Table of Content

22 October 2021, Volume 45 Issue 5

Previous Issue   

Delphi method and nominal group method for medical consensus formation

Tao Yangxu, Li Jianjun

2021, 45(5):  369-373.  doi:10.3760/cma.j.issn.1673-5803.2021.05.001

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Medical service providers are faced with the problem of how to make decisions when they are unable to reach an agreement due to the lack of scientific evidence or there are conflicting evidence on a certain issue. Making consensus is one of their solutions. This review introduces two common consensus formation methods, namely Delphi process and nominal group technique. Delphi process collects the opinions of relevant experts on a given problem through a questionnaire and makes repeated evaluation. Nominal group technique is to collect the views of relevant experts on a given problem through structured meetings and conduct repeated evaluation. (Int Rev Ophthalmol, 2021,45：369-373)


Advancement of ocular infection with two highly pathogenic coronaviruses：SARS-CoV and SARS-CoV-2

Zhang Yuhang, Xie Xiaohang, Zhang Fengyan

2021, 45(5):  374-379.  doi:10.3760/cma.j.issn.1673-5803.2021.05.002

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The global pandemic of COVID-19 has brought renewed attention to coronaviruses. In studies of the three highly pathogenic coronaviruses that have caused pandemics in this century (SARS-CoV, MERS-CoV and SARS-CoV-2), there is direct evidence that SARS-CoV and SARS-CoV-2 can cause ocular infections in humans. In addition to ocular symptoms, coronavirus infection can also cause a variety of systemic clinical manifestations through ocular infection. The two highly pathogenic coronaviruses (SARS-CoV and SARS-CoV-2) are more prevalent and have a higher mortality rate. The ocular symptoms of the two viruses are similar, as are the viral structure and the process of ocular infection, mainly through the binding of their specific S proteins to relevant receptors on the cell surface, allowing their nucleic acids to enter the cell and use the intracellular protein synthesis pathway to the process of transcription, assembly, folding and expression of various cytokines through its receptor proteins is similar. This article reviews the characteristics of two highly pathogenic coronaviruses, SARS-CoV, which became prevalent  in 2003, and SARS-CoV-2, which caused a worldwide epidemic in late 2019, the progress of research on the ocular infection pathway and the current status of research related to viral ocular infections, and the need for ocular virus protection and ocular screening of patients. (Int Rev Ophthalmol, 2020, 45：374-379)


Progress of topical pharmacotherapy for ocular surface squamous neoplasia

i Hanling, Zhao Zhiyuan, Zhang Hui

2021, 45(5):  380-385.  doi:10.3760/cma.j.issn.1673-5803.2021.05.003

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Ocular surface squamous neoplasia（OSSN） is the most common ocular surface tumor. Topical pharmacotherapy, a non-invasive and less surgical trauma, has become the first way in the treatment of OSSN. At present, in addition to the chemotherapeutic drugs (such as mitomycin C, 5-fluorouracil, interferon α2b, retinoic acid)with anti-metabolic, anti-tumor and immunomodulatory effects, other antiangiogenic therapy and etiological treatment (such as anti- vascular endothelial growth factor, cidofovir) have also been used in the clinical treatment of OSSN.  (Int Rev Ophthalmol, 2020, 45： 380-386)


Research progress on conjunctival melanoma

Wang Jinjin, Li Jing, Ma Jianmin

2021, 45(5):  386-392.  doi:10.3760/cma.j.issn.1673-5803.2021.05.004

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Conjunctival melanoma (CM) is a rare tumor with a mortality rate of 30%. This kind of tumor shows the worst prognosis among conjunctival malignant tumors. CM is caused by the malignant transformation of melanocytes in the basal layer of conjunctival epithelium. In some patients,  the corresponding conjunctival pigmented lesions before conjunctival melanoma,  such as primary pigmented melanosis and conjunctival pigmented nevus can be found. It is most common in the bulbar conjunctiva or corneoscleral margin,  but also in the palpebral conjunctiva. CM can invade the eyeball or orbit,  and metastasize to local lymph nodes,  brain and other organs. Histopathological examination is the gold standard for diagnosis. Most CM can be resected with surgery. Postoperative adjuvant therapy can reduce the risk of local recurrence and distant metastasis.(Int Rev Ophthalmol, 2020, 45: 386-392)


Advances in the pathogenic factors of acanthamoeba keratitis 

Gao Min, Sun Xuguang

2021, 45(5):  393-396.  doi:10.3760/cma.j.issn.1673-5803.2021.05.005

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The increasing use of contact lenses worldwide has led to an increase in cases of acanthamoeba keratitis. This review summarized the results of the pathogenic factors of acanthamoeba keratitis, including the demographic features of the patients ( gender, age, profession), time of presentation, geographical distribution, and predisposing risk factors（contact lens wear, ocular trauma, ocular surgery, coexistent ocular disease or mixed-infection） from different countries in recent years. (Int Rev Ophthalmol,2020,45：393-396)


Progress in vivo evaluation of morphology and function of aqueous humor outflow pathway

Zhu Xiaofeng, Wu Yanyan, Yu Minbin, Yang Yangfan

2021, 45(5):  397-403.  doi:10.3760/cma.j.issn.1673-5803.2021.05.006

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The common reason of pathological high intraocular pressure in glaucoma is the obstruction of aqueous humor outflow, so the morphological observation and functional study of aqueous humor outflow channel is the focus of glaucoma prevention and treatment. The study of the morphology and function of aqueous humor outflow channel is of great significance for the study of the pathogenesis of glaucoma, the selection of surgical methods and the development of targeted drugs. The imaging methods of aqueous humor outflow include anterior segment optical coherence tomography (AS-OCT), OCT angiography (OCTA), ultrasound biomicroscopy (UBM) in vivo imaging, static and real-time aqueous humor angiography, etc. OCT and UBM can evaluate the structure of aqueous humor outflow channel, while aqueous humor angiography is a functional assessment. At present, there is no precise relationship between the outflow characteristics of aqueous humor structure and the value of functional flow. Aqueous humor angiography can be used to study and evaluate the drug efficacy of glaucoma. It is also helpful to guide trabecular meshwork targeted minimally invasive glaucoma surgery to achieve a better effect of lowering intraocular pressure. However, aqueous humor angiography is invasive and can only be used in the operating room. In the future, the method of evaluating aqueous humor outflow pathway needs to be further improved in order to better understand the structure of aqueous humor outflow pathway and anterior segment structure and improve the level of diagnosis and treatment of glaucoma through the combination of structural and functional evaluation. (Int Rev Ophthalmol,2020,45：397-403)


The influencing factors of intraocular lens stability

ang Jing, Luo Juan, Zhang Jinsong,

2021, 45(5):  404-408.  doi:10.3760/cma.j.issn.1673-5803.2021.05.007

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With the advent of the era of precise refractive cataract surgery, intraocular lens (IOL) has been widely used in clinical treatment. The stability of IOL mainly includes the stability of longitudinal position and horizontal position, including the effective position, decentration, tilt, and the rotation stability of IOL. The change of intraocular position of IOL will affect the refractive state and wavefront aberrations, especially the high-order aberrations and imaging quality. We will review the influencing factors of IOL stability, including the characteristics and shapes of capsulorrhexis, the designs and materials of IOL, the eye tissue and the surgery factors, which should be paid more attention.(Int Rev Ophthalmol, 2021, 45：404-408)


Prediction of effective lens position in intraocular lens calculation formula and its influencing factors

Li Xiuyuan, Chang Pingjun, Zhao Yune

2021, 45(5):  409-414.  doi:10.3760/cma.j.issn.1673-5803.2021.05.008

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The prediction method of effective lens position (ELP) in different intraocular lens (IOL) calculation formulas (such as Holladay, SRK/T, Haigis, Hoffer Q, Olsen, Barrett Universal I formula, etc.) is different, and its accuracy is also different. In addition, ELP is a dynamic process after cataract surgery, which is affected by many factors, such as the material and shape of IOL, the shape and size of capsulorhexis, the method of capsulorhexis, the condition of the patient and so on.(Int Rev Ophthalmol, 2021, 45: 409-414)


ongenital pupillary-iris-lens membrane with goniodysgenesis

Yang Xueying, Chen Changzheng

2021, 45(5):  415-419.  doi:10.3760/cma.j.issn.1673-5803.2021.05.009

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Congenital pupillary-iris-lens membrane with goniodysgenesis (CPILMG) is a rare anterior segment disease, typically manifested as a pinpoint-sized pupil, continuously growing pupil membrane and goniodysgenesis.CPILMG usually has monocular disease and has no family heredity. Patients usually have albuginea and irisbulging that cover the pupil area, and are prone to have deprivation amblyopia and angle-closure glaucoma. The main treatment for CPILMG is surgical treatment. A small number of patients who has deep anterior chamber and spontaneous regression of pupil membrane can be followed up for observation. Present studies about CPILMG mainly focus on some case reports. It is easy to be misdiagnosed clinically with Axenfeld-Rieger syndrome (ARS) and persistent fetal vasculature (PFV). Learn more about the linical manifestations and differentiation of CPILMG will be helpful in clinical diagnosis and treatment. Research with larger sample size are expected to further investigate the different stages of CPLIMG and its developing process, its corresponding pathogenesis and treatment methods, so as to improve the understanding of the disease.(Int Rev Ophthalmol, 2021, 45： 415-419)


Recent understandings of benzalkonium in anti-glaucoma drugs lead to dry eye disease

Xu Shushu, Zhong Yisheng

2021, 45(5):  420-425.  doi:10.3760/cma.j.issn.1673-5803.2021.05.010

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A large part of glaucoma patients who have been treated with topical anti-glaucoma drugs for a period have experienced dry eye of varying degrees. Preservatives in anti-glaucoma drugs, particularly benzalkonium chloride (BAK）, are believed to play a major role in the development of dry eye in patients. Based on existing research, this paper summarizes several main mechanisms of benzalamine causing dry eye. BAK can directly acts on tear film and destroy tear film stability, resulting in tear evaporation increasing and tear film osmolarity elevating. BAK has cytotoxic effects on corneal epithelial cells, conjunctival goblet cells and meibomian gland cells, thus can affect the secretion of mucus and lipid in tear film. BAK can also cause chronic inflammation of the eye surface, leading to discomfort in patients. By exploring the mechanism of BAK causing dry eye, we hope to provide ideas for guiding the use of glaucoma and developing a new antiseptic system for eyedrops.(Int Rev Ophthalmol, 2021, 45：420-425)


Research progress of intravitreal injection therapy for non-infectious uveitis

Wei Bixia, Ding Lin

2021, 45(5):  425-430.  doi:10.3760/cma.j.issn.1673-5803.2021.05.011

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Non-infectious uveitis (NIU) treatment is designed to control inflammation, reduce complications and protect vision. NIU intravitreal injection therapy can reduce systemic side effects and frequent drug use, and has become an effective alternative to systemic drug use. In addition, the intravitreal injection approach can achieve personalized and precise treatment for NIU patients. Intravitreal injection of glucocorticoid (Ozurdex, Retisert, Iluvien, Yutiq, triamcinolone acetonide), anti-vascular endothelial growth factor (bevacizumab, ranibizumab, aflibercept), anti-tumor necrosis factor-α (adalimumab, infliximab), immunosuppressants (sirolimus, methotrexate, cyclosporine A) can be effective treatment NIU inflammation and complications related to macular edema and inflammatory choroidal neovascularization. But the lack of controlled studies makes it difficult to compare these drugs, and some are expensive and have little experience in clinical trials. (Int Rev Ophthalmol, 2021, 45： 425-430)


Research progress on pathogenesis of ocular demodex infestation

Wang Yuqian, Liu Zuguo, Li Ying

2021, 45(5):  431-436.  doi:10.3760/cma.j.issn.1673-5803.2021.05.012

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Ocular demodicosis is a series of ocular surface diseases caused by demodex infestation. Demodex is the most common ectoparasite living on humans, only two species have been identified on humans, namely Demodex folliculorum and Demodex brevis. Demodex has highly complex biological characteristics. The pathogenic characteristics of mites, such as internal and external structure, living habits, are one of the basic factors that can lead to diseases. Differential expression of important functional genes is likely correlated with pathogenicity disparities between these two demodex species. Both demodex mites can induce histopathological changes, such as follicular distention, epithelial hyperplasia, reactive hyperkeratinization, and granulomatous reaction. Microorganisms might be involved in the pathogenesis of Demodex, Bacillus oleronius and Corynebacterium kroppenstedtii subsp. are reportedto be symbiotic bacteria inside demodex mites. In addition, the mites may act as vectors by carrying bacteria on their surface. Demodex might have the capacity of immune-modulating, due to immunosuppression and risk factors, and increased demodex mite numbers may trigger a host immune reaction by activation of multiple pathways leading to ocular surface inflammatory changes. In order to perform deep research on the pathogenesis of demodex, the present review would provide insight into ocular demodicosis, which will ultimately improve the diagnosis and treatment of this disease.(Int Rev Ophthalmol, 2021, 45：431-436)


Research progress in Norrie disease

Gao Xiang, Wang Yusheng

2021, 45(5):  437-442.  doi:10.3760/cma.j.issn.1673-5803.2021.05.013

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Norrie’s disease is an X-linked recessive disorder characterized by retinal dysplasia and congenital or infantile blindness. Mutations in the Norrie’s disease protein (NDP) gene, which located on chromosome Xp11.3 might affect the formation of key disulfide bonds in the cystine-knot motif of norrin protein. The ocular phenotype in Norrie’s disease is typically characterized by a glistening mass known as a “pseudoglioma” behind the lens and thick fibrovascular proliferative vitreoretinopathy attached to the posterior aspect of the lens, and the extra-ocular manifestations of Norrie’s disease include hearing loss, cognitive impairment, behavior disturbance and seizures. Prenatal diagnosis and early retinal laser photocoagulation or vitrectomy intervention can improve the natural course of patients with Norrie’s disease to some extent. (Int Rev Ophthalmol, 2021, 45：437-442)


Role of exosomes in the pathogenesis and treatment of fundus diseases

Fan Xiaole, Jiang Bo, Sun Dawei, Zhang Zhongyu

2021, 45(5):  442-448.  doi:10.3760/cma.j.issn.1673-5803.2021.05.014

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Exosomes are small vesicles secreted into the extracellular cells after the fusion of intracellular polycystic bodies and cytoplasmic membranes. Exosomes contain a variety of active substances, and their roles in intercellular communication, disease progression or as biomarkers have been gradually concerned by researchers of fundus diseases. Studies have shown that exosome is involved in the pathological process of wet age-related macular degeneration (wAMD), while mesenchymal stem cell exosomes reduce the transcription and translation of vascular endothelial growth factor (VEGF) in wAMD. In rat diabetic retinopathy, IgG-containing exosomes in plasma activate the classical complement pathway in the retina to promote endothelial injury; while mesenchymal stem cell derived exosomes containing miR-126 can limit endothelial cell injury. In ischemic retinopathy, exosomes of bone marrow mesenchymal stem cells restore retinal function in ischemic mice. Studies on patients with macular hole showed that mesenchymal stem cell exosomes isolated from human umbilical cord tissue combined with vitrectomy had therapeutic effect on macular hole. Exosomes secreted by mesenchymal stem cells in patients with retinal detachment can inhibit the apoptosis of photoreceptor cells. Detection of exosome markers in patients with uveal melanoma is expected to be an early diagnosis method for uveal melanoma. Exosomes secreted by microglia have protective effect on retinoprthy of prematurity. With the understanding of exosome system and its related signal transmission mechanism and disease outcome process in fundus diseases, it is of great significance to optimize treatment and prevention of fundus diseases. (Int Rev Ophthalmol, 2020, 45：442-448)


Optimal selection of animal models in the pathogenesis study of diabetic retinopathy

Wang Qiyun, Zhang Xinyuan, Lin Xiao

2021, 45(5):  449-454.  doi:10.3760/cma.j.issn.1673-5803.2021.05.015

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Diabetic retinopathy (diabetic retinopathy, DR) is characterized by retinal micro-vasculopathy and neuronal degeneration. At present, a variety of animal models have been developed for DR research through drug and diet induction and genome editing. Among the animals, rodents are the most commonly used mammals for studies of pathogenesis of DR, especially in the fields of genetic research, drug intervention (especially gene therapy, stem cell transplantation) and others. Due to the specific structure of macular which cannot be found in other animals, the non-human primates animal model has become significant important for DR research because its pathophysiological characteristics are very similar to those of human beings. In addition, dogs, pigs, cats, zebrafish ect are also utilized for establishing models of DR. Whether the DR model was induced or spontaneous established, most of them can only be found to show the lesions of early stage of DR, such as retinal microaneurysm, hard exudate, punctate and macular retinal hemorrhage, retinal vein dilatation, abnormality of retinal micro-vessels and so on. Only a few of them can be induced to show some late clinical features of DR, these typical clinical sign usually can be induced by local ischemia or injection of vascular endothelial growth factor. (Int Rev Ophthalmol, 2021, 45：449-454)


Relationship between circular RNA and retinal development and retinal diseases

Jiang Meixia, Lin Tingting

2021, 45(5):  455-458.  doi:10.3760/cma.j.issn.1673-5803.2021.05.016

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Circular RNA (circRNA) is a special type of non-coding RNA molecule ubiquitous in eukaryotes. It has a closed loop structure, and is highly conservative and stable, and has a regulatory role in a variety of diseases. CircRNA can participate in the regulation of retinal inflammation, cell apoptosis, angiogenesis, and oxidative stress response, etc., and plays an important regulatory role in eye development and disease progression. The change of circRNA may be earlier than the change of the fundus morphology, so the circRNA detected in tissues, saliva, blood and exosomes is expected to be used for biomarkers for diagnosis and prognosis of retinal diseases (such as glaucoma, diabetic retinopathy, proliferative vitreoretinopathy, age-related macular degeneration, etc.). Intervention of circRNA expression can significantly affect the biological functions of vascular endothelial cells and regulate vascular permeability. It is expected to be used as a gene therapy method to provide a new direction for the treatment of retinal diseases.(Int Rev Ophthalmol, 2020, 45: 455-458)



TGFβ-related signaling pathways in proliferative vitreoretinopathy

Zhang Wuyue, Sang Aimin

2021, 45(5):  459-inside back cover.  doi:10.3760/cma.j.issn.1673-5803.2021.05.017

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Proliferative vitreoretinopathy (PVR) is a common cause of failure and recurrence of retinal detachment surgery. The pathophysiological mechanism of PVR is complex, and TGF-β-mediated signaling pathway network plays an important role in the formation of PVR. In this paper, we reviewed the progress of TGF-β -mediated MAPK, Notch, Akt, BMP, RhoA/ROCK, PKA, and JAK/STAT signaling pathways in PVR, and illustrate their important roles in the formation of PVR, so as to provide a new idea for clinical treatment. (Int Rev Ophthalmol, 2020, 45：459-inside back cover)