy and indirect cyclopexy can be used for treating cyclodialysis without comorbidities. However, cyclodialysis is frequently accompanied with vitreoretinopathy, lens subluxation and cataract, which require secondary surgery after cyclopexy. It is critical to combined suitable surgical methods in these situations. For example, vitrectomy, cryotherapy, gas endotamponade and scleral buckling can be adopted when combined with vitreoretinopathy. Insertion of a capsular tension ring or modified capsular tension ring in the capsule bag and implantation of intraocular lens can be used when combined with lens subluxation. Combined surgery should be selected according to other situations of cyclodialysis cleft. (Int Rev Ophthalmol, 2020, 44：176-181)

Pharmacological therapy of presbyopia

Wu Qinghui1, Zhong Hua2

2020, 44(3):  182-186.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.007

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The pharmacological therapy of presbyopia mainly includes parasympathetic agonists such as carbachol, pilocarpine, presbidrops, etc, which stimulate the contraction of ciliary muscle and enhance the accommodated ability of eye. Lipoic choline sulfate and Liquid Vision could be used to reduce the hardness of the lens, restore the elasticity of the lens and enhance the near vision ability. However, these drugs still have some limits, including working on single factor, unclear mechanism of combined drugs, lack of multi-center research support, and unclear the optimal concentration of the drug combination, long-term efficacy, drug side effects, patient compliance etc. Whether it is necessary to adjust the concentration, frequency and administration time according to the degree of accommodated ability decrease also needs further verification. (Int Rev Ophthalmol, 2020, 44：182-186)

The role of microglia activation in the pathogenesis of age-related macular degeneration and other neurodegenerative diseases

Wu Jing1, Liu Fang1, Zhang Jingfa2

2020, 44(3):  187-191.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.008

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Microglia, as the resident macrophage in the central nervous system, play an important role in the surveillance of microenvironment and active defense, which plays a pivotal role in the pathogenesis of age-related macular degeneration (AMD). Amyloid β (Aβ) is an important component of drusen in patients with AMD, and microglia accumulate obviously around drusen. Aβ could induce the activation of microglia, however, over-activated microglia result in the damage of retinal pigment epithelium (RPE) and the apoptosis of photoreceptor, secreting many pro-inflammatory factors and exacerbating the progression of AMD. The generation and accumulation of Aβ is the main pathologies in Alzheimer's disease (AD), more activated microglia with amoeboid morphology gathering within or nearby the senile plaques were evidenced in the pathological sections of brain tissue from patients with AMD. In Parkinson's disease (PD), the damage and death of dopaminergic neurons are accompanied by an increasing number of activated microglia in the surrounding area of substantia nigra. There is also a great number of activated microglia in the brain of amyotrophic lateral sclerosis (ALS). Thus, suppression of microglia activation might provide a novel therapeutic strategy to treat the neurodegenerative diseases including AMD.(Int Rev Ophthalmol, 2020, 44：187-191)

The role of microRNA in corneal neovascularization

Chen Zufeng, Zou Jun

2020, 44(3):  192-196.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.009

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Corneal neovascularization (CNV) occurs in many ocular diseases, which is one of the main factors affecting corneal transparency. MicroRNA is closely related to pathological CNV, and can affect the generation of CNV by regulating the expression of various cytokines and signal pathways. It mainly includes miRNA that inhibit CNV (such as miR-184, miR-204) and miRNA that promote CNV (such as miR-126, miR-132, miR-21, and miR-27a/b).  Regulation of these miRNAs is expected to be therapentic method for CNV. The antisense miRNA oligonucleotide antigomir can be used to inhibit the endogenous miRNA effect in promoting curred angiogenesis.(Int Rev Ophthalmol, 2020, 44：192-196)

Common ocular surface light damage and its pathogenesis

Zhang Yifan1, Song Hui1, Zhao Shujun2, Nan Li1

2020, 44(3):  196-201.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.010

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The ocular surface is exposed to external light for a long time, and various ocular surface light damage diseases are common in the clinic. Short-wave invisible light, mainly ultraviolet rays can cause diseases such as acute photochemical keratitis, pterygium, keratoconus, etc. The most common ocular surface damage caused by visible light represented by blue light is dry eye, which is closely related to the use of electronic lighting and video terminals. Light damage causes ocular edema, angiogenesis, and tissue hyperplasia of the ocular surface. The main mechanisms are related to inflammation, apoptosis, and oxidative stress. (Int Rev Ophthalmol, 2020, 44：196-201)

Pathogenesis and new treatment strategies of human cytomegalovirus anterior segment inflammation

Wang Gechun, Yuan Fei

2020, 44(3):  202-206.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.011

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Human cytomegalovirus (hCMV) anterior segment infections often manifest as corneal endotheliitis and anterior uveitis. HCMV corneal endotheliitis may be caused by hCMV replication in corneal endothelial cells (CEC) or anterior chamber associated immune deviation. Treatment needs to target the inflammatory components and the virus itself, and systemic or local ganciclovir combined with local glucocorticoid therapy can be used. HCMV anterior uveitis can manifest as Posner-Schlossman syndrome (PSS) and Fuchs syndrome. The high affinity of hCMV for CEC and trabecular meshwork cells often leads to a decrease in CEC density and an uncontrollable increase in intraocular pressure. HCMV anterior uveitis can develop as secondary glaucoma. When corticosteroids, antiviral and antihypertensive medicines are ineffective, glaucoma surgery and other treatments need to be performed in time. (Int Rev Ophthalmol, 2020, 44：202-206)

Repair of severe full-thickness eyelid defect

Liu Han, Zhang Hong

2020, 44(3):  207-213.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.012

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Severe eyelid full-thickness defect seriously endangers the health and appearance of the eye surface, and the reconstruction requires the replacement of the external musculocutaneous layer as well as the internal mucosal layer. The defect of the anterior eyelid can be covered with various local flaps (such as kite flap, gliding flap, rotating flap, etc.) and free flaps. The defect of the posterior eyelid needs to be reconstructed by selecting appropriate meibomian, meibomian conjunctival composite tissue or conjunctival substitute materials including autogenous tissue, allogeneic tissue and synthetic materials.  (Int Rev Ophthalmol, 2020, 44：207-213)

The clinical application of Pentacam AXL in ophthalmology

Wang Zhongye1,Sun Xuequan2,Zhong Zhaoyu2,Jiang Yaqin2

2020, 44(3):  214-后插Ⅱ.  doi:10.3760/ cma.j.issn.1673-5803.2020.03.013

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The application of Pentacam AXL in cataract, glaucoma, keratoconus and orthokeratology is increasing year by year. It can guide to optimize IOL (for example, choosing astigmatism correction IOL according to the total corneal astigmatism, choosing IOL according to the total corneal spherical aberration, choosing the multifocal IOL according to the kappa angle), calculate the IOL degrees (using the total corneal refraction power to calculate the true corneal curvature, measuring the axial length according to PCI) for cataract patients, and evaluate the progress of cataract (according to the Pentacam nucleus system). It can also monitor the structure of the chamber angle and the central cornea thickness, screen the subclinical keratoconus, monitor the changes of the cornea after corneal cross-linking, and monitor the wearing of the orthokeratology. However, Pentacam AXL can not monitor fixation, has low recognition of IOL, and only provides the formula of diopter of astigmatism correction IOL and is easily affected by tear film.(Int Rev Ophthalmol, 2020, 44: 214-Post insert Ⅱ)