Table of Content

22 June 2024, Volume 48 Issue 3

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Development history of ocular prosthesis and status of three-dimensional printing ocular prosthesis

Niu Linghan, Li Dongmei

2024, 48(3):  161-165.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.001

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Starting with the glass prosthetics from 18th century, ocular prosthesis has been continuously improved in terms of materials and craftsmanship, in order to provide better appearance and wearing experience for patients. With the development of technology, the combination of three-dimensional printing (3D printing) with computer-aided design (CAD), material manufacturing and other technologies has brought new ideas to the entire process of ocular prosthesis design and production. In terms of iris localization and color determination, 3D printed ocular prosthesis has a more accurate appearance. By combining CAD technology and eye socket scanning technology, 3D printed prostheses can provide a more accurate appearance. Compared with traditional prostheses, it shortens the customization time and reduces labor investment.

Research progress on dynamic changes of iris in patients with primary angle closure glaucoma

Xu Jiayi, Peng Junjie, Wang Jibing

2024, 48(3):  166-171.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.002

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Primary angle-closure glaucoma (PACG) is a kind of glaucoma with similar anatomical structure characteristics ( shallow anterior chamber, relatively small cornea, relatively thick lens, short axial length, etc. ). The common cause of PACG is acute or chronic closure of the anterior chamber angle, which hinders the outflow of aqueous humor, increases intraocular pressure, and leads to visual impairment. Iris tissue structure plays an important role in the pathogenesis. Previous studies have mostly focused on the characteristics of iris static anatomy. However, not all suspected primary angle closure (PACS) individuals with similar anatomical features will develop into PACG. With the development of anterior segment imaging technology, recent studies have found the abnormal iris dynamic changes, such as the iris tissue structure, dynamic changes, biomechanical properties and autonomic nerve function, etc., play the important roles on the early screening of PACG and the prediction of PACS disease progression.

Relationship between high myopia and primary open angle glaucoma

Lin Leying, Lin Peijie, Lai Mingying

2024, 48(3):  172-176.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.003

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Primary open-angle glaucoma is a chronic and progressive optic neuropathy with characteristic morphological changes of optic disc and retinal nerve fiber layer, and without other eye diseases or congenital abnormalities, which will eventually lead to irreversible blindness. High myopia is an independent risk factor for primary open angle glaucoma, but it is accompanied by changes in eyeball morphology and optic disc structure, which brings difficulties to early clinical diagnosis and treatment. At present, a large number of studies show that the risk of primary open angle glaucoma in patients with high myopia is higher than that in patients with non-high myopia. This paper summarizes the relationship between high myopia and primary open angle glaucoma from the aspects of epidemiology, intraocular pressure, axial length, visual field, optic disc and retinal nerve fiber layer.

Research progress of stem cell exosomes in treatment of glaucoma

Lv Jiayan, Fu Qiang, Man Xuejing

2024, 48(3):  177-183.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.004

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Glaucoma is a group of diseases characterized by characteristic optic atrophy. Its pathological manifestations are the damage and apoptosis of retinal ganglion cells. Stem cell exosomes are extracellular microvesicles released by stem cells, which not only retain the function of stem cells in promoting the regeneration and repair of damaged retinal ganglion cells, but also mitigatethe side effects of stem cells, and therefore have become a substitute for stem cells. In addition, stem cell exosomes can also induce the proliferation of trabecular meshwork cells and promote aqueous humor outflow; and it can be used as a drug carrier of anti-scarring drug aptamer S58 in anti-glaucoma surgery, delaying the degradation of S58 and significantly enhancing the duration of its anti-scarring effect. Based on the biological characteristics and functions of exosomes. The research progress of exosomes in glaucoma treatment puts forward that exosomes secreted by stem cells have broad application prospects in glaucoma treatment.

Research progress of late intraocular lens dislocation after cataract surgery

Tian Zhiyong, Wan Xiuhua

2024, 48(3):  183-187.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.005

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Late intraocular lens (IOL) dislocation is a dislocation of the IOL that occurs 3 months or more after cataract surgery and is a rare but serious complication after cataract surgery. Studies have shown that the cumulative incidence of which in 10~15 years after surgery is 0.1% to 3%, and the incidence has been increasing in recent years. Dislocation of IOL may be caused by rupture of the zonular dehiscence and contraction of the capsular bag due to a variety of factors, including pseudoexfoliation, high myopia, and trauma, etc. At present, there are a series of preventive and therapeutic measures for advanced IOL dislocation. The most common treatment methods include IOL repositioning surgery and IOL exchange surgery. The specific surgical method needs the surgeon to comprehensively evaluate the situation of IOL dislocation to decide.

Application of intraoperative optical coherence tomography in posterior chamber phakic intraocular lens implantation

Zhang Shuai, Liu Jiewei

2024, 48(3):  188-193.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.006

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Posterior chamber phakic intraocular lens implantation is currently one of the most common refractive surgeries, and its safety and effectiveness have been unanimously recognized. However, there are also some postoperative complications, most of which are related to postoperative vault. Therefore, postoperative vault is an important indicator to evaluate the success of surgery. In clinical practice, we mainly predict postoperative vault through preoperative examination and hope to achieve ideal vault. The emergence of intraoperative optical coherence tomography (iOCT) greatly improves the accuracy of prediction, allowing doctors to observe real-time changes in vault during surgery. With the advancement of technology, it is possible to better adapt to the surgical process, reduce interference with the operator, and achieve better surgical outcomes.

Research progress of measurement methods of lens nuclear opacities

An Junye, Yuan Ping, Zhang Junting, Wang Tao, Yi Yunmin

2024, 48(3):  194-199.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.007

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Lens nuclear opacities can objectively reflect the degree of lens opacity in patients with nuclear cataract, and can also indirectly evaluate the difficulty of phacoemulsification and postoperative visual acuity recovery. At present, the international LOCS III grading method and the Emery grading method in China are subjectively graded by the degree of turbidity and color of the lens nucleus, which are qualitative analysis and have certain unrepeatability. Recently, objective lens nucleus opacities measurement methods such as Scheimpflug technology and optical correlation tomography (OCT) have been emerging, which not only can improve the high accuracy and repeatability, but also can be combined with machine deep learning to automatically predict cataract grading, which is conducive to the refined preoperative evaluation of cataract patients.

Roles of ferroptosis in the pathogenesis of cataract

Guo Dongling, Zhu Xiangjia

2024, 48(3):  200-204.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.008

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Previous studies have shown that cataractous lenses exhibit characteristics of ferroptosis, including increased levels of oxidatively active iron, elevated lipid peroxidation, and a disrupted glutathione peroxidase system. Recent researches have confirmed that epithelial cells from age-related cataract lenses underwent ferroptosis. The use of agents like astaxanthin and melatonin can delay cataract formation by inhibiting the ferroptosis pathway. Additionally, the levels of lipid peroxidation and oxidative active iron in high myopia-associated cataracts have been found to be higher than those in age-related cataracts.

Capsule polishing in cataract surgery to prevent posterior capsule opacification

Zheng Xin, Wan Xiuhua

2024, 48(3):  205-210.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.009

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Posterior capsular opacification (PCO) is one of the common complications after phacoemulsification. Modern cataract surgery technology has significantly reduced the occurrence of this complication, with the improvement of modern surgical technology and intraocular lens materials, making the rate of YAG laser posterior capsulotomy is declining. Capsular membrane polishing, whether instruments, water flow polishing or negative pressure polishing can effectively remove the fiber stent on the posterior capsule surface and the detached epithelial cells, and can effectively prevent PCO. In patients with adequate anterior and posterior capsule polishing, the incidence of postoperative PCO is usually reduced.

Research advance of peudophakic cystoid macular edema

Hu Yizhuo, Zhang Fengyan

2024, 48(3):  210-216.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.010

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Pseudophakic cystoid macular edema (PCME), also known as Irvine-Gass syndrome, is the most common cause of unexpected visual loss after cataract surgery. Diabetes mellitus, epiretinal membrane, prostaglandin analogues are its risk factors. It’s widely accepted that inflammation is the leading pathological mechanism, some cytokines and immune-relatedfactors may contribute to the pathological process. As for the prophylactic and treatment, besides the conventional nonsteroidal anti-inflammatory drug (NSAID) and steroid, new researches indicate that intraoperative intracameral phenylephrine-ketorolac, subtenon/subconjunctival steroid, dexamethasone implant or triamcinolone acetonide, postoperative intracanalicular corticosteroids, yellow subthreshold micropulse laser achieve promising outcome.

Influence of different corneal refractive surgery on corneal biomechanics

Yang Haoming, , Liang Gang

2024, 48(3):  217-223.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.011

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Different types of corneal refractive surgery have different effects on corneal biomechanical characteristics due to different cutting methods and cutting depth. Large incision and large cutting amount have great effects on corneal biomechanical characteristics. Regarding the impact of corneal biomechanics alone, current studies have shown that PRK is smaller than SMILE, followed by LASIK and FS-LASIK. The ocular response analyze（ORA）and corneal visualization scheimpflug technology（Corvis-ST）were used to measure corneal biomechanics, excluding patients with poor mechanical indexes. For patients with soft and thin corneas, under the comprehensive consideration of all aspects of the patient's conditions, it is more appropriate to choose the surgical method with less influence on the mechanics (such as small incision lenticule extraction), and adopt the surgical design such as small light area to ensure the safety and stability of the operation. It can effectively avoid or reduce the occurrence of postoperative complications.

Source of corneal astigmatism

Zhang Xinru, Fan Zhenhong, Gao Mengman, Guo Xiujin

2024, 48(3):  224-228.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.012

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Astigmatism can be divided into corneal astigmatism and intraocular astigmatism based on their sources. Corneal astigmatism accounts for 70% of the total refractive power of the eye, and the cornea is the main source of human astigmatism. The sources of corneal astigmatism can be divided into congenital astigmatism and acquired astigmatism. Congenital astigmatism can be caused by certain trace element deficiencies, while acquired astigmatism can be caused by ocular surface factors, orbital factors, surgical factors, and other related factors. Acquired astigmatism can be reduced through surgery or changing the original surgical method. Understanding of the sources of corneal astigmatism aims to provide clinical evidence for the development of new surgical methods to reduce surgical astigmatism in the future, and to provide clinical ideas for avoiding acquired astigmatism in the early stages without affecting vision.

Mechanism and safety of controlling myopia with repeated low-level red light

Li Haobin, Ge Jinling

2024, 48(3):  229-234.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.013

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The research results of repeated low-level red light (RLRL) irradiation assisted treatment of myopia in children and adolescents show that RLRL irradiation can slow down the growth of myopia in children and adolescents. The possible mechanism is to increase choroid thickness, promote retinal dopamine secretion, inhibit melatonin secretion, promote cell repair, and inhibit cell apoptosis. The safety of RLRL has also been widely controversial in clinical practice, as the retina of children and adolescents is not yet fully developed. Long term repeated exposure to low-level red light may induce radiation-induced cataracts, degeneration of retinal tertiary neurons and pigment epithelial cells, and macular light damage.

Mechanism of borneol promoting permeability and its potential application in treatment of eye diseases

Jiang Yuting, Qu Lijun

2024, 48(3):  235-240.  doi:10.3760/ cma.j.issn.1673-5803.2024.03.014

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Borneol, a lipid-soluble terpenoid, which has a good selective permeation enhancement effect on hydrophilic and high molecular weight drugs by changing the tight junction structure between skin stratum corneum and loose endothelial cells. Additionally, borneol positively impacts the penetration of drugs in physiological eye tissue and pathological lesion tissues. It accomplishes this by loosening corneal epithelial cells, enabling the phospholipid bilayer to arrange in an orderly way and expanding the intercellular space, thus promoting infiltration and channel induction. Furthermore, borneol has the ability to regulate retinal vascular endothelial cells and tight junction proteins within the blood-eye barrier, corneal barrier, and retinal barrier. This modulation can enhance the therapeutic effects of various drugs used in the treatment of ocular diseases.