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Table of Content

    22 June 2023, Volume 47 Issue 3
    Previous Issue   
    Research progress of tafluprost eye drops in the treatment of glaucoma
    Sun Longyan, Shi Yan, Fan Zhigang
    2023, 47(3):  193-202.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.001
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    Tafluprost is a prostaglandin analogue (PGA) with strong FP receptor affinity, which was first reported in 2003. Whereafter, Tafluprost eye drops, as the first originally developed preservative-free PGA agent, came on the market, and has been used as the first-line drug in the treatment of open-angle glaucoma and ocular hypertension. The unique difluoride atomic structure gives tafluprost stronger metabolic stability, making it perform similar efficacy with a lower concentration compared to other PGA. A large number of clinical studies on tafluprost eye drops have confirmed its effect of reducing intraocular pressure, and the adverse reactions occur less and to a lesser degree. In addition to reducing intraocular pressure, tafluprost is considered to have other pharmacological effects, including ocular blood flow improvement and optic nerve protection, as well as a protective effect on other ocular tissues. Recent clinical trials have begun to focus more on the evaluation of the safety of preservative-free tafluprost eye drops, especially for the ocular surface condition. In 2022, the preservative-free tafluprost eye drops (Tapros) were marketed in China. This article will review the pharmacological mechanism and pharmacokinetics of tafluprost, and discuss its clinical efficacy, safety, and tolerability of preservative-free tafluprost eye drops to provide clinical guidance. (Int Rev Ophthalmol, 2023, 47: 193-202)

    Progress of pharmacotherapy for conjunctival papilloma
    Yuan Jiali, Xu Yesheng, Zheng Libin, Yao Yufeng
    2023, 47(3):  203-209.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.002
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    Conjunctival papilloma is one of the most common ocular surface tumors, and it can affect visual function in severe cases. Pharmacotherapy or surgery combined with pharmacotherapy has the advantages of wide coverage and a relatively low recurrence rate and is gradually becoming a trend to replace surgical treatment. Available topical drugs include interferon alpha-2b, mitomycin C, 5-fluorouracil, dinitrochlorobenzene, bevacizumab, etc. Oral cimetidine is also used for conjunctival papilloma management. This article reviews the efficacy and safety of pharmacotherapy (local medication and intraoperative combination application) for conjunctival papilloma. (Int Rev Ophthalmol, 2023, 47: 203-209)
    Research progress on ocular administration methods
    Chen Xinyi, He Ting, Shen Ting
    2023, 47(3):  210-217.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.003
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    In recent years, various new dosage forms of ocular drugs have been developed, such as nano preparations (including nanoparticles, nanospheres, nanoemulsions, nanosuspensions, nanoliposomes, nanomicelles, fluorescent nano and dendritic macromolecules, etc.), sustained-release gels (including temperature-sensitive, pH, ionic and self-assembled peptide hydrogels, etc.), contact lenses, implants, microneedles, etc., which effectively improve the bioavailability of ocular drug administration, patient compliance, and achieve continuous administration, reduce drug side effects, and reduce chronic damage to the eyes , improves the therapeutic effect of eye medication. (Int Rev Ophthalmol, 2023, 47: 210-217)

    Research progress of intraocular sustained-release drugs
    Guo Zhaoxing, Wan Xiuhua
    2023, 47(3):  218-222.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.004
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    Intraocular extended-release drugs have the characteristics of long administration interval and high patient compliance. In recent years,  new anti-vascular endothelial growth factor extended-release devices, such as Port Delivery System with Ranibizumab, have entered phase III clinical trials for treatment of age-related macular degeneration; the indications for dexamethasone extended-release formulations (Ozurdex, Dexycu, Dextenza) have been further expanded and have been used for retinal vein obstruction, non-infectious uveitis, and diabetic macular edema treatment;  extended-release drops for the treatment of endophthalmitis, glaucoma, and cystine disease are expected to to improve the quality of patient care by replacing traditional eye drops. (Int Rev Ophthalmol, 2023, 47: 218-222)

    Pharmacokinetics of intravitreal anti-VEGF drugs in age-related macular degeneration
    Zhu Jian, Chen Yixun, Zhu Rongrong
    2023, 47(3):  223-227.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.005
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    Intravitreal injection of anti-vascular endothelial growth factor (VEGF) is currently the first-line treatment for age-related macular degeneration (AMD). The commonly used anti-VEGF drugs are Avastin, Ranibizumab, Aflibercept and Brolucizumab. For patients with AMD, the half-life, time to peak and drug concentration in atrial fluid, vitreous humour and serum are different between drug. In addition, different ophthalmic procedures such as cataract surgery, vitectomy and silicone oil filling can cause pharmacokinetic changes. It is recommended to use anti-VEGF drugs with long half-live and lasting efficacy in clinical treatment.(Int Rev Ophthalmol, 2023, 47: 223-227)
    Overview of pharmacological treatment strategies for presbyopia
    Zhang Yu, Wang Jia, Yin Yue, Jiang Yaping, Chen Yihui
    2023, 47(3):  228-232.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.006
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    Pharmacological treatment of presbyopia has the potential to become an alternative that is distinct from spectacles and easy to use in the future. At present, there are three main types of drugs - miotic agents, lens softeners and refractive function modulators in the research and development. Miotic agents treat presbyopia by producing a pinhole effect that increases the depth of focus at all working distances. The effects of miotic agents are transient, common adverse events include headache and nocturnal vision loss, and long-term efficacy and safety data are not available. There have been studies in which miotic agents have been used in combination with other drugs to achieve an additive therapeutic effect or to reduce adverse events. However, these combined effects are unknown. The aim of this review is to summarize some recent advances in the pharmacological treatment for presbyopia. (Int Rev Ophthalmol, 2023, 47: 228-232)
    Research progress on the safety and effectiveness of ICL implantation in the treatment of patients over 40 years of age with high myopia
    Du Xueyu, Yan Hong
    2023, 47(3):  233-237.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.007
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    With the improved safety of implantable collamer lenses (ICL) implantation, a number of studies have been conducted to perform ICL surgery in patients over 40 years of age with high myopia. This article summarizes the advantages, postoperative complications, and remaining problems of ICL implantation for the treatment of high myopia in patients over 40 years of age. The analysis focuses on the choice of correction method, lens power calculation reserve, lens opacity, and decrease in endothelial cell density related to the age of the implanted patient. In contrast to age-appropriate patients, the preoperative selection of correction method and lens power calculation reserve are based on the patient age, patient preference for vision, preoperative refractive power, and adaptability to monocular vision. Lens opacity is the most important complication after ICL implantation in patients over 40 years of age and is one of the reasons for secondary surgery, so a preoperative lens evaluation is recommended. ICL implantation for high myopia over 40 years of age has good treatment results and low complications, but its long-term safety needs further investigation. (Int Rev Ophthalmol, 2023, 47: 233-237)

    Ocular characteristics and molecular genetics advances of Waardenburg syndrome
    Peng Chuzhi, Jia Hongyan, Jiao Yonghong
    2023, 47(3):  238-243.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.008
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    Waardenburg syndrome (WS) is characterized by sensorineural hearing loss and generalized (skin, hair, and eyes) pigmentation abnormalities. WS is a highly clinically and genetically heterogeneous disorder. Special craniofacial features such as synophrys, telecanthus, a high and broad nasal root, and white forelock are usually found in WS. Heterochromia iridum is the most common and recognizable manifestation of ocular pigmentation abnormalities in WS, and pigmentation of the choroid and retina can also occur. Ocular abnormalities such as ptosis, strabismus, and glaucoma may lead to visual dysfunction. WS is divided into four subtypes according to different clinical presentations. Ocular pigmentation abnormalities can occur in each subtype. Type I WS and type III WS may be accompanied by telecanthus, and type IV may present as nystagmus when the nervous system is involved. It has been confirmed that PAX3, MITF, SOX10, EDN3, EDNRB, and SNAI2 are disease-causing genes for WS. (Int Rev Ophthalmol, 2023, 47: 238-243)
    Advances of goniosynechialysis in the treatment of primary angle closure glaucoma
    Yang Lei, Wang Jibing
    2023, 47(3):  244-249.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.009
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    The concept of goniosynechialysis (GSL) was described a half century ago. It was difficult to perform due to technically anterior chamber collapse at the beginning and later good clinical efficacy was obtained with viscoelastic maintaining anterior chamber and  irrigating cyclodialysis spatula combined with peripheral iridectomy to eliminate the pupillary block. Modern therapeutic system of GSL was developed based on the former research experiences, the procedures including, crystalline lens extraction, intraocular lens implantation combined with direct view under goniolens or endoscope. Modern therapeutic system of GSL has currently become the main effective method for primary angle-closure glaucoma (PACG). It’s advantages include quick, less invasive, bleb independent, restoring physiological drainage rout of aqueous humor. Recently, minimally invasive glaucoma surgery (MIGS) were also applied in the treatment of PACG, for example, partial goniotomy (GT) or ab interno trabeculectomy (Kahook Dual Blade, KDB) was added to the modern GSL system (GSLplus) for PACG, thereby the therapeutical effect of PACG was improved and more alternatives were provided, and has excited application potential. This article reviews the history, mechanism, modern procedures , clinical efficacy, concerned issues and the future trend of GSL. (Int Rev Ophthalmol, 2023, 47: 244-249)

    Application and research status of artificial intelligence in glaucoma early screening, diagnosis and follow-up   
    Wang Ziyi, Liu Hanruo
    2023, 47(3):  250-256.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.010
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    This review summarized the latest researches on the application of artificial intelligence (AI) in early screening, diagnosis and follow-up of glaucoma, and discusses its advantages and challenges. (Int Rev Ophthalmol, 2023, 47: 250-256)

    The potential role of TNF-α in the pathogenesis of glaucoma
    Jiang Na, Li Shuning
    2023, 47(3):  257-263.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.011
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    Tumor necrosis factor-α (TNF-α) is a multipotent pro-inflammatory cytokine that plays an important role in apoptosis, cell survival, inflammation and immunity. TNF-α is involved in the inflammatory response of the trabecular meshwork in glaucoma patients, which may lead to impaired outflow and elevated intraocular pressure. It has also been shown that TNF-α is involved in retinal ganglion cell apoptosis in glaucoma, and that TNF-α and its receptors can both promote neuroinflammation and secondary neuronal damage and may play a protective role under pathological conditions. (Int Rev Ophthalmol, 2023, 47: 257-263)

    Research progress on the pathogenesis of Fuchs syndrome
    Chen Zijie, , Mao Yukai, Liu Xuyang, Zhu Yihua
    2023, 47(3):  264-268.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.012
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    Fuchs uveitis syndrome is a chronic non granulomatous iridocyclitis characterized by posterior corneal opacities  and iris discoloration. Due to the mild inflammatory response in the early stage, it is easy to be ignored, while in the later stage, it can cause serious complications that impair vision, such as cataracts and glaucoma. Therefore, the treatment of Fuchsuveitis syndrome is mainly aimed at the treatment of complications, such as phacoemulsification combined with intraocular lens implantation, trabeculectomy or glaucoma drainage valve surgery, and the use of anti-glaucoma drugs. At present, the etiology of Fuchs uveitis syndrome is not yet clear. Some authors believe that Fuchs uveitis syndrome is a group of diseases with similar clinical manifestations caused by multiple causes, while the others believe that the disease is caused by viral infection and does not belong to the syndrome. In addition, genetics, immunity, and sympathetic nerves may also be related to Fuchs uveitis syndrome. (Int Rev Ophthalmol, 2023, 47: 264-268)
    The change of higher order aberrations before and after corneal refractive surgery
    Liu Jiahui, Guo Xiujin, Gao Mengman
    2023, 47(3):  269-275.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.013
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    Higher-order aberrations are closely related to visual quality. Higher-order aberrations before and after corneal refractive surgery are related to various factors such as patient congenital factors, intraoperative patient cooperation, surgical plan selection, and postoperative corneal healing response. Improving patient examination before surgery, providing personalized design plans, maintaining good fixation and positioning during surgery, improving and updating surgical equipment, rational postoperative medication, and reducing postoperative complications are all important for reducing postoperative higher-order aberrations. This article describes the common factors that affect higher-order aberrations before and after surgery and the progress of research on higher-order aberrations and visual quality, with the aim of reducing the induction of higher-order aberrations and providing new research ideas for improving the accuracy and personalisation of corneal refractive surgery. (Int Rev Ophthalmol, 2023, 47: 269-275)
    Relationship between reticular macular disease and systemic microvascular dysfunction
    Chu Zhe, Ren Qi, Cheng Lu, Cheng Hao
    2023, 47(3):  276-282.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.014
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    Reticular macular disease (RMD) is an important phenotype of early and intermediate-stage age-related macular degeneration, which is closely related to choroidal capillary layer perfusion disorders, i.e., microcirculation disorders. Microcirculation dysfunction can lead to tissue dysfunction, especially for the eyes, kidney, heart and other hypermetabolic organs. Several studies indicate RMD may be part of a multisystem disorder affecting other vascular beds such as the kidney and heart. Microcirculatory disorders in kidney, heart and other organs are related to the occurrence of RMD, and they are intrinsically related in their pathogenesis. RMD may be used as a predictor of chronic kidney disease, coronary artery disease or coronary artery microcirculation disorders. (Int Rev Ophthalmol, 2023, 47: 276-282)

    Positioning management after macular hole mainstream vitrectomy
    Yang Meng, Pang Shaofang, Hu Bojie
    2023, 47(3):  283-288.  doi:10.3760/ cma.j.issn.1673-5803.2023.03.015
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    The majority of macular hole surgery, vitrectomy combined with internal limiting membrane peeling and vitreous cavity gas filling, require special postoperative positions, such as face-down position (FDP). The study of postoperative position selection and monitoring can help improve patient compliance, increase the time in the correct position and reduce the time in a poor position. How to reduce the FDP time or develope other positions and procedures that can replace FDP while ensuring the macular hole closure rate is the focus of the study. Strict maintenance of FDP for a certain period is the standard postoperative care procedure for patients with macular hole >400 μm. The effect of postoperative non-supine position compared with FDP on the rate of hole closure when the macular hole is < 400 μm has not been concluded. Current FDP position monitors include Maculog electronic device, curved fixture head position monitor connected to headphones, head fixed sensor, and adhesive eye mask with the sensor. For non-supine position monitoring, there are roll ball type sensors with tilt switch type head position monitoring devices, and wearable wireless positioning sensor with real-time audio-visual feedback, which can serve as a reminder and record of patient's postoperative position. Some studies have used intraoperative and postoperative OCT examinations to guide the duration of FDP. (Int Rev Ophthalmol, 2023, 47: 283-288)
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