Table of Content

22 December 2021, Volume 45 Issue 6

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Techniques and progress of 24-hour intraocular pressure measurement

Zhang Yuning, Yang Yangfan, Yu Minbin

2021, 45(6):  465-470.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.001

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Intraocular pressure(IOP) has a fluctuation and circadian rhythm. Twenty-four-hour IOP is significant for the diagnosis, treatment and therapeutic assessment of glaucoma. In the clinic 24-hour IOP measurement via multiple IOP measurements by tonometers, fails to capture the true information of dynamic IOP. Implant tonometry consists of simple implant tonometry and compound implant tonometry, with a pressure sensor directly implanted in the eye to realize long-term or permanent IOP monitoring. Contact lens tonometry could monitor 24-hour IOP continuously by means of contact lenses inserted with a sensor that can detect corneal deformation related to IOP changes. Continuous tonometry shows a bright application prospect in studying the changes of IOP, and assisting in the diagnosis and therapeutic decision-making of glaucoma. (Int Rev Ophthalmol, 2021, 45: 465-470)

The mechanism of palmitoethanolamide in the treatment of glaucoma

Tang Liying, Xie Tingyu, Zhang Mouxin, Liu Zuguo

2021, 45(6):  471-476.  doi:10.3760/cma.j.issn.1673-5803.2021.06.002

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Palmitoylethanolamide(PEA) is a member of fatty acid ethanolamide(FAE) family. At present, PEA has been proved to reduce intraocular pressure, regulate blood supply of optic nerve and neuroprotective effects, and may become a new approach for the treatment of glaucoma. PEA may treat glaucoma by regulating aqueous outflow channel, inhibiting inflammatory response, regulating blood supply to optic nerve and protecting optic nerve. (Int Rev Ophthalmol, 2021, 45: 471-476)





T&E regimen for diabetic macular edema

Yin Lidong, Jiang Bo, Zhang Zhongyu, Sun Dawei

2021, 45(6):  477-482.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.003

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The first-line clinical treatment for diabetic macular edema (DME) is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF). Treat and extend (T&E) is an active treatment regimen in which patients are treated until the lesion is stable and the interval of treatment can be extended or shortened during the follow-up period depending on whether the disease is stable. This regimen is being progressively used in the treatment of patients with DME. Compared with commonly used treatment regimens, the T&E regimen reduces the risk of fewer fixed injections per month and overtreatment while avoiding the possibility of undertreatment every two months. Follow-up intervals can be adjusted according to best-corrected visual acuity (BCVA) or central retinal thickness (CRT), and regular treatment can improve vision and anatomy as compared to on-demand treatment regimens. However, there is no unified standard for the design of T&E protocol in the current study, and more clinical studies are needed to further standardize it. (Int Rev Ophthalmol, 2021, 45: 477-482)

Role of glial cells in the occurrence and development of diabetic retinopathy

Lin Peijie, Zhao Qian, Fan Wei, Lai Mingying

2021, 45(6):  483-487.  doi:10.3760/cma.j.issn.1673-5803.2021.06.004

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The pathogenesis of diabetic retinopathy(DR) is still unclear. During the occurrence and development process of DR, retinal glial cells(including astrocytes, Müller cells and microglial cells) react becoming activated and undergo a series of changes: glial fibrillary acidic protein expression, decreased glutamic acid metabolism, up-regulated aldose reductase activity, increased oxidative stress, secretion of pro-inflammatory signals. Excessive activation of glial cells plays an important role in the DR course.(Int Rev Ophthalmol, 2021, 45: 483-487)





Research progress of diabetic optic neuropathy

He Shan, Hu Ailian

2021, 45(6):  488-494.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.005

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Diabetic optic neuropathy(DON) is on the rise year by year with the increasing prevalence of diabetes and has become a significant cause of blindness and disability in the world. The manifestations of DON include diabetic papillopathy, neovascularization of optic disc, non-arteritic anterior ischemic optic neuropathy and optic nerve atrophy. Fundus fluorescein angiography, optical coherence tomography angiography, perimetry and visual electrophysiological examination have important diagnostic value for DON. The factors affecting DON are complex, including diabetes duration, severity of diabetic retinopathy, blood glucose control and so on. The occurrence and development of DON is related to diabetes-related metabolic regulation, advanced glycation end products, oxidative stress and hemodynamics, which provides a research direction for the prevention and treatment of DON. Retinal photocoagulation, intravitreal injection of anti-VEGF and glucocorticoid,  can effectively prevent the progression of DON and improve the visual function of patients. (Int Rev Ophthalmol, 2021, 45: 488-494)

Role of pupil diameter in the course of diabetes mellitus

Sun Changce, Zhang Xiaojun

2021, 45(6):  495-498.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.006

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The most common pupillary manifestations of autonomic neuropathy in diabetic patients include decreased pupillary diameter, reduction of pupillary constriction and dilation, and decreased sensitivity to anticholinergic drugs. Diabetic autonomic neuropathy is associated with pupillary diameter, and the change of pupillary diameter is of diagnostic value for early diabetic autonomic neuropathy. As a simple, inexpensive, accurate and sensitive method for the detection of early diabetic autonomic neuropathy, pupil diameter measurement has the potential to improve the prognosis of patients with diabetic neuropathy. (Int Rev Ophthalmol, 2021, 45: 495-498)

Performance of choroidal tumors on optical coherence tomography and optical coherence tomography angiography

Wang Qimiao, Wei Pinghui, Xie Shiyong, Pang Yaju

2021, 45(6):  499-505.  doi:10.3760/cma.j.issn.1673-5803.2021.06.007

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Optical coherence tomography(OCT) can be used for the observation and diagnosis of choroidal tumors(such as choroidal melanoma, choroidal metastasis, choroidal hemangioma, choroidal osteoma, etc.). The tumor surface morphology, the degree of retinal edema, the retinal inferior fluid, photoreceptor layer changes, retinal structural integrity, choroidal thickness, and abnormal reflection structure can be described qualitatively and quantitatively by OCT. Optical coherence tomography angiography (OCTA) can observe the characteristics of retinal and choroidal blood flow in the tumor and its surrounding tissues, and guide the treatment of choroidal tumors to a certain extent. (Int Rev Ophthalmol, 2021, 45: 499-505)



The value of OCT/OCTA in predicting visual function after pars plana vitrectomy of rhegmatogenous retinal detachment

Hu Weiwen, Huang Xionggao

2021, 45(6):  506-512.  doi:10.3760/cma.j.issn.1673-5803.2021.06.008

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Optical coherence tomography(OCT) and optical coherence tomography angiography(OCTA) can be used to study the retinal microstructure and microvascular morphology of patients with rhegmatogenous retinal detachment(RRD). OCT/OCTA parameters, such as retinal thickness, photoreceptor layer status, subretinal fluid, outer retinal fold, macular cystoid edema, epiretinal membrane, macular hole, preoperative macular state, retinal capillary plexus and foveal avascular zone, are related to visual function after pars plana vitrectomy of RRD. As a supplement to visual function examination, OCT/OCTA has important guiding value in the analysis and prediction of visual function after pars plana vitrectomy of RRD.(Int Rev Ophthalmol, 2021, 45: 506-512)

The role of exosomes derived from mesenchymal stem cells in the treatment of retinal degenerative diseases

Sun Hanhan, Liu Xianning, Zhang Hongbing, Wang Yao

2021, 45(6):  513-518.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.009

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Mesenchymal stem cells are a type of multifunctional stem cells with self-renewal ability, multi-differentiation potential and immune regulation. The exosomes derived from mesenchymal stem cells have similar biological properties as mesenchymal stem cells. They are nano-scale, high in stability, low in immunogenicity, easy to obtain and preserve, and can easily pass through biological barriers to enter target organs. Studies have shown that bioactive substances such as proteins, lipids and DNA, mRNA and non-coding RNA carried by the mesenchymal stem cell-derived exosomes can play a role in the treatment of retinal degenerative diseases(such as age-related macular degeneration and retinitis pigmentosa) by anti-inflammatory, inhibiting of neovascularization and protecting of retinal photoreceptor cells, which may provide new treatment options for degenerative retinal diseases. (Int Rev Ophthalmol, 2021, 45: 513-518)





Role of myeloid cell trigger receptor-1 in the pathogenesis of ophthalmopathy

Tang Qiuyang, Shi Haihong

2021, 45(6):  519-522.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.010

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Triggering receptor expressed on myeloid cell-1(TREM-1) is a cell surface receptor belonging to the immunoglobulin superfamily. Its signaling pathway participates in the amplification of inflammatory response, and inhibition of its pathway can reduce inflammation level. In eye diseases, both in animal model and clinical infectious keratitis patients, the expression of TREM-1 in corneal tissues is significantly increased compared with normal cornea, which can expand the inflammatory response of keratitis, and is positively correlated with inflammatory mediators and clinical inflammation scores. Inhibition of its signaling pathway can reduce corneal inflammatory response to varying degrees, affecting the clinical prognosis of keratitis. In addition, the expression of TREM-1 was significantly increased in relevant tissues of animal models of ocular toxoplasmosis, ischemic optic neuropathy and retinal neovascular disease.TREM-1 blocker(LR12) is currently in phase II clinical trials. (Int Rev Ophthalmol, 2021, 45: 519-522)

Surgical treatment of lens dislocation

Wang Juexue, Wan Xiuhua

2021, 45(6):  523-529.  doi:10.3760/cma.j.issn.1673-5803.2021.06.011

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Lens dislocation can be treated differently depending on its severity and complications. Lens luxation back to vitreous body can be treated conservatively with contact lenses, and if glaucoma, persistent uveitis, or corneal injury occurs, emergency surgical intervention is required. Phacoemulsification combined with intraocular lens(IOL) implantation can be selected for a small dislocation range(<180°), and tension ring implantation can be combined for severe zonule damage. The IOL can be fixed to the iris or sclera with or without suture, or with capsular support devices.(Int Rev Ophthalmol, 2021, 45: 523-529)





Research on the mechanism of lenticular senescence

Fu Yushan, Zhou Nan, Qi Yanhua

2021, 45(6):  529-534.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.012

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Lens epithelium is the center of lens metabolism,  and its senescence will lead to cataract. Several mechanisms are involved in the progression of cataract including: shortening of telomere length in lens epithelial cells,  the long-term existence of intracellular oxidative stress activating multiple inflammatory pathways involved in cell signaling,  decreased autophagy activity,  and the inactivation of the anti-aging enzyme -SIRT. Meanwhile,  the damage of protein and lipid homeostasis in lens and the imbalance of water balance will accelerate the process of lens aging. (Int Rev Ophthalmol,  2021,  45: 529-534)



Role of inflammation in pathogenesis of meibomian gland dysfunction

Xie Luoying, Yan Xiaoming

2021, 45(6):  535-540.  doi:10.3760/cma.j.issn.1673-5803.2021.06.013

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Meibomian gland dysfunction(MGD) is the main cause of dry eye and is also a common disease in ophthalmology clinic. The main mechanism of MGD is terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. The response of meibomian gland to inflammatory stimuli, the antibacterial and anti-inflammatory meibum, androgens and peroxisome proliferator-activated receptor gamma (PPAR-γ) involved in the regulation of inflammation may mediate the meibomian gland's resistance to inflammatory cell infiltration. Dysbacteriosis of meibomian gland and infection of demodex can induce inflammation and thus affect the pathogenesis and development of MGD. To clarify the role and mechanism of inflammation in MGD will provide new ideas and theoretical basis for the prevention and treatment of MGD. (Int Rev Ophthalmol, 2021, 45: 535-540)

Mucins and ocular surface disease

Zhang Chen, Fang Zijie, Zhao Shaozhen

2021, 45(6):  540-545.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.014

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Ocular surface mucins are a group of large and complex heavily glycosylated proteins, that cover all the surface of ocular. They can be divided into secretory mucins and membrane-associated mucins, which play a key role to lubricate and maintain integrity of the ocular surface. Ocular surface mucins are closely related to ocular surface diseases, including dry eye, infection, allergy and immune diseases. Mucins can connect water into glue, prevent the evaporation of tear. They also interact with a variety of inflammatory factors and play an important role in maintaining the epithelial cell barrier of the ocular surface. In addition, mucins can also participate in intracellular signal transduction and play an anti-infection role. To date, many medicines have been observed as secretagogues of mucins, such as diquafosol sodium, rebamipide, nerve growth factor and thymosin, etc. The emergence of these drugs has brought more therapeutic targets for many ocular surface diseases such as dry eye. (Int Rev Ophthalmol, 2021, 45: 540-545)

Research progress on the pathogenesis of pterygium

Zhang Xin, Jiang Yaping, Chen Yihui

2021, 45(6):  546-550.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.015

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Pterygium is a common ocular surface disease. Long-term chronic ultraviolet radiation is the most important factor in the development of pterygium. The oxidative stress, chronic inflammation, hyperplasia and apoptosis, extracellular matrix remodeling and heredity caused by ultraviolet rays are important mechanisms of the pathogenesis of pterygium. In addition to the  P53 gene mutations, epigenetics including m6A methylation, DNA methylation, and various non-coding RNA regulation are also found to play an important role in the pathogenesis of pterygium. (Int Rev Ophthalmol, 2021, 45: 546-550)





The molecular biological mechanism of restarting and regulating the visual cortex plasticity in adult amblyopia

Sun Yaling, Yan Xingke, Liu Anguo

2021, 45(6):  550-555.  doi:10.3760/cma.j.issn.1673-5803.2021.06.016

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Adult visual cortex plasticity may be associated with "brakes", visual related signaling pathways and cellular molecules. “Brakes” limit plasticity by altering neural transmission between parts and connections, blocking these "brakes" can promote the recovery of dendritic spines density in pyramidal cells of the visual cortex, increase the frequency of miniature excitatory synaptic current and spinal density on neuron dendrites, and enhance visual evoked potential to reactivate the plasticity in adult visual cortex plasticity and treat amblyopia. The abnormity of NRG1-ErbB4 and PSA-NCAM signaling pathways also change the plasticity, structure and function of neuron morphology. The blocking of N-methyl-D-aspartate-receptor, cyclin-dependent kinase 5 and histone deacetylase can promote long-term potentiation, regulate V1 chromatin structure and transcription in adults to regulate reactivation of visual cortex plasticity in adults.(Int Rev Ophthalmol, 2021, 45: 550-555)

The relationship between accommodation and convergence and refractive errors in patients with intermittent exotropia

Zhang Lu, Guo Changmei

2021, 45(6):  556-560.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.017

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Intermittent exotropia (IXT) shows abnormal accommodation and convergence. The mechanism of the change of accommodation and convergence is related to the formation of binocular monovision in order to control the exotropia in IXT patients, and excessive accommodation while using fusional convergence. There is an interactive relationship between IXT and myopia. The asymmetry between the IXT fixing eye and the deviating eye can indicate the reason for the difference in myopia progression between the two eyes and provide advice on the choice of surgical approach.(Int Rev Ophthalmol, 2021, 45：  556-560)





Munchausen syndrome and its eye manifestation

Li Li, Zhang Zhen, Zhang Yue, Li Simin, Zhao Fanning, Sun Xuguang

2021, 45(6):  560-564.  doi:10.3760/ cma.j.issn.1673-5803.2021.06.018

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Munchausen syndrome,  a kind of factitious disorder,  belongs to mental illness. It mainly refers to the syndrome in which the patient,  by imitating or creating physical symptoms or signs,  pretends to be a sick personfor the purpose of seeking medical help and getting attention. Clinical presentation of Munchausen syndrome can start with ocular symptoms or only involve ocular tissue. The form is various,  such as intraocular foreign bodies,  ocular pain without causes,  spontaneous dislocated eyeball and rupture of eyeball caused by self-injury. In severe cases vision loss,  enucleation and other adverse outcomes can be caused. Most ophthalmic clinicians have low recognition and vigilance for Munchausen syndrome,  so there are great challenges in its early diagnosis and treatment. (Int Rev Ophthalmol,  2021,  45: 560-564)