Table of Content

25 May 2012, Volume 21 Issue 3

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Etiology of frequent-blinking in children

ZOU Liu-he, ZHAO Meng

2012, 21(3):  145-148. 

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The frequent blinking has become more and more common complaint of children's parents in ophthalmic clinics. It was always dignosed as conjunctivitis or keratitis. In fact, the common causes of pediatric frequent blinking were pediatric dry eye syndrome, refractive error, child Tic disorder, allergic conjunctivitis, and so on. The misdiagnosis of frequent blinking in children not only could delay the proper treatment, but also could make the children suffer from the ocular surface damages related to the eye drops. Therefore, we should thoroughly learn the underlying causes of frequent blinking in children in order to give the proper treatment in time.

Endothelial keratoplasty; chances and challenges

PAN Zhi-qiang

2012, 21(3):  149-150. 

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Endothelial keratoplasty is popular in recent years. This article focuses on the characteristics of endothelial keratoplasty, the difference with penetrating keratoplasty, the indications and complications of endothelial keratoplasty, the imperfection of endothelial keratoplasty, and the suggestion on potential solution.

To achieve better visual quality in corneal refractive surgery

ZHANG Feng-ju

2012, 21(3):  151-153. 

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Excimer laser corneal refractive surgery has become the common procedure to correct refractive error. Although the modern corneal refractive surgery has achieved better unaided vision and good effect, but it is still needed to be improved and modified further. In this article, the unsatisfactory factors and resolve proposal are stated here in order to search for the best way for the perfect visual quality after corneal refractive surgery.

Blepharitis and relative corneal and conjunctival changes

SUN Xu-guang

2012, 21(3):  154-156. 

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Clinical charactaristics, diagnosis, and treatment of herpes simplex keratitis

LI Ying

2012, 21(3):  157-161. 

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The effects of anti-inflammatory eye drops on injury and healing of rabbit corneal epithelium

SUN Ya-jie, LI Ai-peng, PAN Zhi-qiang

2012, 21(3):  166-171. 

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Objective  To investigate side actions of some anti-inflammatory eye drops applied frequently on corneal epithelium and to observe the effects on healing of corneal epithelium using these eye drops routinely. Design Experimental study. Participants 80 New Zealand rabbits. Method Rabbits were divided randomly into two groups (40 rabbits per group), the rabbits of one group had the healthy cornea and were given the eye drops every one hour in their right eyes for 5 days; and the rabbits of the other group had de-epithelium cornea (ethyl alcohol to make a 6 mm epithelium defect in the center) and were given the eye drops four times per day in their right eyes for 7 days. Each group was divided randomly into five subgroups in which the right eye were given topical sodium choloride, pranoprofen, diclofenac sodium, bromfenac sodium and tobramycin-dexamethasone, respectively. The signs were observed with slit lamp at an interval time (before epithelium injury, 12, 24, 48, 72, 96 hours and 5, 6, 7 days after epithelium injury). The histopathologic examination of rabbit corneas was performed for the epithelium thickness at the end of experiment. Main Outcome Measures conjunctival congestion, secretions in the conjunctival sac, the injury and healing time of the corneal epithelium. Results Compared with the sodium choloride subgroup, all the four subgroups with frequent anti-inflammatory eye drops showed none obvious local excitation, but the corneal epithelium defects were existed partly, which was more serious in the diclofenac sodium subgroup (9 points), which was significantly higher than the sodium choloride subgroup (0 point) and the bromfenac sodium subgroup (1 point) (P<0.05), while at the 5th day the epithelial cell layers of cornea in tobramycin-dexamethasone subgroup (3.67±0.52 layers) are less than that of the control group (4.17±0.41 layers)(P<0.05). As for the de-epithelium group, when compared with the sodium choloride subgroup(66.0±11.1 hours), the average corneal healing time in diclofenac sodium, tobramycin+dexamethasone, pranoprofen, and bromfenac sodium subgroups were  (75.0±27.0) hours, (75.0±8.5) hours, (69.0±15.4) hours and (66.0±11.1) hours, respectively (P>0.05), but the epithelial cell layers of cornea in tobramycin-dexamethasone subgroup (2.00±0.00 layers) and diclofenac sodium subgroup (2.50±0.55 layers) are less than that of the control group (5.00±0.00 layers) (P<0.05). Conclusion Frequently using anti-inflammatory eye drops may result in rabbit’s corneal epithelium damage to some extent. Routine topical diclofenac sodium and tobramycin-dexamethasone may interfere rabbit corneal epithelium healing.

Causes of the delaying treatment for severe herpes simplex keratitis and efficacy of the comprehensive treatment

JIANG Yang, LI Ying, WANG Zhong-hai, LUO Yan, JIN Yu-mei

2012, 21(3):  172-177. 

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 Objective To investigate the causes of the delaying treatment of severe herpes simplex keratitis (HSK) and to evaluate the clinical effects of comprehensive treatment for HSK. Design Retrospective case series. Participants 102 eyes of 100 patients with severe HSK attended to Peking Union Medical College Hospital from Sep. 2008 to Nov. 2010. Methods The treatment histories of 52 patients (53 eyes) with complete records were retrospectively analysed. For all of the participants, ganciclovir were administered 0.5~1.0 g, 3 times per day orally and 4 times per day locally combined with 0.1% fluorometholone eye drops 3 times per day or 20~30 g prednisolone once per day orally; and tropicamide 1~3 times per day according to the condition. Preventive antibiotics were administered in cases with corneal ulcer and incomplete epithelium, while eye protectants in all cases. Visual acuities and signs were evaluated before and after the therapy at 1st，2nd, and 4th week. Curative effects were analyzed. Main Outcome Measures Causes of the delaying treatment; visual acuity, ciliary congestion, corneal infiltration, corneal opacity, corneal edema, folding of the descemet membrane and keratic precipitates; effective and curative rate. Results 12 (23.08%) of severe HSK cases were misdiagnosed as iritis administered with steroid without antiviral drugs, in which 2 patients were misdiagnosed as iritis combined with band degeneration of cornea and 1 patient was misdiagnosed as iridocorneal endothelial syndrome. Keratitis type of  32 (61.54%) cases was not clarified, 24 (75%) of which were administered with antibiotics without antiviral drugs. 24 (66.67%) patients who suffered iritis or trabecular meshwork inflammation were not administered with steroid or ciliary body relaxant. 1 patients suffered secondary ocular hypertension caused by trabecular meshwork inflammation was administered with pilocarpine every hour. For the effects of the comprehensive treatment, comparing with the mean visual acuity before the treatment (0.29±0.40), the mean visual acuity at 1st, 2nd, and 4th week (0.34±0.41, 0.42±0.42, and 0.56±0.45, respectively) after the treatment was improved significantly (t=6.153, 7.275, 9.220, respectively, all P=0.000). The conditions of ciliary congestion, corneal infiltration, corneal opacity, corneal edema, folding of the descemet membrane and keratic precipitates improved significantly at 1st，2nd, and 4th week (F=231.543，136.700，106.031，58.323，19.183，60.590, respectively； all P=0.000). During the follow-up observation for 1 year, 4 cases (3.92%) developed recurrence and 3 cases (2.94%) got their cornea become thin with the condition under control. No other adverse conditions was observed. Conclusion It is the important guarantee to cure severe HSK that attention should be paid to original diagnosis and comprehensive treatment.

Clinical characteristics of 247 patients with dry eye

CUI Xian-jin, SUN Qian-na

2012, 21(3):  177-180. 

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Objective  To review and analyse the clinical characteristics of dry eyes. Design Retrospective case series. Participants A total of 247 new outpatients (494 eyes) with dry eyes who visited in Linyi People Hospital from Oct. 2010 to Dec. 2011 were included. Methods The clinical records of the participants were reviewed and some dry eye tests were performed, including slit-lamp examination, corneal fluorescein staining test, tear break-up time (BUT) and basal Schirmer Ι test (SΙt). Make sure of excluding other ocular diseases, the definition of the dry eyes were: (1) BUT≤5 s, and had one of the positive subjective symptoms; (2) 5 s＜BUT≤10 s, and had one of the positive subjective symptoms, and SΙt ≤5 mm; (3) BUT≤10 s, and had one of the positive subjective symptoms, and positive fluorescein staining of cornea. Clinical types of dry eyes were including aqueous tear deficiency, meibomian gland dysfunction(MGD), and mixed type. Main Outcome Measures The positive subjective symptoms, corneal fluorescein staining test, BUT and SΙt. Results On analyzing the main complaints of 247 patients (mean age 29.32±14.28 years; range 13~78 years, the ratio of male and female was 1:1.25.) , the most common complaints were asthenopia (182 cases, 73.68%) and ocular dryness (174 cases, 70.45%), then followed by ocular itching (171 cases, 69.23%), foreign body sensation (159 cases, 64.37%), red eye (150 cases, 60.73%),  impairment of vision (144 cases, 58.30%) , photophobia /lacrimation (116 cases, 46.96%) and ophthalmalgia (97 cases, 39.27%). Among the 247 cases, 114 cases (46.15%) were aged 30~44 years and 73 cases (29.55%) aged 18~29 years. 170 cases (68.83%) were aqueous tear deficiency, whose mean age was 26.14±10.19 years; 56 cases (22.67%) were MGD,  whose mean age was 36.30±8.26 years; 21 cases were mixed type, whose mean age was 50.23±9.28 years(F=2.84, P<0.001). Conclusion The clinical manifestations of dry eyes are diversely. Dry eyes may occurred in any age, more and more young people were diagnosed as dry eyes with computers and TV used extensively in the life and works. And the most common clinical type is the aqueous tear deficiency.

Effects of different monochromatic lights on the dynamic expression of retinal vasoactive intestinal polypeptide in guinea pigs

LIU Peng-fei, XIAO Lin, CHANG Li-bin, JIN En-zhong, CHEN Si.

2012, 21(3):  181-186. 

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 Objective To observe the effects of monochromatic lights with similar luminance on the preditable changes in eye growth and expression of  vasoactive intestinal polypeptide (VIP) in guinea pigs and to discuss the relative mechanism. Design Experimental study. Participants Thirty-six 1 week old British species of tri-color male guinea pigs. Method 36 guinea pigs were randomly divided into A, B and C groups, each with 12, which were respectively raised in red light (610 nm, long wave-length), bule  light (430 nm, short wave-length) and white light (broad spectrum) with same luminance (200 lux). At the time of 0 w, 3 w and 6 w of experiment, refraction and axial length were measured. Besides, 4 guinea pigs of each groups were randomly selected to be removed eyes at the 6th w. The eyes removed were fixed 48 h in 4% Paraformaldehyde phosphate buffer solution, and then separated sclera from retina and choroids. Calculated dry weight of sclera obtained. While the left retina tissues were made into paraffin sections to HE staining and detect expression of VIP with immunohistochemistry (SP three steps). Main Outcome Measures  Refraction, axial length, dry weight of sclera, counts of retina VIP-immunoreactive cells and the value of retina VIP integrated optical density(IOD).  Results  At the end of study, refraction of red, blue, and white light groups was respectively 2.696±0.171 D， 5.139±0.151 D, and 3.161±0.122 D (F=605.169，P=0.000）, whereas the corresponding axial length of three groups was repectively 8.273±0.165 mm, 8.019±0.151 mm, and  8.161±0.120 mm （F=6.009，P=0.009）. Average dry weight of sclera in each group was 0.609±0.088 mg，0.716±0.101 mg, and 0.680±0.041 mg with no statistic difference （F=2.292，P=0.126） yet, there was a significant variation between that of Group A and Group B (F=1.256，P=0.048）. VIP was most expressed in inner plexiform layer , ganglion cell layer and nerve fiber layer of retina, with scattered expressed in inner nuclear layer and photoreceptor cells layer. In addition, the expression of VIP in retina was most in Group A, the number of retina VIP-immunoreactive cells and the value of retina VIP IOD were respectively 43.250±9.939 and 1.622±0.119; while that was least in Group B, corresponding results of the two measurements mentioned above were 27.500±4.928 and 1.273±0.127 respectively. There existed great difference among three groups (F=8.478, 5.082; P=0.002, 0.000).  Conclusions Red light(long wave-length) could promote eye growth and myopia occurrence, while blue light (short wave-length) was on the opponent. VIP, a potential signal molecular, may be involved in the regulation of monochromatic lights on eye growth, by affecting scleral metabolism and morphological structure.

Clinal effects of LASIK on binocular vision in myopic anisometropia

YANG Liang, HU Qi, KANG Yang, HUANG Lei, WANG Ke-meng

2012, 21(3):  187-190. 

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Objective To analyze the clinical effects on binocular vision after LASIK for myopic anisometropia, and evaluate its clinical value in the view of vision quality. Design Prospective case series. Participants 36 cases (72 eyes) with myopic anisometropia who received LASIK. Methods All the cases were followed-up for at least 3 months. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refraction and binocular vision were analyzed before and 3 months after surgery. Main Outcome Measures UCVA, BCVA, refraction，simultaneous binocular visions，combined, short and long distance stereopsis visions before and after LASIK. Results The UCVA was 0.01~0.2 before LASIK, while the UCVA reached 1.0 after LASIK. The amount of myopic anisometropia before LASIK was (5.01±1.96) D（ 2.50~9.00 D）, and the amount was (0.28±0.22) D（0.00~0.75 D） after LASIK（P＜0.01）. In 26 cases with high degree anisometropia (2.50 D≤anisometropia degree≤6.00 D), 12 cases of glasses-corrected patients got normal short distance stereopsis vision and 22 cases of LASIK-treated patients got normal short distance stereopsis vision (P＜0.05); in the 10 cases with severe anisometropia (anisometropia degree ＞6.00 D), there was no patients who got normal short distance stereopsis vision at both the pre-operation and post-operation. 33 cases of glasses-corrected patients and 34 cases of LASIK-treated patients got simultaneous binocular visions (P>0.05). 18 cases of glasses-corrected patients and 33 cases of LASIK-treated patients got combined visions. 13 cases of glasses-corrected patients and 23 cases of LASIK-treated patients got long distance stereopsis visions (P<0.05). There was no significant difference in simultaneous binocular visions, but of great significance among combined, and long distance stereopsis visions (P＜0.05). Conclusions LASIK for myopic anisometropia can improve the visual acuity, reduce the refractive difference, and increase combined and stereopsis vision. LASIK was effective for myopic anisometropia.

A morphological study on the effects of intravitreal triamcinolone acetonide exerted on rabbit retina

LI Qian, LIU Wu, WANG Jing-zhao, YANG Lin, MO Bin

2012, 21(3):  191-195. 

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 Objective To evaluate the effects of triamcinolone acetonide(TA) crystals on the rabbit retina. Design Experimental study. Participants Twenty-one New Zealand white rabbits. Method The animals were divided into group A (Crystal A), B (Crystal B) and C (balanced salt solution, BBS). Group A was divided into subgroup A1, A2 and A3; group B was divided into subgroup B1 and B2, and group C was divided into subgroup C1 and C2. Crystal A and B were purified by centrifugation from two commercial TA injections. The right eyes in subgroup A1, A2, A3 were injected intravitreally with Crystal A of 4 mg, 20 mg and 40 mg, respectively; the right eyes in subgroup B1 and B2 were injected with Crystal B of 4 mg and 20 mg, respectively; the right eyes in subgroup C1 and C2 were injected with 0.1 ml and 0.2 ml BBS respectively as control. Retina structure was examined by light microscope(LM) and transmission electron microscope(TEM).  Main Outcome Measures Fundal morphology, retina structure under LM and TEM structures of photoreceptors. Results At 8 weeks after injection, none of the eyes showed abnormalities in anterior segments and fundus. LM examinations showed that retina structures in injected eyes of group C and group A appeared normal comparing with the eyes without injection, while in the injected eyes of group B, inner and outer retinal structure disorganization was noted, with subgroup B2 showing more obvious changes. TEM examinations showed that eyes in subgroup C1 and C2 showed edema of the photoreceptor mitochondriae with cristae disruption, whereas nuclei and discs of the photoreceptors appeared normal. In subgroup A1, A2 and A3, slight edema of the photoreceptor discs was shown, while nuclei and mitochondriae appeared normal structure; Furthermore, the mitochondriaes were shown to be more orderly arranged as dose increased, which suggested a potential dose-dependent protective effect. Comparing with the uninjected eyes and the injected eyes in group A and C, the injected eyes in group B showed marked changes such as edema of the photoreceptor discs and mitochondriae, and pyknosis and karyolysis of photoeceptor nuclei. The eyes in subgroup B2 showed more remarkable disorganization than the eyes in group B1. Conclusion The two commercial TA crystals show differential effects on the rabbit retina. Both products show dose-related toxic effects to retinal sturcture, which might be induced by vehicle components. Whether the therapeutic benefit outweighs the potential toxicity should be determined before clinical application. Some products may produce potential protective effects on photoreceptor mitochondria, which needs to be proved in the further investigations.

Effects of Fufang Xueshuan Tong Capsule on the retinal microcirculation in branch retinal vein occlusion

LI Yi-bin, HAO Lin-na, LI Liao-qing, XIAO Yuan-yuan

2012, 21(3):  196-199. 

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Objective To evaluate the value of Fufang Xueshuan Tong Capsule for branch retinal vein occlusion(BRVO) and its effect on the formation of collateral vessels. Design Clinical comparing study. Participants 90 cases with a defined natural BRVO history of 3~6 months were enrolled. Methods 90 cases were randomly divided into two group: treatment group (45 cases) and control group (45 cases). All the patients in treatment group were prescribed Fufang Xueshuan Tong Capsule (1.5 g, tid) and iodizedlecithin (1.5 mg, tid), while troxerutin  (120 mg, tid) and iodizedlecithin (1.5 mg, tid)  for the controls. All the patients received a monthly visual acuity and fundus examination using indirect ophthalmoscope, and received fundus fluorescein angiography(FFA) per 3 months. When the nonperfusion area revealed by FFA was more than 5 PD or neovascularisation, the laser photocoagulation was performed. Evaluation on the formation of the collateral vessels at the 6th month. Main Outcome Measures The prevalence of laser treatment and the formation of the collateral vessels. Results In treatment group, 31(68.89%) patients received laser treatment, while 33(73.33%) patients were treated by laser in control group. The difference between the two groups showed no significance (P=0.37). At the 6th month, collateral vessels could be detected in 34 (75.56%) patients in treatment group, while 24 (53.33%) patients in control group. There was a significant difference between the two groups (P=0.047). Conclusions Fufang Xueshuan Tong Capsule might be helpful to the formation of the collateral vessels in BRVO.

Levator palpebrae superioris evaluation in congenital blephroptosis: pathogenesis investigation by magnetic resonance imaging analysis

SUN Qian, LI Dong-mei, JIANG Hong, WANG Zhen-chang, HAO Lei

2012, 21(3):  201-205. 

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Objective To reveal the pathogenesis of congenital blephroptosis by comparing the thickness and cross sectional area of the levator palpebrae superioris (LPS) on magnetic resonance imaging (MRI) between patients suffered from moderate to severe congenital blephroptosis (aged from 14 to 22) and healthy volunteers (aged from 14 to 23). Design Cross-sectional study. Participants Twenty-seven sick eyelids and 13 normal eyelids of 20 patients and 40 healthy eyelids of 20 volunteers were enrolled. 13 normal eyelids of the unilateral congenital blephroptosis patients were also included. Methods Twenty-seven sick eyelids and 13 normal eyelids of 20 patients who had unilateral or bilateral blephroptosis and 40 healthy eyelids of 20 volunteers were evaluated by MRI. MRI was taken when the eyes were naturally closed. The origin of the measurement was chosen at the point where the optic nerve left the eyeball. 2 points with 0.5 mm in space forward and 2 points with 0.5 mm in space backward from the origin were set. Based on each setting points, the cross-sectional area was measured on coronal MRI, while the height of the LPS was measured on sagittal MRI. Main Outcome Measures The cross-section area of LPS measured on coronal MRI and the height of LPS measured on sagittal MRI. Results The data of the patients was in normal distribution, while the data of the volunteer was not. So the nonparameter test was used in data analysis of the two groups. The cross-sectional area（S2=2.66±1.25，S1=2.51±1.29，S0=2.39±1.28，S-1=1.78±0.96，S-2=1.09±0.42） and the height （T2=1.05±0.27，T1=1.04±0.26，T0=1.00±0.24，T-1=0.89±0.28，T-2=0.79±0.26） of LPS in patients’ sick eyes decreased significantly compared with volunteers’ （T2=1.48±0.08，T1=1.40±0.09，T0=1.32±0.10，T-1=1.21±0.07，T-2=1.10±0.06， S2=4.83±0.71，S1=4.53±0.75，S0=4.50±0.68，S-1=3.13±0.56，S-2=1.85±0.48）（all P<0.001）. As for the unilateral patients, the cross-sectional area and the height of LPS of the sick eyes showed significant difference when compared with the patients’ normal eyes（all P＜0.05）. However, there was no statistical difference between the patients’ normal eyes and the volunteers’ eyes （all P＞0.05）. Moreover, as far as the cross-sectional area and the height of LPS was concerned, there was no difference between the right and left eyes of the volunteers（all P＞0.05）. Conclusion LPS of congenital blephroptosis patients was significantly thinner than those of the healthy volunteers. Dysgenesis of the LPS may be the main cause of the simple congenital blephroptosis.

The correction of the deep superior sulcus after the orbital implantation of hydroxyapatite

HOU Zhi-Jia, LI Dong-Mei, HAO Lei

2012, 21(3):  206-209. 

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Objective To study the treatment of the deep superior sulcus after the orbital implantation of hydroxyapatite(HA). Design Retrospective case series. Participants 55 patients（55 eyes） with deep superior sulcus after the HA implantation. Methods The participants received dermis fat transplantation, hemisphere HA implantation or orbital fracture rehabilitation by HA compound material, respectively. The choose of the surgical method was based on the degree of the superior sulcus and the pathogenesis. Main Outcome Measures The degree of the superior sulcus and the appearance before and after surgery were evaluated. Results The situation of deep superior sulcus in all 6 cases who received dermis fat graft was improved after the surgery within 3 months. Gradual absorption of the dermis fat beneath the skin was observed after 3 months. Finally, 1 patient remained mild but improved superior sulcus, while the other 5 patients obtained relatively acceptable correction. The results of the 10 patients who received hemisphere HA implantation and the 37 patients who received orbital fracture rehabilitation were satisfying. The other 2 patients received orbital fracture rehabilitation combined with dermis fat transplantation, and the results were satisfying. Conclusions The condition of deep superior sulcus after the orbital implantation of HA may achieve satisfying results by choosing proper surgical methods depending on the degree of the superior sulcus and the pathogenesis.

Three cases with primary orbital malignant melanoma

XU Xiao-lin, GE Xin, SHI Ji-tong, LI Bin

2012, 21(3):  210-214. 

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Objective To describe characteristic presentation of rare primary orbital malignant melanoma in Chinese, and analyze the differences between Chinese cases and Caucasian cases. Design Retrospective case series. Participants Three cases with primary orbital melanoma under the care of the Oncology Clinic at Beijing Tongren Hospital. Methods Retrospective review of clinical presentation, treatment, radiology and pathology characteristics for the three cases. Main Outcome Measures Clinical manifestation, MRI appearances, and pathology characteristics. Results Thorough physical examination of all the three patients demonstrated the absence of cutaneous or mucous melanoma, excluding the possibility of metastatic melanoma. No pigmentary disorders were visible on face, eyelid, conjunctiva, and sclera, excluding the pathologic basis of congenital melanosis. MRI of two cases was consistent with the typical characteristics of melanoma, but MRI of one case didn’t suggest melanoma. Pathologic examination revealed the pathologic type of the three cases, which was spindle cell, epithelial cell and mixed cell melanoma, respectively. One case originated from the inner wall of cyst, which is a definite cystic epithelial basis, so it could be presumed that the melanocytes migrated from the neural crest and adherent to the cystic wall epithelial cells might be the origination of orbital melanoma. All the three cases were treated by primary resection. After surgery, two cases accepted systemic chemotherapy and one patient did not. There has been no recurrence or metastasis in 40 to 48 months follow-up. Conclusion MRI may provide some clues for pre-operation diagnosis of primary orbital malignant melanoma. The melanocytes adherent to the inner wall of cysts may be the origination of the tumor. These encapsulated tumors may be treatable by primary resection.

Experiences in teaching the graduate students to writing manuscripts included by SCI

LI Yang

2012, 21(3):  215-216. 

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Papers included by Science Citation Index (SCI) relatively reflect the forefront of every international research fields. The current article briefly described the key points for writing manuscripts included by SCI.