Table of Content

22 October 2023, Volume 47 Issue 5

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Ocular manifestations of novel coronavirus infection

Shen Xiaoyuan, Yang Yangfan, Chen Zidong, Yu Minbin

2023, 47(5):  385-391.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.001

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The coronavirus disease 2019 (COVID-19) pandemic has caused a sustained global outbreak with extremely diverse clinical manifestations, affecting multiple organ systems throughout the body, including the eyes. Increasing evidence suggests that COVID-19 may replicate and spread within ocular tissues, leading to ocular symptoms. Ocular symptoms may occur in both the acute infection phase and the autoimmune inflammatory response phase of the infection caused by COVID-19, which may involve various ocular tissues (eyelids, conjunctival, cornea, sclera, lens,and other ocular tissues), presenting as inflammatory and vascular related clinical manifestations. Although whether COVID-19 is transmitted through the eyes is still controversial, protecting eye hygiene and avoiding eye contact with contaminants remains an important prevention and control measure.

Relationship between cerebrospinal fluid dynamics and pathophysiological mechanisms of optic nerve damage diseases

Fu Yingdi, Xie Yuan, Wang Ningli

2023, 47(5):  392-399.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.002

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In recent years, it has been proposed that the impairment of cerebrospinal fluid (CSF)dynamics is the common pathophysiological mechanism causing diseases associated with optic nerve impairment. Further study of CSF dynamics, especially optic nerve subarachnoid space (ONSAS) cerebrospinal fluid dynamics, may contribute to the understanding of conditions such as idiopathic intracranial hypertension, spaceflight-associated neuro-ophthalmic syndrome, normal-tension glaucoma and other diseases that cause optic nerve damage and visual impairment, and provide more ideas for their prevention and treatment.The CSF may not flow into ONSAS because of the degree of optic canal stenosis, intraocular pressure and the variation of anatomic structure. The change of ONSAS cerebrospinal fluid pressure is the main factor that cause optic disc edema and atrophy. The changes of pressure and inflammation stimulate the proliferation of meningeal epithelial cells in ONSAS and make the space of lumen become smaller, it leads to the occurrence of optic nerve sheath compartment syndrome, which damages the CSF dynamics and further leads to optic nerve injury. At present, there is no gold standard for evaluating CSF pressure in ONSAS and means to monitor CSF dynamics in real time. The change of CSF pressure in ONSAS can only be roughly judged by the change of optic nerve sheath diameter or intracranial pressure.

Advances in pathogenesis of nutritional optic neuropathy

Yang Xueli, Mao Junfeng

2023, 47(5):  400-405.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.003

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Nutritional optic neuropathy (NON) is a dysfunction of the optic nerve caused by nutritional deficiencies or metabolic disorders. It is primarily characterized by progressive bilateral and painless loss of central visual acuity associated with malnutrition or poor eating habits. There are also certain risk factors make the patient more susceptible to optic neuropathy including long-term smoking, alcohol abuse, chronic diarrhea and bariatric surgery. It is widely accepted that the pathogenesis of NON are dominated by the theory of mitochondrial dysfunction. Oxidative stress damage and axon demyelination also play important roles in the development of the disease.

Mechanisms of photoreceptor death in retinal degenerative diseases

Li Yihui, Jin Zibing

2023, 47(5):  406-412.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.004

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Retinal degenerative diseases, characterized by progressive loss of photoreceptors, cause irreversible damage to vision. In the past, apoptosis and necrosis were considered to be the main mechanisms of photoreceptor death. Recently, pyrodeath, autophagy, PARP-1-dependent cell death and iron death have been confirmed to be related to photoreceptor death. Specially, autophagy has a dual effect on photoreceptor cells. Inhibition of these signaling pathways can reduce the photoreceptor death in retinal degenerative diseases. With the further of the understanding of cell death, the diagnosis and treatment of retinal degenerative diseases will be updated and improved.

Role of platelets in retinopathy of prematurity

Kong Jiayi, Li Manhong, Zhang Zifeng, Wang Yusheng

2023, 47(5):  413-417.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.005

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Retinopathy of prematurity (ROP) has already become the leading cause of blindness in children worldwide, while neovascularization is the significant pathological cause of ROP occurrence and development. Except for participating in coagulation and hemostasis, wound healing, inflammation and tumor metastasis, platelets, the cellular debris produced by mature macrophages, play an important role in angiogenesis through regulating angiogenesis related factors and cells. Researchers have shown that the role and variation of platelets in ROP may provide new ideas for early screening and treatment with platelets infusion.

Correlation between hypertensive retinopathy and other important target organs injury

Zhao Runze, Sun Xiaojia, Lian Kun, Chang Tianfang, Dou Guorui

2023, 47(5):  418-423.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.006

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With the aging of China's population, the incidence of hypertension is increasing year by year. Retinal blood vessels have similar anatomical structure and functional characteristics with cerebrocardiovascular structure and renal blood vessels, meanwhile small retinal arteriopathy in hypertensive patients may precede the clinical symptoms of other important target organs damaged by hypertension, and retinal microcirculatory changes are expected to be a predictor of systemic pathologic changes in hypertensive patients. Although the correlation between hypertensive retinopathy and damage to the major target organs of hypertension has been confirmed, the examination and diagnostic criteria used in various studies are different, making replicability and clinical dissemination difficult. In recent years, the clinical application of artificial intelligence diagnosis model established by multi-modal hypertension retinopathy big data under fundus photography and optical coherence tomography (flow angiography) may solve this problem.

Hyperglycemia induces diabetic retinopathy through oxidative stress

Ding Yuwan, Huang Hong, Xu Jing

2023, 47(5):  424-429.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.007

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Diabetic retinopathy (DR) is a retinal microvascular complication that arises with the prolongation of the disease in diabetic patients. Its main pathological changes include retinal inflammation, increased vascular permeability, and abnormal retinal surface angiogenesis. Multiple mechanisms are involved in the development of DR, and oxidative stress is an important mechanism in its development, which includes the polyol pathway, advanced glycation end products (AGEs) pathway, the hexosamine pathway (HBP), the protein kinase C (PKC) pathway, and the angiotensin II (ANG II) pathway. The initiation of oxidative stress triggers an intracellular cascade reaction that generates excessive reactive oxygen species. Excessive reactive oxygen species lead to protein modification, inflammatory response, apoptosis, dysregulation of autophagy, impaired mitochondrial function, interfering with a variety of signaling pathways and affecting a variety of biological processes, which result in the onset and progression of DR. Further study of these interactions is important for understanding the pathogenesis of DR and finding relevant therapeutic strategies.

Idiopathic macular epiretinal membrane and its OCT and OCTA imaging features

Wang Gechun, Yuan Fei

2023, 47(5):  429-435.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.008

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Macular epiretinal membrane is a non-vascular fibroblast membrane located on the retinal inner surface in the macular area. Idiopathic macular epiretinal membrane (iERM) accounts for about 80%. Currently, optical coherence tomography (OCT) is the preferred diagnostic method for identifying iERM. OCT technology enables the early detection of the thickened and enhanced layer in the macular region associated with iERM. The information provided by OCT, such as the staging of the condition, central macular thickness, and integrity of the ellipsoid zone, plays a significant role in follow-up, determining the optimal timing for surgery and predicting prognosis. Optical coherence tomography angiography (OCTA) combines the technology of OCT and vascular imaging. In patients with iERM, OCTA images exhibit differences compared to those of normal eyes due to the traction caused by the epiretinal membrane on the retinal vasculature. Therefore, key parameters obtained through OCTA, such as the FAZ (foveal avascular zone) area, degree of vascular distortion, and vascular density, provide valuable insights for evaluating the prognosis of patients. The application of OCT and OCTA aids in more accurate diagnosis and management of patients with macular epiretinal membrane.

Progress in targeted therapy and immunotherapy for eyelid malignancies

Zhang Luyin, Jiang Libin

2023, 47(5):  436-444.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.009

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Eyelid malignancies are common ocular adnexal malignancies, which can not only affect the patient's vision and appearance, but also have a great threat to the patient's life. In recent years, based on the studies of the Hedgehog pathway, epidermal growth factor receptor (EGFR) and v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) mediated pathways and the immune checkpoint pathway, some targeted agents have shown certain efficacy and safety against eyelid malignancies, such as basal cell carcinoma, cutaneous squamous cell carcinoma, malignant melanoma, and Merkel cell carcinoma. Targeted therapy and immunotherapy provide additional options for patients with eyelid malignancies that recur after surgical resection, progress after systemic therapy, locally advanced or metastatic. Combined therapies have a higher response rate and longer survival than monotherapy. In the future, with the discovery of more downstream targets and better combined therapies, more treatment options will be available for eyelid malignancies.

Research progress of eyelid malignant melanoma

Li Yuwen, Ma Jianmin

2023, 47(5):  445-451.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.010

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Malignant melanoma of eyelid（MME） is a rare ocular tumor characterized by high malignancy, rapid progression and poor prognosis, accounting for less than 1% of eyelid tumors. MME has an increasing tendency in recent years. MME originates from nevus cells, epidermal melanocytes, or dermal melanocytes. The elderly population is the main group at risk for developing MME, which mainly occurs in the inner and outer canthus and develops in the direction of skin and conjunctiva. The development process is highly variable, which may rapidly grow into a large mass, or slowly increase. Sometimes the local lesions may be small, but distant metastasis has already occurred. The average survival time of late-stage patients is 7.5 months, and the 2-year and 5-year survival rates are 15% and 5% respectively. Early diagnosis and early surgical resection is the best choice to cure MME.

Associated factors of myopic shift after surgery for congenital cataract children

Du Qiuxuan, Yuan Jing, Su Wenjie, Huang Yusen

2023, 47(5):  452-455.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.011

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It is a common clinical scientific problem that myopic shift after congenital cataract surgery in children. The influencing factors are being explored. Among which, the younger the patient when cataract extraction with intraocular lens (IOL) implantation is performed, the greater the myopic shift. Moreover, patients can be treated with IOL implantation or optical correction after cataract extraction, achieving similar axial growth in a long-term follow-up period.The visual axis opacity and glaucoma after surgery can both increase the myopic shift. Clarify the best time point for IOL implantation, accurately calculate the IOL power, reasonable planning of follow-up time, has important clinical significance to improve the long-term visual quality of patients and reduce excessive myopic shift.

Progress on prediction of vault after ICL implantation

Zhu Qiujian, Yuan You, Song E

2023, 47(5):  456-461.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.012

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Vault is an important index to evaluate the safety of implantable collamer lens(ICL) implantation, and is also the focus of this surgical research. The choice of ICL size is the most important controllable factor for postoperativevault. The most traditional ICL size selection method is selected by white-to-white diameterand anterior chamber depth, but the accuracy of this method is not satisfactory. Therefore, researchers have tried to predict the postoperative arch height and ICL size through ultrasound biomicroscopy（UBM）, anterior segment OCT and even artificial intelligence, and achieved certain results. This article attempts to compare and analyze various vaulting prediction and ICL size selection methods, and expounds the characteristics, effects and evolution history of various methods.

Progress on blue-light filtering IOL

Guo Zhaoxing, Wan Xiuhua

2023, 47(5):  462-465.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.013

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Blue-light filtering introcular lens (IOLs) can effectively filter out some of the short wavelength blue light and are expected to provide protection to the fundus. Research confirms that blue light-filtering IOLs do not significantly affect postoperative color vision, sleep quality, or contrast sensitivity. Several long-term cohort studies have provided new evidence-based medical evidence for retinal protection, but some studies still suggest that blue light-filtering IOLs do not have significant advantages over clear IOLs.

Ocular surface complications in patients with AIDS

Gu Jie, Zhuang Xun, Zhu Rongrong

2023, 47(5):  466-470.  doi:10.3760/cma.j.issn.1673-5803.2023.05.014

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Acquired immune deficiency syndrome (AIDS) involve multiple organs and systems. It is prone to missed and misdiagnosed because of diversification and the lack of typical symptoms in eyes. The patients with AIDS are more likely to develop ocular surface diseases, such as ocular surface squamous neoplasia, vernal keratoconjunctivitis, keratitis, dry eyes and so on. They can affect visual function and even cause blindness if not treated in time.

Role of human herpesvirus and human papillomavirus in the pathogenesis of pterygium

Zhou Shuowen, Xu Yesheng, Zheng Libin, Yao Yufeng

2023, 47(5):  471-474.  doi:10.3760/cma.j.issn.1673-5803.2023.05.015

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Primary pterygium is a triangular fibrovascular lesion originating from the conjunctiva that often breaks through the limbus and extends to the cornea. The pathogenesis of primary pterygium has yet to be fully elucidated, but ultraviolet light, wind and dust, viral infection, and other factors may be involved in it. Pathogenetic researches indicate that human herpesvirus(HHV) and human papillomavirus(HPV) are detected in pterygium tissue, but the prevalence varies greatly, suggesting that the virus infection may only act as one of the factors in pterygium pathogenesis or recurrence. If the involvement of the virus is confirmed in pterygium pathogenesis, antiviral medications or vaccination may become a new research direction for pterygium therapy.

Effect of anti-VEGF drugs on cornea

Qi Yuanyuan, Jin Cuihua, Xue Xinxia, Zhang Lijun,

2023, 47(5):  475-480.  doi:10.3760/ cma.j.issn.1673-5803.2023.05.016

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Anti-（vascular endothelial growth factor，VEGF） is a first-line treatment for many retinal vascular diseases leading to macular edema. In clinical practice, repeated intraocular injections is required to achieve therapeutic effects. Intraocular injection is safety, and only few complications such as elevated intraocular pressure and intraocular inflammation have been reported. In recent years, clinicians have gradually begun to pay attention to the effects of repeated injections of anti-VEGF drugs on cornea. It has been reported that anti-VEGF drugs may affect corneal epithelium, corneal endothelium, corneal nerve, corneal biomechanics, dry eye and other aspects, which should be paid attention to by ophthalmologists.