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    25 May 2019, Volume 28 Issue 3
    Characteristic features of retinal and choroidal vasculatures as biomarkers and warning for systemic diseases
    HUI Yan-nian
    2019, 28(3):  161-164.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.001
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    Retinal vessels is the only blood vessel in the human vascular system that can be seen directly in vivo. Its morphological structure or function changes can directly or indirectly reflect the situation of some systemic diseases. Similarly, some systemic diseases also have characteristic manifestations in retinal vessels. With the rapid development of optical coherent tomography (OCT) and OCT angiography (OCTA), the understanding of choroidal vessels has been enchanced. It has been found that some eye diseases are closely related to the changes of choroidal vessels, and the relationship between them and the systemic diseases has also been revealed. Characteristic changes of retinal and choroidal vessels such as retinal vessel diameters and tends, retinal nerve fiber layer defect, and the capillary density of retina and choroid may serve as biomarkers of systemic diseases and play a role in the pathogenesis, early warning, diagnosis and treatment response assessment of diseases.

    Six-month outcomes of ab-interno microcatheter-assisted trabeculotomy in primary congenital glaucoma
    SHI Yan, WANG Huai-zhou, YIN Peng, XIN Chen, WAN Yue, LIANG Xin-tong, WANG Ning-li
    2019, 28(3):  165-168.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.002
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    Objective To evaluate the effectiveness and safety of ab-interno microcatheter-assisted trabeculotomy in primary congenital glaucoma (PCG). Design Retrospective case series. Participants 27 cases (30 eyes) of PCG with transparent cornea from Beijing Tongren Eye Center in August 2018 to February 2019. Methods Ab-interno microcatheter-assisted trabeculotomy was performed in all patients. Patients were further divided into circumferential trabeculotomy group and partial trabeculotomy group, and without or with previous surgery group. The follow-up is 6 months. Main Outcome Measures IOP, numbers of antiglaucoma medications and postoperative complications. Results The mean baseline IOP was (31.5±6.1) mmHg on a median of 3(range: 1~4) medications. The mean IOP and numbers of antiglaucoma medications at the last follow-up was significantly reduced to (15.7±3.6) mmHg on a median of 0 (range 0~3) medications (both P<0.001). IOPs at baseline and last follow-up were both not significantly different between circumferential trabeculotomy group (17 eyes) and partial trabeculotomy group (13 eyes) (both P>0.05), while the IOP reduction was greater in circumferential trabeculotomy group (54.7%±10.1%) than that in partial trabeculotomy group (37.5%±16.8%,P=0.002). IOPs at baseline and last follow-up, and IOP reduction were all not significantly different between eyes without (16 eyes) or with (14 eyes) previous surgery (all P>0.05). Hyphema was seen in all eyes and 6 eyes (20%) had transient IOP spike in the early postoperative days. Conclusion The short-term follow-up shows that ab-interno microcatheter-assisted trabeculotomy is feasible for the treatment of primary congenital glaucoma with transparent cornea.

    Short-term efficacy of trabeculotomy combined with phacoemulsification for primary open angle glaucoma
    WAN Yue, YIN Peng, SHI Yan, XIN Chen, LIU Lu, WANG Huai-zhou, WANG Ning-li
    2019, 28(3):  169-175.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.003
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    Objective To observe the safety and efficacy of trabeculotomy combined with phacoemulsification for primary open-angle glaucoma (POAG) with cataract. Design case-controlled study. Participants Thirty-six eyes of 36 POAG patients with cataract underwent surgery in Beijing Tongren Eye Centre from Mar. 2018 to Mar. 2019. Methods According to the surgical method selected by the patients, the patients were divided into two groups: 12 patients (12 eyes) receiving trabeculectomy combined with phacoemulsification were the observation group, and 24 patients (24 eyes) receiving trabeculectomy alone were the control group. The intraocular pressure (IOP), visual acuity, complications and the types of antiglaucoma drugs were recorded and compared between the two groups before surgery and at 1, 2, 3, 5 days, 1 week and 1 month after surgery. Main Outcome Measures IOP, the presenting visual acuity, short-term postoperative complications and antiglaucoma drops. Results The highest preoperative IOP for treatment group and control group were (34.08±8.21) mmHg and (37.75±8.61) mmHg respectively(P=0.46). Mean IOP decreased postoperatively, being (20.75±11.89) mmHg at 1 day, (21.23±8.72) mmHg at 1 week, and (15.00±2.22) mmHg at 1 months in treatment group, and being (16.08±5.63) mmHg at 1 day, (22.08±11.48) mmHg at 1 week, and (16.05±5.25) mmHg at 1 months in control group. The intraocular pressure decreased with time in the two groups after surgery (all P<0.001). Although postoperative intraocular pressure fluctuations were different between the two groups, there was no statistical significance (P=0.77). The mean amplitude of IOP decrease in the two groups after 1 month were 53.09%±15.19% and 55.68%±15.63% respectively (P=0.64). Mean kind of antiglaucoma drops before surgery was 2.67±0.99 and 3.08±0.72(P=0.16), and decreased to 0.17±0.58 and 0.96±1.33 in treatment group and control group at 1 months after the surgery (P=0.06). Transient IOP spikes were observed in 16.67% and 54.17% in the treatment group and control group (P=0.03). The most frequent postoperative complication was hyphema, 83.3% in treatment group and 62.5% in control group (P=0.21). Ciliary body detachment was observed in 25.0% in treatment group versus 75.0% in control group (P=0.004). In treatment group, the presenting visual acuity of operated eyes improved in 8 eyes(66.7%), and remained in 4 eyes (33.3%). In control group, the presenting visual acuity of operated eyes remained in 20 eyes (83.3%), and decreased in 4 eyes (16.7%),the change of visual acuity was different in the two groups (P<0.001). Conclusion Both trabeculotomy combined with phacoemulsification and trabeculotomy alone could reduce IOP effectively for POAG. The incidence of transient IOP spike was lower in trabeculotomy combined with phacoemulsification than trabeculotomy alone. However the middle- and long-term efficacy between the two groups is yet to be determined.

    Outcomes of microcatheter-assisted trabeculotomy in childhood glaucoma
    WANG Bo 1,2, DI Hao-hao2, YANG Xiao-yuan3, GAO Chuan-wen2, CHEN Peng2, WANG Huai-zhou4
    2019, 28(3):  178-181.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.004
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    Objective To evaluate the efficacy and safty of microcatheter-assisted trabeculotomy for the childhood glaucoma with or without previous surgeries. Design Retrospective case series. Participants 28 cases (39 eyes) of children with primary congenital glaucoma (PCG) were treated with microcatheter-assisted trabeculotomy at Zhengzhou Second People's Hospital from April 2017 to May 2018. Methods 28 cases (39 eyes) were divided into two groups according to the surgery history. Group A (15 cases, 22 eyes) had no previous anterior chamber angle surgery. Group B (13 cases, 17 eyes) had one or more previous failed angle surgeries. The intraocular pressure(IOP), the number of the drugs for reducing intraocular pressure, and postoperative complications in two groups were observed. Main Outcome Measures IOP, number of drugs for reducing intraocular pressure, surgical success rate. Results Mean IOP decreased from (31.23±6.05) mmHg on 3 (median, range: 1~4) medications in Group A and (29.47±5.75) mmHg on 3 (median, range: 1~4) medications in Group B preoperatively to (15.14±4.63) mmHg on 0 (median, range: 0~2) medications in Group A and (15.65±4.03) mmHg on 0 (median, range: 0~2) medications in Group B at  last  visit  respectively (all P<0.05).  Complete success rate (77.27% vs 88.24%, P>0.05) were comparable between Group A (90.91%) and Group B (94.12%). Complications were minimal. Conclusion The result of 6 months or over shows that microcatheter-assisted trabeculotomy is effective and safe in the treatment of PCG for those children who have no previous angle surgery or those children who had one or more previous failed angle surgeries.

    Six-month efficacy of application of domestic illuminated microcatheter on penetrating canaloplasty
    CHENG Huan-huan2, DENG Yu-xuan2, GU Juan2, ZHANG Shao-dan1,2, XIE Yan-qian1,2, LE Rong-rong1,2, YE Cong1,2, LIANG Yuan-bo1,2, WANG Ning-li3
    2019, 28(3):  182-185.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.005
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    Objective To observe the preliminary application of the domestic illuminated microcatheter on penetrating canaloplasty. Design Prospective case series. Participants 30 cases (30 eyes) of glaucoma patients were treated with the penetrating canaloplasty from May 2018 to August 2018 in Eye Hospital of Wenzhou Medical University. Methods A window at the corneal-scleral bed after the canaloplasty using the domestic illuminated microcatheter was made, enabling aqueous to redirect into the opening of schlemm canal with intension sutures. No antimetabolite agents were used in the surgical procedure. Time points of follow-up were arranged at 1 day, 1 week, 1, 3 and 6 months after the surgery. Qualified success was defined as intraocular pressure (IOP)≤21 mmHg with medication. Complete success was defined as IOP≤21 mmHg without medication. Main Ooutcome Measures Rate of circumferential catheterization of the canal, IOP, number of medication, surgical success rate and complications. Results 23 eyes (76.7%) achieved the 360 degrees’ catheterization of the canal. The mean preoperative IOP was (34.3±13.9) mmHg. The mean IOP at 1 day, 1 week, 1, 3 and 6 months after the surgery was (15.0±9.7) mmHg, (17.3±8.8) mmHg, (15.6±3.7) mmHg, (13.9±6.1) mmHg and (13.4±3.3)mmHg, respectively (P<0.001). The mean number of preoperative medication was 3.4±1.2. The mean number of postoperative medication was 0.2±0.9, 0.5±0. 9, 0.2±0.5, 0.1±0.2 and 0.2±0.5, respectively (P<0.05). Surgical success rate at 6 month after surgery was 95.0%(19/20) (qualified success) and 85.0%(17/20)(complete success), respectively. With regard to complications, hyphema was observed in 4 eyes(18.2%), meanwhile hypotony and grade I shallow anterior chamber was observed in one of the eyes(4.5%). No filtering bleb was observed in 19 eyes (95.0%)  at 6-month after the surgery. Additionally,transient elevated IOP was observed in 9 eyes (40.9%). Conclusion The result of six-month follow-up shows the domestic illuminated microcatheter can achieve about 75% success rate of circumferential catheterization in the procedure of penetrating canaloplasty. Obvious IOP reduction and few filtering blebs were observed. Longer-term follow-up is required.

    Effect of stretch on human trabecular cell viability and function regulation of aqueous humor outflow
    WU Shen, ZHANG Jing-xue, LIU Qian, WANG Ning-li
    2019, 28(3):  186-191.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.006
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    Objective Observing the changes of human trabecular cell viability and expression of genes involved in aqueous humor outflow regulation under the strong mechanical stretch. Design Experimental study. Participants Human trabecular meshwork cells(HTMCs). Methods The HTMCs were divided into three groups: 0 h control, 12 h and 24 h according to the stretch time. Cultured HTMCs were subjected cyclic stretch on the Flexcell Strain system at a level of 22% increment in surface area for 12, 24 hours. The AV-PI method was used to detect the apoptosis rate of HTMCs. Western-blotting was used to detect the expression of signal pathway protein related to survive, and qPCR was used to detect the expression of the genes related to the regulation of aqueous outflow. Main Outcome Measures The apoptosis rate of HTMCs, the expression of integrin-Fak-Akt cell signaling pathway, the expressions of 15 genes related to aqueous humor outflow regulation. Results Compared the HTMCs undergoing the mechanical stretch (0, 12, 24 h), the apoptosis rate was 0.71%±0.18%, 0.77%±0.19%, 0.87%±0.31%, respectively (P=0.7298). The phosphorylated Akt was 1.00, 2.17±0.06, 1.69±0.07, respectively (P<0.01). The phosphorylated Fak397 was 1.00, 1.85±0.09, 1.31±0.08, respectively (P<0.01). At the same time, the expression of matrix metalloproteinases (1, 2, 3, 7, 9, 10, 11, 12, 14) increased (all P<0.01). The expression of metallopeptidase inhibitor (1, 2, 3) decreased (all P<0.01). And the expression of IL-6 was 1.00, 1.28±0.06, 1.47±0.06, respectively(P<0.01). Conclusion High strength mechanical stretch can increase the vitality of trabecular meshwork cells and promote the secretion of aqueous outflow regulation related factors. This may be one of the mechanisms of canaloplasty to reduce the intraocular pressure.

    In situ imaging of trabecular meshwork outflow pathways basing on two-photon confocal microscope
    ZHANG Jing1, QIAN Xiu-qing2, ZHANG Hai-xia2, SHI Mei-lin1, LIU Zhi-cheng2
    2019, 28(3):  192-196.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.007
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    Objective To observed the microstructures of the trabecular meshwork (TM) outflow pathways of rats using the two-photon confocal imaging technique without tissue fixation and staining. Design Experimental study. Participants The six SD rats. Methods Six rats were randomly divided into two groups (group A and group B). After being sacrificed, the intact eyeball of the rat (group A) was used to acquire the longitudinal section imaging data of the TM outflow pathways. The left eyes of the SD rats in group B were dissected for the cross section and sagittal plane of the TM outflow pathways imaging,and the other eyes was used as the control group. Through the anterior chamber of the eye, the self-built two-photon confocal imaging system (the excitation wavelength of 950 nm, lateral resolution of 0.3 μm and axial resolution of 1.5 μm) was used to image the microstructures of the TM and adjacent tissues from different directions. And the relation between the average cross-sectional diameter of Schlemm’s canal and the imaging depth based on image processing was quantitatively investigated. Main Outcome Measures The imaging depth of the TM outflow pathways from different directions, the structural features of the TM and the average cross-sectional diameter of Schlemm’s canal. Results The imagings of longitudinal section, cross section and sagittal structural features of the TM and the adjacent tissues were obtained based on two-photon confocal microscope. The fibers of TM seem to be heterogeneous with depth increases. The fibers of the deep TM were densely arranged, and the formed pores were small; the fibers of the shallow trabecular meshwork were interlaced, and the formed pores were large to facilitate the outflow of aqueous humor. The average cross-sectional diameter of the Schlemm’s canal was varied from 34 μm to 68 μm in the imaging depth range from 190 μm to 215 μm below the limbus. Conclusion Our research provides a trans-scleral imaging method to visualize the microstructure of the TM outflow pathways, which laid a methodological basis for further understanding of aqueous humor outflow dynamics in the TM outflow pathways.

    Trabecular meshwork stem cells homing and effect on the wound-recovering of trabecular meshwork
    XIN Chen1, WU Shen1, DU Yi-qin2, WANG Ning-li1
    2019, 28(3):  197-201.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.008
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    Objective To investigate the role of collagen on the homing of trabecular meshwork stem cells (TMSCs) and the interaction of the TMSCs and trabecular meshwork (TM) cells in damage repairing. Design Experimental study. Participants Human TM cells and TMSCs. Methods Human primary TM cells and TMSCs were cultured and passaged. Then they were characterized by quantitative RT-PCR for gene expression and dexamethasone-induced experiment. TMSCs affinity was evaluated by comparing attached cell numbers in a co-culture system. The interaction of the TM cells and TMSCs was recorded by the wound-healing assay and time-lapse microscope. Main Outcome Measures The characterization of the TMSCs and TM cells. Affinity of TMSCs and TM status in the wound-healing assay. Results TMSCs expressed higher level of OCT4 while TM cells expressed higher levels of Chitinase 3-like1 (CHI3L1) and myocilin (MYOC). The expression of MYOC increased in response to dexamethasone.  The numbers of TMSCs attached to the wells with TM feeder (13.1±5.3, P=0.0009), with collagen (22.6±10.1, P<0.0001), with TM feeder and collagen (4.8±2.2, P<0.001) were all significant higher than the attached cells in the plain cell culture wells (3.7±0.5). With ADM3100, inhibition of CXCR4, the numbers of TMSCs attached to the wells were similar in various condition. In wound-healing model, TMSCs induced the division and migration of wounded TM cells. Conclusion TMSCs induced the migration of TM cells to the wounded region hence promoting wound healing. Collage plays a role in the homing of TMSCs.

    Effects of a broad-spectrum mechanosensitive ion channels inhibitor ruthenium red on intraocular pressure
    FANG Jing-wang1, TIAN Li-ping2, LIU Ya-ni1, WU Shen3, ZHANG Jing-xue3, XIN Chen3, WANG Ning-li3, ZHU Wei1
    2019, 28(3):  202-206.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.009
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    Objective To study the effects of broad-spectrum mechanosensitive ion channels inhibitor ruthenium red on the regulation of intraocular pressure. Design Experimental research. Participants Human primary trabecular meshwork (TM) cells and 10 C57BL/6J mice. Methods Human primary TM cells were isolated and characterized based on cell morphology and “biomarkers” expression. Mechanosensitive currents in TM cells were detected by patch-clamp recording. A broad-spectrum mechanosensitive ion channel inhibitor, ruthenium red (RR) was applied to inhibit mechanosensitive currents in TM cells. 10 C57BL/6J mice were randomly divided into 2 groups. Saline (control group, n=5) or RR (RR group, n=5) was injected into the anterior chambers of mice, respectively. Intraocular pressure (IOP) was measured daily and outflow facility was measured at 12 days after injection. Main Outcome Measures mechanosensitive currents (pA), IOP (mmHg) and aqueous humor outflow facility (μl/min/mmHg). Results Mechanosensitive currents of RR group (-67.6±30.2 pA) was significantly lower than the mechanosensitive currents before administration(-309.7±65.9 pA)(P=0.003). At the 10th day after the injection, IOP was decreased in RR group (14.67±2.11 mmHg) compared to vehicle control (17.85±3.66 mmHg) (P=0.0604). At 12 days after the injection, outflow facility in RR group mice (0.01058 ± 0.00236 μl/min/mmHg) was decreased significantly compared to that in controls (0.00324 ± 0.001352 μl/min/mmHg) (P=0.0273). The pumping rate in RR group mice(0.37±0.15 μl/min)was higher than that in controls (0.28±0.05 μl/min) (P=0.6278)to maintain certain level of pressure (15 mmHg). Conclusion Mechanosensitive currents in human primary TM cells can be inhibited effectively by RR. Outflow facility can be significantly reduced by RR. Meanwhile, aqueous humor production rate can be regulated by RR, which result in a reduction of IOP in mice. These results provide a novel therapeutic approach to lower IOP in glaucoma.

    Effects of gingival mesenchymal stem cells on the morphology of filtering blebs after trabeculectomy in rabbits
    MA Yao, ZHANG Hai-juan, MA Ke
    2019, 28(3):  207-211.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.010
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    Objective To observe the effect of gingival mesenchymal stem cells (GMSC) on the morphology of filtering blebs after experimental anti-glaucoma surgery in rabbits and to explore its effective concentration. Design Experimental study. Participants Fifty New Zealand white rabbits. Methods Fifty rabbits were randomly divided into five groups with 10 rabbits in each group: group I (GMSC 104/ml), group II (GMSC 105/ml), group III (GMSC 106/ml), group IV (Healaflow group) and group V (saline group). Each rabbit underwent right trabeculectomy and 0.3 ml of GMSC, Healaflow or saline were injected into the conjunctiva at the end of the operation. Intraocular pressure was measured at 1, 2 and 4 weeks postoperatively; anterior segment OCT scan was performed at 4 and 8 weeks postoperatively to classify the filtering blebs in anterior segment OCT images (flat diffuse type, cystic type, microcystic type, non-vesicular type, in which flat diffuse type and microcystic type as functional, cystic type and non-vesicular type as non-functional). The cross-sectional area of the filtering blebs was calculated and compared. Main Outcome Measures Intraocular pressure, classification of filtering bleb function and cross-sectional area of filtering bleb. Results At 2 weeks after operation, the mean intraocular pressure of group I~V was (5.43±0.76), (5.20±1.08), (4.27±0.79), (5.71±0.84), (4.71±1.09) mmHg (F=3.998, P=0.008). There was significant difference between group III and group V (P=0.006).  There was no significant difference in mean intraocular pressure between group I, II, IV and group V (all P>0.05). At 4 weeks after operation, the proportion of the functional follicles in group I~V was 60%, 50%, 90%, 87.5% and 37.5%, respectively. There was significant difference between group III and group V (χ2=5.513, P=0.043). There was no significant difference between group I, II, IV and group V (all P>0.05). At 8 weeks after operation, the proportion of the functional follicles in group I~Ⅳ was 60%, 40%, 80%, 85.7% respectively, higher than that in group V (25%). There was significant difference between group III, IV and group V (χ2=5.445, 5.529, P=0.049, 0.041). There was no significant difference between group I, II and group V (all P>0.05). At 4 weeks after operation, the cross-sectional area of the follicles in group I~V was (0.161+0.081) , (0.159+0.111) , (0.195+0.095),  (0.087+0.060), (0.041+0.025) mm2 (F=4.998, P=0.002), and there was significant difference between group I~III and group V (P=0.004, 0.005, 0.001), but there was no significant difference between group IV and group V (P>0.05); at 8 weeks after operation, the cross-sectional area of the follicles in group I~V was (0.171+0.087),  (0.208+0.130),  (0.180+0.099),  (0.052+0.018), and  (0.042+0.029) mm2 (F=6.409, P=0.001). There was significant difference between group Ⅰ, Ⅱ, Ⅲ and group V (P=0.004、0.000、0.002). There was no significant difference between group Ⅳ and group V (P>0.05) . There was no significant difference among groupⅠ, Ⅱ, and Ⅲ at 4 and 8 weeks after operation (all P>0.05). Conclusion GMSC can prolong the existence time of functional filtering blebs in rabbits after trabeculectomy to a certain extent.

    Genetic and phenotype characteristics analysis of two Waardenburg syndrome families
    CHEN Chun-jie, XIAO Ting, XU Ke, XIE Yue, ZHANG Xiao-hui, LI Yang
    2019, 28(3):  212-218.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.011
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    Objective To report genetic and clinical features of two Waardenburg syndrome families. Design Retrospective case series. Participants Two Waardenburg syndrome families, four patients, were collected from Beijing Tongren Hospital in 2018. Methods The medical history, abnormalities of hair, and skin pigmentation of the probands and the affected members in the two families were recorded. The probands and affected members underwent a detailed ophthalmic evaluation and auditory examinations. Peripheral blood were collected from two probands and their family members and the relationships of the members and pedigree diagrams were recorded. The DNA of two probands were sequenced with six genes lead to Waardenburg syndrome with Sanger sequencing. The online bioinformatics analysis software were used to predict the pathogenicity of the detected mutations, and the pathogenic mutations were performed the co-segregated analysis. Finally, according to the American College of Medical Genetics and Genomics (ACMG) pathogenic grading guidelines, the detected mutations were classified into the five levels. Main Outcome Measures Pathogenic mutation, eye and systemic pigment abnormalities, fundus and audiometry. Results EDNRB and PAX gene mutations were detected in two Waardenburg syndrome families, caused Waardenburg syndrome type I and Waardenburg syndrome type IV, respectively. The probands of both families had abnormal iris pigmentation, poor hearing, whitening of the hair and wide roots of the nose, but the degree and location were different. All confirmed or suspected members of both families had white hair or prefrontal white hair without abnormal skin pigmentation. Conclusion The study identified the pathogenic genes of two Waardenburg syndrome families and expanded the mutation spectrum of PAX3 and EDRRB genes. Genetic testing is an important means for differential and subtypes diagnosis of the suspected Waardenburg syndrome.

    Efficiency of 5% compand lidocaine cream on alleviating pain from botulinum toxin A injections for blepharospasm
    LI Yue1, WANG Wen-xian2, DONG Gui-xia2
    2019, 28(3):  219-221.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.012
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    Objective  To evaluate the efficiency of 5% compand lidocaine cream on alleviating pain from botulinum toxin A (BTX-A) injections for bilateral blepharospasm. Design Case-controlled study. Participants 24 patients who were treated with BTX-A  injections for bilateral blepharospasm in Beijing Tongren Hospital were selected from August 2018 to December 2018 and whose previous VAS pain score was not less than 8 without pain intervention. Methods BTX-A injections were given in both eyes of the patients. 5% compand lidocaine cream was applied for 30 minute prior to BTX-A injections on one side (right-left design by random number table, observed side), whereas the other side received BTX-A injections only (control side). Patients completed VAS pain score immediately after injections and were followed up 2 weeks later to observe the side-effects. Main Outcome Measures VAS pain score, side effects. Results The average pain score of all 24 patients was 6.73±1.25 on the observed side and 8.68±0.42 on the control side (P=0.000). All 24 patients experienced no significant side effects during the follow-up period. Conclusion 5% compand lidocaine cream represents a safe and effective means to alleviate pain from botulinum toxin A injections for bilateral blepharospasm patients.

    Association between candidate gene polymorphisms and diabetic retinopathy: Meta-analysis
    FAN Wen-ying, LIU Ning-pu
    2019, 28(3):  222-228.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.013
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    Objective To collectively evaluate the association of candidate genes polymorphisms with diabetic retinopathy (DR) in patients with type 2 diabetic mellitus. Design Meta-analysis. Participants Literatures investigating the association of genetic variants in three candidate genes of diabetic retinopathy. Methods Overall review of available literatures investigating the association of genetic variants in three candidate genes, including pigment epithelium derived factor (PEDF), tumor necrosis factor-α (TNF-α) and paraoxonase 1 (PON1) genes, with the risk of DR was conducted on 4 electronic databases(Pubmed, ISI, Enbose, and CNKI). Meta-analysis was performed by Stata 12.0 to calculate pooled odds ratios (ORs). Potential sources of heterogeneity and publication bias were explored. Main Outcome Measures Pooled OR, Pheterogeneity and publication bias. Results Thirteen studies with genotype frequency data including 2729 cases with DR and 3420 diabetic controls free of DR were included. Meta-analysis showed significant association of DR with rs12948385 variant of PEDF gene (dominant model: OR=1.371, 95%CI: 1.072~1.755, P=0.012; allelic model: OR=1.266, 95%CI: 1.028~1.560, P=0.027) and L55M variant of PON1 gene (recessive model: OR=2.998, 95%CI: 1.282~7.010, P=0.011). A statistically significant association was detected between the rs1800629 variant of TNF-α gene and proliferative diabetic retinopathy (PDR) in allelic model (OR=1.291, 95%CI: 1.019~1.636, P=0.034). No publication bias was observed. Conclusion Rs12948385 variant of PEDF gene and L55M variant of PON1 gene may be associated with DR, and rs1800629 variant of TNF-α gene may be correlated to PDR.

    Efficacy of vitrectomy through adjusted scleral incisions for ocular toxocariasis
    LIU Jing-hua, LI Song-feng, DENG Guang-da, MA Jing, LI Liang, MA Yan, ZHOU Dan, LU Hai
    2019, 28(3):  230-234.  doi:10.13281/j.cnki.issn.1004-4469.2019.03.014
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    Objective To explore the clinical effects of vitrectomy through adjusted scleral incisions on ocular toxocariasis. Design Retrospective case series. Participants 139 patients (139 eyes) with ocular toxocariasis who underwent vitrectomy with adjusted scleral incisions in Beijing Tongren Hospital between March 2012 to March 2018 and with a postoperative follow-up of at least 5 months were included. Methods The medical records of the patients including general information, results of preoperative ultrasonic bimicroscope (UBM) examination, surgical approaches, pre- and post-operative visual acuity and anatomical changes were retrospectively described. Postoperative visual acuity improvement was defined as two or more lines better than before;and postoperative visual acuity deterioration was defined as two or more lines worse than before;stable postoperative visual acuity was defined as changes no more than one lines. Main Outcome Measures Pre- and post-operative visual acuity, anatomical changes and complications. Results 46.0%(64/139 eyes) of the patients underwent vitrectomy combined with lensectomy. The follow-up-time was 29±9 months. At last follow-up, visual acuity improved in 85 eyes (85/121, 70.2%),remained stable in 27 eyes (27/121,22.3%) and deterioration in 9 eyes (9/121,7.5%); 99 eyes (96/139, 69.1%) had tractional retinal detachment preoperatively, among which 65 eyes had retinal reattachment or partial retinal reattachment. Postoperative hypotony within 1 week and postoperative ocular hypertension after 1 month were most common complications. Conclusion Vitrectomy through adjusted scleral incisions assisted by preoperative UBM seems to be beneficial for the short-term prognosis of visual acuity and anatomic outcomes of ocular toxocariasis. Preoperative UBM seems to valuable in detecting the extent and range of peripheral vitreoretinal pathologies of ocular toxocariasis and assisting in selecting the optimum location of scleral incisions.

    Agreement of axial length measurements between IOLMaster 700 and IOLMaster 500
    ZHAO Qi1, YANG Wen-li1, LI Dong-jun1, WANG Zi-yang1, CHEN Wei1, LI Yi-feng1, CUI Rui1, SHEN Lin1, XIAN Jun-fang2
    2019, 28(3):  235-238. 
    Asbtract ( 434 )  
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    Objective To investigate the agreement of axial length (AL) measurements between IOLMaster 700 and IOLMaster 500 in postoperative patients. Design Diagnosis test. Participants A total of 109 eyes from 88 postoperative patients in Beijing Tongren Hospital. Methods Postoperative status included LASIK, aphakic, phakiciol, pseudophakic, postvitrectomy, and siliconoil. Measurements of AL examined with IOLMaster 700 and IOLMaster 500 by an experienced technician in the same time. The paired t test, the intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate the agreements of the AL measurements between the two devices. Main Outcome Measures The AL measurements, the ICC, and Bland–Altman analysis. Results There were significant differences between the results of the two devices in post-LASIK and pseudophakic (P<0.001). Good agreements were indicated by the ICC(0.999 to1.000)and 95%CI(0.998~1.000). Bland-Altman analysis showed that the maximum absolute values of 95% limits of agreement (LoA) were small (0.014~0.089). Conclusion In postoperative patients, the agreement of AL measurements between IOLMaster 700 and IOLMaster 500 was excellent.