Table of Content

22 August 2021, Volume 45 Issue 4

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Classification and progress of glaucoma surgery

Li Xiangji, He Xiangge, Zhu Xiaomin, Jing Jin, Wang Wei, Xie Lin

2021, 45(4):  273-279.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.001

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Surgery is an important intervention in treatment of glaucoma. In this article, according to the different mechanisms of intraocular pressure (IOP) lowering classifies the surgical procedures into two categories: increasing drainage of aqueous humor and reducing the generation of aqueous humor. Additionally, the basis of the drainage pathways, divides the increasing drainage of aqueous humor type into two subtypes: external drainage and internal drainage which includes Schelemm canal drainage approach and suprachoroidal space drainage approach. Reducing the generation of aqueous humor is divided into three subtypes: cyclophotocoagulation, ultrasond cycloplasty (UCP), cyclocryotherapy. Currently, combined trabeculectomy remains the mainstream procedure of external drainage surgery and various glaucoma drainage devices have been used in clinic. In terms of internal drainage surgery, among the procedures of Schlemm canal drainage approach, internal or external 360°transluminal trabeculotomy, trabeculotomes and microstents have been gradually applied in clinic, and achieve excellent surgical outcome. The safety and efficacy of the implant devices relying on suprachoroidal space drainage approach need further studies. New types of aqueous humor generation reduction procedure are becoming safer and controllable and no longer limited to the treatment of blind advanced glaucoma patient. (Int Rev Ophthalmol, 2021, 45: 273-279)

Progress in application of KDB abinterno trabeculectomy on glaucoma treatment

Ju Hong, Cai Hongying

2021, 45(4):  280-284.  doi:10.3760/ cma.j.issn.16735803.2021.04.002

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As one of the minimally invasive glaucoma surgeries, KDB Abinterno trabeculectomy can remove trabecular meshwork in a wide range without destroying adjacent tissues, reducing the resistance of aqueous outflow, and thus reducing intraocular pressure. It has certain therapeutic effects on a variety of types of glaucoma. Compared with filtration bleb dependent surgery, it is simple, less complications, high safety, does not destroy the conjunctiva, and does not affect the subsequent operation. This article reviews the principle, procedure, efficacy, safety and combined operation of KDB abinterno trabeculectomy for glaucoma. (Int Rev Ophthalmol, 2021, 45: 280-284)

Application of implantable sustained release drug delivery system on glaucoma treatment

Han Xiao, Zhong Yuyu

2021, 45(4):  285-289.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.003

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There are many factors affecting the incidence of glaucoma, and intraocular pressure is still the only controllable factor. Drug therapy is mainly based on topical administration of conventional eye drops. This method has certain shortcomings, including the low bioavailability of the drug, the uncorrect medication of the patient and the low compliance. In recent years, the continuous development of drug delivery system (DDS) has made it possible to successfully solve the above problems. Implantable DDS can be divided into degradable type and non-degradable type, which can keep the effective concentration of the drug in the eye for a long time, and is especially suitable for eye diseases that require long-term treatment. In recent years, a total of 5 new glaucoma drug slow-release devices including bimatoprost SR, ENV515, iDose, OTX-TP, L-PPDS have been put into clinical trials. (Int Rev Ophthalmol, 2021, 45: 285-289)

Clinical research progress of CO2 laser assisted deep sclerectomy

Chen Tianyi, Dang Guangfu, Yang Xiao

2021, 45(4):  290-295.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.004

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In recent years, CO2 laser assisted deep scleral incision (CLASS) has been widely used in treatment of glaucoma because of its advantages of minimally invasive, simple operation and less complications. CLASS surgery is an improvement of traditional non penetrating filtering surgery (NPTS). With the assistance of CO2 laser, the risks and difficulties of traditional NPTS operation has been greatly reduced. Although CLASS surgery is not superior to traditional trabeculectomy in reducing intraocular pressure, it is superior to trabeculectomy in the incidence of early postoperative complications, the protection of corneal endothelium, and the operability of reoperation. At the same time, CLASS surgery can be combined with other surgical methods, providing new ideas and theoretical basis for the prevention and treatment of glaucoma. (Int Rev Ophthalmol, 2021, 45: 290-295)

Treatment of microspherophakia

Zheng Jialei, Deng Michael, Jiang Yongxiang

2021, 45(4):  295-299.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.005

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Microspherophakia is a rare congenital disease characterized by increased anteroposterior diameter and reduced equatorial diameter. The common complications of microspherophakia include crystalline subluxation or dislocation and secondary glaucoma. The complications occur at an early time and lead to a high rate of blindness. Therefore, it's necessary to diagnose and treat the disease at the earliest. The treatment for microspherophakia can be divided into lens surgery and anti-glaucoma treatment. Lens surgery include lens aspiration +intraocular lens (IOL) implantation, lens aspiration + modified capsular tension ring (MCTR) implantation + IOL implantation, etc. Anti-glaucoma operations include YAG laser iridotomy, trabeculectomy and so on. Currently, there is no unified treatment method, and there are many feasible treatment methods according to the severity of complications. The visual acuity recovers obviously after the lens operation, but different anti-glaucoma treatments have different effects on intraocular pressure control. The long-term effectiveness and safety of the treatments remain to be observed. (Int Rev Ophthalmol, 2021, 45: 295-299)

Ocular manifestations and advances of phacomatosis pigmentovascularis

Huang Shitong, Yang Yangfan, Yu Minbin

2021, 45(4):  300-306.  doi:10.3760/cma.j.issn.1673-5803.2021.04.006

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Phacomatosis pigmentovascularis (PPV) is a congenital syndrome characterized by diffuse epidermal capillary malformation and pigmented nevus. PPV also have systemic involvement. Ocular manifestations of PPV include glaucoma, periocular erythema, retinal vascular abnormalities, choroidal hemangioma, ocular melanocytosis, iris hererochromia, iris mammillation and fundus hyperpigmentation. Extracutaneous complications of PPV are the key in the treatment. The treatment of its associated glaucoma is challenge and most still refer to the treatment of glaucoma complicated with Sturge-Weber syndrome.(Int Rev Ophthalmol, 2021, 45: 300-306)

Changes of axial length and refractive status and related factors after cataract surgery in infants with congenital cataract

Qian Shuyi, Zhao Yune

2021, 45(4):  307-311.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.007

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The changes of axial length, keratometry and refractive status after infantile cataract surgery are important for surgical timing of secondary intraocular lens (IOL) implantation and calculation of IOL power. The growth rate of axial length is related to age of surgery, laterality of congenital cataract (unilateral or bilateral), postoperative complications and so on. Postoperative myopia shift is difficult to predict due to axial elongation, and it is also affected by the age of surgery, the timing of intraocular lens implantation and the value of target refraction.(Int Rev Ophthalmol, 2021, 45: 307-311)

Association between dyslipidemia and mebomian gland dysfunction

Shi Yu, Zeng Qingyan,

2021, 45(4):  312-317.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.008

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Clinical studies have shown that there is a close correlation between dyslipidemia and mebomian gland dysfunction(MGD). Higher serum total cholesterol (TC), triglyceride (TG) and low density lipoprotein (LDL) can promote the development of MGD. Studies have found that elevated high density lipoprotein (HDL) can lead to the progression of MGD. It was found by animal experiments that dyslipidemia may lead to various pathological changes of meibomian glands. Some lipid-lowering drugs also have some therapeutic effects on MGD. (Int Rev Ophthalmol, 2021, 45: 312-317)

Effect of phakic posterior chamber intraocular lens on calculation of intraocular lens

Diliaremu Ailihamu, Cai Yan, Li Zhao, Mieradilijiang Duolikun

2021, 45(4):  317-321.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.009

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The effect of posterior chamber intraocular lens（PIOL）implantation on the structure of anterior segment and its safety have been confirmed by a number of studies. With the passage of time, patients with PIOL implantation are faced with cataract. The calculation of intraocular lens (IOL) before cataract surgery is an important factor to obtain good visual quality. The anterior chamber depth, anterior chamber volume and chamber angle parameters values after PIOL implantation in phakic eyes were significantly different from preoperative values. A few of studies have shown that there was no significant difference in the axial length and keratometry measured by IOL-Master, and in the IOL power calculated using different formulas before and after PIOL implantation. The IOL power before cataract surgery often needs to be measured by A ultrasound because of the opacity of refractive medium. The effect of PIOL implantation on A ultrasound biometric measurement in phakic eyes has not been concluded, so more studies are needed to complete the conclusion of the effect of PIOL implantation on the calculation of the IOL power, to provide reference for the treatment of cataract after the PIOL power implantation.(Int Rev Ophthalmol, 2021, 45: 317-321)

Research progress of matrix regenerating agents in promoting corneal epithelial wound healing

Li Pengwei, Guo Jianqiang, Liu Jiangchuan, Mu Yalin

2021, 45(4):  322-325.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.010

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Corneal epithelial defects usually heal within 48 hours. However, It is difficult to cure persistent corneal epithelial defect and chronic corneal ulcer with traditional therapy. The healing of corneal epithelium depends largely on the remodeling of extracellular matrix(ECM). Heparin sulfate (HS) is an important component of the ECM. It can specifically bind to matrix proteins, growth factors and cytokines, thus protecting them from proteolysis and facilitating tissue healing. In recent years, matrix regenerating agents (RGTA) consisting of heparan sulfate mimetic polymers has been gradually applied on clinical practice to promote corneal epithelial wound healing. RGTA is a pure bioengineering polymer that can completely resist the degradation of heparanase. It can replace the enzymatically hydrolyzed HS in damaged tissues, so as to reconstruct the stable environment in ECM. Clinical studies show that RGTA can effectively treat refractory corneal ulcer and is a promising new method.(Int Rev Ophthalmol, 2021, 45: 322-325)

Pathogenesis and treatment of neurotrophic keratitis

Zhang Zhen, Zhang Yue, Li Mengxi, Li Li

2021, 45(4):  326-330.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.011

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Neurotrophic keratitis is a kind of refractory corneal disease. Trigeminal nerve injury due to various reasons could lead to changes in nerve morphology, decreased secretion function and sensitivity, which would trigger corneal inflammatory response, causes epithelial defects, delayed healing, corneal ulcers and a series of pathological changes. At present, the new treatment strategy is mainly the use of nerve growth factor (NGF). Although nerve transplantation is proved to be effective by clinical practice, the difficulty of surgery and the risk of trauma make it need further clinical study. Pergolide and nanomicelle curcumin are expected to provide new therapeutic ideas for clinical use.(Int Rev Ophthalmol, 2021, 45: 326-330)

Progress on hydrogel anti-vascular endothelial growth factor drug delivery system in Ophthalmology

Meng Jie, Zhu Rongrong

2021, 45(4):  330-334.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.012

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The hydrogel has excellent biocompatibility and similar optical and rheological properties to the vitreous body. It can be easily injected into the vitreous cavity and has the characteristics of sustained drug release. It can be used as a carrier for anti-vascular endothelial growth factor (VEGF) drug delivery system for the treatment of various retinal and choroidal diseases. In recent years, many types of hydrogel carriers have been successfully developed in animal models, including natural and synthetic hydrogels, some of which can sustainably release bevacizumab, conbercept and other anti-VEGF drugs in the eye. The release of anti-VEGF drugs from hydrogels generally goes through the initial release stage, diffusion release stage and degradation release stage. How to control the release rate in the hydrogel, increase the drug loading and prolong the degradation time of the hydrogel in the vitreous are urgent problems to be solved at the present stage. (Int Rev Ophthalmol, 2021, 45: 330-334)

Effect of angiopoietin on ocular development and related ocular diseases

Zhu Zhe, Zhang Chenchen, Xiao Jun

2021, 45(4):  335-340.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.013

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Angiopoietin and corresponding Tie tyrosine kinase receptors constitute the Ang-Tie signaling pathway, which plays an important role in the development of ocular and the pathological process of ischemic and neovascular diseases. During the development of the eyeball, the Ang-Tie signaling pathway is involved in the development of retinal blood vessels, the regression of primitive vitreous blood vessels, and the development of the drainage channels of aqueous humor in the corners. In mature individuals, the Ang-Tie signaling pathway plays an important role in maintaining blood vessel stability. Its imbalance can destroy the barrier function of endothelial cells, leading to pathological changes such as vascular leakage, and is widely involved in vascular diseases in the retina, choroid, and cornea. In addition, there are currently a variety of Ang-Tie pathway-related drugs for eye diseases and are under development. (Int Rev Ophthalmol, 2021, 45: 335-340)

Role of oxidative stress and autophagy in pathogenesis of dry age-related macular degeneration

Wang Jiajing, Ji Jing

2021, 45(4):  341-345.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.014

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Age-related macular degeneration (AMD) is recognized as the leading cause of visual impairment among people over 60 years old. The main pathological feature of dry AMD is the degeneration and death of retinal pigment epithelium (RPE), in while oxidative stress is the major cause of death of RPE. In the resistance of RPE to oxidative stress, autophagy plays a key role. Sustained oxidative stress can lead to dysfunction of autophagy, which can activate inflammasomes and cause inflammation, and finally exacerbate the damage of RPE. Dysregulated autophagy has a great impact on the development of AMD. (Int Rev Ophthalmol, 2021, 45: 341-345)

Role of lipid metabolism in age-related macular degeneration

Liang Yinghui, Chen Yiwen, Cui Yao

2021, 45(4):  346-350.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.015

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The characteristic change of age-related macular degeneration (AMD) is the lipid deposits and drusen in Bruch’s membrane. Therefore, the formation of AMD lesions is considered to be related to lipid metabolism. The decrease of dietary omega-3 long-chain polyunsaturated fatty acids (omega-3 LC-PUFAs) intake and the increase of the circulating high-density lipoprotein cholesterol are associated with the increased risk of AMD. Some gene variations of lipid metabolism are associated with the risk of AMD, but not all the gene variants that increase the concentration of circulating high-density lipoprotein will increase the risk of AMD. Retinal lipids maintain its homeostasis through uptake from circulatory system, autophagy degradation, local synthesis，secretion and outflow. When the retinal lipids homeostasis changes, local lipid accumulation and peroxidation takes place, and finally the characteristic inflammatory lesions of AMD appears. However, the role of lipid granules and whether local or circulating HDL-C or both are involved in the pathogenesis of AMD are not clear. In addition, the results of omega-3 LC PUFAs and lipid-regulatory drugs in the treatment of AMD are inconsistent, which need further study. (Int Rev Ophthalmol, 2021, 45: 346-350)

Role of PI3K/Akt pathway on the pathogenesis and development of diabetic retinopathy

Peng Yu, Ye Bo, Chen Jiansu

2021, 45(4):  351-356.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.016

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Diabetic retinopathy (DR) is one of the most common microvascular diseases caused by diabetes, and it is also considered to be the main cause of the obvious loss of vision and even blindness in patients with diabetes in the late stage. The phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) signaling pathway is one of the important regulatory mechanisms for the body to maintain normal physiological functions. It participants in biological processes such as metabolism, inflammation, and cell proliferation in the body. In recent years, many studies have found that the PI3K/Akt signaling pathway is also involved in the pathogenesis and development of DR by regulating retinal neovascularization, insulin resistance, oxidative stress, retinal nerve damage and inflammation. The proper regulation of PI3K/Akt signaling pathway can reduce retinal neovascularization, alleviate inflammatory response, control insulin resistance, relieve retinal nerve injury and oxidative stress, thereby take a preventive effect on DR. However, due to the complexity of the pathological process of DR, studing the various effects of this pathway on different tissues and cells at different stages of DR in order to activate or inhibit accurately and selectively, and ultimately effectively improve and treat various pathological changes of DR, is the direction we should strive for in the future.(Int Rev Ophthalmol, 2021, 45: 351-356)

Diagnosis and treatment of ocular hemangioendothelioma

2021, 45(4):  357-363.  doi:10.3760/cma.j.issn.1673-5803.2021.04.017

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Hemangioendothelioma is a rare borderline or low-grade malignant angiogenic tumor, which mainly occurs in the soft tissue, liver, lung, bone and other parts of the body. It is generally infiltrative growth and occasionally metastasis. Ocular hemangioendothelioma is a more rare type of hemangioma, and there is no unified diagnosis for its characteristics and lack of treatment guidelines. Ocular hemangioendothelioma is mainly located in the orbit, but sometimes also in the eyelid and lacrimal organ. The clinical manifestations were eyelid swelling and exophthalmos. Imaging examination often showed local infiltration and growth of tumor with destruction of orbital bone, and systemic metastasis was rare. Most of the pathological changes were vascular endothelial cell proliferation. Immunohistochemical staining showed that CD31 and CD34 were positive. The main treatment is local complete resection of the tumor, but the bleeding tendency of the tumor should be paid attention to during the operation. Surgical combined with radiotherapy and chemotherapy is still a safe treatment for primary orbital hemangioendothelioma. (Int Rev Ophthalmol, 2021, 45: 357-363)

Relationship and differential diagnosis between IgG4-related ocular diseases and ocular adnexal lymphoma

Liu Rui, Ma Jianmin

2021, 45(4):  364-368.  doi:10.3760/ cma.j.issn.1673-5803.2021.04.018

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Immunoglobuling4-related ophthalmic disease (IgG4-ROD) is a common ocular disease that can develop into lymphoma, but the mechanism of its occurrence is unknown. Ocular adnexal lymphoma is the most common ocular malignancy in adults. The clinical manifestations and imaging features of IgG4-ROD and ocular adnexal lymphoma are similar, so it is difficult to distinguish them based on clinical manifestations and imaging changes alone. The results of histopathological examination and genetic test are still the gold standard for the identification of them.(Int Rev Ophthalmol, 2021, 45: 364-368)