Table of Content

22 August 2020, Volume 44 Issue 4

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Application of functional near-infrared spectroscopy in ophthalmology

Chai Yongxin, Bi Ailing, Wen Ying, Bi Hongsheng

2020, 44(4):  217-221.  doi:10.3760/cma.j.issn.1673-5803.2020.04.001

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Functional near-infrared spectroscopy (fNIRS) is a new brain functional imaging technique developed in recent years, which is suitable for simultaneous detection of hemodynamic changes in the cerebral cortex when subjects are stimulated. Visual disorders commonly seen in ophthalmic clinic are often accompanied by functional abnormalities in the visual cortex. FNIRS can simultaneously detect the hemodynamic responses in the visual cortex during visual tasks or treatment, providing brain parameters for the diagnosis and efficacy evaluation of eye diseases, such as amblyopia, glaucoma, optic neuritis, diabetic retionpathy, etc.

Allergen-specific immunotherapy for allergic conjunctivitis

Chen Shudi, Yan Xiaoming

2020, 44(4):  222-227.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.002

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The prevalence of allergic conjunctivitis is increasing worldwide, which leads to a considerable effect on patient quality of life, reduces work productivity, and increases health care costs. The pharmaceutical management of allergic conjunctivitis provides only transient relief from symptoms. Allergen-specific immunotherapy (allergen-specific immunotherapy, AIT) via subcutaneous (subcutaneous allergen immunotherapy, SCIT) and sublingual (sublingual allergen immunotherapy, SLIT) routes has disease-modifying effects and can induce immune tolerance to allergens. Lots of literature suggests that, AIT can not only improve the symptoms of allergic conjunctivitis and increase threshold of reactivity to allergens, but also showed a beneficial long-term effect. However, both SCIT and SLIT can introduce local and systemic allergic reactions. Poor patient compliance and prolonged course are major shortcomings of AIT. In the future, new forms with short-term treatment period and alternative application routes can be developed to provide patients with more convenient and safer options.

Recent advances of limbal niche cells

Xu Lingjuan, Li Shen, Wang Wei, Li Guigang

2020, 44(4):  228-231.  doi:10.3760/cma.j.issn.1673-5803.2020.04.003

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Limbal niche cells (LNCs) are a kind of mesenchymal stem cells isolated from limbal stem cells microenvironment. These niche cells display a phenotype typical of vascular endothelial progenitor cells and mesenchymal stem cells. LNCs support limbal epithelial stem cells viability and exhibit a potential to differentiate to multiple cell types such as vascular endothelial cells, corneal epithelial cells, corneal stromal cells and so on. Therefore, they can prevent or treat limbal stem cell deficiency caused by alkaline burns in animal experiments. LNCs have also shown the ability to remodel pathological stromal tissue, suppressing inflammation and neovascularization and restoring transparency. All these abilities give LNCs the potential for allograft or even autologous stem cells treatment for corneal wound healing and other corneal diseases.

Progress of limbal stem cell transplantation for limbal stem cell deficiency

Wan Xichen, Le Qihua

2020, 44(4):  232.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.004

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Healthy limbal stem cells are essential for maintaining the transparency and integrity of the corneal epithelium. Severe damage of limbal stem cells and/or limbal stem cell niche caused by a variety of reasons can lead to limbal stem cell deficiency (LSCD). Limbal stem cell transplantation, one of the effective treatments for LSCD, including conjunctival limbal autograft transplantation (CLAU), living related conjunctival limbal allograft transplantation(lr-CLAL), keratolimbal allograft (KLAL); ex vivo cultivated limbal epithelial autograft ( EVLAU), ex vivo cultivated limbal epithelial allograft (EVLAL); simple limbal epithelial transplantation (SLET), allogeneic SLET (allo-SLET), could maximally restore the function of limbal stem cells. With the improvement of surgical technique in recent years, the surgery-related complications gradually decrease and the graft survival prolongs, which improves the prognosis of LSCD greatly.

Influencing factors on the postoperative progression of corneal collagen crosslinking in keratoconus

Liang Dengfeng， Zeng Qingyan

2020, 44(4):  238-244.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.005

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Corneal collagen crosslinking (CXL) has been demonstrated to retard or arrest progression of the keratoconus, especially in the middle and early stages of the disease. So far, articles have shown that there was still a certain possibility of continuous progression post CXL. Factors of postoperative progression include that: criteria of postoperative progression, surgical protocol (epithelium-off or transepithelial CXL, drug-delivery of riboflavin, duration and pattern of ultraviolet A irradiation), age, cone location, preoperative Kmax value, eye rubbing and (or) allergies. Most articles suggested that the effect of preventing keratoconus progression were as follows: epithelium-off CXL >iontophoretic CXL >riboflavin penetration enhanced CXL, Dresden protocol >accelerated CXL, adult >pediatric, central cone >peripheral cone, preoperative low Kmax >preoperative high Kmax, no eye rubbing and allergy >combined with eye rubbing and (or) allergy. This paper will detail the above factors that influence the progression of the keratoconus after CXL and provide reference for clinical intervention and prognosis evaluation.

Research progress in diabetic ocular surface lesions

Xiang Ying,Li Xia,Song Xiusheng

2020, 44(4):  245-249.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.006

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The prevalence of diabetes mellitus has been increased year by year, and its complications and mortality is a serious health problems in the world. Compared with diabetic retinopathy, the diabetic ocular surface complications were insufficiently studied by ophthalmologists. Keratopathy and tear film changes of diabetes mellitus patients are the main complications with a high incidence. Keratopathy mainly presents as cornea neuropathy and epithelial disease. However, the stardard of diabetic ocular surface lesions is not established yet. Reactive oxidative stress caused by high levels of glucose is key pathogenic factor of keratopathy, so it can provide a research clue for the treatment of ocular surface complications for diabetes mellitus.

Related factors of misalignment of Toric intraocular lens

Chen Dongjie, Zhao Yun’e

2020, 44(4):  250-256.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.007

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With the improvement of cataract surgery technology and the development of design and materials of the intraocular lenses (IOL), cataract surgery is gradually becoming refractive surgery. Patients also pursue better postoperative visual experiences. However, corneal astigmatism is always the major factors affecting the postoperative visual quality. Toric IOL is a common clinical method for correcting preexisting astigmatism in patients with cataracts. Misalignment of Toric IOL is an important factor that affects the effect of astigmatism correction. In order to reduce the misalignment of Toric IOL to achieve great postoperative results, we should pay attention to ocular biometry, Toric IOL power and calculation, marking techniques before the surgery, master the standard surgical procedure, and understanding the impact of various types of Toric IOL and patients’ axial length on the rotational stability postoperatively.

Novel advances on orbital IgG4-related ocular diseases

Wu Huarong, Gao Wen, Zhang Guanghong, Tian Yanming

2020, 44(4):  256-261.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.008

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IgG4-related ocular disease ( IgG4-ROD) is a kind of autoimmune disease with a large number of lymphocyte and plasma cell infiltration, obliterative phlebitis and sylvan or whirlpool fibrosis. It can involve many eye tissues or organs, such as lacrimal gland, extraocular muscle, orbital fat and trigeminal nerve. Its main clinical manifestations are chronic painless swelling and / or exophthalmos on both or one side of the orbit, which may be accompanied by peripheral Lymphadenopathy, usually not obvious visual impairment, but serious can make function loss of the involved tissues and organs and affect the daily life of patients. The pathogenesis of IgG4-ROD is not clear. According to the existing literature, it may be related to the production of autoantibodies, microbial infection and genetic factors. For the treatment of IgG4-ROD, at present, glucocorticoids, immunosuppressants, biological agents and surgical treatment are the main clinical methods. Although these treatment methods can achieve certain efficacy, there are certain limitations such as high recurrence rate, serious side effects and postoperative complications.

Advances in gene targeted therapy for intraocular malignant tumors

Guan Wenxue, Peng Xiaoyan

2020, 44(4):  262-265.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.009

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With the development of precision medicine, targeted therapy, as a new biologic therapy, has become a hot research topic. This paper reviewed the advances in gene targeted therapy for uveal malignant melanoma (UM), retinoblastoma (RB) and primary vitreoretinal lymphoma (PVRL). With the mutation rate of GNAQ/GNA11 gene exceeding 90% in UM patients, GαQ and Gα11 protein inhibitors FR900359 or their derivatives may be a potential therapeutic option. Combination therapy with protein kinase C and ERK kinase inhibitors may improve the treatment response in patients with metastatic UM. Targeted therapy strategies for Yes associated protein may be an effective means to treat UM in the future. Nutlin-3a is a small molecular inhibitor of MDM2-p53 interaction, which kills retinal mother cell lines at high concentrations. SYK inhibitors are potential targets for RB treatment under development. Silencing CKS1B gene can inhibit the growth and invasion of RB cells. Ibrutinib may prevent or delay central nervous system involvement in CD79B-positive PVRL patients.

Ocular solitary fibrous tumors

Sun Hui, Cai Rongrong, Wang Shuyi, Bi Yingwen

2020, 44(4):  266-271.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.010

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Solitary fibrous tumor (SFT) is a spindle cell tumor of mesenchymal origin that typically occur in pleura tissue. Ocular SFT as a rare disease, which may occur in a variety of areas, including eyelid, intro-orbital, intra-bulbar. Ocular SFT is mainly seen in adults，monocular onset. The clinical features of the patients often present with eyelid swelling, proptosis, vision disturbances and a palpable mass. CT and MRI revealed a well-circumscribed ovoid mass with intensely enhancement, because of the prominent blood vascular channels within the tumor. The classic histopathological feature of SFT is ovoid to spindle shaped cell growing in a haphazard manner. Background stroma was fibro-collagenous and richly “storiform pattern and staghorn” vessels. A diffuse and intense staining of CD34 and STAT6 are important diagnostic clue favoring SFT. CD99, vimentin and Bcl-2 are also frequently positive in SFT. Scientists have recently identified NAB2-STAT6 gene fusions in the vast majority of SFT, which may promote the formation of SFT. Radical surgical resection seemed to be the most important treatment segment. When the lesion is not completely cleared or in recurrent and malignant cases, postoperative radiotherapy can be used as an adjuvant therapy. SFT as an intermediate tumor, its biological behavior is between benign and malignant. Because of the possibility of its local invasion, local recurrence or distant metastasis, long-term follow-up is mandatory.

Clinical management strategies for familial exudative vitreoretinopathy

Yan Hongxiang, Zhang Zifeng, Li Manhong, Wang Yusheng

2020, 44(4):  272-278.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.011

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Familial exudative vitreoretinopathy (FEVR), a rare hereditary vitreoretinal abnormality, characterized by insufficient vascular development is a leading cause of visual impairment and even blindness in people under 30 years old. It is a lifelong disease with obvious clinical heterogeneity and unpredictable progression. Although significant presentations may not occur in the early stages, the characteristic clinical features show up with progression, which includes avascular peripheral retina, subretinal exudation, peripheral retinal neovascularization, retinal fold, macular dragging, and even retinal detachment resulting in blindness finally. In order to prevent or stabilize the disease, preserve visual function, and further improve the quality of life, it is of significance to pay close attention to identifying clinical stages of FEVR according to ocular manifestations and wide-field angiography, and developing appropriate clinical management strategies. Early identification, regular follow-up and genetic counseling should be performed in clinical practice. Photocoagulation, cryotherapy and anti-vascular endothelial growth factor therapy can be applied in early stage to control exudation and neovascularization. Scleral buckling and vitrectomy can be used in late stage to prevent unfavourable prognosis. In addition, for pediatric and adolescent patients with FEVR, it is indispensable of functional vision training and psychological rehabilitation as well .

Current research of silicone oil-related visual loss

Ma Ya, Peng Xiaoyan

2020, 44(4):  278-283.  doi:10.3760/cma.j.issn.1673-5803.2020.04.012

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Silicone oil (SO) is a relatively safe intravitreal tamponade and widely used in vitreoretinal surgery. Severe, irreversible and unexplained visual loss of a few patients were noticed during SO tamponade or after SO removal. However, no remarkable signs were found in examinations. Some retinal structural changes have been noted in these patients recently, such as thinning of inner retina and microcystic macular edema in inner nuclear layer. Several hypotheses of pathogenesis had been put forward, such as failure of potassium siphoning by Müller cells, retinal light exposure, higher intraocular pressure during SO tamponade, longer SO tamponade duration and retinal ischemia during surgery. Even though, the pathogenesis of this issue remains elusive. Further study will help to understand the exact mechanisms.

Quality of life assessment of strabismus and amblyopia patients

Yao Yao, Fu Jing

2020, 44(4):  284-288.  doi:10.3760/ cma.j.issn.1673-5803.2020.04.013

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Strabismus and amblyopia are common and closely related eye diseases. The damage to the corrected visual acuity, stereo vision and other related visual functions and changes in appearance will affect the quality of life(QoL) of patients. QoL is an important indicator for comprehensive evaluation of patients' physical and mental health. At present, there are special scales in the field of strabismus and amblyopia for the evaluation and selection of different subjects. The apparent decline in the QoL of strabismus patients is mainly affected by binocular vision function, the appearance of strabismus and social evaluation, and it will be significantly improved after surgery and other treatments. The QoL of amblyopia patients is relatively normal, but it is susceptible to early patching treatment and declines, and as the treatment effect improves, it gradually improved.