Table of Content

25 January 2019, Volume 28 Issue 1

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Problems in the diagnosis of glaucoma in China 

LI Jian-jun, WANG Ya-xing.

2019, 28(1):  1-4.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 001

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Early diagnosis of primary glaucoma is a key and essential part in the prevention and treatment of glaucoma. At present, the major issues in glaucoma diagnosing in China are as following, the undervaluation of fundus photography, the insufficient quality of fundus photography, the over-reliance or mis-interpretations of OCT or visual field reports, the inadequate knowledge on glaucoma recognition of the non-glaucoma specialists, and the deficiency of ophthalmic PACS system in medical facilities, etc. Future steps should be taken, including the education to the non-glaucoma physicians, standardized training on fundus photography, formulating and promoting glaucoma diagnosis guidelines, and implementing information technology improvement within hospital and encouraging collaborative medical management. (Ophthalmol CHN, 2019, 28: 1-4)

Diagnosis and treatment of acute orbital compartment syndrome 

ZHU Yu.

2019, 28(1):  5-10.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 002

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 Acute orbital compartment syndrome(AOCS) is one of the emergency ophthalmologists and emergencies what physicians should be familiar with. The orbit is a relatively closed space. When the amount of orbital content increases in a short time, it can cause a sharp increase in intraorbital pressure, leading to optic nerve and retinal blood supply disorders. High orbital pressure over a certain period of time will cause irreversible visual loss. Based on the literature, the etiology, pathogenesis, clinical manifestations, imaging examination, diagnosis and treatment of AOCS were reviewed in this paper. (Ophthalmol CHN, 2019, 28: 5-10)

Etiological and clinical therapeutic changes trend of neovascular glaucoma in Beijing Tongren Hospital from 2002 to 2016

QIAO Chun-yan1, SHAO Lei1, XU Xin-yue1, DU Xiu-juan2, YANG Xiao-han1, CAO Kai1, LIU Tao1.

2019, 28(1):  11-16.  doi:DOI：10. 13281/j. cnki. issn.1004-4469. 2019. 01. 003

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 Objective To investigate clinical etiological and therapeutic changes trend of neovascular glaucoma(NVG) from 2002 to 2016. Design Retrospective case series. Participants the NVG inpatients in Beijing Tongren Hospital from 2002 to 2016. Methods Totally 1094 cases (1152 eyes) of consecutive NVG inpatients were enrolled and reviewed. The gender, age, etiology were compared between two periods (in 2002-2006 and in 2012-2016). For therapeutic analysis, taking 2013 as a key point when anti-VEGF drugs were widely used, operation method of NVG was analyzed. Main Outcome Measures the constituent ratio of etiological and operative methods. Results The first clinical etiology of NVG both in 2002-2006 group (121 cases) and in 2012-2016 group (486 cases) were diabetic retinopathy (54.5%, 52.1%), followed by retinal vein occlusion (33.1% , 26.7%). Cases of central retinal artery occlusion and intraocular tumor increased significantly in 2012-2016. Coats disease (36.4%) was the most common original disease in children. Cyclodestructive procedures were the most popular (37.2%) before 2013, then significantly decreased to 18.1% (χ2=53.997, P=0.000), while vitreous injection of anti-VEGF drugs were the first therapy after 2013, of which composition ratio increased from 2.9% to 45.1% (χ2=246.599, P=0.000). External filtration was decreased from 32.6% to 16.6% (χ2=38.495, P=0.000), and retinal photocoagulation or condensation combined ciliary body damage was decreased from 11.1% to 2.2% (χ2=38.495, P=0.000). If the cases of simple vitreous anti-VEGF drugs were removed, the first therapy was ciliary body destructive surgery in both periods, and the second was external filtration(all P>0.05). Conclusion The clinical demographic characteristics and etiological change trend of NVG in 2002-2016 don’t change too much. The first etiology of NVG is diabetic retinopathy, followed by retinal vein occlusion. As the clinical application of anti-VEGF drugs, the cases accepted anti-VEGF treatment are significantly increased, and becomes the first therapy of NVG instead of ciliary body destructive surgery. The ciliary body destructive surgery and trabeculectomy were decreased, but are still main operation methods. (Ophthalmol CHN, 2019, 28: 11-16)

Observation and analysis on nail fold microcirculation in primary open angle glaucoma

TIAN Jia-xin, LI Meng, XIN Chen, XIE Yuan, SHI Yan, SANG Jing-hong, WANG Huai-zhou, WANG Ning-li.

2019, 28(1):  17-23.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 004

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 Objective To investigate abnormalities of nailfold microcirculation in patients with primary open angle glaucoma (POAG).  Design Prospective comparative case series.  Participants 51 patients with POAG (POAG group) including 34 patients with high tension glaucoma (HTG group) and 17 patients with normal tension glaucoma (NTG group) diagnosed in Beijing Tongren Hopistal and 70 normal healthy subjects (control group). Methods  Nailfold capillaroscope (JH-1004 microscope) was used to examine the fourth digit of nondominant hand of each subject. The hemorrhages of nail fold capillaries were observed. Capillary density, avascular zone (distance in proximal area of two capillaries), arterial limb diameter and venous limb diameter of capillaries (the widest diameter of limb) were measured.  Case number and score of avascular zones>200 μm, capillary hemorrhages, dilated capillaries (a capillary with arterial limb wider than 15 μm or with venous limb wider than 20 μm) were analyzed. We coded nailfold microcirculation into 4 categories according to the severity respectively. (e.g., 0 for no dilated capillary, 1 for 1 dilated capillary category, 2 for 2 dilated capillary categories, 3 for 3 or more dilated capillary categories). Main Outcome Measures  Nailfold capillary density, number of cases of avascular zones > 200 μm, hemorrhages, dilated capillaries and severity score of abnormal conditions. Results The capillary density of HTG group, NTG group and control group were 9(9,10),10(9,10) and 10(9,10) ( χ2=4.123, P=0.127). The subjects with avascular zones in HTG group, NTG group and control group were 20(58.8%), 8(47.1%) and 27(38.6%) (χ2=3.894, P=0.143). The subjects with hemorrhages in HTG group, NTG group and control group were 15(44.1%), 6(35.3%) and 18(25.7%) (χ2=3.633, P=0.163). The subjects with dilated capillaries in HTG group, NTG group and control group were 18(52.9%),7(41.2%)and 21(30.0%) (χ2=5.195, P=0.074). The difference between POAG and control group was significant ( χ2=4.492, P=0.034). The severity score of avascular zones in HTG group, NTG group and control group were 1(0,1.25), 0(0,1) and 0(0,1) (χ2=3.842, P=0.146). The severity score of hemorrhages in HTG group, NTG group and control group were 0(0,1), 0(0,1) and 0(0,1) (χ2=3.156, P=0.206). The severity score of dilated capillaries in HTG group, NTG group and control group were 1(0,2), 0(0,1) and 0(0,1) (χ2=8.125, P=0.017). There is significant difference between HTG and control group (Z=-2.904, P=0.004).  Conclusion  The dilated capillaries in nailfold capillaroscopy are more frequent in POAG patients with the higher severity of dilated capillaries in HTG, which implied that microcirculation abnormalities may play a role in the pathogenesis of POAG. There is no significant difference of nailfold microcirculation between HTG and NTG. The reasons may involve the limited sample size and indicators about nailfold microcirculation. (Ophthalmol CHN, 2019, 28: 17-23)

The effect of peripheral anterior synechia extent on intraocular pressure control of laser peripheral iridoplasty in acute primary angle-closure glaucoma

LI Si-zhen1, LIANG Yuan-bo2, WANG Ning-li3, SUN Xia3, FAN Su-jie4,SUN Lan-ping4, LIU Wen-ru4, SUCIJANTI3.

2019, 28(1):  23-28.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 005

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 Objective  To evaluate the effects of peripheral anterior synechia (PAS) on acute attack stage of acute primary angle-closure glaucoma (APACG) cases who received argon laser peripheral iridoplasty (LPIP). Design prospective comparative case series. Participants 116 patients (116 eyes) with acute stage of primary angle-closure glaucoma in Handan Eye Hospital. Methods 84 eyes received LPIP treatment (LPIP group) and 32 eyes received medical treatment (medical group). Intraocular pressure ( IOP) at 1, 2 and 6 hours (IOP1 h, IOP2 h, and IOP6 h) were measured after treatment. IOP, fundus examination, gonioscopy, endocellium cell count (ECC) was measured after the IOPs were controlled. Main outcome Measures IOP and PAS extent. Results Strong correlation was found between PAS and attack duration (AD) in LPIP group and medical group (r=0.579, 0.288; P<0.05).  Strong correlation was found between PAS and IOP2 h, IOP6 h in LPIP group (r=0.296, 0.334; P<0.05). PAS extent in AD≤24 h group (2.3±2.9 clocks) was smaller than AD>24 h group (6.2±4.0 clocks) ( P<0.001). There was no difference in IOP1 h, IOP2 h and IOP6 h between PAS≤6 clocks group and PAS>6 clocks group in APACG received medical treatment. IOP1 h (28.4±15.1), IOP2 h (22.0±13.1) and IOP6 h (17.9±8.52) in PAS≤6 clocks group were lower than those (35.5±15.5, 29.6±11.4, 24.9±10.4, P=0.066, 0.020, 0.003) in PAS>6 clocks group.  Conclusions  APACG with PAS≤6 clocks has better IOP control than those with PAS >6 clocks in LPIP. (Ophthalmol CHN, 2019, 28: 23-28)

The study on the characteristics of ciliary body in primary acute angle closure glaucoma

LI Ai-lin1,2, GUO Li-xia2, LV Ai-guo2, CUI Hong-yu2, ZHANG Zhi-hong2, ZHANG Xin2, FAN Su-jie2.

2019, 28(1):  29-33.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 006

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 Objective To evaluate the effect of ciliary body on the pathogenesis of acute angle-closure glaucoma by observing the change of the shape and position of ciliary body before and after the acute attack of angle-closure glaucoma. Design Prospective comparative case series. Participants 30 patients with primary acute angle-closure glaucoma admitted to Handan Eye Hospital (the third hospital of handan city) from December 2016 to December 2017. Methods Ultrasound biomicroscopy (UBM) and intraocular pressure (IOP) were performed at the acute attack, 1 month and 6 months after the acute episode of glaucoma. The parameters of ciliary body in UBM images were measured and analyzed by measuring software. Main Outcome Measures Central anterior chamber depth (ACD), maximum ciliary body thickness (CBTmax), ciliary body thickness at the scleral spur (CBT0), ciliary body thickness at 1 mm posterior to the scleral spur (CBT1), anterior placement of the ciliary body，(APCB), trabecular-ciliary process distance (TCPD), iris-ciliary processes distance(ICPD), trabecular meshwork-ciliary process angle（TCA）, trabecular meshwork-iris angle(TIA). Results Compared with the fellow eyes, ACD (1.73, 196 mm), CBTmax (1.07, 1.16 μm), CBT0 (0.90, 0.98 μm) and TIA (1.73, 7.12 degree) in acute attack eyes presented statistical differences (all P<0.05). There were statistically significant differences in ACD, CBTmax, CBT0, APCB, ICPD, TCA, and TIA (all P<0.05) between the acute attack eye and the first month after remission, and there were statistically significant differences in ACD, APCB, TCA, and TIA between the acute attack eye and the six months after remission, but the differences were variant. Conclusion Compared with the fellow eyes and the remission eyes, the acute attack eyes of primary angle-closure glaucoma showed the anatomical features of shallow anterior chamber, narrow angle, thin ciliary body and forward relative position. (Ophthalmol CHN, 2019, 28: 29-33)

One-year efficacy of drainage tube implantation of Ahmed valve by scleral tunnel for neovascular glaucoma 

YE Qin1, LIN Yu-ni2, YAO Yi-hua1, ZHU Yi-hua1.

2019, 28(1):  34-38.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 007

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Objective To evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation via two different pathways on intraocular pressure (IOP) and complications in patients with neovascular glaucoma (NVG). Design Retrospective comparative case series. Participants Twenty cases (20 eyes) with NVG were undergone AGV implantations in First Hospital of Fujian Medical University. Methods Ten cases (10 eyes) were treated with scleral flaps implantation (SF group), the other 10 cases (10 eyes) were treated with scleral tunnels implantation (ST group). In the scleral tunnel group, a 27G needle was inserted into the anterior chamber parallel to the iris at 4 mm from temporal-superior corner limbus to form a tunnel for inserting a drainage tube of Ahmed glaucoma valve. A follow-up ranged from 1 to 29 months (mean 11.6±5.77 months). Main Outcome Measures IOP, surgical success rate and complications with slit-lamp. Results Compared with pre-operation, IOP was significantly reduced to 17.0±8.97 mmHg in the SF group, while significantly decreased to 18.5±7.78 mmHg in the ST group at the end of follow-up. The difference of IOP at each time point in each group was statistically significant compared with that before surgery. However, there was no significant difference in IOP between two groups at each time point of follow-up. The complete success rate of SF group was 60% and the partial success rate of 30%. The complete success rate of ST group was 80% and the partial success rate of 20%. The complete success rate between two groups was statistically significant (P=0.035), while the partial success rate was not statistically significant (P=0.487). The incidence of shallow anterior chamber with low tension of the ST group (0 case) was significantly lower than that of the SF group (4 cases) (P=0.0433). Conclusion The efficacy is similar between the two different pathways of AGV implantations in patients with NVG. Our results indicate that the procedure via scleral tunnels is simpler and convenient with a lower incidence of shallow anterior chamber with low tension within one year. (Ophthalmol CHN, 2019, 28: 34-38)

Needle revision combined with sclera filtering channel reconstruction for late failure bleb 

QIN Jian-xiang, XIE Yan-qian, HU Cheng, WANG Xiao-jie, LIANG Yuan-bo.

2019, 28(1):  39-42.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 008

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Objective To investigate the efficacy of the first needling revision combined with scleral channel reconstruction for late-failed filtering bleb after glaucoma filtration surgery. Design Retrospective cases series. Participants 25 eyes of 24 patients were underwent bleb needling combined with sclera channel reconstruction from March 2014 to October 2016 in the Eye Hospital of Wenzhou Medical University  Methods For late failed filtering bleb, subconjunctival scarring was separated by the needle, then the needle was advanced under the sclera flap to separate, then puncture into the anterior chamber, or puncture into the anterior chamber directly through whole sclera if the edge of sclera flap was invisible, to ensure that the anterior chamber communicates with the filtering bleb. Conjunctive injection of 5-Fu was given after the operation and the patients were followed-up to observe the intraocular pressure (IOP). Success was defined as postneedling IOP≤21 mmHg with or without any antiglaucoma medications. Main Outcome Measures  IOP, complications and numbers of anti-glaucoma medications. Results The average interval between index filtering operation and bled revision was 53.5±67.7 months. Mean IOP was 28.4±9.8 mmHg before surgery and 24.6±11.9 mmHg at last postoperative follow-up. Mean follow-up was 7.6±7.8 months. The mean number of anti-glaucoma medications was reduced from 2.7±1.1 preoperatively to 0.8±0.9 at 6 months postoperatively. The success rate was 44% at 6 months. Conclusions Needling revision with sclera channel reconstruction is a safe and easy procedure, having an acceptable success rate of surgery for the treatment of late-failed bleb. This procedure can be recommended before second filtering surgery for failing bleb. (Ophthalmol CHN, 2019, 28: 39-42)

The epidemiological study of peripapillary choroidal vascular layers thickness in Chinese aged 50 and over

XU Jie1, WANG Ya-xing1, JIANG Ran1, ZHAO Jing1, ZHANG Qi1, WEI Wen-bin1, XU Liang1, JOST B. Jonas2.

2019, 28(1):  43-48.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 009

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 Objective To measure peripapillary choroidal layers thickness and to assess its associated factors in 50 years old or over population of Beijing Eye Study. Design Population-based cross-sectional study. Participants 3468 participants in Beijing Eye Study 2011 with a mean age of 64.4±9.6 years.  Methods A detailed interview, general examinations and ophthalmic examinations were performed. Using spectral-domain optical coherence tomography, we measured the large vessel layer and small-to-medium vessel layer of the peripapillary choroid in a circular scan with a diameter of 3.4 mm around the optic nerve head centre at eight locations equidistant (45° ) to each other. Multivariate linear regression analysis of choroidal thickness with demographic, systemic and ocular biological parameters was performed. Main Outcome Measures peripapillary choroid vessel layer thickness. Results Peripapillary choroidal layers thickness measurements were available for 3000 (86.5%) participants. The mean small-to-medium choroidal vessel layer thickness, large choroidal vessel layer thickness was 31.40±7.18 μm, 102.76±48.17 μm, respectively. The thickest was located on superior section (120.1±55.8 μm, 35.3±9.9 μm, respectively) and the thinest was located on inferior section (79.3±40.5 μm, 30.7±9.3 μm, respectively). In multivariate analysis, thicker small-to-medium choroidal vessel layer thickness was associated with younger age (P<0.001), shorter axial length (P<0.001), smaller beta zone (P<0.001), and higher cognitive function score (P=0.01). Thicker large choroidal vessel layer thickness was associated with younger age (P<0.001), shorter axial length (P<0.001), smaller alpha zone (P=0.002), smaller beta zone (P<0.001), and higher cognitive function score (P=0.026). Conclusion The mean small-to-medium choroidal vessel layer thickness and large choroidal vessel layer thickness is thickest superiorly and thinnest inferiorly. Thicker mean thickness of small-to-medium choroidal vessel layer thickness and large choroidal vessel layer thickness were significantly associated with younger age, shorter axial length, smaller beta zone and higher cognitive function score. (Ophthalmol CHN, 2019, 28: 43-48)

Intraocular pressure with AccuPen tonometer in children aged 3 or younger

SU Xiao-dan, ZHAO Shu-ping, DENG Min.

2019, 28(1):  49-51.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 010

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 Objective To study the normal intraocular pressure (IOP) and its influencing factors in infants aged 0-3 years. Design Cross-sectional survey. Participants 514 cases of normal infants aged 0-3 years. Methods Under the sedation of chloral hydrate, IOP in supine position was measured three times in each eye with AccuPen hand-held digital tonometer. The central corneal thickness was measured by hand-held corneal thickness gauge. Pearson correlation analysis was performed between IOP and corneal thickness. Main Outcome Measures IOP. Results The mean IOP in the right eye was (15.63±2.76) mmHg, and that in the left eye was (16.17±2.66) mmHg. There were 454 cases in 0-12 months group, mean IOP in right eye (15.69±2.82) mmHg), left eye (16.26±2.69) mmHg; 51 cases in 13-24 months group, mean IOP in right eye (15.31±2.16) mmHg, left eye (15.51±2.19) mmHg; 9 cases in 25-36 months group, mean IOP in right eye (14.67±2.92) mmHg and left eye (15.11±2.85) mmHg. There was a weak positive correlation between IOP and central corneal thickness (r=0.302-0.313, P=0.000). Conclusion There is no significant difference in IOP between 0-3 year’s old infants and adults. (Ophthalmol CHN, 2019, 28: 49-51)

Efficacy of six months on intravitreal injection of conbercept for retinopathy of prematurity

ZHOU Zhen-bao1, YANG Hui1, WANG Na1, SU Li-miao1, ZHUO Nan2.

2019, 28(1):  52-55.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 011

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 Objective To evaluate the effectiveness of intravitreal injection of conbercept (IVC) for retinopathy of prematurity (ROP). Design Retrospective case series. Participants 24 patients (47 eyes) of ROP including threshold lesions or pre-threshold lesions of type I in 33 eyes and aggressive posterior ROP (AP-ROP) in 14 eyes had received IVC in Xiamen Children’s Hospital from January to December 2017. Methods All patients were treated with IVC 0.03 ml. Follow-up examinations were performed at 1, 2, 4, 6, 10, 14, 18, 24 weeks after treatment. Effective treatment included disappearance of additional lesions, reduction of vasodilation, crest regression and vascularization of peripheral non-vascularized areas. Main Outcome Measures Numbers of eyes with effectiveness or recurrence. Results All the eyes had received the IVC. 39 eyes were cured for single injection. 4 eyes had received twice injections. 4 eyes had required additional laser photocogulation. 1 eye had received vitrectomy. All the treatments were effective, and no recurrence was found in the follow-up examinations. During the follow-up, local punctiform effusion which was along with the retinal blood vessel was observed in 2 eyes following the first examination. No notable ocular and systemic complications related to the IVC injections were observed. Conclusions IVC is effective in the treatment of ROP, but the safety need to be evaluated for a long time. (Ophthalmol CHN, 2019, 28: 52-55)

Ocular manifestations and characteristics of children tuberous sclerosis: 18 cases report 

SU Xue-gang1, WANG Xu2, LENG Fei3, LI Li3, BAI Da-yong3.

2019, 28(1):  56-60.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 012

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Objective To investigate the ophthalmic features of children with tuberous sclerosis (TSC). Design Retrospective case series. Participants 18 cases of children with TSC. Methods The clinical data of TSC children including fundus photography, infrared fundus photography, coherent optical tomography (OCT) and TSC1/TSC2 gene detection data were retrospectively analyzed. Main Outcome Measures Imaging findings of the external eye, anterior segment and fundus. Results The average age of TSC patients was 7.12±3.33 years. There were 5 cases (27.8%) of eyelid fibroma, 2 cases (11.1%) of eyelid skin depigmentation, 2 cases (11.1%) of white irregular iris nodules and 1 case (5.6%) of white iris deposits. 39, 28, 13 hamartomas were respectively found with OCT, infrared fundus photography and color fundus photography in 11 cases (22 eyes) of TSC. There were 9 TSC2 gene mutations in 11 patients, 2 of which were newly discovered mutations. Conclusion In addition to eyelid and iris involvement, retinal hamartoma is more common in children with TSC. OCT has a higher detection rate of early retinal hamartoma than fundus photography. (Ophthalmol CHN, 2019, 28: 56-60)

Application of academic group-oriented teaching in ophthalmic clinical teaching

ZHOU Ji-chao1, ZHANG Chun1, FENG Yun1, NI Wei1, LIU Zi-yuan1, YANG Lei2, TIAN Yan-jie1.

2019, 28(1):  62-65.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 01. 013

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Objective To evaluate the teaching effect of academic group-oriented teaching in ophthalmic probation. Design Prospective randomized controlled teaching study. Participants 98 students of clinical medical 8 year program of grade 2012 in Peking University Health Science Center. Methods 48 students were divided into the experimental group and the other 48 students into the control group. Academic group-oriented teaching was applied to the experimental group, and the control group was taught in regular PBL+CBL. The teaching effectiveness was investigated on 3 days, 3 months and 6 months after teaching. Main Outcome Measure Satisfaction degree, determination rate of vocational intention and career planning of students. Results The excellent rate of ophthalmic knowledge test (33.3%) and overall satisfaction of teaching (87.5%) in the experimental group was better than in the control group (8.3% and 33.3%) on 3 days after teaching. Occupational intention determination rate (43.8%), occupational planning determination rate (68.8%) and oral test excellent rate (29.2%) on 3 days after teaching in the experimental group were better than in the control group (16.7%, 43.8%, 8.3%, respectively). However, there was no significant difference in the results on 6 months after teaching. Conclusion Academic group-oriented teaching may can improve the teaching quality rapidly in the early and middle period of ophthalmic practice teaching, and help students make career planning, but the effect in the late teaching is not clear. (Ophthalmol CHN, 2019, 28: 62-65)