Table of Content

22 April 2023, Volume 47 Issue 2

Previous Issue   

A systematic review of diagnostic criteria for subclinical keratoconus

Jiang Hanxiao, Xu Yesheng, Zheng Libin, Yao Yufeng

2023, 47(2):  97-103.  doi:10.3760/cma.j.issn.1673-5803.2023.02.001

Asbtract ( 279 )  

Related Articles | Metrics

Objective  To identify the diagnostic criteria used for the terms subclinical keratoconus in published articles. Methods  This was a systematic review of all research on the use of the keyword "subclinical keratoconus" in PubMed, Cochrane Library, Embase database, CNKI, Wanfang Data Knowledge Service Platform and China Science and Technology Journal Database from January 2000 to March 2022. Two independent reviewers analyzed the data. The inclusion criteria for articles included that a sample size of subclinical keratoconus eyes was greater than 20 eyes, they contained the definition of subclinical keratoconus, and Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of literature. Inclusion criteria for definition and examination technology used of the selected articles were then analyzed. Results  A total of 263 studies were included, of which 207 were excluded. Definitions for subclinical keratoconus included that the criteria of having keratoconus in the fellow eye was in 66.07% (37 of 56) of the articles. Lacking of any keratoconus-related findings/signs in the slit-lamp biomicroscopy was in 35.71% (20 of 56). Normal-appearing corneal on slit-lamp biomicroscopy, or keratometry, or retinoscopy, or ophthalmoscopy was in 33.93% (19 of 56). Conclusions  This review demonstrates the lack of unified criteria to define subclinical keratoconus. According to the literature review, the most common subclinical keratoconus definition used refers to an eye with keratoconus in the fellow eye and normal-appearing corneal on slit-lamp biomicroscopy.(Int Rev Ophthalmol, 2023, 47: 97-103)

Relationship between choroidal volume and pathogenesis of angle closure glaucoma

Zheng Xuanli, Lin Haishuang, Wan Rui, Zhang Shaodan, Liang Yuanbo

2023, 47(2):  104-109.  doi:10.3760/cma.j.issn.1673-5803.2023.02.002

Asbtract ( 223 )  

Related Articles | Metrics

The mechanism of angle closure glaucoma is unclear. Although a direct causal relationship between choroidal volume changes and angle closure glaucoma has not been established, angle closure glaucoma has thicker choroidal thickness and higher proportion of choroidal effusion. Obstruction of venous return and abnormal distribution of arterial blood flow may be the possible mechanism of increased choroidal volume in angle closure glaucoma. Increased choroidal volume may be a key factor in the development of angle-closure glaucoma.(Int Rev Ophthalmol, 2023, 47: 104-109)

Current status of glaucoma patient management

Si Zhibo, Zhang Chenchen, Zheng Yajuan

2023, 47(2):  110-115.  doi:10.3760/cma.j.issn.1673-5803.2023.02.003

Asbtract ( 294 )  

Related Articles | Metrics

Lifelong follow-up is necessary for glaucoma patients. It is critical to manage glaucoma as a chronic disease. At present, there are different management strategies for glaucoma patients worldwide. In developed countries, hierarchical diagnosis and treatment system and supporting education are adopted to improve patients' treatment compliance. In recent years, the management of glaucoma patients in China has gradually developed from the tertiary hospital responsibility system to the mobile medical management mode, including disease screening, diagnosis and long-term follow-up.(Int Rev Ophthalmol, 2023, 47: 110-115)

Advances on intracameral antibiotics to prevent endophthalmitis after cataract surgery

Liu Jianying, Chang Di, Li Jing, Wan Xiuhua

2023, 47(2):  115-120.  doi:10.3760/cma.j.issn.1673-5803.2023.02.004

Asbtract ( 263 )  

Related Articles | Metrics

Intracameral injection of antibiotics is to inject a small amount of antibiotics into the anterior chamber after cataract extraction to prevent endophthalmitis. The most commonly used drugs are cefuroxime, moxifloxacin and vancomycin. Cefuroxime and vancomycin exert antibacterial effects mainly by interfering with the synthesis of bacterial cell walls. The mechanism of action of moxifloxacin is to inhibit II and IV topoisomerases, interfering with bacterial DNA replication, repair, and transcription. The conventional recommended dose for intracameral injection of cefuroxime and vancomycin is 1.0 mg/0.1 mL, while there is currently no standard dose for moxifloxacin. To avoid drug resistance while ensuring safety, the recommended dose of moxifloxacin is 0.5 mg/0.1 mL. The effectiveness of intracameral injection of antibiotics in preventing endophthalmitis after cataract surgery has been proven by a large number of clinical studies, but complications need to be further studied. (Int Rev Ophthalmol, 2023, 47: 115-120)

Mechanism of inflammatory response in posterior capsule opacification after cataract surgery in high myopia

Ma Hui, Bao Yongzhen

2023, 47(2):  121-125.  doi:10.3760/cma.j.issn.1673-5803.2023.02.005

Asbtract ( 237 )  

Related Articles | Metrics

High myopia is a high risk factor for cataract and posterior capsule opacification (PCO) after cataract surgery. The occurrence time of PCO in high myopia is earlier, the degree is heavier, the treatment risk is higher. Previous studies have shown that inflammatory response plays an important role in the pathogenesis of high myopia and PCO, and the inflammatory microenvironment in high myopia seems to be closely related to the occurrence of PCO. The elevated levels of inflammatory factors such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β), and matrix metalloproteinase-2 (MMP-2) in highly myopic eyes are involved in epithelial-mesenchymal transition and extracellular matrix contraction, which promotes the development of PCO.(Int Rev Ophthalmol, 2023, 47: 121-125)

Femtosecond laser assisted clear corneal incision in cataract surgery

Li Jinqiu, Zhao Chunmei, Liu Xiangyun, Hong Yang, Liu Yuning

2023, 47(2):  126-130.  doi:10.3760/cma.j.issn.1673-5803.2023.02.006

Asbtract ( 226 )  

Related Articles | Metrics

A well-constructed transparent corneal incision during cataract surgery can effectively prevent or reduce postoperative endophthalmitis and other complications, and improve the visual quality of patients. Femtosecond laser can improve the stability and tightness of the incision by making multi-plane and multi-shape incisions with different positions, angles and lengths. Although the reproducibility and reproducibility of the incision morphology are better than those made by corneal knife, there are still differences with preoperative presets. The effect of femtosecond laser made corneal incision on intraoperative astigmatism, corneal endothelial cell apoptosis, Descemet's membrane detachment and wound remodeling still needs more clinical research evidence. How femtosecond laser can accurately identify and locate the incision in the cornea and the optimal parameters for making the incision are still the focus of future research. (Int Rev Ophthalmol, 2023, 47: 126-130)

Research status of dome-shaped macula in high myopia

Yao Ailin , Chu Yanhua

2023, 47(2):  131-137.  doi:10.3760/cma.j.issn.1673-5803.2023.02.007

Asbtract ( 374 )  

Related Articles | Metrics

As a progressive pathological condition, dome-shaped macula (DSM) is characterized by an inward convexity or bulge of the retinal pigment epithelium in the macular region, with the bulge height over than 50  μm, which occurs mostly in patients with high myopia. The pathogenesis of DSM development remains unclear; several hypotheses have been suggested, such as tangential vitreoretinal traction, localized thickening of sclera and choroid in the macular area, and macular Bruch’s membrane defect. DSM is often accompanied by serous retinal detachment, choroidal neovascularization, macular splits and other complications, thus increasing the risk of visual impairment. Clinically, asymptomatic patients with DSM mainly take regular follow-up observation. When serous retinal detachment and significant visual impairment appear, treatment with half-dose photodynamic therapy, supplementary of laser photocoagulation or oral mineral corticoid receptor antagonists may have a beneficial effect. However, more large clinical studies are required to confirm the exact efficacy of these treatments. Optical coherence tomography (OCT) and related fundus image examinations provide objective evidences for clinical diagnosis. OCT can visually display the inward bulge of the macula and other changes associated with it. (Int Rev Ophthalmol, 2023, 47: 131-137)

Prognostic factors for postoperative visual acuity in idiopathic epiretinal membrane

Zhao Yi, Yang Zhen, Zhang Chen, Yang Xiaoli

2023, 47(2):  138-143.  doi:10.3760/cma.j.issn.1673-5803.2023.02.008

Asbtract ( 196 )  

Related Articles | Metrics

Most studies showed that idiopathic epiretinal membrane (IERM) patients with better preoperative best corrected visual acuity and shorter duration of symptoms will obtain better postoperative visual acuity. Preoperative imaging features such as preoperative macular morphology, macular fovea thickness, ellipsoid zone integrity and photoreceptor outer segment length have certain predictive value for postoperative visual acuity in IERM.(Int Rev Ophthalmol, 2023, 47: 138-143)

Biomarkers for the treatment effect of diabetic macular edema with anti-vascular endothelial growth factors

Pang Shaofang, Yang Meng, Hu Bojie

2023, 47(2):  144-149.  doi:10.3760/cma.j.issn.1673-5803.2023.02.009

Asbtract ( 286 )  

Related Articles | Metrics

At present, anti-vascular endothelial growth factor (VEGF) drugs have become the first-line treatment for diabetic macular edema (DME), but there are still some patients with poor therapeutic effect. Numerous cytokines are involved in the development of DME and their expression levels change after treatment with anti-VEGF drugs, which may be relevant to the prognosis of DME. Baseline VEGF and monocyte chemotactic protein (MCP)-1 in aqueous humor and intercellular adhesion molecule (ICAM)-1 and solutable VEGF receptor (sVEGFR)-2 after anti-VEGF treatment may serve as potential biomarkers to evaluate DME treatment. Imaging changes such as central macular thickness, macular volume, hyperreflective foci, subretinal fluid, vessel density and foveal avascular zone could predict and evaluate the therapeutic effect of DME. Therefore, understanding the baseline cytokine, post-treatment cytokine levels, imaging changes and the correlation among them is helpful to guide the personalized treatment of DME patients from different perspectives, explore the pathogenesis of DME and search for potential therapeutic targets for DME. (Int Rev Ophthalmol, 2023, 47: 144-149)

The role of the vitreous microenvironment in the development of diabetic retinopathy

Huang Xiaofeng, Guo Tai, Zhao Hanpeng, Liu Yue, Cui Ying

2023, 47(2):  150-155.  doi:10.3760/cma.j.issn.1673-5803.2023.02.010

Asbtract ( 216 )  

Related Articles | Metrics

Diabetic retinopathy (DR) has a complex pathogenesis involving the accumulation of advanced glycosylation end products, oxidative stress, chronic inflammation, retinal ischemia and hypoxia, and neuronal degenerative disease, which leads to alterations in the vitreous microenvironment. The vitreous microenvironment refers to the surrounding structures and components in the vitreous cavity that can affect retinal cells and retinal neovascularization, which covers metabolites, physical components, cellular components, and biochemical components in the vitreous. The alteration of these components may promote the progression of DR through multiple pathways, such as protein kinase C activation, formation of advanced glycation end products, upregulation of cytokines, etc.  Therefore, the study and understanding of the changes in the vitreous microenvironment are of great importance for preventing and treating DR.(Int Rev Ophthalmol, 2023, 47: 150-155)

Appliance of fundus multimodal imaging in the diagnosis and follow-up of Coats disease

Zhou Ziyi, Dou Guorui, Wang Yusheng

2023, 47(2):  156-162.  doi:10.3760/cma.j.issn.1673-5803.2023.02.011

Asbtract ( 257 )  

Related Articles | Metrics

Coats disease is characterized by retinal telangiectasia. Fundus fluorescein angiography (FFA) is the authentic standard for the diagnosis of retinal vasodilation and leakage in Coats disease. In addition, fundus photography and ocular B-ultrasound are also widely used in the diagnosis and evaluation of Coats disease. While considering the lack of specificity in the examination results, their assistance in the diagnosis and follow-up of Coats disease are limited. Optical coherence tomography (OCT) could display the structural changes of each layer of the retina and clarify the pathological tissues, providing plenty of information for the clinical diagnosis of Coats disease. Optical coherence tomography angiography (OCTA) and ultra-widefield fluorescein angiography (UWFA) could accurately evaluate the pathological condition of Coats disease. At the same time, ultra-widefield fundus photograph (UWF) and colored photography have supplemented more information with traditional fundus photography techniques. Therefore, the combination of UWF and UWFA with OCT and OCTA can provide more comprehensive information for the diagnosis of Coats disease, and provide a more comprehensive means of follow-up, evaluation and further understanding of the pathogenesis for the Coats disease. (Int Rev Ophthalmol, 2023, 47: 156-162)

Pathogenesis and malignant transformation mechanism of IgG4-related ophthalmic diseases

Yan Haihan, Ma Jianmin

2023, 47(2):  163-169.  doi:10.3760/cma.j.issn.1673-5803.2023.02.012

Asbtract ( 431 )  

Related Articles | Metrics

IgG4-related ophthalmic disease (IgG4-ROD) is an occult-progressive disease characterized by IgG4 and plasma cell infiltration, mattostriate fibrosis, and occlusive phlebitis in tumor-like tissues. At present, the pathogenesis and malignant mechanism of IgG4-ROD remain unclear. After pathogen infection, the pathogen recognition receptor encoded by the innate immune recognition germ line activates B cells, and promotes the activation and class switch to IgG4 of B cells with the assistance of Tfh cells, resulting in the infiltration of IgG4 in tissues. B cells activate cytotoxic T lymphocyte (CTL) cells, which together with CTL cells promote fibrosis. IgG4-ROD can malicious change into mucosa associated lymphoid tissue type (MALT),  immunity and inflammation may be involved in the pathogenesis.(Int Rev Ophthalmol, 2023, 47: 163-169)

The role of oxytocin in visual cortex plasticity

Sun Yifan, Hao Rui

2023, 47(2):  170-174.  doi:10.3760/cma.j.issn.1673-5803.2023.02.013

Asbtract ( 204 )  

Related Articles | Metrics

Oxytocin is a neurotransmitter synthesized by the hypothalamus. Oxytocin and astrocytes play important roles in promoting visual cortex plasticity. It has been shown that dark-reared mice have reduced excitatory synaptic transmission in primary visual cortex and decreased oxytocin secretion. Oxytocin participates in the opening of the critical period via Somatostatin-positive (SST+) interneurons, and it is related to neurogenesis in adulthood. Both endogenous and exogenous oxytocin can affect the morphology of astrocytes. The synaptic elimination of astrocytes is closely related to the refinement of neural circuits. The immature astrocytes reopen critical period in adult mice, which means the critical period can be extended as long as delaying the maturation of astrocytes. (Int Rev Ophthalmol, 2023, 47: 170-174)

Mesenchymal chondrosarcoma of orbit

Jia Hongqin, Cai Rongrong, Bi Yingwen

2023, 47(2):  175-180.  doi:10.3760/cma.j.issn.1673-5803.2023.02.014

Asbtract ( 186 )  

Related Articles | Metrics

Orbital mesenchymal chondrosarcoma is a relatively rare ocular neoplasm, and the male: female ratio is 1.1:1. It is unilateral and occurs mainly in young adults which HEY1-NCOA2 gene fusion can be detected by molecular genetics. In the early stage, ocular compression symptoms such as proptosis and diminution of vision are the main symptoms. In severe cases, it may invade adjacent structures or organs, but distant metastasis is very rare. Characteristic calcification on imaging is helpful to assist the preoperative diagnosis. Mesenchymal chondrosarcoma is difficult to differentiate in histopathology which is a small round-cell tumor with typical biphasic histology. Currently, this tumor is treated primarily with surgical resection, and the recurrence rate is high, postoperative radiotherapy may improve the patient's prognosis. (Int Rev Ophthalmol, 2023, 47: 175-180)

Application of polymerase chain reaction in diagnosis and guiding treatment of human herpesvirus keratitis

Wang Dandan, Xu Yesheng, Zheng Libin, Yao Yufeng

2023, 47(2):  181-185.  doi:10.3760/cma.j.issn.1673-5803.2023.02.015

Asbtract ( 194 )  

Related Articles | Metrics

Human herpes virus is the most common pathogen causing viral keratitis. Polymerase chain reaction (PCR) technology can rapidly and accurately detect suspected pathogens in a limited number of eye samples by amplifying target genes. After optimization, PCR technology is more suitable for clinical detection. Multiplex PCR can identify various virus subtypes at the same time, which is more efficiency and requires less sample. Quantitative real-time PCR can detect viral load, which can be used to guide whether drug resistance occurs during the treatment process and whether to stop the medicine. Solid-phase PCR can reduce the pipetting error, and the detection results are more rapid and stable. A thorough understanding of various PCR techniques and their applications will help to better diagnose and guide the treatment of herpes virus-associated keratitis. (Int Rev Ophthalmol, 2023, 47: 181-185)

Pathogenesis of allergic conjunctivitis-associated dry eye

Jiao Xiting, Gao Ning, Yang Ruibo

2023, 47(2):  186-191.  doi:10.3760/cma.j.issn.1673-5803.2023.02.016

Asbtract ( 178 )  

Related Articles | Metrics

Allergic conjunctivitis is a common ocular surface disease in clinics and one of the important risk factors for triggering or aggravating dry eye. Allergic conjunctivitis and dry eye are mutually reinforcing and causal. The former can induce or exacerbate dry eye through mechanisms such as damaging the epithelial barrier of the ocular surface, causing tear film instability, meibomian gland dysfunction, and lid-wiper epitheliopathy. Meanwhile, dry eye can promote and aggravate ocular allergy due to (relatively) insufficient tear volume, injury to the ocular surface epithelial barrier, and neurogenic inflammatory responses. In addition, dysbiosis of the ocular surface and mental disorders such as anxiety and depression also bridge the coexistence or interconversion of the two.(Int Rev Ophthalmol, 2023, 47: 186-191)