Table of Content

25 July 2012, Volume 21 Issue 4

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Pros and cons of fine needle aspiration biopsy in ocular tumors 

WEI Wen-Bin, TU Ying

2012, 21(4):  217-221. 

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【Abstract】 Fine-needle aspiration biopsy (FNAB) is an important method of intraocular tumors biopsy and often used in diagnosis of choroids tumors and primary intraocular lymphoma. The sensibility and specificity of FNAB will increase with technique improvement of biopsy and handling the samples. Compared with other methods of intraocular biopsy, FNAB shows more convenient, quickly and safer. However, dissemination of tumor cells may still be the potential risk of FNAB. Indication of FNAB should be correctly selected before used. (Ophthalmol CHN, 2012, 21: 217-221)

The advance in treatment of macular edema secondary to central retinal vein occlusion—from clinical trial to clinical practice

ZHANG Yong-Peng, Peng-Xiao-Yan-

2012, 21(4):  222-227. 

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【Abstract】 Central retinal vein occlusion (CRVO) is a common, sight-threatening retinal vascular disorders. The etiology of CRVO is complicated and current treatments for CRVO and its sequelae such as macular edema are still tough. However, there are many emerging treatments in recently years. Intravitreal pharmacologic agents which include anti-vascular endothelial growth factor (Bevacizumab, Ranibizumab, Pegaptanib, and VEGF Trap-Eye), triamcinolone acetonide and sustained delivery corticosteroid device (fluocinolone acetonide and dexamethasone) are promising. There are also some researches on the efficiency of laser and surgery. Several large, well-designed, prospective, randomized controlled trials are still ongoing worldwidely. Although the efficiency and safety of some treatments have been proved by evidence-based medicine, there are still lots of questions which should be answered on the way from clinical trial to clinical practice. (Ophthalmol CHN, 2012, 21: 222-227)

Several issues for the diagnosis and treatment of anterior uveitis with increased intraocular pressure

WANG Hong, SHEN Lin-

2012, 21(4):  228-232. 

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【Abstract】 Some anterior uveitis lack of severe fibrinous exudation and posterior synechiae of iris, such as viral anterior uveitis, Fuchs syndrome and Posner-Schlossman syndrome, can be manifested as persistent or recurrent elevated intraocular pressure, and its treatment is often difficult. Recently, Singapore scholars described clinical features of cytomegalovirus anterior uveitis in immuocompetent patients, and presented a new idea to diagnosis and treatment of the anterior uveitis with ocular hypertension. Though Fuchs syndrome and Posner-Schlossman syndrome have similar clinical manifestations to cytomegalovirus anterior uveitis, and cytomegalovirus infection may be the pathogenesis of the two diseases, whether to join the antiviral therapy for the Fuchs syndrome, Posner-Schlossman syndrome or not, is still a problem worthy of discussion. (Ophthalmol CHN, 2012, 21: 228-233)

Persistent ocular hypertension after glaucoma and cataract surgery in congenital aniridia

HAN Dong, 吕Jian-Hua , LI Jian-Jun, ZHANG Xiu-Lan, CHEN Hong, WU Ren-Yi, TANG Guang-Xian

2012, 21(4):  234-238. 

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【Abstract】 A 11-years old boy with congenital aniridia and glaucoma received trabecuectomy in his both eyes when he was 6 months-old. When he was 10 years-old he received phacoemulsifacation and intraocular lens surgery, and 6 months after phacoemulsifacation his intraocular pressure with non-contact tonometer was 32/34 mm Hg (OD/OS). However, his central corneal thickness was 850/827 μm (OD/OS), and cup-disc ratio was 0.2 in both eyes. Does he need to continue treatment? (Ophthalmol CHN, 2012, 21: 234-238)

Retinal microvascular changes for branch retinal vein occlusion

WANG Feng-Hua, SHEN Ran, SUN Lan-Ping, GUO Li-Xia, PENG Yi, LIANG Yuan-Bo, WANG Ning-Li

2012, 21(4):  239-243. 

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【Abstract】 Objective To investigate the association between retinal microvascular abnormalities and branch retinal vein occlusion (BRVO). Design Case-controlled study. Participants 58 cases of BRVO in Handan Eye Hospital and 200 control cases of non-BRVO with age-and gender-matched normal eyes from the population based Handan Eye Study. Methods Fundus ditated photographs for both eyes were obtained in all subjects. Signs of focal microvascular abnormalities were qualitatively evaluated from photographs. Retinal vascular caliber measurements were performed using IVAN software, Australia. Main Outcome Measures Focal arteriolar narrowing (FAN), arteriovenous nicking (AVN), opacification of arteriolar wall (OPAC), central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE) and arteriole-to-venule ratio (AVR). Results Among all BRVO patients, the mean CRAE was 136.0±20.7 μm, and the mean CRVE was 207.2±23.1 μm, and AVR was 0.66±0.13. The mean CRAE, CRVE and AVR of the control eyes were 152.0±19.3 μm, 235.3±29.7 μm and 0.65±0.06, respectively. After adjusting for age, gender, hypertension and diabetes, patients with BRVO were significantly more likely to have FAN, AVN and OPAC signs, with the adjusted odds ratios of 5.65 (95%CI=1.77~18.03), 3.42 (95%CI=1.48~7.89) and 3.44 (95%CI=1.44~8.24) than non-BRVO subjects, respectively(All P<0.05). Conclusions Eyes with BRVO had narrow CRAE and CRVE when compared with age-and gender-matched normal eyes. Our findings demonstrate a strong relation between BRVO and retinal microvascular changes. (Ophthalmol CHN, 2012, 21: 239-243)

Mini macular lesions in eclipse retinopathy 

MA Kai, LI Zhi-Hua, XIONG Ying, MO Bin, YAO Ning- Liu-Ning-Pu

2012, 21(4):  244-247. 

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【Abstract】 Objective To observe the manifestation and prognosis of mini macular lesions in eclipse retinopathy. Design Retrospective case series. Participants Six patients (11 eyes) with macular lesions from Tongren Hospital after the eclipse happened in 2009 were included into analysis. Methods Optical coherence tomography (OCT), autofluorescence photography, micro visual field and multifocal electroretinogram (mfERG) in all 6 patients were examined and followed up. Follow-up time was 2-18 months. Main Outcome Measures Visual acuity, OCT, and autofluorescence changes. Results Rupture of photoreceptor outer segment layer and inner layer of retinal pigment epithelium (RPE) in the fovea of the all 11 affected eyes was found on OCT images. Hypo-fluorescence in the fovea on autofluorescence photographs and yellow spot on color fundus photographs were found. In 7 eyes the results of the other auxiliary examinations were normal. Visual acuity at first visit was 0.6-0.8, and 1-4 weeks later visual acuity was 1.0 or better in all patients. Conclusion Mini macular lesions in eclipse retinopathy can be found promptly with OCT and autofluorescence photography. Visual recovery of this lesion is better. (Ophthalmol CHN, 2012, 21: 244-247)

Pars plana vitrectomy combined with intravitreal triamcinolone acetonide injection for diabetic macular edema in severe proliferative diabetic retinopathy

ZHAO Shuang-Xi, ZENG Jun

2012, 21(4):  248-252. 

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【Abstract】 Objective To evaluate efficacy of vitrectomy combined with intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema in patients with severe proliferative diabetic retinopathy (PDR). Design Retrospective comperative case series. Participants 25 consecutive patients (28 eyes) who underwent pars plana vitrectomy (PPV) for treatment of PDR in the Second Xiangya Hospital of Central South University from July 2007 to April 2010.  Methods 12 patients (14 eyes) were allocated into the IVTA group received an intravitreal injection of 2 mg (0.05 ml) of triamcinolone acetonide at the end of surgery. 13 patients (14 eyes) as controls received only vitrectomy. All the patients  were followed up with OCT examination for 6 months.The preperative complexity score of PDR was similar between two groups. Main Outcome Measures LogMAR Best-corrected visual acuity (BCVA), central macular thickness (CMT). Results At 6-month follow-up, mean post-operative BCVA- LogMAR was significantly better in IVTA group (0.76±0.45) than the control (1.20±0.50) (t= 2.473, P=0.020). The significant reduction of central macular thickness was observed in the IVTA group (266.92±50.23 μm) compared with the control (285.37±46.81 μm) (t=16.470, P=0.000). Conclusions Pars plana vitrectomy combined with IVTA for the treatments of diabetic macular edema in severe PDR is effective and can improve BCVA better. (Ophthalmol CHN, 2012, 21: 248-252)

Efficacy and complications of heavy silicone oil Densiron68 for traumatic retinal detachment

LI Lin, LI Qi-Yan, PANG Xiu-Qin

2012, 21(4):  252-256. 

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【Abstract】 Objective To observe efficacy and complications of  heavy silicone oil (HSO) Densiron68 for traumatic retinal detachment. Design Retrospective compare case series. Participants 40 eyes of 40 patients with traumatic retinal detachment in Beijing Tongren Hospital. Methods The pars plana vitrectomy and retinal detachment surgery were applied to the 40 patients.HSO was applied to 20 patients with retinal detachment arising from inferior or posterior retinal breaks (HSO group). Other 20 patients were applied with standard silicone oil (SSO group). The follow-up time was 12 to 68 weeks. Main Outcome Measures Visual acuity, intraocular pressure, retinal reattachment and complications. Results The retinal reattachment rate in HSO group was 50% (10/20) compared to 55% (11/20) in SSO group (P=0.752). The recurrent rate of superior retinal detachment was 60% (6/10) in HSO group, and 11% (1/9) in SSO group (P=0.057). The recurrent rate of inferior retinal detachment was 10% (1/10) in HSO group, and 67% (6/9) in SSO group (P=0.020). In HSO group, logMAR visual acuity improved from preoperative 2.63±1.00 to postoperative 2.19±0.86 (P=0.037). In SSO group, logMAR visual acuity improved from preoperative 2.27±1.06 to postoperative 1.74±1.04 (P=0.112). Significant increase of intraocular pressure occurred in 30% patients in SSO group while 0% in HSO group (P=0.020). Emulsification rate of silicone oil in SSO group was 75% compared to 100% in HSO group (P=0.047). Conclusion Heavy silicone oil Densiron 68 is applicable to traumatic retinal detachment with inferior or posterior retinal breaks. It is not advised to use heavy silicone oil for long term tamponade because of its higher emulsification rate compared with standard silicone oil. (Ophthalmol CHN, 2012, 21: 252-256)

Stromal cell-derived factor-1 promotes axonal regeneration of retinal ganglion cells in retinal explants

CEN Ling-Ping, LIANG Jia-Jian, ZHANG Ming-Zhi

2012, 21(4):  256-260. 

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【Abstract】 Objective To investigate whether stromal cell-derived factor-1 (SDF-1) has promoting effects on axonal regeneration in retinal explant. Design Experimental study. Participants Fischer 344 rats retina. Methods Optic nerve of rats were crushed 5 days before retinal explant culture, and culture plate was coated with poly-lysine and laminin before culture. Retinas were dissected out from eye cups and cut into 8 pieces followed by sticking onto the coated wells with retinal ganglion cell layer downward. Retinal pieces were incubated in neurobasal-A/B27 for 7 days before examination under an inverted fluorescent microscope. Explants were assigned to the following groups: control, SDF-1 groups with 20 ng/ml, 70 ng/ml, 200 ng/ml, 500ng/ml, 1000 ng/ml, and SDF-1 plus AMD3100 group. Main Outcome Measures Number and average length of regenerating axons. Results Average umber and length of the regenerating axons in control group were 17/explant and 1mm respectively. Promoting effects of SDF-1 was positively correlated to its concentrations. SDF-1 with middle and high concentration enhanced the axonal regeneration by 2-3 folds. The promoting effect of SDf-1 was reduced by half when adding the receptor inhibitor AMD3100. Conclusions SDF-1 has promoting effects on axonal regeneration of retinal ganglion cells in retinal explants and has dose-response. (Ophthalmol CHN, 2012, 21: 256-260)

Improved primary culture and identification of rat retinal microvascular endothelial cells in vitro

HU Jian-Yan, WU Qiang, SONG Bei-Wen, JIA Li-Li, CHEN Yong-Dong, YAN Liang

2012, 21(4):  261-263. 

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【Abstract】 Objective To establish a reliable method for primary culture of rat retinal microvascular endothelial cells (RRMEC) in vitro in order to study the basic pathogenesis of retinal neovascularization disease. Design Experimental study. Participants Rat retinal microvascular endothelial cells. Methods With the isolation of active retinal blood vessels and enzyme digestion of retinal tissue, RRMECs were cultured in RPMI-1640 supplemented with fetal bovine serum, and endothelial cell growth supplement (ECGs). The RRMECs were observed under microscope. Immunocytochemistry was also performed using a monoclonal antibody against Factor VIII and platelet endothelial cell adhesion molecule (PECAM-1, CD31) for identification. Main Outcome Measures RRMEC morphology and fluorescence staining. Results RRMECs in primary culture attached the walls and scattered in monolayer arrangement with clear boundary, mostly in fusiform, partly in cobblestone-like growth. RRMECs began to confluence within 3-5 days. The purity of RRMEC was high. The rate of  positive staining for Factor VIII (fluorescence staining perinuclear) and CD31 (fluorescence staining in cytoplasm) was 95%. Conclusions RRMECs with high purity can be obtained by isolation of retinal blood vessels, digestion with trypsin and collagenase, and use of ECGs and gelatin-coated bottles, which is a repeatable better method. (Ophthalmol CHN, 2012, 21: 261-263)

Short-term change of intraocular pressure after vitrectomy combined phacoemulsification

LI Na, MA Kai, CUI Rui

2012, 21(4):  264-267. 

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【Abstract】 Objective To evaluate the short-term change of intraocular pressure (IOP) after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation. Design Retrospective comparative cases series. Participants 106 eyes of 102 consecutive inpatients who had undergone vitrectomy in Department of Ophthalmology, Beijing Tongren Hospital  in 2010. Methods The cases with vitreous hemorrhage/opacity or macular disease who had undergone standard 20 gauge pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation (32 eyes of 30 patients) or without (74 eyes of 70 patients), excluding the cases with preoperative medical history of any possible effects on IOP. Main Outcome Measures IOP. Results Compared the combined cataract operation group with single vitrectomy group, the preoperative IOP (13.8±3.9, 14.5±3.0 mm Hg) had no significant difference (P=0.319), the average IOP of postoperative day 1 (16.4±9.1, 16.4±9.1 mm Hg), day 2 (13.9±5.6, 14.7±5.1 mm Hg) and day 3 (13.1±4.4, 13.8±4.6 mm Hg) had no significant difference (P>0.05 for each). Average IOP of postoperative day 1 was significantly higher than the preoperative one in the single vitrectomy group. Postoperative ocular hypertension incidence (15.6% vs 27.1%) in the two groups had no significant difference, which both mainly (80% vs 90%) occurred on the first postoperative day. All the five cases with ocular hypertension in the combined group occurred in eyes with diabetic retinopathy. Conclusion Combined with cataract surgery does not significantly increase the recent IOP and the incidence of ocular hypertension after vitrectomy. (Ophthalmol CHN, 2012, 21: 264-267)

Efficacy of combining treatment based on clinical stage in neovascular glaucoma 

LIU Guo-Jun, CHOU Yi-Jie, YU Zhan, PANG Feng, DI Xia, JIN Dong, LI Ju

2012, 21(4):  268-272. 

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【Abstract】 Objective To study the efficacy of combining treatment based on clinical stage for neovascular glaucoma (NVG). Design Retrospective case series. Participants Sixty-nine eyes of 63 cases with NVG were divided into 3 groups: the iris neovascularization (INV) group (16 eyes of 15 cases), the NVG with open angle (O-NVG) group (22 eyes of 20 cases) and the NVG with angle closure (C-NVG) group (31 eyes of 28 cases). Methods In the INV group, panretinal photocoagulation (PRP) were done in all cases, of which 3 eyes underwent cataract surgery and 1 eye received intravitreal bevacizumab. In the O-NVG group, anti-glaucoma drug was used based on PRP.  8 eyes of 22 eyes underwent trabeculectomy, 4 eyes received cataract surgery, 2 eyes combining vitrectomy and 5 eyes required intravitreal bevacizumab. In the C-NVG group, bevacizumab was injected into the vitreous based on PRP, trabeculectomy or cyclophotocoagulation; in which 21 eyes underwent combining vitrectomy and cataract surgery, 12 eyes received silicone oil tamponade. All cases were followed up for 18.6±15.3 months. Main Outcome Measures Intraocular pressure(IOP), visual acuity, iris neovascularization, anterior chamber angle and complications. Results The number of the eyes with invariability or improvement of visual acuity after treatment in INN, O-NVG and C-NVG group was 15(93.8%), 17(77.3%) and 16(51.6%)  respectively(χ2=9.76, P<0.01). The IOP before treatment in the three groups was (14.6±3.8) mmHg, (31.6±9.1) mmHg and（44.8±12.2）mmHg , respectively. The IOP after treatment was (14.1±3.6)mmHg, (17.9±3.9) mmHg and (18.9±10.8) mmHg respectively(F=185.8, P<0.001). Iris neovascularization after treatment disappeared in all eyes of the INV group, in 20/22 eyes of the O-NVG group and in 28/31 of the C-NVG group. The anterior chamber angle after treatment was still wide in the INV group. The range of open angle after treatment was larger than before treatment in 18/22 eyes of the O-NVG group because of atrophy of neovascular membrane in the angle, while in the C-NVG group, the range of open angle was same as before treatment, though the neovascular membrane appeared different degree of atrophy. The incidence of the complications after treatment in the three groups was 6.3%, 22.7% and 48.4%, respectively (χ2=9.75, P<0.01). Conclusion Efficacy of combining treatment based on clinical stage in NVG especially for early and intermediate stage is good. (Ophthalmol CHN, 2012, 21: 268-272)

The effects of hydroxycamptothecin on the apoptosis of fibroblasts isolated from subconjunctival scar in failed trabeculectomy and its mechanism 

TANG Wei, QIAN Chao-Xu, YUAN Zhi-Lan

2012, 21(4):  273-277. 

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【Abstract】 Objective To study the effect of hydroxycamptothecin(HCPT) on fibroblasts，which were isolated from the subconjunctiva scar in failed trabeculectomy and illustrate its possible mechanisms. Design Experimental study. Participants Fibroblasts cultured from the subconjunctival scar in failed trabeculectomy. Methods Fibroblasts cultured from the subconjunctival scar in failed trabeculectomy were identified. Cell apoptosis was detected by flow cytometry (FCM). Treated with different concentrations of HCPT, with or without caspase inhibitor Z-VAD-FMK, the expression levels of caspase-3, -8, -9 mRNA were observed with RT-PCR. Main Outcome Measures The expression levels of caspase-3, -8, -9 mRNA. Results FCM showed that the apoptosis rate of fiboblasts after 24 hours culture under 0.06, 0.25, 1.0, 4.0 mg/l HCPT treatment was 0.87%, 4.97%, 5.76%, and 33.1%, respectively (P<0.05). By RT-PCR, the higher doses of HCPT were, the higher expression levels of caspase-3, and -9 mRNA were, while the expression level of caspase-8 was lower than the control group. When Z-VAD-FMK existed, it could decrease the levels of caspase-3, -8, -9 mRNA. Conclusion HCPT can result in the apoptosis of fibroblasts in vitro and has dose-dependent. This apoptosis may be achieved through caspase-3, -9 routes. (Ophthalmol CHN, 2012, 21: 273-277)

Clinical evaluation of the rebounder tonometer in patients with congenital glaucoma

ZHEN Yi, WANG Tao, WANG Wen-Xin, ZHENG Song

2012, 21(4):  278-281. 

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【Abstract】 Objective To evaluate the clinical value of the rebounder tonometer (RBT) in congenital glaucoma by comparing with Perkins applanation tonometer and Schiotz tomometer. Design Evaluation of diagnostic techniques. Participants 29 cases (29 eyes) of the congenital glaucoma patients aged 12.0 ± 3.0 months who were measured intraocular pressure (IOP) in Beijing Tongren Eye Center. Method IOP was measured with the rebound tonometer, Schiotz tonometer and Perkins applanation tonometer. Measurements  were repeated three times each tonometer. Main Outcome Measures IOP values and Pearson correlation coefficient. Results Mean IOP values obtained by RBT, Schiotz and Perkins tonometer were 19.3±8.5 mm Hg, 21.1±10.8 mm Hg, and 18.5±7.8 mm Hg, respectively(F=0.61, P=0.55). The difference of IOP values among three tonometers was not significant. The average difference between RBT and Perkins tonometer was 0.8±2.4 mm Hg. The average difference between Schiotz and Perkins tonometer was 2.6±2.4 mm Hg. The average difference between Schiotz and RBT was （1.8±2.4）mm Hg. The values of Perkins applanation tonometer were significant correlated with RBT （r=0.934，P=0.000） and Schiotz（r=0.933，P=0.000）. Conclusion The accuracy of rebounder tonometer can meet the IOP measurement needs in congenital glaucoma patients. (Ophthalmol CHN, 2012, 21: 278-281)

The macula changes under Spectralis OCT  in type 2 diabetes after  intensive treatment

CHEN Zhen-Guo, LIN Si-Si, CHEN Jia-Wei, ZHONG Hong-Liang, LU Chun-Jie, TIAN Bei, WEI Wen-Bin

2012, 21(4):  283-284. 

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Multiple teaching methods for medical students in ophthalmology teaching 

SHI Xiang-Yu, DAI Hong-Lei, DING Ning, HE Lei

2012, 21(4):  286-288. 

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【Abstract】 This paper suggests using multiple educational methods during ophthalmology teaching in order to improve students’ clinical and teaching comprehensive ability. These include integrated curriculum, adopting multimedia form, interaction and active discussion during lesson, introducing and training thinking habbits of evidence-based medicine, improving ophthalmic medical students' interest in learning and learning initiative. It is important to take students as the active aspects of various teaching methods so as to improve the quality of ophthalmology teaching. (Ophthalmol CHN, 2012, 21: 286-288)