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Table of Content

    22 April 2021, Volume 45 Issue 2
    Treatment of non-arteritic anterior ischemic optic neuropathy
    Wang Ling, Yang Hui
    2021, 45(2):  81-88.  doi:10.3760/cma.j.issn.1673-5803.2021.02.001
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    Nonarteritic anterior ischemic optic neuropathy (NAION) is one of optic neuropathy with complex pathogenesis, which involves systemic vascular risk factors and regional anatomical factors. Control of systemic risk factors is the key to treatment. At present, the three major treatment attempts include improving circulation (such as intraocular pressure intervention, extracorporeal counterpulsation and surgery), reducing optic disc edema (such as systemic or local corticosteroid, local intravitreal injection of anti neovascularization drugs), and neurotrophic agents (such as stem cells therapy).(Int Rev Ophthalmol, 2021, 45: 81-88)

    Drug treatment of non-infectious uveitis
    Zhang Chuanhong, Xue Liping
    2021, 45(2):  89-98.  doi:10.3760/cma.j.issn.1673-5803.2021.02.002
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    Glucocorticoids and other immunosuppressants are the primary therapeutic options for non-infectious uveitis. Novel biodegradable sustained-release vitreous implants are promising for extensive clinical applications, and biological agents have shown unique efficacy. The currently applied topical glucocorticoid implants include fluocinolone acetonide implant, dexamethasone vitreous implant, etc. The immunosuppressants include antimetabolites methotrexate, azathioprine, and mycophenolate mofetil, etc.; T cell inhibitors cyclosporine, tacrolimus, and rapamycin, etc.; and alkylating agents cyclophosphamide and chlorambucil, etc. The biological agents include anti-tumor necrosis factor agents infliximab, adalimumab, etanercept, golimumab, and certolizumab, etc.; interleukin receptor antagonists anakinra, canalizumab, and tocilizumab, etc.; selective B lymphocyte inhibitor rituximab; and selective T lymphocyte inhibitor abatacept, etc. Different agents have their respective scopes of application and adverse reactions. It is particularly important to select a treatment regimen appropriate for the patient’s condition, to control disease progression, and to reduce complications.(Int Rev Ophthalmol, 2021, 45: 89-98)

    Progress of choroidal abnormal changes in polypoid choroidal vasculopathy
    Dong Su, Jiang Bo, Zhang Zhongyu, Sun Dawei
    2021, 45(2):  98-102.  doi:10.3760/cma.j.issn.1673-5803.2021.02.003
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    A structurally and functionally intact choroid tissue is vitally important for the retina function. Polypoidal choroidal vasculopathy (PCV) is a fundus disease characterized by choroidal anomalous branch vascular network (BVN) and polypoid expansion at the end of the vascular network. PCV is a pachychoroid disease. Conversions can occur between spectrum diseases, and there are characteristic choroidal changes between them: focal or diffuse choroidal thickening, increased proportion of choroidal macrovascular layer thickness, choroidal vascular hyperpermeability, secondary retinal pigment epithelial dysfunction or neovascular formation. Current studies have shown that PCV with different choroidal changes has differences in treatment response and prognosis. Re-understanding PCV from the perspective of choroid is helpful to judge prognosis and guide treatment. (Int Rev Ophthalmol, 2021, 45: 98-102)

    Progress in diagnosis and treatment of polypoid choroidal vasculopathy
    Chen Lina, Xu Guoxing
    2021, 45(2):  103-110.  doi:10.3760/cma.j.issn.1673-5803.2021.02.004
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    Polypoid choroidal angiopathy (PCV) is a common fundus disease in Asian people. It presented as orange-red nodular lesions under ophthalmoscope, which can associate with serous or bloody retinal pigment epithelial detachment and subretinal hemorrhage. Indocyanine green angiography (ICGA) is still recognized as the gold standard for diagnosis, but the rise of new auxiliary examination technologies such as OCT and OCTA also provide us with new ideas for the diagnosis of PCV. OCT can clearly display the level of branching vascular network (BVN), and brings us great convenience for follow-up because of its non-invasive and convenience. Clinical diagnosis criteria have also been established according to the OCT features of PCV. With the deepening of understanding of the PCV, different treatment options have been proposed, including monotherapy (such as, thermal laser photocoagulation, intravitreal anti-vascular endothelial growth factor, photodynamic therapy and vitrectomy) and combination therapy. In order to standardize the diagnosis and treatment of PCV, clinical features, diagnosis and treatment progress of PCV were reviewed in this paper.(Int Rev Ophthalmol, 2021, 45: 103-110)

    Roles of EndoMT in pathogenesis of diabetic retinopathy
    Liu Shuang, Yu Ying
    2021, 45(2):  110-117.  doi:10.3760/cma.j.issn.1673-5803.2021.02.005
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    Endothelial-to-mesenchymal transition (EndoMT) is a complex biological process in which endothelial cells lose their specific markers and acquire mesenchymal phenotype and function. EndoMT is involved in both the extraocular and intraocular complications of diabetes, such as diabetic cardiomyopathy, diabetic nephropathy and neovascular glaucoma due to diabetic retinopathy (DR). EndoMT also plays significant roles in the pathogenesis of DR. Under the stimulation of high glucose and hypoxia, EndoMT occurs in retinal microvascular endothelial cells, and promotes the formation of retinal neovascularization and fibrovascular membrane through key factors like SNAI and TWIST as well as signal pathways such as TGF-β, Notch and Wnt. Exploring the roles and mechanisms of EndoMT in the pathogenesis of DR will provide new ideas and theoretical basis for the prevention and treatment of DR. (Int Rev Ophthalmol, 2021, 45: 110-117)

    Factors related regression after intermittent exotropia surgery
    Peng Tingting, Yu Xinping
    2021, 45(2):  118-123.  doi:10.3760/cma.j.issn.1673-5803.2021.02.006
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    Intermittent exotropia is a common type of strabismus in adolescents. Its unknown pathogenesis and high postoperative regression rate are a hot spot in clinical research. This article reviews the correlation between the postoperative regression and the surgical method, surgical age, preoperative angle of deviation, preoperative refractive power, early postoperative eye position, and combined non-surgical treatment. At present, above factors are controversial about the correlation with postoperative regression. However, early postoperative eye position overcorrection and combined non-surgical treatment can reduce the risk of postoperative regression in intermittent exotropia.(Int Rev Ophthalmol, 2021, 45: 118-123)

    Pediatric vision screening techniques and standards
    Yao Yao, Chen Weiwei, Fu Jing
    2021, 45(2):  123-130.  doi:10.3760/cma.j.issn.1673-5803.2021.02.007
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    Children's visual screening plays an important role in the early detection and intervention of potential eye diseases. With the continuous development of medical technology and an in-depth understanding of the development process of the visual system, the methods and standards of children's visual screening are constantly updated and improved. The main goals of children's visual screening are refractive errors, strabismus, amblyopia and their risk factors. The screening methods include direct vision testing and instrument-assisted visual inspections (photographic refractor, automatic refractor, pediatric visual scanner, etc.). Direct vision test does not require professional and technical personnel, and the cost is low, but it has requirements for children's age and degree of cooperation. The instrumental examination covers a wide range of subjects and has high sensitivity, but requires professional and technical personnel to operate, which is costly and easily leads to excessive referrals. Although there is no unified visual screening program, there is a clear consensus on the screening items, referral criteria, and risk factors that can be carried out by children of all ages. To achieve the universalization and standardization of children's visual screening, many aspects still need to work hard and improve.(Int Rev Ophthalmol, 2021, 45: 123-130)

    Advances in biological characteristics of amniotic membrane extraction
    Hu Shuxian, Zhang Wenjia, Hu Zhulin
    2021, 45(2):  130-134.  doi:10.3760/cma.j.issn.1673-5803.2021.02.008
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    As a biofilm, amniotic membrane has been used in the medical field for a long time. However, it has disadvantages such as high preservation cost and inability to continuously deliver cytokines to the wound surface. With the research on the active components of amnion, amnion-related products have come out, which retain certain characteristics of amnion, make up for the deficiency of amnion, and broaden the way for the clinical application of amnion products. The basis of amniotic membrane related products is amniotic membrane homogenate. Serum biological characteristics (low immunogenicity and immune response, promote wound healing, anti angiogenesis formation, inhibit scar formation, antibacterial and antimicrobial cancer cell growth, etc.) of amniotic membrane homogenate were reviewed in this paper.(Int Rev Ophthalmol, 2021, 45: 130-134)

    Dry eye treatment based on tear functional units
    Zhang Lei
    2021, 45(2):  135-140.  doi:10.3760/cma.j.issn.1673-5803.2021.02.009
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    There are many causes of dry eye, and its main feature is the imbalance of tear film homeostasis. With the increase in knowledge regarding the pathophysiology of dry eye, it is found that the maintenance of tear film homeostasis benefits from the normal operation of each component of lacrimal function unit. Lacrimal functional unit comprises cornea, conjunctiva, lacrimal gland, meibomian glands and the neural network that connects them. It controls secretion of the tear film in a regulated fashion. Compromise in one or more components can result in homeostasis disruption of ocular surface leading to dry eye disease. Therapy targeting cornea includes autologous serum, nerve growth factor, contact lens and anti-inflammatory treatment; therapy targeting conjunctiva includes vitamin A, anti-inflammatory treatment and operation. Therapy targeting lacrimal gland includes cyclosporine A, androgen and regeneration of lacrimal gland; therapy targeting meibomian glands includes warm compresses, manual lid massage and ω -3 fatty acid. Therapy targeting tear film includes compensation of tear, stimulating tear production, controlling tear evaporation and regulating excessive nasolacrimal drainage. Understanding the physiological function and pathological changes of the main components of lacrimal function unit is helpful to provide ideas for personalized treatment of dry eye. (Int Rev Ophthalmol, 2021, 45: 135-140)

    Progress on complicated cataract after ICL implantation
    Liu Zhenyu, He Hailong, Wang Jinda, Wan Xiuhua
    2021, 45(2):  141-145.  doi:10.3760/cma.j.issn.1673-5803.2021.02.010
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    Implantable contact lens (ICL) implantation is now gradually accepted as one of the correction methods for refractive errors with the continuous progress of modern refractive surgery. The incidence of complicated cataract after ICL implantation is about 2% ~ 3.5%, and cataract surgery is needed in severe cases (<1%). The early complication of cataract after ICL implantation is related to the operation, patient's age and diopter, while the late complication of cataract is mainly due to the contact between ICL and lens or the change of aqueous humor circulation. In recent years, the incidence of early postoperative complicated cataract has decreased significantly, which is related to the improvement of ICL material and design type, and the increase of surgical experience. Some studies suggest that the ideal vault of ICL should be between 250 μm and 750 μm. (Int Rev Ophthalmol, 2021, 45: 141-145)

    The relationship between intraocular pressure and lamina cribrosa parameters by OCT
    Du Yifan, Wu Jian, Wang Ningli
    2021, 45(2):  145-151.  doi:10.3760/cma.j.issn.1673-5803.2021.02.011
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    The deformation of lamina cribrosa and the decrease of blood flow have been regarded as the first factors of optic nerve axon damage in glaucoma. Pathological intraocular pressure increase has been proved to be closely related to the occurrence and development of glaucoma. With the continuous improvement of OCT technology, the study of the pathogenesis of glaucoma by measuring the changes of lamina cribrosa and peripheral parameters with intraocular pressure has also been widely concerned around the world. A large number of studies have shown that the lamina cribrosa depth (LCD), the prelaminar tissue thickness (PTT), the lamina cribrosa curvature index (LCCI) and the optic nerve head vascular density are all correlated with intraocular pressure by OCT and OCT technology. Higher intraocular pressure can affect the progress of glaucoma through its dual effects on lamina cribrosa structure and blood flow. However, the role of intraocular pressure is not the only factor affecting the lamina cribrosa. (Int Rev Ophthalmol, 2021, 45: 145-151)
    The application and research advance of pupillary detection in glaucoma screening
    Zhang Di, Suo Lingge, Zhang Chun
    2021, 45(2):  152-157.  doi:10.3760/cma.j.issn.1673-5803.2021.02.012
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    The pupillary light reflex is a potential functional sign of the afferent pathway of the retina and optic nerve. Abnormal pupillary light reflex or relative afferent pupillary disorder will arise when glaucoma patients develop asymmetrical optic neuropathy in one or both eyes. With the development of pupil detection equipment, the accuracy of detecting optic nerve damage in glaucoma based on pupil dynamic image recognition technology has improved a lot. This article reviews the application and progress of new pupil detection methods in glaucoma in recent years, evaluates the accuracy and development status of pupil accessing instruments for glaucoma detection, and provides a reference for exploring glaucoma screening approaches. (Int Rev Ophthalmol, 2021, 45: 152-157)

    Progress of bilateral diffuse uveal melanocytic proliferation
    Cai Zhipeng, Zhang Hong, Yuan Minli, Su Fei
    2021, 45(2):  158-164.  doi:10.3760/cma.j.issn.1673-5803.2021.02.013
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    Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic ocular syndrome characterised by diffuse uveal thickening and proliferation of benign melanocytes which leads to progressive loss of vison bilaterally. The pathogenesis of BDUMP is unclear. The typical clinical findings is a giraffe-like pattern with multiple scattered oval or round subretinal greyish patchy lesions separated by polygonal orange pigmentation. Multimodal imaging and immunologic investigations facilitate early diagnosis of BDUMP. Plasmapheresis with simultaneous treatment of the underlying malignancy is the most effective treatment. (Int Rev Ophthalmol, 2021, 45: 158-164)

    Progress of study on orbitalnecrobiotic xanthogranuloma
    Sun Mei, Ma Jianmin
    2021, 45(2):  165-171.  doi:10.3760/cma.j.issn.1673-5803.2021.02.014
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    Necrobiotic xanthogranuloma (NXG) is a rare chronic progressive multiple organ disease, and it is a subtype of adults’ yellow orbital granuloma. The typical clinical manifestations of NXG are multiple sclerosing yellow-brown plaques or nodules around the orbit, and the lesions may have atrophy, ulcer and telangiectasia. NXG mainly affects the skin and subcutaneous tissues. It can also affect other body systems and internal organs, also causing serious complications of eye. At present, the etiology and pathogenesis of NXG are unknown. The most prominent histopathological features of NXG is large areas of denatured collagen with granulomatous inflammation, and cholesterol crystal Touton giant cell, foam cells and foreign body giant cell can be seen in the lesion specimen. The prognosis of NXG is usually good, but there is no radical treatment. Chemotherapy with alkylating agents is most commonly used, and corticosteroids combined with chemotherapy can be used to treat NXG with other systemic diseases. Focal glucocorticoid injection, radiotherapy, and surgical excision may be used for local and minor lesions. Other treatments include interferon, plasmapheresis, and intravenous immunoglobulin and so on, but the results vary. (Int Rev Ophthalmol, 2021, 45: 165-171)

    Surgical treatment for chronic dacryocystitis
    Pang Zuoxiang, Yu Haibin
    2021, 45(2):  172-176.  doi:10.3760/cma.j.issn.1673-5803.2021.02.015
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    Chronic dacryocystitis is a common lacrimal disorder caused by the obstruction or stenosis of nasolacrimal duct. Currently, there is no effective drug therapy for chronic dacryocystitis and the purpose of different treatment methods is to relieve obstruction and rebuild drainage. We review the literature and compared seven kinds of methods for the treatment of chronic dacryocystitis. It is believed that endoscopic endonasal dacryocystorhinostomy is more effective and less invasive for the treatment of chronic dacryocystitis. With the help of dacryoendoscope, we can observe the inside of lacrimal duct and probe through the obstruction or stenosis area and intubation of lacrimal stent may also help to achieve a better outcome. We should conduct personalized treatment according to the specific situation of the patient in clinical practice. (Int Rev Ophthalmol, 2021, 45: 172-176)