Table of Content

22 June 2021, Volume 45 Issue 3

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Application of digital image analysis in ophthalmic plastic surgery

Hui Shiqi, Li Dongmei

2021, 45(3):  177-182.  doi:10.3760/cma.j.issn.1673-5803.2021.03.001

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To objectively and accurately measure eyelid position could help in preoperative planning, file medical records, postoperative evaluation in plastic surgery, also for teaching, education and research purpose. However, traditional manual measurements are subject to the experience of clinicians and the learning curve effect. Studies have found that using the image-based approach compare favorably with clinical manual measurements. Standardized digital image offers a highly reproducible and reliable means for facial morphometric data measurement and image manipulation using a vast array of digital Apps and tools. Identical camera position and setting, lighting condition, background and the pose of the patient are widely recognized as imperative to high-quality photographs. The traditional measurement method (manual ruler measurement), digital software and semi-automated measurement of commonly used data are compared, and the use of appropriate digital software and standardized photography is helpful for the evaluation of ophthalmic plastic and cosmetic surgery. (Int Rev Ophthalmol, 2021, 45: 177-182)

The pathogenesis of pigmentary glaucoma

Pu Liping, Qing Guoping

2021, 45(3):  183-187.  doi:10.3760/cma.j.issn.1673-5803.2021.03.002

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Pigmentary glaucoma is a kind of secondary open-angle glaucoma with relatively simple pathogenesis. The main reason for elevated intraocular pressure is increased aqueous outflow resistance owing to an accumulation of pigment granules in the trabecular meshwork. These pigment granules can not only cause mechanical obstruction of the intertrabecular spaces, but also lead to the loss of trabecular cells which had overload phagocytized pigment granules, the fusion of trabecular lamellae with collapse of intertrabecular spaces, and the obliteration of the canal. In recent studies, the aqueous humor dynamic changes in the uveosceleral outflow pathway, complex molecular genetics and immune mechanism might be involved in the pathogenesis of pigmentary glaucoma. (Int Rev Ophthalmol, 2021, 45: 183-187)

The research of neovascular glaucoma therapy

He Yuan, Quan Zhuoya , He Beilei , Zhang Ruixue ,

2021, 45(3):  188-193.  doi:10.3760/cma.j.issn.1673-5803.2021.03.003

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Neovascular glaucoma (NVG) is a kind of refractory blinding eye disease which has poor therapeutic effect to drugs and surgery. Early applications of eye drops to lower the high intraocular pressure levels are effective in prevent any further deterioration of diseases. Panretinal photocoagulation can control the retinal ischemic primary disease and reduce the incidence of neovascularization in the anterior segment.Traditional filtration or shunt surgery is inevitable when peripheral anterior synechia formation and angle closure have occurred, and the results are unsatisfactory. In recent years, surgery combined with anti-vascular endothelial growth factor drugs has been considered as a novel method to improve the prognosis, but was not help to reduce intraocular pressure. Some ciliary body surgical seem to have good benefits on improving intraocular pressure. However, which treatment options are better for NVG patients deserve further investigation and exploration. (Int Rev Ophthalmol, 2021, 45: 188-193)

Research on biomechanics of lamina cribrosa

Liu Chengtan, Liang Yuanbo

2021, 45(3):  193-197.  doi:10.3760/cma.j.issn.1673-5803.2021.03.004

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As a biomechanical structure, the strain on the lamina cribrosa (LC) caused optic nerve damage. The intraocular pressure (IOP) is considered to be the main influential factor in LC biomechanics, for elevating IOP could induce large strain in LC. Correspondingly, lowering IOP after glaucoma surgery or medication could relieve strain levels in the LC. As a component of the trans-lamina cribrosa pressure difference(TLCPD), CSF pressure also affects LC. Lowering CSF pressure increases TLCPD, which leads to strain of LC. In addition, horizontal eye movements could induce large strain in LC through the pulling action of the optic nerve sheaths.(Int Rev Ophthalmol, 2021, 45: 193-197)





Physiological and pathological changes of retinal and choroidal structure during pregnancy

Liu Chenchen, Du Jiantong, Li Jun

2021, 45(3):  198-204.  doi:10.3760/cma.j.issn.1673-5803.2021.03.005

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Due to changes in hormone levels and hemodynamics in pregnant women, the thicknesses of the retina and choroid increase during pregnancy, but the structure of the retina and choroid in women with gestational diabetes and preeclampsia is thinner than that of healthy pregnant women. Women with severe preeclampsia have thicker retina and choroid compared with healthy pregnant women and healthy non-pregnant women. (Int Rev Ophthalmol, 2021, 45: 198-204)

Imaging of microaneurysms in diabetic retinopathy

Zhang Jing, Ding Lin

2021, 45(3):  204-210.  doi:10.3760/cma.j.issn.1673-5803.2021.03.006

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Microaneurysm (MA) has four types of ultrastructures: Type I vascular endothelium is intact but lacks pericytes; Type II blood vessels have red blood cells in the lumen, but endothelial cells and pericytes are absent; Type III irregularly shaped red blood cell contour in the lumen, part of the lumen is occluded; and Type IV blood vessels are completely hardened. Color fundus photography MA showed small red dots with a diameter of 15-60 μm. Fundus fluorescein angiography is considered to be the gold standard for diagnosis of MA. It is manifested by the arterial phase with sharply defined circles and strong fluorescent spots of varying sizes, and some late fluorescein leakage can be seen. On OCT, MA is a highly reflective ring-shaped cyst structure, which is divided into three types: complete ring-shaped structure type, incomplete type, and non-ring-shaped structure type. The classification of MA by OCTA includes focal bulging, saccular, fusiform, mixed, pedunculated, and irregular. The multispectral ocular fundus imaging 550 nm, 580 nm, and 590 nm are all displayed as small black dots, and in the pseudo-color image, they are displayed as red dots. The multicolor scanning laser imaging can show the MA as small black dots (low reflection signal) more clearly than fundus photography, and the detection rate is higher than fundus photography. (Int Rev Ophthalmol, 2021, 45: 204-210)

Light-induced retinal damage in the pathogenesis of age-related macular degeneration#br#

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Zhang Yumeng, Zhang Jingfa, Sun Xiaodong

2021, 45(3):  211-215.  doi:10.3760/cma.j.issn.1673-5803.2021.03.007

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The etiology of age-related macular degeneration (AMD) is complex and its pathogenesis has not been fully elucidated, which is related to age, environment, genetics, oxidative stress and inflammation, etc. In rodent models of light-induced retinal damage (LIRD), the fundus demonstrated similar pathological features as seen in AMD, such as oxidative stress, inflammatory responses, endoplasmic reticulum stress, autophagy and mitophagy, DNA damage and cell senescence, aswellas neovascularization, which in turn damage its structure and function. (Int Rev Ophthalmol, 2021, 45: 211-215)

Application of microperimetry in macular edema

Wei Puying, Zhang Wenbo, Yang Liu

2021, 45(3):  216-220.  doi:10.3760/cma.j.issn.1673-5803.2021.03.008

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Macular edema secondary to diabetic retinopathy, retinal vein occlusion, and uveitis can severely affect visual function. Microperimetry that allows precise and efficient assessment of regional retinal sensitivity can assist in objective analysis of the correspondence between microstructural changes of macular edema and the functional decline. As a complement to visual acuity, microperimetry can detect  changes in visual function brought about by new therapies.(Int Rev Ophthalmol, 2021, 45: 216-220)





The structure and function of Bruch’s membrane and its relationship with myopia

Min Yalan, Liu Weifeng

2021, 45(3):  221-225.  doi:10.3760/cma.j.issn.1673-5803.2021.03.009

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Bruch membrane is divided into 5 layers between the pigment epithelium and the choroid, which regulates metabolism between choroid and retinal pigment epithelium to maintaining normal visual function. Its morphology and composition change with age, resulting in the decline of its function. Also, Bruch membrane plays an important role in the occurrence and progress of myopia, especially in high myopia. Bruch membrane opening, as the inner layer of the optic nerve head layers, is shifted in the temporal direction in the process of axial elongation. The lack of Bruch membrane at the temporal disc side is the histological equivalent of the parapapillary gamma zone. Gamma zone enlarges and the prevalence of Bruch membrane defects in the macular region increases with longer axial length. (Int Rev Ophthalmol, 2021, 45: 221-225)

Research progress of lens capsule

Ge Wenling, Yu Fangliang

2021, 45(3):  226-230.  doi:10.3760/cma.j.issn.1673-5803.2021.03.010

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Lens capsule is a special layer of substrate membrane that wraps the lens. Its physical properties and microstructure will change with the increase of age. For example, with the aging the thickness of lens capsule increases, elasticity decreases, hardness increases, and roughness changes. The lens capsule may be the mediator of immune cell migration and plays an indispensable role in the regulation of lens growth and development. As a stable material with easy source and low antigenicity, lens capsule from cataract surgery can be applied in the treatment of other ophthalmological diseases, such as promoting the healing of corneal ulcer, applied in glaucoma filtrating surgery, macular hole repairment, and even can be used as a substitute for Bruch's membrane. In cataract surgery, many different methods of capsulorhexis have different effects on the capsule.(Int Rev Ophthalmol, 2021, 45: 226-230)





Artificial intelligence in diagnosis and classification of cataract

Chen Shuying, Wang Kaijie, Wan Xiuhua

2021, 45(3):  231-236.  doi:10.3760/cma.j.issn.1673-5803.2021.03.011

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Artificial intelligence (AI) has been widely used in cataract detection and classification. At present, there are mainly two cataract detection and classification methods based on slit lamp photos and color fundus photos. At the same time, a variety of algorithm models can obtain the lens features of cataract patients to get more accurate diagnosis and grading results, such as support vector machine regression model, group sparse regression model, convolution recurrent neural network model, deep convolution neural network model and so on. (Int Rev Ophthalmol, 2021, 45: 231-236)





Strategy and challenges of phacoemulsification in patients with thrombocytopenia

Sun Caixia, Yuan Fei

2021, 45(3):  237-240.  doi:10.3760/cma.j.issn.1673-5803.2021.03.012

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If the platelet count of cataract patients is below the lower limit of normal, incision bleeding, spontaneous hemorrhage of intraocular blood vessels and hyphema may occur during or following the cataract surgery, which seriously affects the safety and effect of surgery. For patients with very low platelet count, platelet transfusion or drugs should be used to increase platelet count before operation. In addition, the systemic condition and primary disease of patients with thrombocytopenia should be carefully evaluated before cataract surgery, and the best treatment plan should be chosen in cooperation with hematologists. (Int Rev Ophthalmol, 2021, 45: 237-240)





Role of autophagy in the pathogenesis of corneal diseases

Yu Rui, Gao Honglian, Li Xinmeng, Liu Qiqi, Zhang Lei

2021, 45(3):  240-245.  doi:10.3760/cma.j.issn.1673-5803.2021.03.013

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Autophagy is a highly conservative process of material cycle in eukaryotic cells and plays an important role in the survival and maintenance of cells. Autophagy makes an important impact in the development of corneal diseases such as keratoconus, dry eye, herpes simplex keratitis, Fuchs corneal endothelial dystrophy, granular corneal dystrophy type 2, etc. However, its role in corneal neovascularization and fibrosis remains unclear.(Int Rev Ophthalmol, 2021, 45: 240-245)





MicroRNA and corneal wound healing

Liu Yuxin, Wang Liqiang

2021, 45(3):  246-250.  doi:10.3760/cma.j.issn.1673-5803.2021.03.014

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MicroRNA has a critical role in corneal wound healing. A complex and regulated sequence of cellular reactions involve cell death, migration, proliferation, differentiation, and extracellular matrix remodeling. Distributed in different levels of cornea, microRNA is a key regulator in growth factors, cytokines and signaling pathways downstream. Variety of microRNAs simultaneously modulates multiple signaling pathways and represents a complex and precise regulatory network to participate in the cascade reaction of corneal wound healing. Meanwhile, the deposition of extracellular matrix and the angiogenesis caused by the altered microRNA expression indicates the importance of microRNA in corneal pathological repair.(Int Rev Ophthalmol, 2021, 45: 246-250)





Research on biomarkers of pterygium

He Mengxuan, Shi Haihong

2021, 45(3):  251-256.  doi:10.3760/cma.j.issn.1673-5803.2021.03.015

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The exact pathogenesis of pterygium is not completely understood, which result in high recurrence rate after surgery. The biomarkers of pterygium include tumor suppressor genes, proliferation/apoptosis related proteins, growth factors, matrix metalloproteinases and tissue inhibitors of metalloproteinases, interleukins, heat shock proteins, tight junction proteins, cell adhesion molecules, extracellular matrix proteins and viruses. There is a complex network relationship between these biomarkers, and there is no clear distinction between primary and secondary, and they can promote the occurrence and development of pterygium individually or cooperatively. If the expression of these biomarkers is effectively regulated, it may be the fundamental method to prevent, treat and reduce the recurrence rate of pterygium surgery.(Int Rev Ophthalmol, 2021, 45: 251-256)





Influencing factors of formation of the form-deprivation-myopia in guinea pigs

Li Xinmeng, Gao Honglian, Yu Rui, Cui Yuying, Qiu Yu, Zhang Lei

2021, 45(3):  256-262.  doi:10.3760/cma.j.issn.1673-5803.2021.03.016

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The pathogenesis of myopia is that abnormal visual stimulation effect on retinal and cause the change of retinal signal factors, which is then transmitted to the sclera through the retinal pigment epithelium-choroid pathway, induces extracellular matrix (ECM) reconstruction and the sclera remodeling. Form-deprivation-myopia (FDM) is one of the commonly used models in guinea pigs to study myopia. The study on FDM induction in guinea pigs mainly focused on the intervention with different drugs such as nitric oxide synthase, melatonin, M receptor blockers, dopamines, intraocular pressure lowering drugs, peroxisome proliferator activated receptor α (PPAR α) agonists and antagonists, hypoxia inducible factor, which causes the changes of dopamine, matrix metalloproteinase-2 (MMP-2), tissue inhibitor matrix metalloproteinase-2 (TIMP-2), transforming growth factor-β (TGF-β) , α-smooth muscle actin (α-SMA) and type I collagen, thus affecting the process of FDM. (Int Rev Ophthalmol, 2021, 45: 256-262)

Epidemiological study status of hyperopia in preschoolers

Fu Fayan, Li Jun

2021, 45(3):  263-268.  doi:10.3760/cma.j.issn.1673-5803.2021.03.017

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Preschoolers aged from 3 to 6 years are in a critical period of visual development, and hyperopia is predominant. According to statistics, the prevalence of hyperopia (defined as equivalent spherical ≥+2.00 D) in preschoolers ranges is from 10.4% to 30.03%. However, due to the different inclusion criteria, population, examination method and age, the prevalence of hyperopia in preschoolers varies to some extent. Genetic and environmental factors, ethnic differences, unhealthy eye behaviors, and maternal smoking during pregnancy may be factors that affect preschoolers' hyperopia.(Int Rev Ophthalmol, 2021, 45: 263-268)

Evaluation of visual quality after small incision lenticule extraction

Zhou Cong, Dai Lili

2021, 45(3):  268-272.  doi:10.3760/cma.j.issn.1673-5803.2021.03.018

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Small incision lenticule extraction (SMILE) is a lamellar corneal refractive surgery, which has become one of the mainstream corneal refractive surgery. The evaluation of postoperative visual quality can be divided into subjective visual quality (visual acuity, contrast sensitivity, visual quality questionnaire) and objective visual quality (wavefront aberration, point spread function, Strehl ratio, modulation transfer function). The vision recovered quickly, and the uncorrected visual acuity was significantly improved of patients after SMILE surgery. Postoperative high-order aberrations, spherical aberrations, and coma increased, contrast sensitivity, visual scale evaluation, and binocular visual function decreased at early, but gradually recovered in 3~6 months. (Int Rev Ophthalmol, 2021, 45: 268-272)