Table of Content

22 February 2022, Volume 46 Issue 1

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Effect of anti-VEGF therapy on retinal ischemia in diabetic retinopathy

Hou Simeng, Li Yibin

2022, 46(1):  1-4.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.001

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Retinal ischemia is one of complications of diabetic retinopathy (DR), commonly evaluated by retinal nonperfusion area (RNP) which has a strong relationship with high expression of vascular endothelial growth factor (VEGF) in the process of DR. Previous studies found that VEGF played an important role in endothelial cell hypertrophy, leukocyte plugging in the development of retinal vessel closure, while RNP could be successfully improved after anti-VEGF treatment. However, many clinical data showed that anti-VEGF treatment was incapable of stopping the progression of RNP. Besides, the studies based on OCTA demonstrated that anti-VEGF contributed to retinal reperfusion, but the effect on intraretinal microvascular abnormalities (IRMA ) and RNP around showed different results: RNP could be reperfused, stable or deteriorated. Further studies about the mechanism of anti-VEGF on RNP deterioration are still needed for stopping even reversing retinal ischemia and RNP in DR. (Int Rev Ophthalmol, 2022, 46: 1-4)

Roles of oxidative stress in diabetic retinopathy

Liu Yu, Li Lele, Sang Aimin

2022, 46(1):  5-10.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.002

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Diabetic retinopathy (DR) is not only a common complication of diabetic patients, but also one of the serious microvascular complications. There are many reasons for the occurrence of DR, the exact pathogenesis is still unclear, but oxidative stress has an important relationship with the occurrence and development of DR. Oxidative stress activates DR through advanced glycation end products (AGE) pathway, polyol pathway, hexosamine pathway and protein kinase C (PKC) pathway, generates a large number of reactive oxygen species (ROS), damages retina, leads to oxidative damage of DNA, and finally leads to apoptosis. The increase of oxidative stress level activates cytokines, and cytokines can further up regulate the level of oxidative stress and form a vicious circle. (Int Rev Ophthalmol, 2022, 46: 5-10)

Application of OCTA parameters in diagnosis and treatment of eye diseases

Li Yingying, Feng Jie, Ding Tianjiao

2022, 46(1):  11-16.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.003

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Optical coherence tomography angiography (OCTA) is a new technique for ocular vascular imaging, which has been widely used in the angiogenesis of retina, choroid and optic nerve. It can provide not only the morphological information of retinal vessels, but also the quantitative measurement of fundus vascular density. OCTA measurement parameters include macular superficial retinal capillary network (superficial capillary plexus, SCP) density, retinal deep capillary network (deep capillary plexus, DCP) density and macular fovea non-vascular area (foveal avascular zone, FAZ) area and so on. Retinal microvascular system is an important basis for maintaining visual function, and retinal vascular density is an index to measure the state of retinal microvascular circulation. Macular SCP density, DCP density and FAZ area are related to the occurrence and development of many eye diseases, such as retinal obstructive disease, macular hole, diabetic retinopathy, high myopia, central serous chorioretinopathy and age-related macular degeneration. It is of great clinical significance to observe the early changes of fundus blood flow and to explore the pathogenesis and curative effect evaluation of related ocular diseases by OCTA.(Int Rev Ophthalmol, 2022, 46: 11-16)

Residual astigmatism after Toric intraocular lens implantation

Wei Ke, Zhao Zhennan, Jiang Yongxiang

2022, 46(1):  16-21.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.004

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Toric intraocular lenses is a stable and effective solution for astigmatism in cataract patients. While unexpected postoperative residual astigmatism remains in some patients, which will affect the postoperative visual quality. The common causes of postoperative residual astigmatism include instrument measurement error, calculation error, operation related factors and intraocular lens rotation, etc. In order to reduce postoperative residual astigmatism, appropriate treatment should be adopted according to the severity and causes, such as using glasses, contact lenses or femtosecond laser assisted excimer laser insitu keratomileusis (FS-LASIK), etc. and intraocular lens realignment of necessary. (Int Rev Ophthalmol, 2022, 46: 16-21)

Intraocular lens modification for prevention of posterior capsule opacification

Li Meng, Mao Yingyan, Wan Xiuhua

2022, 46(1):  22-28.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.005

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Posterior capsule opacification (PCO) is the most common complication after cataract surgery. PCO is formed by the proliferation, migration, epithelial-mesenchymal transition, and wound healing reaction of the residual lens epithelial cells after cataract surgery. Modification of the intraocular lens (IOL) to prevent and treat PCO has the advantages of excellent targeting efficiency and fewer follow-up medical intervention. According to the effect materials of IOL modification, it can be classified into two types: drug loading and non-drug modification. According to whether the effect of preventing or inhibiting PCO can be controlled, it can be classified into the controllable modification and non-controllable modification. (Int Rev Ophthalmol, 2022, 46: 22-28)

Genetic study of congenital lens ectopic

Zhang Jing, Zhao Junhong, Li Junlin

2022, 46(1):  28-33.  doi:10.3760/cma.j.issn.1673-5803.2022.01.006

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Congenital ectopic lens presents obvious genetic predisposition, so far, related genes include FBN1 and their family genes, ADAMTS family genes, CBS gene, LTBP2 gene, TGFBR2 gene, etc.. Related diseases involve Marfan syndrome, congenital contractural arachnodactyly (CCA) syndrome, Weill-Marchesani syndrome (WMS), homocystinuria (HCU), etc. The mutation of genes leads to abnormal assembly and degradation of microfibers in the suspensory ligament of the lens, resulting in ectopia of the lens, the study of pathogenesis and gene animal experiments are in the groping stage. (Int Rev Ophthalmol, 2022, 46: 28-33)

Ocular structural changes after congenital cataract surgery

Liu Jingying, Song Xiaobei, Liu Xian, Gu Xuejun

2022, 46(1):  34-38.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.007

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Abnormal eye development of congenital cataract (CC) children is correlated with visual deprivation obscuring the visual axis. Reliable estimates of the associated characteristics of anterior and posterior segmental biometry can benefit the guidelines for CC treatment. The thickness of the central cornea increased and the axial length tended to increase normally after the operation, while the changes of corneal endothelial cells, thickness of retina and choroid have certain differences, which may be related to the surgeon, the research subjects, with or without intraocular lens (IOL) implantation, the duration of follow-up, the research methods, the selection of the control group and other factors.(Int Rev Ophthalmol, 2022, 46: 34-38)

Application of different visual function examinations on evaluation of surgery indication in early cataracts

Li Yuzhi, Huang Yukan

2022, 46(1):  39-44.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.008

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As cataract surgery has entered the era of refractive surgery from the era of rejuvenation surgery, its significance and indications have undergone significant changes. The influence of visual quality instead of visual acuity has become the most important factor in evaluating whether a patient has surgical indications, but at present, there is no conclusion on which visual quality evaluation indicators is used to determine the basis for surgery. The subjective visual indicators used in the present study included visual acuity, contrast sensitivity, contrast visual acuity and visual function quality of life scale; objective visual indicators include objective scattering index, modulation transfer function, modulation transfer function cutoff frequency and Strehl ratio, etc. It is recommended to use objective evaluation as the basis and combining with the subjective indicators for timing selection of early cataract surgery, to provide a guarantee for improving postoperative satisfaction of patients.(Int Rev Ophthalmol, 2022, 46: 39-44)

Application of glucocorticoids on the treatment of infectious keratopathy

Tang Jing, Deng Yingping, Sun Xuguang

2022, 46(1):  45-50.  doi:10.3760/cma.j.issn.1673-5803.2022.01.009

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Infectious keratitis is a risk of corneal related blindness, and anti-infection is the main treatment approach, while the glucocorticoid therapy remains controversial. The appropriate utilization of the glucocorticoid in different infectious keratitis could be helpful for the anti-inflammatory effect and release the complications. It was suggested that the glucocorticoid could be used in the bacterial keratitis after 48 hours antibiotic treatment, which can reduce the formation of corneal scarring. The glucocorticoid used in the viral keratitis is still limited in the stromal and endothelial infection, which could obviously alleviate the inflammation. Glucocorticoids are easily worsen the exacerbation of fungal keratitis, so it could be only used after the fungal infection was controlled. Glucocorticoid utilized in acanthamoeba keratitis has gotten some progress in the basic research, but still no consensus on the timing of use. (Int Rev Ophthalmol, 2022, 46: 45-50)

Correlation between androgen and dry eye

Zhang Peng, Jie Ying

2022, 46(1):  51-54.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.010

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Dry eye is a multifactorial disease of the ocular surface, which occurs more frequently in women than men, especially postmenopausal women. This sex-related difference in dry eye prevalence is attributed in large part to the effects of sex steroids. At present，the role of estrogen at the ocular surface is less well defined, but the protective effect of androgen at the ocular surface have been clear. Androgen on the ocular surface is mainly derived from the synthesis of androgen precursor in local tissues. Androgen functions by combining with androgen receptors on the ocular surface. Animal experiments and clinical studies have confirmed that androgen deficiency can cause destruction of the lacrimal gland, leading to aqueous deficient dry eye, or meibomian gland dysfunction, reducing the lipid component of the tear film, leading to evaporative dry eye and androgen replacement therapy can be considered to treat aqueous-deficient dry eye and evaporative dry eye. (Int Rev Ophthalmol, 2022, 46: 51-54)

Dry eye disease associated with Sjogren's syndrome

Liu Yuxiu, Ding Lin

2022, 46(1):  55-60.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.011

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Sjogren's syndrome-related dry eye disease (Sjgren's syndrome-related dry eye disease, SS-DED) is a chronic, progressive, and inflammatory autoimmune disease, which refers to dry eye disease (DED) secondary to sjgren's syndrome invading the lacrimal gland, which manifests a series of uncomfortable synptoms such as dry eyes and photophobia. At present, the pathogenesis of SS-DED is still unclear, and studies have found that it is mostly related to factors such as immune dysfunction, genetics, environment, and microbial infections. The treatment principle of SS-DED is to control the condition, relieve symptoms and reduce complications. The treatment includes glucocorticoids, immunosuppressive agents and biological agents. However, the treatment of SS-DED is more difficult and usually requires collaboration between ophthalmologists and rheumatologists. (Int Rev Ophthalmol, 2022, 46: 55-60)

Early diagnoses of keratoconus

He Xi, Li Shiming

2022, 46(1):  60-65.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.012

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Keratoconus is a kind of corneal disease which mostly affect adolescent and could cause blindness, characterized with significant thinning as well as cone-like protruding of cornea. Advanced stage of the disease could be diagnosed by clinical symptoms and examinations of ocular anterior segment easily. However, it is difficult to detect when keratoconus is of early stage, including suspected keratoconus, subclinical keratoconus and forme fruste keratoconus, due to its subtle corneal changes and mild vision loss. Corneal topography is now the most common method being used to diagnose the disease. As another approach to obtain corneal morphology, optical coherence tomography gradually gains more attentions. Ocular reactive analyzer and Corvis ST device could find structure alternations earlier than morphologies by measuring ocular biomechanical parameters. A number of parameters could be obtained by various devices, artificial intelligent technologies has already been used to investigate the regulations of those parameters in diagnosing early keratoconus. Additionally, susceptible genes or biomarkers been investigated would be helpful to differentiate high risk population, reminding them to have ocular examinations regularly in order to find abnormalities as early as possible. (Int Rev Ophthalmol, 2022, 46: 60-65)

Application of polymerase chain reaction detection on the diagnosis of tuberculous uveitis

Xu Huirong, Chen Fang

2022, 46(1):  66-70.  doi:10.3760/cma.j.issn.1673-5803.2022.01.013

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Nowadays, the diagnosis of tuberculous uveitis is still difficult to confirm for whose pathogen is nearly unavailable. As a popular molecular detection method that could amplify the nucleic acid of specific pathogens with trace samples, polymerase chain reaction (PCR) is suitable for the diagnosis of tuberculous uveitis. In clinical practice, the types of PCR technology, intraocular fluid sample and the selection of the target gene sequence and patients, may affect the sensitivity of the PCR detection to a certain extent. Better understanding of the pathogenic mechanism and the anti-tuberculosis response in tuberculous uveitis will do a great help for clinicians to analyze the PCR detection results and treatment outcome from different perspectives.(Int Rev Ophthalmol, 2022, 46: 66-70)

Damage and remodeling of stereopsis caused by anisometropia

Tang Li, Zhang Li

2022, 46(1):  71-75.  doi:10.3760/cma.j.issn.1673-5803.2022.01.014

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Stereopsis is the most advanced form of binocular vision, and its formation mechanism is complicated. Anisometropia is a common cause that damages stereo vision. In terms of optical factors, anisometropia can easily increase binocular parallax and lead to amblyopia. In terms of non-optical factors, the distribution of photoreceptor cells in the retina and the function of neurons in the visual cortex are both potentially affected by anisometropia. Together, these changes affect the development of the brain's visual cortex and further impair stereo vision. The key to stereoscopic remodeling is to regulate the activity of neurons to improve the plasticity of cerebral cortex after optical correction. (Int Rev Ophthalmol, 2022, 46: 71-75)

Methods for measuring strabismus objectively

Zhou Yusong, Zhuang Yijing, Li Jinrong

2022, 46(1):  76-79.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.015

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Strabismus measurement is of great significance in the diagnosis and treatment of strabismus. Among a series of examinations, the measurement of deviation is particularly important. Currently, the results assessed by the prism-cover test (PCT) are mainly used as the "gold standard" in clinical practice. However, it relies strongly on the experience and subjective judgment of the examiner. Therefore, to improve the repeatability and objectivity of the evaluation procedures, and reduce the difficulty and time of the examination, attempts were made to develop objective automated strabismus measurement devices.They base on virtual reality (VR), infrared camera, or eye tracker, to perform the objective measurement of strabismus by simulating the traditional inspection methods or using some other novel methods. (Int Rev Ophthalmol, 2022, 46: 76-79)

Research progress of retina injury in acute ocular hypertension

Zhang Xinyi, Yang Yangfan, Yu Minbin

2022, 46(1):  80-84.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.016

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Acute ocular hypertension is a leading cause of retinal damage, vision impairment and even blindness during the acute attack of glaucoma. The rapid elevation of IOP in a short period of time can induce retinal ganglion cell apoptosis and tissue damage in all retinal layers (retinal thinning, reduction of retinal cells, changes of blood perfusion) through the mechanism of ischemia reperfusion injury, and the visual function (visual acuity, visual field, electrophysiological examination ) will change as well. (Int Rev Ophthalmol, 2022, 46: 80-84)

Clinical applications of ultra-widefield multimodal fundus imaging on intraocular tumors

Feng Yu, Wang Qian, Wei Wenbin

2022, 46(1):  85-91.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.017

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Advances in fundus imaging technology have enabled transformative shifts in the diagnosis and management of intraocular tumor (such as retinoblastoma, choroidal melanoma, primary vitreoretinal lymphoma, retinal capillary hemangioma and metastatic carcinoma). With each successive improvement in ultra-widefield fundus, fluorescein fundus angiography, fundus autofluorescence and indocyanine green fundus angiography, our observations on the nature, location, and secondary lesions caused by the tumor has become increasingly rich with the additional information that multimodal imaging paradigm provides. Although there is still a lack of standards for application and diagnostic criteria and are still problems such as low resolution, pseudocolor image, warping of the retinal area and artifact, ultra-widefield imaging plays a greater role in new medical models such as clinical diagnosis and treatment and telemedicine. It is reasonable to expect that with continued technological advances in multimodal widefield imaging that our ability to capture further detail and resolution of the retina will continue to expand. Ultra-widefield will become the standard-of-care imaging modality for many diseases and find more new clinical and research applications such as for screening and telemedicine. (Int Rev Ophthalmol, 2022, 46: 85-91)

Research progress on secondary orbital melanoma

Wang Jinjin, Ma Jianmin

2022, 46(1):  91-96.  doi:10.3760/ cma.j.issn.1673-5803.2022.01.018

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Secondary orbital melanoma is a common type of orbital melanoma and has complicated origins. The most common primary tumor is choroidal melanoma, followed by conjunctival melanoma and cutaneous melanoma, and rarely caused by eyelid and paranasal sinus melanoma. According to the difference of primary tumor, the symptoms and signs manifest various, such as proptosis, diplopia, visual damage and pain. Diagnosis of this disease tend to be difficult. It is spiny and vital to be distinguish from primary orbital melanoma. Histopathological examination can help clinicians gain the diagnosis of melanoma, CT and MRI show the primary focus. Surgery is the main treatment, and adjuvant radiotherapy and chemotherapy should be considered. At present, immunotherapy has shown promising prospects in the theatment of secondary orbital melanoma caused by distant metastasis. As a kind of highly malignant tumor, prognosis of this disease is difficult to predict because of its perplexing origins as early as possible. (Int Rev Ophthalmol, 2022, 46: 91-96)