Table of Content

25 January 2012, Volume 21 Issue 1

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Outdoor activity and myopia control

XU Liang

2012, 21(1):  1-2. 

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Although special attention to children’s myopia by society and government, and taking many measures for its control, the prevalence of children’s myopia is not decrease but continuously increases. This paper will explain the causes of high prevalence of children’s myopia with plot of epidemiological surveys in deferent regions. Firstly, the prevalence of children’s myopia is correlated with age. Secondly, civilization, modernization and smaller activity space are risk factors of myopia. Thirdly, for recent 10 years the prevalence of myopia has significantly been increasing. Fourthly, the prevalence of primary students is correlated with strong preschool education. We quote some researches and illustrate that myopia is caused by long-term near-distance activity and lacking of outdoor activity. (Ophthalmol CHN, 2012, 21: 1-2)

Comment on combined surgery on coexisting cataract and glaucoma

ZHANG Xiu-lan

2012, 21(1):  3-6. 

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The advance of phacoemulsification has been making huge significant contribution to the management of glaucoma. However, management of glaucoma with coexisting cataract has raised many discussions in recent years including current treatment strategies, indications, surgical procedure, timing and outcomes. This short paper will discuss these issues. Surgical strategy of primary angle-closure glaucoma (PACG) should be determined with an individualized approach based on the degree of peripheral anterior synechiae, the number of glaucoma medications, the opacity of lens and visual functions. Proficient operation skills are needed for choosing combined surgery. Cataract extraction should be greatly avoided during acute attack stage of PACG. The effect of cataract extraction in primary open angel glaucoma (POAG) still needs further study to clarify. For other types of glaucoma such as malignant glaucoma, aggressive lens extraction is of controversial. (Ophthalmol CHN, 2012, 21:3-6)

Screening for primary angle-closure glaucoma

KONG Xiang-Bin, HE Ming-Guang

2012, 21(1):  7-10. 

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The ideal screening methods for primary angle-closure glaucoma (PACG) should be simple, quick, noninvasive and easy-to-perform that aims to quantify the anterior chamber angle. Some methods have been proposed, such as the oblique flashlight test, A-scan ultrasound, van Herick test, gonioscopy, ultrasound biomicroscopy, anterior segment optical coherence tomography, scanning peripheral anterior chamber depth analyzer and Scheimpflug photography although each of them has their advantages and disadvantages. In clinical practice, one may choose a method most appropriate or consider combining two or more methods in order to improve the sensitivity and specificity of screening. (Ophthalmol CHN, 2012, 21: 7-10)

The advances of the expert consensus and the first-line medications of topical intraocular pressure-lowering agents in glaucoma treatment.

REN Ze-qin

2012, 21(1):  11-13. 

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There are six main classifications and thousands of all combination schemes of topical intraocular pressure-lowering agents currently available in management of glaucoma. The clinical guidelines have kept renewing in recent years aiming to guide the clinical doctors in their maximum reasonable medical therapy. In the present paper, the selection path of drug application and the expert consensus from 2011 World Glaucoma Congress are briefly introduced, with the target intraocular pressure and the first-line medications as a center. (Ophthalmol CHN, 2012, 21: 11-13)

Glaucoma treatment during pregnancy and lactating

LI jian-jun

2012, 21(1):  14-18. 

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In most situations, pregnancy can decrease the intraocular pressure (IOP) of women with pre-existing glaucoma. In managing the pregnant glaucoma patient with medical therapy, we must consider not only the systemic side effects on the mother, but also any potentially harmful effects on the developing fetus. All anti-glaucoma medications are categorized as class C by the Food and Drug Administration, except brimonidine, which belong to class B. Although there are no high quality of researches to prove aitiglaucoma medications causing harmful effects of fetus and newborns, it is better to stop or avoid medications during the first 12 weeks of gestation. In other gestation time, the lowest effective dosage of medication should be considered. Systemic absorption can be reduced by punctal occlusion, eyelid closure, and blotting the excess drops away during administration. In those patients who need surgery, most local anesthetics may be used safely because they have not been shown to be teratogenic in humans. Antifibrotic agents usually used adjunctively in trabeculectomy, however, should be avoided. Glaucoma laser procedures, such as laser peripheral iridotomy and selective laser trabeculoplasty, can be used for pregnant women. (Ophthalmol CHN, 2012, 21: 14-18)

Types and pathogenesis of normal tension glaucoma

CHEN Yan-Yun, LIANG Yuan-Bo, QIAO Li-Ya

2012, 21(1):  19-23. 

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The clinical manifestation (including glaucomatous optic nerve damage and visual field damage) and pathogenesis of normal tension glaucoma are in some degree different from primary open angle glaucoma. In this review, the hypothesis of normal tension glaucoma pathogenesis is divided into different subgroups, including hypoxia ischemia subgroup (a link with arterial hypotension, myocardial ischemia, headache and migraine, increased plasma levels of endothelin-1, increased platelet aggregation, or ischemia encephalopathy, etc), abnormal autoimmunity subgroup (with monoclonal gammopathy, anti-rhodopsin antibody, autoantibodies to Heat Shock Proteins , neuron-specific enolase autoantibodies, or antiphospholipid antibodies), neurodegenerative diseases related subgroup (Alzheimer disease, Parkinson disease), abnormal endocrinological subgroup(e.g., hypothyroidism). The hypothesis of normal tension glaucoma pathogenesis subgroups will benefit for the clinical management. (Ophthalmol CHN, 2012, 21: 19-23)

Treatment of residual angle closure with small pupil and severe flat anterior chamber after peripheral laser iridotomy

CHEN Hong, CHEN Xiao-Ming, ZHANG Xiu-Lan, GUO Wen-Yi, ZHANG Hong, HUANG Yu-Sen, LV Jian-Hua, LI Jian-Jun

2012, 21(1):  24-28. 

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We reported 2 cases of refractory residual angle closure glaucoma patients aged over 50 years with small pupil, severe flat anterior chamber and lens opacification, and more than 5 years after laser peripheral iridotomy (LPI) or iridoectomy. The purpose of this case discusion is to pay attention to long-term follow-up of primary angle-closure patient after LPI, to promote personalized treatment for residual glaucoma, and to present our experience of cataract surgery in patients with small pupil and severe flat anterior chamber. (Ophthalmol CHN, 2012, 21: 24-28)

Prevalence and causes of visual field loss determined by frequency doubling perimetry in elderly population of Beijing

WANG Ya-Xing, XU Liang, LI Jian-Jun, ZHANG Rong-Xiu, SUN Xiu-Ying, Jost B. Jonas

2012, 21(1):  29-33. 

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Objective To determine prevalence and causes of visual field loss (VFL) as determined by frequency doubling perimetry in elderly Chinese. Design Population-based cross-sectional study. Participants 4 439 participants inhabited in certain rural villages or urban communities of greater Beijing were enrolled. Methods Detailed ophthalmic examinations and questionaire were applied. Visual field was assessed by frequency doubling threshold perimetry. An abnormal visual field was defined as at least one test location of reduced sensitivity. Main Outcome Measures Prevalence of visual field defects and their causes. Results Of the 4 439 persons examined, 4 350 (98.0%) subjects (8 617 eyes) provided measurement data by frequency doubling perimetry.  In subjects aged 40 to 49 years, most frequent cause for VFL was degenerative myopia followed by glaucoma, other optic nerve diseases, and cataract. In the subjects aged 60 to 69 years, most frequent cause for VFL was cataract, followed by glaucoma and degenerative myopia. In the subjects aged 70+ years, most frequent cause for VFL was glaucoma, followed by cataract and degenerative myopia. VFL was significantly associated with age (P<0.001), myopic refractive error (P<0.001), rural region (P=0.001), low level of education (P=0.01), degree of nuclear cataract (P<0.001), and intraocular pressure (P<0.001). Conclusions Degenerative myopia, cataract and glaucoma were the most common causes for visual field defect in adult Chinese. (Ophthalmol CHN, 2012, 21: 29-33)

Early optic disc morphological changes following trabeculectomy: Image matching study

LI Jian-Jun, XU Liang, YANG Hua, WANG Ya-Xing, WANG Shuang

2012, 21(1):  34-38. 

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Objective To study the changes of early optic disc morphological following trabeculectomy in adults. Design Retrospective case series. Participants Fifty-seven eyes out of 57 glaucoma patients aged 47.5±18.5 years old who were performed trabeculectomy in Beijing Institute of Ophthalmology from June 2010 to October 2011. Methods Patients who underwent trabeculectomy by the same surgeon were continuously selected from Tongren Eye Electronic Medical Record System. The inclusion criteria was that intraocular pressure was fully controlled after operation, and fundus photographs were available both pre- and post-operation. The two photographs were compared after being matched and flickered with a specific computer software. Qualitative analysis of optic disc and posterior pole fundus was performed. Main Outcome Measures Morphological changes of optic disc in fundus images. Results Reversal of optic cup after trabeculectomy were observed in 43 eyes (75.4%), and obviously reversal was observed in 30 eyes (52.6%). The mean age of participants with or without reversal of optic cup area was 43.7±18.7, or 59.7±13.6 years, respectively (t=-3.0,  P=0.009). Chronic glaucoma was major (95.3%) in patients with reversal of optic disc cupping. Location changes (mainly shift to the concentric) of optic disc vessels were found in 43 eyes (75.4%), which is significantly correlated with the presence of optic disc cupping reversal (r=0.775, P=0.000). Changes in optic disc and para-disc vessel diameter (29 eyes, 50.9%), and the occurence of macular edema (13 eyes, 22.8%) were also noticed. Conclusion Reversal of optic disc cup and the changes in optic disc vessel diameter and location are common in adults early after trabeculectomy, especially in younger patients. (Ophthalmol CHN, 2012, 21: 34-38)

Large intraocular pressure fluctuation and enlargement of beta zone parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy

ZHANG Ya-Qin, XU Liang, ZHANG Li, LI Jian-Jun

2012, 21(1):  39-42. 

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Objective To evaluate the risk factors of the glaucomatous optic neuropathy progression in patients with primary open angle glaucoma (POAG). Design Retrospective case series. Participants The study included 197 eyes of 115 patients with POAG. All the patients were followed up for at least 3 years in Beijing Tongren Eye Center. Methods Mean follow-up time was 56.64±14.84 months. All the patients had complete fundus photographs and intraocular pressure(IOP) recording. The glaucoma specialists, masked to chronological sequence, examined pairs of optic disc photographs to determine whether the appearance of the optic disc had changed. Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Long-term IOP fluctuation was defined as the standard deviation of IOP. Main Outcome Measures Multivariate Logistic regression analysis of the factors which may lead to the progression of the glaucomatous optic neuropathy. Results Progression of glaucomatous optic nerve changes was detected in 98 eyes (49.75%) and 99(50.25%) eyes were stable.  There were statistically significant differences between progressive and non-progressive eyes for optic disc hemorrhage (P=0.02) and enlargement of beta zone parapapillary atrophy (P=0.000). In univariate logistic analysis, there were statistically significant differences between progressive and non-progressive eyes for peak IOP (P=0.001), IOP fluctuation (P=0.000) and duration of follow up (P=0.041). In multivariate logistic regression analysis, there were statistically significant differences between progressive and non-progressive eyes for IOP fluctuation (P=0.000, OR=2.522) and enlargement of beta zone parapapillary atrophy (P=0.000, OR=25.655). The IOP fluctuation was larger in patients with glaucomatous optic neuropathy progression (2.87±1.29, 0.89-7.21) than the patients who were stable (2.11±0.94, 0.25-4.97). There were 75 eyes with enlargement of beta zone parapapillary atrophy in the 98 eyes with glaucomatous optic neuropathy progression (76.53%). Conclusions  Large intraocular pressure fluctuation and enlargement of beta zone parapapillary atrophy are predictive factors for progression of optic neuropathy in POAG. (Ophthalmol CHN, 2012, 21: 39-42)

The management model of malignant glaucoma with phacoemulsification cataract extraction

YOU Xin-Ying, Wang-Tao

2012, 21(1):  43-46. 

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 Objective To report the feasibility of the management model of malignant glaucoma with phacoemulsification cataract extraction. Design Retrospective case series. Participants 12 cases of malignant glaucoma with cataract after the filtration surgery which were invalid to medical treatment. Methods All 12 eyes were given priority to phacoemulsification cataract extraction and the implantation of posterior chamber foldable intraocular lens combined with goniosynechialysis and vitreous water pocket aspiration. Some relapse cases were performed Nd: YAG laser capsulotomy and hyaloidotomy or anterior vitrectomy. Ultrasound biomicroscopy (UBM) was examined at preoperation and 2 weeks of postoperation besides the routine examination. The mean following-up was 15.8±5.2 months. Main Outcome Measures Intraocular pressure (IOP), central anterior chamber depth (ACD) and visual acuity changes. Results The mean central ACD and IOP before surgery were 0.38±0.17 mm and 31.50±3.50 mm Hg. 5 eyes were cured after the surgery of phacoemulsification cataract extraction and the implantation of posterior chamber foldable intraocular lens combined with goniosynechialysis. Among the 7 relapsed eyes, 5 eyes underwent Nd: YAG laser capsulotomy and hyaloidotomy, and the other 2 eyes which relapsed again after laser treatment were performed anterior vitrectomy. The average central ACD was 2.31±0.37 mm at 2 weeks postoperatively and the mean IOP was 14.60±4.8 mm Hg at the last follow-up. The visual acuity increased or kept unchanged. Conclusions The small sample data in our study shows that the phacoemulsification cataract extraction and posterior chamber foldable intraocular lens implantation may be a first alternative in treating malignant glaucoma which is invalid to medical treatment. The Nd: YAG laser capsulotomy / hyaloidotomy and the anterior vitrectomy can be performed in the relapsed cases. This step by step treatment model is feasible. (Ophthalmol CHN, 2012, 21: 43-46)

Clinical analysis of 49 cases with intraocular lens dislocation

WANG Hai-Yan, Pang-Xiu-Qin, He-Lei, PEI Xue-Ting, WANG Shao-Li, LU Hai

2012, 21(1):  47-51. 

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 Objective To discuss the clinical characteristics of intraocular lens (IOL) dislocation. Design Retrospective cases series. Participants 49 eyes (49 cases) of intraocular lens dislocation in Beijing Tongren Hospital from 2004 to 2011. Methods Clinical data of intraocular lens dislocation were reviewed retrospectively. Main Outcome Measures  Age, original disease, history of disease, position and type of intraocular lens, cause, surgical method, and complication. Results Majority of 49 cases of intraocular lens dislocation were cases with surgery of age-related cataract (46.9%) and traumatic cataract (28.6%). 6 cases with dislocation of intraocular lens with ciliary sulcus fixation happened 1 year after surgery. Majority of intraocular lenses dislocated located in vitreous body (53.1%) and “C” loop (89.8%). 75.5% of causes were original disease and surgery. Ciliary sulcus fixation or re-fixation of intraocular lens (47 eyes, 95.9%) could achieve good centration and stability of the intraocular lens. Naked vision of 0.1 or more accounted for 59.6% at 2 weeks after fixation or re-fixation. Conclusion Intraocular lens dislocation is related with original disease and surgery. Ciliary sulcus fixation of intraocular lens is an effective strategy to treat intraocular lens dislocation. But intraocular lens with ciliary sulcus fixation still happens to dislocate. (Ophthalmol CHN, 2012, 21: 47-51)

Capsular hooks and modified capsular tension rings for moderate-severe lens subluxation

DING Lu-Qi, ZHENG Ke

2012, 21(1):  52-55. 

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Objective To investigate the efficacy and safety of capsular hooks and modified capsular tension rings (MCTR) for the treatment of moderate to severe lens subluxation during phacoemulcification with intraocular lens (IOL) implantation. Design Retrospective case series. Participants 15 cases (19 eyes) of moderate to severe lens subluxation in which range of lens dislocation was from 135° to 225° in Beijing Intech Eye Hospital from January 2009 to January 2011. Methods  Data were collected from total 19 eyes of 15 patients with moderate to severe lens subluxation, who received the phacoemulsification and IOL implantation in the assistance of capsular hooks and MCTR. The range and location of lens dislocation were observed preoperatively. Visual acuity, refractive power, intraocular pressure and anterior segment of the eyes were observed postoperatively. The average follow-up period was 16.4±4.8 months. Main Outcome Measures Visual acuity, complications. Results The MCTR was implanted successfully in all 19 eyes (100%). At the last follow-up, visual acuity improved in all 19 eyes with no complications such as IOL asymmetry, high intraocular pressure, MCTR incarceration, serious posterior capsular opacification or vitreous hernia. Conclusion The capsular hooks and modified capsular tension rings are helpful for the treatment of moderate to severe subluxated lens during phacoemulsification. It can prevent from occurring of intraocular lens decentration and decrease the surgical complications. (Ophthalmol CHN, 2012, 21: 52-55)

The prevention effect of cyclosporine A nano-particle eye drop on cornea immune rejection in a rat penetrating cornea transplantation model 

MA Ke, ZHANG Hai-Juan, WU Yan, XU Qing, YOU Yu-Xia

2012, 21(1):  55-59. 

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Objective  To investigate the prevention effect of cyclosporine A nano-particle eye drop on cornea immune rejection in a rat experimental model. Design Experimental study. Participants Fifty Lewis rats and twenty-five F344 rats. Method Fifty Lewis rats were divided into 5 groups (group A to group E), all of which were received penetrating cornea transplantation in the right eyes. The provider were F344 rats. Group A received vehicle eye drop, group B received ordinary cyclosporine eye drop, group C to E received 0.5%, 1% and 2% cyclosporine A nano-particle eye drop respectively. All the receptor eyes received the eye drops 4 times a day. Cornea were observed with slit lamp and photographs were taken everyday within 14 days after cornea transplantation, and then observed every other day until 28 days. The mean survival time and rejection index (RI) were calculated. The corneas were studied pathologically at day 14th. Main Outcome Measures Cornea survival time, rejection index, pathologically observation of cornea. Results  The mean survival time in group A, B, C, D, E were 8.1±1.37 days, 12.5±4.72 days, 12.11±4.46 days, 13.11±4.65 days and 13.56±3.88 days respectively(F=2.916, P=0.032). The survival time in any of group B, C, D, E is longer compared with group A (all P<0.05). RI of group A to E was 7.3±0.67, 5.5±1.35, 6.11±1.45, 5.22±1.48 and 4.77±1.20, respectively (F=5.782, P=0.001). RI in group B, C, D, E is lower compared with group A(all P<0.05).  No significant difference was found between any of group C, D, E and ordinary cyclosporine eye drop (P=0.297, 0.634, 0.219). But significant difference was found between 2% cyclosporine A nano-particle group and 0.5% group (P=0.03).  Conclusion  Cyclosporine A nano-particle eye drop can effectively prevent cornea rejection after penetrating cornea transplantation. Its effect is similar to ordinary cyclosporine eye drop. The effect of 2% cyclosporine A nano-particle eye drop was better than 0.5% cyclosporine A nano-particle eye drop. (Ophthalmol CHN, 2012, 21: 55-59)

Comparison of efficacy and complications in treatment of diabetic macular edema by intravitreal bevacizumab with intravitreal triamcinolone acetonide for first priority: a meta-analysis 

MA Nan, LI Dan, GAO Fu-Lin, HU Lian-Na

2012, 21(1):  60-64. 

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Objective To evaluate the efficacy and safety in treatment of diabetic macular edema (DME) by intravitreal bevacizumab (IVB) with intravitreal triamcinolone acetonide (IVT) for first priority. Design Meta analysis. Participants Published literature in Medline, EMbase, Cochrane library and CBM which comparing IVB with IVT in treatment of DME for first priority. Methods According to evaluation guidelines of Cochrane collaboration, clinical controlled trials (CCTs) were searched using Medline, EMbase, the Cochrane Library and CBM. Methodology qualities of literatures were performed by experienced researchers according to the Jadad Score. RevMan 5.1 offered by Cochrane was used to do the meta-analysis. Main Outcome Measures central macular thickness, best corrected visual acuity and adverse events. Results Only 7 literatures (417 eyes) were selected into meta-analysis. The result of analysis showed that IVT group had a more reduced central macular thickness with -55.34 μm (95%CI: -104.51- -6.17 μm, P=0.03) than IVB group. However, no significant difference in visual acuity was observed between IVB and IVT group (P=0.06). Adverse event rates (mainly elevation of intraocular pressure) in IVT group was 14.3 times (95%CI: 4-50 times) more than IVB group (P=0.000).  Conclusion Meta-analysis shows that IVT group had a more reduced central macular thickness and equal visual acuity compared with IVB group in treatment of DME, while the adverse event rates were much more than IVB group. More high quality perspective studies are still required for further analysis. (Ophthalmol CHN, 2012, 21: 60-64)

Short-term outcome of off-flap Epi-LASIK for moderate to high myopia

DONG Kun-Feng, ZHANG Yin-Bo

2012, 21(1):  65-68. 

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Objective To observe short-term outcome of off-flap Epi-LASIK for moderate to high myopia. Design Retrospective case series. Participants The study included 203 patients, who had underwent Epi-LASIK in Xingtai Eye Hospital from April 2008 to November 2010. One hundred and ten patients underwent off-flap Epi-LASIK was defined as off-flap group, and 103 patients underwent on-flap Epi-LASIK was defined as traditional group. Methods The uncorrected distance visual acuity (UDVA), refractive status, pain status, level of haze, high degree aberration, and contrast sensitivity function (CSF) were compared between the two groups. All the patients had been followed up for 6 months. Main Outcome Measures Pain status, level of haze, high degree aberration and contrast sensitivity. Results No significant differences in the mean preoperative spherical equivalent between two groups (t=1.62, P=0.11). Compared with the traditional group, the off-flap group had rapider reepithelialization (t=17.25, P=0.00), and less pain at 3 days (Z=11.89, P=0.000) and 5 days (Z=10.34, P=0.000) after operation. Six months after surgery, there was no significant differences in the mean spherical equivalent between groups (t=17.25, P=0.21). Compared with traditional group, the off-flap group had lower level of haze (Z=2.06, P=0.04). Wavefront aberration increased significantly from baseline in both groups (t=-8.05, P=0.00; t=-8.92, P=0.00). Contrast sensitivity function with glare at 18 cpd was better in the off-flap group (1.21±0.13) than in off-flap group (1.15±0.12) (t=2.18，P=0.03). Conclusions Comparing with on-flap Epi-LASIK, off-flap Epi-LASIK offers a rapider visual recovery, comparable pain, a lower level of haze formation, and better visual quality. (Ophthalmol CHN, 2012, 21: 65-68)

The preliminary application of lacrimal passage probing surgery for acute dacryocystitis

QIAO Yu-Chun, Wang-Zhi-Xia, CHEN Jing

2012, 21(1):  70-72. 

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 Objective To report the curative effect of lacrimal passage probing surgery for acute dacryocystitis. Design Retrospective case series. Participants 80 cases (80 eyes) of acute dacryocystitis with abscess formation but without perforation. Method  Based on local and systemic broad-spectrum antibiotics, the lacrimal passage probing surgery was promptly performed in 80 cases of acute dacryocystitis before the lacrimal abscess perforation, and drained the liquor pus from the superior-and inferior-dacrydot. Then the canalicular was daily washed with antibiotics until acute inflammation was controlled. Main Outcome Measures The controlled time of the acute inflammation and the skin reaction of dacryocyst area. Results 1 case (1.3%) in 80 cases formed the false passage, so undertaken the dacryocyst incision and drainage. Acute inflammation in other 79 cases (98.7%) was controlled within 3 days, and no skin ulceration happened. Within 7-15 days the local skin recovered normal color and thickness. Conclusion Our priliminary data shows that prompt lacrimal passage probing surgery for acute dacryocystitis to relieve acute inflammation is fast, safe and effective. (Ophthalmol CHN, 2012, 21: 70-72)