Table of Content

22 February 2023, Volume 47 Issue 1

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Direct measurement and intraocular distribution of intraocular pressure

Ji Yiting, Lin Haishuang, Zhou Mengtian, Xie Yanqian, Liang Yuanbo

2023, 47(1):  1-5.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.001

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Accurate intraocular pressure (IOP) measurement is crucial in eye diseases such as glaucoma. Direct measurement of intraocular pressure can avoid the influence of the cornea on the measurement accuracy and clarify the pressure in the posterior eye segment as well as the distribution of the pressure inside the eyeball. Safe and minimally invasive devices are currently available for the pressure measurement of the anterior chamber and the vitreous cavity. Pupillary block, aphakia and the changes in the composition of the vitreous cavity can affect the pressure distribution in the anterior chamber and the vitreous cavity. Performing intraocular pressure measurements can provide more information and new ideas for diagnosis and treatment of malignant glaucoma and other certain diseases. (Int Rev Ophthalmol, 2023, 47: 1-5)

Research progress of multichannel aqueous humor drainage surgery in treatment of advanced glaucoma

Jiao Kexin, Li Yawen, Zhao Min, Yan Xiaowei, Tang Guangxian, Zhang Hengli

2023, 47(1):  6-11.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.002

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Multichannel aqueous humor drainage surgery through Schlemm canal, suprachoroidal space, deep scleral lake, and subconjunctival filtration jointly promotes aqueous humor outflow and decreases intraocular pressure (IOP), and reduce the incidence of bleb-related complications. The main operations include deep sclerectomy (DS), CO2 laser-assisted sclerectomy surgery (CLASS), penetrating canaloplasty (PCP) and microcatheter-assisted trabeculotomy with deep sclerectomy and trabeculectomy (MATT-DS-Trab). The first two surgical methods retain the inner wall of Schlemm canal and have less interference with the anterior chamber, while the latter two surgical methods combine the excision of trabecular mesh, which overcome the internal and external resistance of Schlemm canal, and achieve good efficacy in the treatment of early and middle glaucoma. Advanced glaucoma requires lower target IOP to protect visual function and prolong visual acuity. This multi-channel aqueous humor drainage surgery provides individualized and precise therapies for patients with advanced glaucoma, improve the success rate of surgery, and reduce the incidence of glaucoma blindness. (Int Rev Ophthalmol, 2023, 47: 6-11)

Rodent models of open-angle glaucoma

Zhang Xinyao, Xu Lijuan, Zhao Yin, Liang Yuanbo

2023, 47(1):  11-17.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.003

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Open-angle glaucoma (OAG) is the most common type of glaucoma. Though the molecular mechanism has not been fully elucidated, ample of studies evidenced that primary OAG correlates with the pathological changes of trabecular meshwork (TM) and distal pathways. This paper focus on the animal models that promote TM structural and functional changes. According to the anatomical structure, these animal models are divided into upstream (injection of exogenous substances into the anterior chamber), middle (laser photocoagulation, ultraviolet irradiation, dexamethasone treatment, benzalkonium chloride stimulation and injection of hypertonic saline into TM) and downstream (closure of episcleral veins, circumlimbal suture and constant light stimulation) obstructive models. The establishment methods, characteristics and underlying mechanisms of the animal models were reviewed aiming to provide strategy for the clinical and basic studies on OAG. (Int Rev Ophthalmol, 2023, 47: 11-17)

Risk factors for acute primary angle closure

2023, 47(1):  18-24.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.004

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Acute primary angle closure (APAC) is an ocular emergency and requires immediate management to avoid blindness. The pathological mechanisms inducing APAC have not been entirely understood. Recent studies summarized the anatomical parameters associated with APAC, including crowded anterior chamber and angle, thicken and anterior moving lens, thinner ciliary body and expansive anterior rotating ciliary process, dynamic changing iris and choroid. Changes in single or multiple anatomical parameters of one or both eyes in such risk groups lead to the onset of APAC, under some predisposing factors (emotions, extreme weather and drugs, etc). (Int Rev Ophthalmol, 2023, 47: 18-24)

Research progress of 24-hour intraocular pressure fluctuation in normal-tension glaucoma

Su Difei, Qing Guoping

2023, 47(1):  24-29.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.005

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Normal-tension glaucoma (NTG) is a chronic progressive optic neuropathy, in which the intraocular pressure (IOP) is within the normal range. More and more evidence shows that NTG accounts for a high proportion of open-angle glaucoma. In the diagnosis of NTG, 24-hour IOP measurement is particularly important, and it is the main sign to differentiate NTG from POAG. The 24-hour IOP monitoring of NTG patients usually shows peak intraocular pressure at night, and the diurnal fluctuation of IOP is often larger than normal. In addition, the average IOP, short-term and long-term IOP fluctuation amplitude and minimum IOP value of 24 h IOP are all the predictive parameters of NTG disease progression. This makes the 24-hour IOP monitoring of NTG patients and individualized treatment based on the characteristics of their 24-hour IOP fluctuation become particularly important. (Int Rev Ophthalmol, 2023, 47: 24-29)

Research progress of lens regeneration

Guo Zhaoxing, Wan Xiuhua

2023, 47(1):  30-35.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.006

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Lens regeneration refers to the process of inducing new lens tissue by constructing a suitable microenvironment for lens development in vitro or in vivo using stem cells as materials. Regenerated lens tissue can be used to establish biological model for drug testing or research the pathological changes of lens diseases, and it is expected to replace artificial lens implantation as a new choice for cataract treatment. At present, the research on it mainly focuses on three aspects: the signal pathway, lens regeneration in vitro and lens regeneration in situ. The Wnt pathway and cell polarity pathway have been further elucidated, human induced pluripotent stem cells have become a new option for in vitro lens regeneration, and the application of minimally invasive procedures has provided the necessary conditions for in situ lens regeneration. (Int Rev Ophthalmol, 2023, 47: 30-35)

Health economic evaluation of telemedicine screening for diabetic retinopathy

Yuan Ziyou, Xie Rui, Li Huilin, Hao Shaofeng

2023, 47(1):  36-42.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.007

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Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus.It is the main cause of low vision and blindness in adults.Screening can enable early diagnosis and treatment of DR, thereby reducing the visual impairment and improving the quality of life. Before organizing large-scale screening,national health departments usually evaluate the effectiveness and the social cost of screening. Inrecent years, many countries and regions have applied telemedicine in primary health institutions to carry out DR screening projects, and used health economics methods to evaluate the cost-effectiveness of screening. Analyzing single or multiple sensitive factors to develop a personalized screening plan to maximize cost-effectiveness. Recent studies on telemedicine in the field of DR screening at home and abroad show that most telemedicine is cost-effective in health economic evaluation, and the development of personalized screening programs can optimize the cost-effectiveness. (Int Rev Ophthalmol, 2023, 47: 36-42)

Pathogenesis of Terson syndrome

2023, 47(1):  42-46.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.008

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Terson syndrome is an intraocular hemorrhage caused by intracranial hemorrhage, which is particularly common in patients with subarachnoid hemorrhage. At present, the specific pathogenesis of Terson syndrome is not clear, but the current mainstream pathogenesis is as follows: first, intracranial hemorrhage leads to increased intracranial pressure, and increased intracranial pressure leads to blocked retinal venous reflux, resulting in venous obstructive bleeding; the other is intracranial hemorrhage along the optic nerve sheath into the eye, causing intraocular hemorrhage. Recently, the lymphatic system from the intracranial to the eyeball has become a new research direction of this disease, providing another possibility for the pathogenesis of Terson syndrome and possibly a new way of thinking for other ophthalmic diseases. (Int Rev Ophthalmol, 2023, 47: 42-46)

Progress on treatment of fungal keratitis with nano preparation improved antifungal drugs

Huang Yue, Li Yan, Li Yuting, Bao Zheng Yilin, Yu Yongyuan, Hu Zhulin

2023, 47(1):  47-52.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.009

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Fungal keratitis is an eye disease that seriously damages vision. At present, anti-fungal eye drops are the main methods to treat fungal keratitis. However, due to the short contact time between anti-fungal eye drops and eye surface, and poor corneal permeability, eye drops are needed to used frequently to maintain the therapeutic concentration of drugs. Frequent topical use of eye drops may be associated with side effects such as congestion and delayed corneal reepithelialization. In recent years, nanomaterials have been found to be a good eye delivery system, which can effectively improve the bioavailability of eye drops and reduce the frequency of eye drops. (Int Rev Ophthalmol, 2023, 47: 47-52)

Corneal epithelial thickness changes after refractive surgery and related influencing factors

Yang Fan, Yang Liu, Huang Yue

2023, 47(1):  53-57.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.010

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Human corneal epithelium has strong ability to remodel itself. When the corneal surface is irregular, the corneal epithelium will reshape the cornea in the form of thickening to a certain extent. The corneal surface changes after corneal laser surgery, which will stimulate the rearrangement of corneal epithelial cells, showing the change of corneal epithelial thickness. The epithelial remodeling is related to surgical procedure, refractive error correction, laser ablation depth and area. Transepithelial photorefractive keratectomy (Trans-PRK) showed obvious epithelial thickening one month after operation, and the thickening area was mainly in the peripheral area; femtosecond laser-assisted in situkeratomileusis (FS-LASIK) and femtosecond laser small incision lenticule extraction (SMILE) showed obvious thickening one week after operation. The difference is that FS-LASIK thickening area is mainly the para-central area, while SMILE thickening area is the peripheral area. The influence of corneal epithelial thickness on postoperative visual acuity, postoperative diopter prediction and corneal refractive stability should not be ignored. (Int Rev Ophthalmol, 2023, 47: 53-57)

Effects of menopause on dry eye in women

Wang Yatong, Zhang Lei, Gao Honglian

2023, 47(1):  58-61.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.011

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Dry eye is a multifactorial ocular surface disease that causes ocular pain, discomfort and vision loss, which seriously affects the quality of life of patients.Female is an important risk factor for dry eye, especially menopausal and postmenopausal women, suggesting that changes in level of sex hormone play an important role in the pathogenesis of dry eye. Sex hormones (estrogen, progesterone and androgen) affect the production of all components of tear, including water, lipids and mucins.Various mechanisms such as reduced level of sex hormone, altered feedback mechanisms, and changes in receptor receptivity interact to alter ocular surface homeostasis, resulting in dry eye. Several studies have shown the potential role of menopausal hormone therapy in dry eye among the menopausal and postmenopausal women. (Int Rev Ophthalmol, 2023, 47: 58-61)

Roles of Th17 cells in pathogenesis of dry eye disease

Sha Yongyi, Kong Xueqing, Xiang Minhong

2023, 47(1):  62-67.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.012

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Dry eye is a common ocular surface disease in clinic, and patients show obvious immune homeostasis disruption. Th17 cells, one of the Th subtypes and producing interleukin-17 (IL-17), are widely present in the human body as important immune cells. They generate the iconic cytokines IL-17A, IL-17F, and IL-22. Transforming growth factor-β, IL-6, IL-21, and IL-23 can promote the differentiation of Th17 cells. Th17 cells play a particularly important role in the immune response of dry eye disease. In dry eye disease, the expression of Th17 related cytokines is increased, and the proportion of Th17/regulatory T cell (Treg) is increased. The migration of Th17 to the ocular surface can further lead to the occurrence and development of dry eye disease. Therefore, searching for Th17-related therapeutic targets may be a key factor in the treatment of dry eye. (Int Rev Ophthalmol, 2023, 47: 62-67)

Research and application of rapamycin on ophthalmic diseases

Ding Xuemeng, Liu Xi, Chen Peipei, Guan Huaijin

2023, 47(1):  68-73.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.013

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The mammalian target of rapamycin (mTOR) is a serine-threonine kinase that has important regulatory effects on cell growth, proliferation, metabolism, autophagy and ageing. Rapamycin (RAPA) is a macrolide immunosuppressant that is widely used after organ transplantation due to its low toxicity and highly potent immunosuppressive effects. Recent studies have shown that rapamycin has application potential in the treatment of various ophthalmological diseases, especially in anti-transplant rejection after corneal transplantation, keratitis, uveitis, cataracts, glaucoma and ocular fundus diseases. The role of rapamycin in immunosuppression, anti-angiogenesis, anti-fibrosis, neuroprotection reflects the promise of its application in ophthalmic diseases. (Int Rev Ophthalmol, 2023, 47: 68-73)

Research progress of aflibercept in the treatment of diabetic macular edema

Zhu Yingxing, Zou Yue, Feng Xiaoxiao, Hua Qiyun, Xiao Libo, Li Yunqin,

2023, 47(1):  74-78.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.014

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Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy (DR). At present, anti-vascular endothelial growth factor (anti-VEGF) drugs, especially aflibercept, have been widely used in clinical practice as the first-line treatment for DME, and have achieved good results. The advantages of arbocept are strong affinity, multiple targets and long half-life, etc. Current studies have shown that arbocept is more suitable for DME patients with baseline visual acuity of 20/50 or worse, and a more optimized delivery mode is still under further exploration. (Int Rev Ophthalmol, 2022, 46: 74-78)

Roles of scleral fibroblasts in pathogenesis of myopia

Liu Zihan, Li Jiaying, Wang Ningli, Zhang Jingxue, Cheng Zhen, Li Shiming

2023, 47(1):  79-84.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.015

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Scleral remodeling is the key to the onset and development of myopia, and scleral fibroblasts play an important role in scleral remodeling. During scleral remodeling, scleral fibroblasts showed an anti-fibrosis, contractile and pro-inflammatory phenotype with low synthesis and high degradation of extracellular matrix components. Currently, hypoxia stimulation, cyclic adenosine monophosphate (cAMP) catabolism, and matrix metalloproteinases (MMPs) expression are three main targets of myopic scleral fibroblasts. Notably, the antihypoxia drugs could reduce experimental myopia by regulating the hypoxia-inducible factor (HIF) signaling pathway, which is worthy of further study. (Int Rev Ophthalmol, 2023, 47: 79-84)

Interleukins and choroidal neovascularization

Zhang Wuyue, Sang Aimin

2023, 47(1):  84-91.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.016

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Choroidal neovascularization (CNV) is a common pathological endpoint of various choroidal retinal diseases and the main cause of irreversible visual impairment in humans. The formation of CNV is a very complex pathophysiological process involving a variety of structural cells, inflammatory cells and inflammatory factors, and is related to local chronic inflammation of the retina. Studies have shown that interleukins (ILs), as a large family of inflammatory cytokines, participate in the occurrence and development of CNV by regulating the expression of pro-angiogenic and anti-angiogenic factors in different immune microenvironments, and regulating the generation and function of ILs may serve as potential therapeutic targets. (Int Rev Ophthalmol, 2023, 47: 84-91)

Application of aqueous humor liquid biopsy in diagnosis and treatment of retinoblastoma

Wang Nan, Li Jing, Ma Jianmin

2023, 47(1):  92-96.  doi:10.3760/ cma.j.issn.1673-5803.2023.01.017

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Retinoblastoma (RB) is the most common intraocular malignancy in children. Biopsy is contraindicated in RB due to its loose tumor tissue.Aqueous humor contains rich biological information and safe to access. Recent studies showed that the related biomarkers in aqueous humor, such as cell-free DNA, trefoil factor family, survivin and neuron-specific enolase, probably played the important roles in the early diagnosis, prediction of tumor invasiveness, observation of therapeutic effects, and evaluation of prognosis in children with RB may become a powerful tool for the diagnosis and efficacy observation of RB. (Int Rev Ophthalmol, 2023, 47: 92-96)