Table of Content

22 August 2023, Volume 47 Issue 4

Previous Issue   

Applications of intraoperative optical coherence tomography in ophthalmic surgery

Zhang Xiruo, Qu Shen, Bi Yanlong

2023, 47(4):  289-295.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.001

Asbtract ( 210 )   PDF (1644KB) ( 743 )  

Related Articles | Metrics

Optical coherence tomography ( OCT ) is gradually becoming widely used in the field of ophthalmology because of its ability to provide high-resolution tissue images that are real-time, noninvasive and can be examined in vivo. This article summarizes the application scenarios of intraoperative OCT (iOCT) in a wide range of anterior and posterior segment surgeries, including corneal surgery, cataract surgery, glaucoma surgery and vitreoretinal surgery. iOCT facilitates a profound understanding of intraoperative tissue anatomy, localization, and dynamic changes. It aids surgeons in making informed decisions during surgery, thereby enhancing surgical safety and precision, and fostering the progression of minimally invasive ophthalmic procedures. However, limitations such as expensive equipment, challenges in tracking scanning, and limited imaging field of view restrict its further development and wider application. (Int Rev Ophthalmol, 2023, 47: 289-295)

Application of optical coherence tomography angiography on assessment of microcirculation changes in glaucoma

Zhang Yihan, Zhang Fengyan

2023, 47(4):  296-301.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.002

Asbtract ( 199 )   PDF (748KB) ( 708 )  

Related Articles | Metrics

Optical coherence tomography angiography (OCTA) is a novel, non-invasive ophthalmic examination technique that provides high-resolution images of microvascular. OCTA can quantitatively analyze optic disc, retinal and choroidal blood perfusion of patients with glaucoma and assess their microvascular changes. Patients with different types of glaucoma may have decreased vessel density of the optic disc, peripapillary, macular retina, choroid and abnormal indexes related to foveal avascular zone, whose changes are related to the degree of visual field defect, the thickness of the nerve fiber layer, and the thickness of the ganglion cell complex.  (Int Rev Ophthalmol, 2023, 47: 296-301)

Modifying hemodynamic abnormalities in the treatment of normal tension glaucoma

Wang Yiyan, Qing Guoping

2023, 47(4):  302-307.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.003

Asbtract ( 166 )   PDF (744KB) ( 653 )  

Related Articles | Metrics

正常眼压性青光眼（normal tension glaucoma，NTG）作为一种特殊类型的青光眼，患者的眼压在正常范围内波动但仍出现进行性视网膜神经节细胞损伤及青光眼性视野缺损。大量研究证实非眼压因素在NTG的发病过程中起重要作用，其中血流流变异常受到了较多的关注。局部眼血流不足、系统性低血压、血管功能调控异常等血流动力学异常会导致NTG患者视乳头灌注压和血供不足从而加重NTG。因此，治疗NTG患者的异常血流状态可能成为降眼压治疗之外的、针对病因的重要治疗方法。（国际眼科纵览，2023, 47：302-307）

Effect of optic disc size on thickness of retinal nerve fiber layer and ganglion cell complex

Li Caixia, Li Shuning

2023, 47(4):  308-314.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.004

Asbtract ( 175 )  

Related Articles | Metrics

Examination of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) have been widely used for the screening and diagnosis of early glaucoma, but the thicknesses of RNFL and GCC are affected by race, age, sex, ocular factors and systemic diseases. Optic disc size is one of the important influencing factors for measuring the thickness of RNFL and GCC in patients with different optic disc sizes using optical coherence tomography (OCT). The measurement of RNFL in the normal scanning mode of OCT is influenced by the size of optic disc, and the RNFL in large optic disc is thicker. Therefore, proportional scanning mode is more suitable for RNFL measurement of different types of optic disc. However, it is still controversial whether patients with larger optic disc have greater GCC thickness measurements than those with small optic disc, which needs further study to verify. (Int Rev Ophthalmol, 2023, 47: 308-314)


Application of capsular tension ring in cataract surgery

Chen Dongjun, Wan Xiuhua

2023, 47(4):  315-321.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.005

Asbtract ( 298 )  

Related Articles | Metrics

When there are anomalies in the zonules,the safety of cataract surgery is significantly compromised,leading to increased risks of vitreous prolapse,capsular rupture,residual lens cortex,and dislocation of the intraocular lens(IOL). The use of capsular tension rings(CTRs)and related intraocular devices allow ophthalmologists to maintain the stability of the capsular bag easily during complex cataract surgeries,enhancing the controllability of anterior segment procedures and reducing or alleviating intraoperative and postoperative complications. Moreover, they improves the prognosis of zonular anomalies related conditions. With continuous advancements in design and materials,the indications for capsular tension rings are expanding gradually. Especially for highly myopic patients,CTRs can effectively stabilize the position of the IOL,provide additional support to the relaxed zonules,inhibit migration and proliferation of residual lens epithelial cells,and improve patients' visual quality while reducing the incidence of retinal detachment post-surgery. (Int Rev Ophthalmol, 2023, 47: 315-321)

Pathological changes in the anterior capsule of diabetic cataract

Xie Yi, Guan Huaijin, Ji Min

2023, 47(4):  322-327.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.006

Asbtract ( 209 )  

Related Articles | Metrics

Diabetic cataract is one of the ocular complications caused or aggravated by diabetes mellitus (DM), its pathogenesis has not been elaborated completely. The lens capsule is an acellular, transparent, smooth basement membrane which acts as a barrier secreted by the lens epithelial cells. In hyperglycaemic states, the permeability of lens capsule membrane is altered and a series of pathological changes occur including: histological abnormalities such as fibrosis of anterior lens capsule, loss of intercellular junctions and gaps between epithelial cells and capsule membrane, ultrastructural abnormalities such as epithelial complex structure, gap laxity, finger-like protrusions and lamellar separation, as well as abnormal expression of basement membrane-related molecules. The balance of internal homeostasis of the lens will then accelerate the development of cataracts. Progress of researches on diabetic anterior lens capsule changes help to rethink the mechanism of diabetic cataract from a different perspective and provide a pathological basis for diagnosis and prevention. (Int Rev Ophthalmol, 2023, 47: 322-327)


Rotational stability  of Toric IOL and its influencing factors

Hong Yang, Zhao Chunmei, Liu Xiangyun

2023, 47(4):  328-332.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.007

Asbtract ( 178 )  

Related Articles | Metrics

Toric IOL implantation is a way to correct cataract with astigmatism. The degree of rotation is positively correlated with the increase of astigmatism and defocus aberration. The rotation of the IOL will lead to different degrees of astigmatism and defocus aberration. Long axial length, irregular capsulorhexis, severe fibrosis of the anterior capsule membrane, poor adhesion of IOL materials, and postoperative vigorous activity are all risk factors for Toric IOL rotation. (Int Rev Ophthalmol, 2023, 47: 328-332)


Advance of immediately sequential bilateral cataract surgery in COVID-19 era

Ren Yuecong, Yan Hong

2023, 47(4):  333-338.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.008

Asbtract ( 185 )  

Related Articles | Metrics

Immediate sequential bilateral cataract surgery(ISBCS) is performed on both eyes on the same day but as separate procedures which was first reported in 1952. The COVID-19 pandemic has sparked a greater interest in ophthalmologist perceptions of ISBCS in recent years because of the cost savings and convenience. Especially in countries where there is a long waiting list for second eye cataract surgery. Despite the advantages of rapid restoration of binocular vision and reduction of epidemic exposure in specific contexts, further clinical research on ISBCS is needed on the long-term safety including bilateral endophthalmitis, refractive surprise, corneal decompensation, and bilateral macular edema. (Int Rev Ophthalmol, 2023, 47: 333-338)


The relationship between dome-shaped macula and refractive state and common complications

Wang Gechun, , Yuan Fei

2023, 47(4):  339-344.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.009

Asbtract ( 210 )  

Related Articles | Metrics

Dome-shaped macula (DSM) shows an inward bulge of the retina and choroid in the macula area on optical coherence tomography. The exact pathogenesis of DSM remains unclear, but it is primarily associated with adaptive compensation due to localized sclera thickening. DSM exists in patients with myopia, emmetropia or hypermetropia,  and is more frequently observed in patients with high ametropia. The prevalence rate is about 10%~20% among high myopia people. Common complications of DSM include  serous retinal detachment, choroidal neovascularization, retinoschisis, macular hole and macular epiretinal membrane, etc. Currently, it needs to be further confirmed that whether DSM is a concomitant or a causal relationship with the occurrence of complications. For asymptomatic DSM, regular follow-up observation is recommended. If complications occur and significantly impair visual function, methods such as anti-vascular endothelial growth factor, photocoagulation, photodynamic therapy or manual therapy can be used. (Int Rev Ophthalmol, 2023, 47: 339-344)

Application of peripheral blood inflammatory markers in diabetic retinopathy

Sun Huixin, Zhou Xiyuan

2023, 47(4):  345-349.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.010

Asbtract ( 160 )  

Related Articles | Metrics

Diabetic retinopathy (DR) is one of the common microvascular complications of diabetes. Previous studies have highlighted the association of chronic inflammation and DR. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and systemic immune-inflammation index (SII) have been proven to be potential inflammatory markers in diabetes mellitus and DR. All the makers above are derived from blood routine test, which is economical, practical, convenient and quick, and have a good application prospect. However, due to the influence of systemic conditions, drug use and other factors, it is currently not widely used in the clinic. Strengthening the monitoring of these makers is helpful for the diagnosis and prognosis of DR. (Int Rev Ophthalmol, 2023, 47: 345-349)


The role of NETs in the pathogenesis of diabetic retinopathy

Feng Qianhong, Yuan Fei

2023, 47(4):  350-353.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.011

Asbtract ( 181 )  

Related Articles | Metrics

Neutrophil extracellular traps(NETs) are network structures composed of nuclear DNA and/or mitochondrial DNA and various proteins released by neutrophils after receiving external stimulation. NETs play an important role in clearing pathogens, inflammation, autoimmunity, etc. Recent years, increasing evidence suggests that NETs are involved in the development of diabetic retinopathy (DR). The hyperglycemic and low-grade inflammatory environment in T2DM can induce NETs in the retina. DR itself also can increase the adhesion of neutrophils in retinal vessels and induce NETs. In addition, some studies have demonstrated that NETs can induce the regression of retinal pathological neovascularization. The study of NETs provides new strategies and directions for the prevention and research of DR. (Int Rev Ophthalmol, 2023, 47: 350-353)


Ocular surface damage of thyroid-associated ophthalmopathy

Lin Xiaoxuan, Li Jinying

2023, 47(4):  354-359.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.012

Asbtract ( 144 )  

Related Articles | Metrics

Thyroid-associated ophthalmopathy associated with autoimmunity is a disease of inflammatory infiltration of periorbital and intraorbital ocular tissue caused by multi-factor disorders, but the pathogenesis has not been elucidated. The ocular damage caused by TAO has a wide range of involvement, and the ocular surface damage has a significant impact on visual function. The enlargement of palpebral fissure, the lesion of meibomian gland, the dysfunction of meibomian gland and the decrease of lipid layer of tear film caused by TAO lead to excessive evaporation of tear and the change of high osmotic pressure of tear, which induces or aggravates ocular surface inflammation. The abnormal expression of inflammatory factors in tears and the pathological changes of main and accessory lacrimal glands, and the decrease of water layer led to the further increase of tear osmotic pressure. The vicious circle of inflammation causes the damage of keratoconjunctival barrier, the decrease of corneal nerve fiber density and the decrease of corneal sensitivity. The changes of corneal biomechanical properties and the decrease of deformability in patients with TAO affected the measurement of intraocular pressure. TAO is also accompanied by orbital tissue hyperplasia and expansion, and the orbital pressure increases in patients, which lead to the disturbance of blood circulation. The nutritional supply of the ocular surface is impaired, and the normal physiological function of the ocular surface including the secretion of mucin by conjunctival goblet cells is affected. Ocular surface damage caused by TAO causes a series of serious eye discomfort and facial damage, which threatens the physical and mental health of patients. (Int Rev Ophthalmol, 2023, 47: 354-359)


Advances in the treatment of fungal keratitis

Lee Yan, Zhou Qing

2023, 47(4):  360-366.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.013

Asbtract ( 157 )  

Related Articles | Metrics

The current difficulties in the diagnosis and treatment of Fungal keratitis (FK) are not easily detected in early diagnosis of the disease, the biotoxicity of antifungal drugs and the low bioavailability of the drugs in the eye, etc. With more research on FK treatment in recent years, new drugs and drug carrier formulations have been proposed and their efficacy has been verified in animal models of FK infection. Regarding surgical treatment, corneal transplantation, and photodynamic therapy are the more commonly used treatment modalities, while the newly proposed low-temperature plasma surgical system is more advantageous in the control of infection and safety in the treatment of FK. (Int Rev Ophthalmol, 2023, 47: 360-366)


Application of stent materials for lacrimal duct intubation surgery

Xu Enpei, Li Guanghui

2023, 47(4):  367-372.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.014

Asbtract ( 147 )  

Related Articles | Metrics

With the continuous advancement in artificial lacrimal duct improvements and tissue transplantation, significant progress has been made in the clinical treatment of lacrimal duct obstruction. However, complications such as postoperative scar obstruction or inflammatory reactions have not been completely resolved. Previous studies mainly focused on optimizing artificial lacrimal duct improvements, but it is currently difficult to achieve better clinical outcomes through surgical modifications. With the development of molecular biology and tissue engineering techniques, new scaffold materials are continuously being developed, providing a broad prospect for the treatment of lacrimal duct obstruction. Silicone-based materials, widely used in clinical tear duct intubation, still need improvement in terms of tissue compatibility compared to polypropylene and polymer materials. The development of new biodegradable materials indicates a new research direction for tear duct intubation materials. In addition, the combination of autologous and allogeneic materials provides a new developmental direction for tear duct bypass reconstruction surgery without the need for internal support.(Int Rev Ophthalmol, 2023, 47: 367-372)


Application of intense pulsed light combined with meibomian gland expression in the treatment of dry eye

Tian Lu, Chen Luxia

2023, 47(4):  373-377.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.015

Asbtract ( 169 )  

Related Articles | Metrics

Intense pulsed light (IPL) is a relatively new treatment for meibomian gland dysfunction (MGD) causing lipid deficiency dry eye.  IPL combined with meibomian gland expression (MGX) is not only effective in treating MGD and other lipid deficiency dry eye, but also prevents the recurrence of blepharitis-associated keratoconjunctivitis (BKC), and is a promising treatment option for aqueous tear deficiency dry eye, surgical and lifestyle-related dry eyes. The combination of multiple approaches may have an important role in refractory dry eyes.(Int Rev Ophthalmol, 2023, 47: 373-377)


Progress in diagnosis and treatment of optic nerve sheath meningiomas

Ren Tingting, Ma Jianmin

2023, 47(4):  378-383.  doi:10.3760/ cma.j.issn.1673-5803.2023.04.016

Asbtract ( 167 )  

Related Articles | Metrics

Optic nerve sheath meningioma (ONSM) is a rare and slow-growing benign tumor that arises from arachnoid epithelial cells. ONSM primarily affects middle-aged women, and its clinical manifestations are mainly painless-progressive vision loss. Diagnosis is largely based on the combination of clinical and imaging findings. The typical CT/MRI findings are tubular or fusiform thickening of the optic nerve, followed by a ” double-track sign” after enhanced scan, which also may be accompanied by calcification. Treatment includes observation, radiotherapy and surgery, among which radiotherapy is the first choice for the treatment of ONSM. At present, there are many radiotherapy methods for ONSM, including spatially fractionated radiation therapy (SFRT), intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), proton beam radiotherapy (PBT), 3-dimensional conformal radiation therapy (3D-CRT), etc. Surgical treatment can cause vision loss in patients and is usually not be used, but new surgical approaches have been proposed in the literature to prevent tumor extension to the contralateral side. Drug therapy has yielded vision improvement in some cases and is expected to be a potential treatment for ONSM. The mortality of ONSM is almost zero, but the visual prognosis is generally poor.(Int Rev Ophthalmol, 2023, 47: 378-383)