Table of Content

25 January 2018, Volume 27 Issue 1

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Glaucoma surgery: what we need to know now for the future?

ZHANG Xiu-lan, LI Fei

2018, 27(1):  1-3.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 001

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 Glaucoma is currently the second leading reason for blindness in the world. In clinical practice, intraocular pressure (IOP) lowering is the only effective way proven to be effective in controlling disease progression. With development of modern cataract surgery and vitreoretinal surgery, surgical techniques of glaucoma have changed a lot. However, there are 2 major challenges. First, traditional filtering surgeries still need improvement in controlling post-surgical scarring and complications. Invention of micro-invasive glaucoma surgery (MIGS) resolved these problems to some extent. Second, for intractable cases, current surgical techniques cannot achieve satisfactory therapeutic effect for all cases. Therefore, there is still a long way for surgical techniques of glaucoma to go. We can expect that MIGS will become the mainstream and refractory glaucoma will be conquered in the future. (Ophthalmol CHN, 2018, 27: 1-3)

Angle-closure like glaucoma secondary to lens suspensory ligament laxity 

FAN Ning1, WANG Ning-li2, LIU Xu-yang1

2018, 27(1):  4-8.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 002

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 The etiology of abnormal lens suspensory ligament laxity includes traumatic suspensory ligament injury, congenital suspensory ligament abnormalities (such as Marfan syndrome) and peripheral retinal degeneration, etc. The suspensory ligament laxity can result in antedisplacement of lens iris diaphragm, shallow anterior chamber, progressive angle closure and peripheral anterior synechia, leading to elevated intraocular pressure and glaucoma similar to primary angle closure glaucoma (PACG). The management of these disorders is critical. Commonly used treatments for PACG, such as pilocarpine eye drops and laser peripheral iridotomy or trabeculectomy, may not work, since the main pathogenic factor is not resolved. In addition, the anterior chamber may sometimes become shallower and in turn, the aqueous misdirection or malignant glaucoma may occur. Zonular abnormalities associated angle closure glaucoma differ from PACG in a number of respects, including age, monocular or bilateral, diopter, axial length, anterior chamber depth, the reaction to mydriatic agents and UBM examination. The treatment regimens are also quite different. Therefore, it is important to differentiate glaucoma secondary to suspensory ligament laxity from PACG. (Ophthalmol CHN, 2018, 27: 4-8)

The questionnaire survey based on WeChat on glaucoma diagnotic methods in China

QIAO Chun-yan1, ZHANG Hui1, ZHAO Ai-ping2, CAO Kai1, YANG Xiao-han1, HU Jian-ping1, LIANG Jing1, SONG Jing1, WANG Ning-li1.

2018, 27(1):  9-15.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 003

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 Objective To obtain the national real situation of glaucoma dignosis and related instrument usage in China. Design Cross-sectional survey. Participants Ophthalmologists who were internet available throughout the mainland. Method The questionnaire and link were designed and sent by WeChat directly. The respondents filled out the questionnaire directly on the mobile phone, and a mobile phone number can only be submitted once. The data analysis was conducted by SAS 9.4, the association analysis used chi square test. Main Outcome Mearsures Utilization rate of  Goldmann tonometer. The ratio of different instruments used to assess the angle of anterior chamber, fundus, and visual field. The utilization rate of different methods for angle classification. Results A total of 1111 questionnaires were received from 28 provincial administrative regions, among which 20.62% were glaucoma specialists and attending doctors, and 48.48% had glaucoma department in their hospitals. Only 25.29% of them used Goldmann applanation tonometer (GAT) as the routine IOP measurement, and 42.94% didn’t regularely use GAT because of the lack of the device. The most favorite methods in checking chamber angle was gonioscopy (69.49%) , followed by UBM (17.55%). Only 35.64% of the respondents whose frequency of utilization of gonioscopy was between 75%~100%, and 29.26% of the respondents whose frequency of utilization of gonioscopy was less than 25%. Scheie classification was the main (74.17%) grading system for gonioscopy. Direct ophthalmoscope was the most common fundus examination instruments (39.97%), followed by indirect slit-lamp lens (29.16%), and the fundus camera was only 11.61%. 25.74% of those being surveyed had a frequency of utilization of fundus camera less than 25%. In visual field test, Humphrey perimetry (45.00%) was most commonly applied. Glaucoma specialists and attending doctors used gonioscope, fundus cameras and Humphrey perimetry significantly more often than others. Conclusion In the current practice of glaucoma diagnosis in China, GAT measurement has not been widely used. The frequency of utilization of gonioscope and fundus camera was low. There is a gap between real clinical situation and international standards, and the process of training and promotion standalization needs to be strengthened to reduce the difference between China and the international level in glaucoma diagnosis guidelines. (Ophthalmology, 2018, 27: 9-15)

Two years follow-up of adult patients with open angle glaucoma treated by canaloplasty 

LIU Yue1,2, CHEN Xiao-ya2,3, LI Meng2,WANG Huai-zhou2.

2018, 27(1):  16-20.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 004

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Objective To evaluate the efficacy and safety of canaloplasty in treating adult patients with open angle glaucoma. Design Retrospective case series. Participants 41 cases (50 eyes) of adult patients with open-angle glaucoma treated in Beijing Tongren Eye Center from January 2011 to April 2014. Method All patients were conducted with canaloplasty. The patients were followed up at 3, 6 months, 1 year, 1.5 years, and 2 years after the surgery. The intraocular pressure(IOP) and the use of IOP lowering drugs were comparative observed in youth group and middle-old age group, non-high myopia group and high myopia group. The complete success was defined as IOP was lower than 21 mmHg without any IOP lowering drugs, and conditional success was defined as IOP was lower than 21 mmHg with IOP lowering drugs. Main Outcome Measures  IOP and usage status of IOP lowering drugs. Results Before the surgery, the average IOP was (24.9 ±8.1) mmHg, the average drug usage was (2.7±1.2) kinds of drugs. The mean IOP at 3, 6 months, 1 year, 1.5 years and 2 years after the surgery were (15.1±3.0) mmHg, (15.5±3.5) mmHg, (15.4±3.1) mmHg, (15.6±4.2) mmHg, (15.8±4.9) mmHg, respectively, all of which were significantly lower than those before surgery (all P=0.000). At 2 years after surgery, the average drug usage was (0.8±1.4) kinds of drugs, which was significantly less than that before surgery (P=0.000). At 2 years after surgery, the complete success rate was 70.3%, and the conditional success rate was 92.6%. There was no significant different between the youth group and middle-old age group in IOP and IOP lowering drugs at different time point after operation. One year after surgery, IOP of high myopia group (14.4±3.3 mmHg) was lower than non-high myopia group (16.2±4.5 mmHg) (P=0.035). There was no significant different between two groups in IOP and IOP lowering drugs during follow-up.  Conclusion  Two years follow-up showed that canaloplasty is an effective and safe way to reduce IOP in adults with open angle glaucoma. (Ophthalmol CHN, 2018, 27: 16-20)

Characteristics of hospitalized patients with glaucoma in Shenyang

FU Bo1, ZHANG Shao-dan1,2, SUN Jing1, LI Ruo-xi1, LIU Chi1,WANG Hai-lin1.

2018, 27(1):  21-25.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 005

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 Objective To analyze the epidemiologic characteristics of hospitalized patients with glaucoma in Shenyang and to provide data for the glaucoma health care. Design Retrospective case series. Participants Hospitalized glaucoma patients of 18 years and older in the Fourth People’s Hospital of Shenyang between Nov.1st, 2011 to Oct. 31st, 2016. Methods 7569 medical files with a discharge diagnosis of glaucoma at this hospital were retrospectively reviewed. Patients were divided into primary angle closure glaucoma (PACG), primary open angle glaucoma (POAG), secondary glaucoma (SG), and other types. The constitution, distribution of age and gender of different glaucoma types were compared and analyzed. Main Outcome Measures Proportion, age and gender distribution of these glaucoma patients. Results Totally, 7569 cases of glaucoma inpatients were recorded. PACG (n=5330) was the main type (70.42%) followed by SG (20.04%).  POAG (n=352) accounted for 4.65% of the cases, while other types of glaucoma (n=370) accounted for the rest 4.89%. The average age of PACG, POAG, SG and other types of glaucoma were 66±10 years, 53±15 years and 57±15 years and 63±13 years, respectively. PACG showed a female predominant manner (M/F ratio:1:2.21), while POAG and SG were male predominated (M/F ratio:1:0.44 and 1:0.65, respectively). During the 5 years, the proportion of POAG showed slow increase (from 3.37% to 5.71%). Distribution of both the age and gender showed no change. Conclusions PACG is still the most commonly encountered type of glaucoma from 2011 to 2016 in Shenyang. The hospitalized POAG in present study is much lower than other cities reported previously. (Ophthalmol CHN, 2018, 27: 21-25)

Diagnostic value of asymmetric parameters of retina and posterior polar macula measured with OCT in early primary open angle glaucoma

WU Rong, ZHOU Zi-xia, LIAO Su-hua, LI Jin-ying.

2018, 27(1):  26-30.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 006

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 Objective To investigate the diagnostic value of asymmetry parameters in retina and macular posterior pole in early primary open angle glaucoma (POAG). Design Diagnostic technique evaluation. Participants 50 eyes of 100 patients with early POAG and 100 eyes of 50 cases in normal control. Methods All eyes underwent Cirrus HD-OCT for thickness of total, inferior, superior retinal nerve fiber layer (RNFL) around the optic disc、macular and ganglion cell-inner plexiform layer (GCIPL), and then calculated intereye and intraeye difference (posterior pole asymmetry parameters analysis). The mean field defect (MD) and pattern standard deviation (PSD) were recorded using a Humphrey perimeter. The area under the curve (AUC) was used to evaluate the ability of the parameters to diagnose early POAG. Main Outcome Measures RNFL thickness, macular thickness and GCIPL thickness of two groups, asymmetric analysis for intereye and intraeye difference of RNFL thickness, macular thickness and GCIPL thickness. The AUC value of each parameter, the sensitivity of the fixed specificity.  Results The RNFL thickness, macular thickness and GCIPL thickness in the early POAG group were significantly thinner than those in the normal control group (P<0.05). In addition to the difference in the intraocular RNFL thickness (P=0.128), there were significant difference (P<0.05) in the absolute difference between the two groups in the asymmetry of other measurement parameters. The highest GCIPL diagnostic efficacy was the intereye difference of the superior GCIPL thickness , AUC was 0.933, followed by the total GCIPL thickness (AUC=0.922). The highest RNFL around the optic disc diagnostic efficacy is intereye difference of the total RNFL thickness (AUC=0.894). The highest macular diagnostic efficacy was total macular thickness (AUC=0.85). The sensitivity of total GCIPL thickness was the highest, with a 95% specificity of 85%, followed by intereye total GCIPL thickness difference of 80%. Conclusion The diagnostic value of RNFL thickness around optic disc and GCIPL thickness, especially their intereye asymmetric parameters respectively were worth more than macular thickness in early diagnosis of POAG measured by Cirrus-HD OCT. But the analysis of intraocular asymmetric parameters showed the lowest diagnostic ability and the lowest AUC. (Ophthalmology, 2018, 27: 26-30)

Comparison the lowering eye pressure effect of two ranges of endoscopic cyclophotocoagulation in the treatment of refractory glaucoma

CHEN Lin1, WANG Hua2, TANG Xin1.

2018, 27(1):  31-35.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 007

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 Objective To compare the difference of lowering effect by phacoemulsification cataract extraction combined with endoscopic cyclophotocoagulation (ECP) between 210 degree and 240 degree treatment. Design Comparative case series. Participants 70 cases (70 eyes) with refractory glaucoma in Beijing Tongren Hospital were included. Methods 70 eyes were randomly divided into two groups, 35 cases were undergoing 210 and 240 degree ECP treatment respectively. All the patients were selected by clear corneal incision phacoemulsification (PE) cataract extraction combined with ECP and goniosynechialysis. The average follow-up period was (21.69±8.93) months. Main Outcome Measures Intraocular pressure (IOP) and IOP lowering pressure medications. Result Preoperative IOP was (26.13±10.58)mmHg in group 210 degree and (24.85±10.78)mmHg in group 240 degree (P=0.620). IOP decreased (7.81±12.55)mmHg and (8.57±11.40)mmHg respectively in the two groups at last follow-up(P=0.131). The average number of medications was (2.71±1.66)in group 210 degree and (2.40±1.65) in group 240 degree before operation(P=0.429), which decreased to (0.46±0.98) in group 210 degree and (0.34±0.80) in group 240 degree at last follow-up(P=0.595). No serious complication during the operation was observed. Conclusion There was no statistical significance in the control of IOP between the 210 degree group and 240 degree group by phacoemulsification cataract extraction combined with ECP. (Ophthalmology, 2018, 27: 31-35)

Micro-mechanism of high pressure damage on corneal endothelial cells

LIANG Ling-ling1, YUAN Jin2, XING Zheng-mao3, LIAO Hong-fei1.

2018, 27(1):  36-41.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 008

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 Objective To investigate the micro-mechanism of high pressure damage on corneal endothelial cells. Design Experimental study. Participants Rabbit corneal endothelial cells. Methods The first generation of rabbit corneal endothelial cells in vitro culture (RCEC) were divided into five groups: group A: 30 mmHg pressure,  group B: the fluctuated pressure, pressure would be set to 15 mmHg-25 mmHg-20 mmHg-10 mmHg, each pressure level for six hours, group C: 50 mmHg pressure , group D: the normal pressure group, group E: without pressure group. The original generation cells were identified by immunohistochemical; cell activity was detected by Flow cytometry. The protein of BcL-2 and P53 of cell was detected with Western blotting test. The expression of Fas/FasL was detected with RT-PCR. The expression in cytoplasm Cytc was detected by Immuno-fluorescence. Main outcome Measures The expression about BcL-2 and P53 and Fas/FasL and Cytc. Results NSE antibody of the primary corneal endothelial cells was positive, and no corneal epithelial cells and corneal stromal cells were found. Corneal endothelial cell activity was lower in high pressures groups by Flow cytometry and most of damaged cells were apoptosis. In the group of 30 mmHg, 50 mmHg and the fluctuated pressure groups, the protein P53 relative expression (OPTDIP53/OPTDIactin) were 0.253±0.014, 0.670±0.019, 0.474±0.016, respectively (F=1210, P=0.000). The expression of Fas/FasL of each group was negative by RT-PCR analysis in each time period. The expression of Cytc in cytoplasm was positive in the high pressure groups with immunofluorescence. Conclusion The damage of the corneal endothelial cell under high pressure environments was caused by apoptosis, while the start of apoptosis pathway was the Cytc being released from mitochondria into the cell cytoplasm, which was endogenous way of apoptosis. (Ophthalmology, 2018, 27: 36-41)

Experiment study on inhibiting conjunctival fibrous scar formation after trabeculectomy with biological collagen membrane in rabbits

ZHANG Jun-xiu, MA Yao, ZHANG Hai-juan, MA Ke.

2018, 27(1):  42-47.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 009

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Objective To observe the inhibitory effect of biological optic membrane(a sponge like collagen matrix) on the formation of conjunctival fibrous scar after trabeculectomy in rabbits.  Design Experimental study. Participants  48 New Zealand albinorabbits. Methods Rabbits were randomly divided into 3 groups: blank control group, Healaflow control group and experimental group, each group of 16. Each rabbit had a trabeculectomy at one eye. Blank control group: simple trabeculectomy. Biomembrane group: suture the biological optic membrane behind the scleral flap during trabeculectomy. Healaflow (a crosslinked sodium hyaluronate gel) group: Healaflow was injected under the scleral flap and conjunctival flap during trabeculectomy. Intraocular pressure was measured at 1, 3, 5, 7, 9, 11, 13, 14, 21, 28 days after the operation, and the condition of filtration bleb was observed at the same time. HE and immunohistochemical PCNA staining were used for histological observation. Main Outcome Measures Intraocular pressure (IOP), filtration bleb, the density and arrangement of inflammatory cells and collagen fibers, and the number of PCNA positive fibroblasts. Results The postoperative IOP of the blank control group, the biological membrane group and the Healaflow group on 7th day were (4.93± 1.40), (3.56± 0.50), (3.49± 0.40) mmHg (P=0.005); on 14th day were (5.53±1.49), (4.00± 0.58), (4.11± 0.41)mmHg(P=0.013); on 28th day were (5.76± 0.94), (5.93±1.34), (5.11± 0.91) mmHg (P=0.246). In the blank control group, nonfunctional filtering blebs began to appear on the 9th day after operation. In the biological optic membrane group and Healaflow group, a small amount of nonfunctional blebs began to appear on the 21th day after operation. HE staining: On 14th day, the number of inflammatory cells reached the peak and the biological membrane began to degrade, the biomembrane holes were disappearring, replaced by the loose arrangement of collagen fibers and a small amount of fibroblasts and inflammatory cells; on 28th day, the number of inflammatory cells in each group decreased significantly. The biological optic membrane completely degraded and the collagen fibers were replaced by loose collagen fibers. PCNA staining: the PCNA positive cells in each group reached the peak on 14th day, and the numbers of PCNA positive cells in the blank control group were always more than that of the biomembrane group and the Healaflow group. Conclusion The biological optic membrane has the effect of preventing the formation of conjunctiva scar after trabeculectomy, and it can maintain a more sustained lower intraocular pressure after trabeculectomy for not a very long time, but it may still has some clinical significance, which needs more clinical researches to explore. (Ophthalmol CHN, 2018, 27: 42-47)

Retrospective analysis of characteristics of corneal donors in Hunan from 2011 to 2016 

HE Sheng-yu1，2, YANG Li-hong2, LONG Wen-xiu1，2, LI Shao-wei1，3, WANG Cong-xiang2, LI Yan1，3

2018, 27(1):  48-51.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 010

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Objective To investigate the characteristics of corneal  donors in Changsha Aier Eye Bank during January 2011 to December 2016 and to discuss strategies of improving corneal donation rate in China. Design  Retrospective cases series.  Participants 295 cases cornea donation donor registration information from January 2011 to December 2016 in the Changsha Aier Eye Bank. Methods  The Changsha Aier Eye Bank records were reviewed and analyzed retrospectively.  Main Outcome Measures  Donor demographics (age and sex), occupation, degree of culture, donor cause of death and donor source. Results  From 2011 to 2016, cases of donations  was 32, 33, 36, 40, 92 and 62 cases, respectively.  There were 21.7% (n=64) of donors  between 40 to 49 years old, and 15.3%  (n=45) were  older than 70 years old. The most common cause of donor death was malignant tumor (44.4%). The workers（29.8%）and farmers （29.2%）were the major proportion of donors. College-level education was the lowest rate (13.2%) . The most  donors  were initiative  donation (33.6%, n=99),  while The Red Cross donation, Organ Donation Center donation and Body  Nonation Center donation was  19.3%  (n=57),  12.9%  (n=38) , 11.2%  (n=33) , respectively.  Conclusions There is an increasing trend of donated corneas in Hunan from 2011 to 2016. That is depended on  the propaganda of eye bank and  various donor sources. (Ophthalmol CHN, 2018, 27: 48-51)

Role of thrombospondin-1 in uveal melanoma angiogenesis mechanism 

ZHANG Xu, LI Bin, XU Xiao-lin, GAO Fei, ZHANG Zhi-bao.

2018, 27(1):  52-57.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 011

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Objective To investigate the relationship between TSP-1 expression and clinical pathological features of uveal melanoma patients and angiogenesis mechanism of uveal melanoma. Design Experimental study. Participants cell line MUM-2B and tissue specimen of uveal melanoma. Method 50 samples of uveal melanoma were collected in Beijing Tongren Hospital. The expression of TSP-1 and CD34 (microvessel density) in the samples was detected using immunohistochemistry. Building the overexpression of TSP-1 lentiviral vector and transfecting the uveal melanoma cell line MUM-2B, the variety expression of VEGF mRNA and protein was detected using Q-PCR and Western Blot. Main Outcome Measures The expression of TSP-1 and microvessel density in the uveal melanoma tissues, the clinical data, and the change of VEGF expression in the cell line before and after the TSP-1 overexpression. Results TSP-1 was positively expressed in 5 samples of 20 patients with ciliary body invasion and 27 samples of 30 patients without ciliary body invasion. There were 3 samples and 29 samples exhibiting the positive expression of TSP-1 in 11 large tumors and 39 medium tumors of uveal melanoma, which were respectively with the significant difference (χ2=5.470, 4.845; P<0.05). No significant differences in the expression of TSP-1 were found between different age, gender, cell type and sclera catheter (P=0.664, 0.606, 0.856, 0.723). The significant differences the microvessel density were found between the positive and negative expression of TSP-1 (Z=-4.616, P<0.05). Building the overexpression of TSP-1 lentiviral vector and transfecting the uveal melanoma cell line MUM-2B, the significant increasing were found in VEGF expression after transfection compared with before the transfecting. Conclusions TSP-1 expression is associated with the uveal melanoma angiogenesis mechanism. The increasing expression of TSP-1 can inhibit the angiogenesis of the tumor. These results imply that TSP-1 expression can be a molecular therapeutic target of uveal melanoma. (Ophthalmol CHN, 2018, 27: 52-57)

Changes of vessel density on optical coherence tomography angiography in central serous chorioretinopathy

MO Bin, ZHOU Hai-ying, JIAO Xuan, LIU Wu.

2018, 27(1):  58-63.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 012

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Objective To analyze optical coherence tomography angiography (OCTA) vessel density of superficial retinal vascular networks and choroidal capillary networks in affected eyes and non-affected eyes of central serous chorioretinopathy (CSC) patients and to explore the pathogenesis of CSC. Design Retrospective case series. Participants 27 patients with CSC and 27 normal people at Beijing Tongren Eye Center from November 2015 to March 2016. Methods All patients underwent OCTA using the RTVue XR Avanti device (Optovue Inc, Fremont, CA) which performed with 3 mm×3 mm Angio Retina mode. The vessel density of superficial retinal vascular networks could be auto-achieved by the OCTA software and the vessel density of choriocapillaris layer could be manually measured in 3 mm and 1mm regions. Main Outcome Measures The OCTA vessel density of superficial retinal vascular networks and choriocapillaris layer. Results On 3 mm×3 mm scans, the mean superficial retinal vessel densities of the whole area were 50.517±3.743 in affected eyes of CSC; and 52.577±3.803 (P=0.042) in non-affected eyes of CSC as well as 48.114± 3.257 (P=0.000) in healthy eyes. The mean choroid capillary vessel densities of the whole area were 56.673±5.750 in affected eyes of CSC; and 60.905±3.174 (P=0.009) in non-affected eyes of CSC as well as 61.361±1.839 (P=0.002) in healthy eyes. Conclusion The superficial retinal vessel density in affected eyes and non-affected fellow eyes of CSC was significantly higher compared to healthy eyes, however, choroid capillary vessel density in affected eyes of CSC was lower than healthy eyes. This might be relevant to central nervous system regulation and choroidal hyperperfusion in CSC. (Ophthalmol CHN, 2018, 27: 58-62)

Improve the training effect of cataract surgery by both application of animal experiment and medical simulation teaching 

JIAO Jian1, Ding Yan-e2, HUA Wen1.

2018, 27(1):  66-70.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 014

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 Phacoemulsification (phaco) usually needs more long and difficult learning curve. Recently, we train the cataract surgery techniques of young ophthalmologist by combined application of animal experiment and medical simulation teaching, and receive some experience for reference. At the beginning of surgical training of phaco, the basic ophthalmic microsurgery training should be performed by combined application of animal experiment and medical simulation teaching. In this article, we compared the advantages and limitations of the animal experiment and medical simulation teaching in the corneal incision making, viscoelastic injection, continuous curvilinear capsulorhexis, hydrodissection and hydrodelineation, lens nucleus phacoemulsification, removing lens cortical, intraocular lens implantation, removing viscoelastic, adjustment intraocular pressure and anterior chamber. (Ophthalmol CHN, 2018, 27: 66-70)

Discussion on continuous medical education strategies and skills training for ophthalmologists

ZHANG Li.

2018, 27(1):  70-72.  doi: 10.13281/j.cnki.issn.1004-4469.2017.01.015

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Continuous medical education is an important component of lifelong learning system. Currently, the main strategies of continuous medical education are through various forms of seminars or conferences to impart knowledge and experience. The medical profession has its particularity, the professional level of diagnosis and treatment of doctors sometimes determining a patient's life and death. This traditional continuing education model, taking much attention to the knowledge and underestimating skills, is not good enough for doctor to provide high-quality health care with aging. Therefore, a new form of continuing medical education should be created for ophthalmologists. Training methods and tools in form of interaction and feedback should be created.  Cases and images library including detailed information and definite diagnosis should be established as well.  Simulating equipment and situation in which a particular set of the actual surgery could be used in order to study or experience the real surgeries. (Ophthalmol CHN, 2018, 27: 70-73)

Four cases of acute angle-closure glaucoma treated by mydriasis with compound tropicamide eye drops

ZHANG Ming1, PENG Xian-yao2, HU Cheng2, MENG Jing-ya2, WU Hai-xia2, LIANG Yuan-bo2.

2018, 27(1):  75-79.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 01. 019

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To summarize the clinical and UBM morphological characteristics of 4 cases of primary angle closure glaucoma (PACG) with acute onset, who were well treated by application of compound tropicamide eye drops, in Eye Hospital of Wenzhou Medical University during a period from 2014 to 2016. All of these 4 patients were men, aged from 65 to 71 years old, including 2 cases of acute PACG and 2 cases of chronic PACG (3 cases of binoculus, 1 case of monocular eye). UBM showed that there were 2 cases with simple pupillary block, and 2 cases with pupillary block combined with anteriorly located ciliary body. The intraocular pressure were not controlled with more than 3 kinds of antiglaucoma drugs, even increased by dripping pilocarpine, but all the cases progressively dropped to below 21 mmHg in 3-15 hours while reversing to compound tropicamide. Among them, with no obvious ciliary block or lens subluxation, anterior chamber angle which were opened widely ≥ 180 ° before acute attack and entirely closed while attacking, opened again about 90°-360° after mydriasis accordantly with the open positions before acute attack. More researches are needed for indications of mydriatic treatment for PACG patients with acute onset. (Ophthalmol CHN, 2018, 27: 75-79)