Table of Content

25 July 2019, Volume 28 Issue 4

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70 years development of ophthalmic imaging technology in China

ZHOU Nan, WEI Wen-bin.

2019, 28(4):  241-244.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 001

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Since the founding of the People's Republic of China, ophthalmic imaging technology has undergone 70 years of development, and has changed rapidly. From fluorescein fundus angiography and indocyanine green fundus angiography, ocular ultrasound examination, optic coherence tomography(OCT) and OCT angiography(OCTA), fundus camera, fundus autofluoresence examination, to computed tomography (CT) and magnetic resonance imaging (MRI), they have greatly deepened the understanding of ophthalmic diseases for us. Many diseases that could not be seen intuitively in the past have been further recognized by means of imaging examination, which has greatly promoted the improvement of the overall level of ophthalmic diagnosis and treatment in China. Especially the appearance of OCT and OCTA is a landmark progress in ophthalmic imaging. Summarizing the progress of ophthalmic imaging technology in China in the past 70 years is not only the review of the development of ophthalmic imaging, but also the guiding significance for the overall development of ophthalmology. (Ophthalmol CHN, 2019, 28: 241-244)

Management tactics of diabetic retinopathy in the anti-VEGF era and the future 

LI Yi-bin.

2019, 28(4):  245-248.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 002

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Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults in the world. Panretinal photocoagulation (PRP) is the standard treatment for proliferative diabetic retinopathy (PDR). Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agent in diabetic macular edema has been studied deeply, while it has also been noted that anti-VEGF treatment can induce regression of DR. Recent studies show that anti-VEGF treatment is noninferior to PRP for PDR, however it may not be viable for all patients because of its cost burden in long-term DR management. PRP still plays an important role in management of DR, and patients may get benefits from combination therapy with PRP and anti-VEGF treatment. The algorithm of the combination therapy needs still to be discussed. The development of new agents and new drug delivery systems which can prolong the durability of anti-VEGF treatment may help us to broaden the implementation of anti-VEGF treatment. (Ophthalmol CHN, 2019, 28: 245-248)

Relationship between geometrical form perception and refractive status of children and adolescents in Anyang

GAN Jia-he1, KANG Meng-tian1, LI Shi-ming1, LI He2, WANG Bo3, WANG Ning-li1.

2019, 28(4):  249-253.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 003

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Objective To investigate the relationship between geometric form perception and refractive status of students in urban areas of central China. Design Cross-sectional study. Participants 2267 students in grade 7 in Anyang of Henan Province were included, in which 2112 students completed cycloplegia optometry and 1701 patients completed geometrical form perception testing. Method The four stimulus arrays were applied to measure the relative salience of the different levels of geometrical invariants namely euclidean, affine, projective, topological invariants. Ophthalmic examination including slit lamp examination, distance visual acuity, vertometer, cycloplegic autorefraction, ocular biometry was also conducted. Main Outcome Measures Average response speed of geometric form test. Result The average perceptual speed for euclidean, affine, projective, topological and baseline invariants in subjects are respectively 1.97±0.67 s, 1.92±0.60 s, 1.44±0.56 s, 0.82±0.18 s, 0.69±0.14 s (F=5.82, P=0.0032). Students with glasses were faster than those without glasses in euclidean (1.93±0.61 s, 2.00±0.71 s), affine (1.88±0.59 s, 1.94±0.60 s), and projective (1.39±0.43 s, 1.47±0.63 s) detection (all P<0.05). The hyperopia group than the myopia group responded slower in projective (1.53±0.54 s, 1.42±0.53 s) and topological (0.85±0.19 s, 0.80±0.18 s) detection (all P<0.05), while non significant difference was found in euclidean and affine detection among three groups. Conclusion Adolescents with spectacles in central China have stronger perceptive ability of geometrical form than those without spectacles, while hyperopic adolescents tend to have stronger perceptive ability of geometrical form than myopic adolescents. (Ophthalmol CHN, 2019, 28: 249-253)

One-year efficacy of intravitreal Conbercept injection for macular edema secondary to central retinal vein occlusion

ZENG Hui-yang, LI Xiao-xia, LIU Qian, XIAO Yuan-yuan, HOU Si-meng.

2019, 28(4):  254-259.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 004

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 Objective To evaluate the 1-year follow-up efficacy of intravitreal injection of Conbercept for treatment of macular edema secondary to central retinal vein occlusion (CRVO). Design Retrospective case series. Participant Twenty-seven eyes in 27 patients with macular edema associated with CRVO were retrospectively reviewed. Methods The CRVO eyes received monthly intravitreal injection of Conbercept (0.5 mg) for 3 months. From then on, the patients were followed up monthly and received PRN injection up to 12 months. Main Outcome Measures Best-corrected visual acuity (BCVA), central retinal thickness (CRT), proportion of patients gaining ≥15 EDTRS letters，the number of total injections in one-year and safty. Results The mean BCVA gain from baseline was 12.7±7.6 letters at month 3 and 14.8±9.6 letters at month 12. The mean CRT reduction from baseline was （374.5±280.7） μm at month 3 and （428.2±241.3） μm at month 12. The proportion of patients who gained ≥15 letters in BCVA was 45.1% at month 3 and 52.9% at month 12. The mean number of injections was 7.6±1.5. No severe local and systemic complications occurred following injection. Conclusion Intravitreal injection of Conbercept by 3+PRN regime was safe and efficacious for treatment of patients with macular edema secondary to CRVO through one-year follow-up. (Ophthalmol CHN, 2019, 28: 254-258)

Clinical characteristics of cytomegalovirus retinitis after pediatric allogeneic bone marrow hematopoietic stem cell transplantation 

WANG Juan1, YAO Jing-lei1, SUN Yuan2, LIU Zhou-yang2, XIAO Juan2, ZU Yan1.

2019, 28(4):  260-264.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 005

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 Objective To observe the clinical characteristics of cytomegalovirus retinitis (CMVR) after allogeneic bone marrow hematopoietic stem cell transplantation (Allo-HSCT) in children. Design Retrospective case series. Participants 167 cases (334 eyes) of Allo-HSCT were included in the study from June 2015 to May 2018 in Beijing Jingdu Children’s Hospital. Methods Retrospective analysis of systemic characteristics, ocular clinical features and follow-up of children with CMVR after HSCT were performed. Main Outcome Measures The composition ratio of CMVR, visual acuity, fundus lesions. Results 12 cases (7.18%) of CMVR developed in 167 consecutive Allo-HSCT recipients (age range, 1-17 years). Average age of CMVR children was 9.8 ± 3.9 years old. There were six males CMVR children (50%). The primary disease of 12 children with CMVR was hemophagocytic syndrome (7 cases, 58.3%). CMVR was diagnosed at a median of 161 days (range, 63 to 295) after HSCT. The CMV-DNA levels of aqueous humor were not significantly associated with the peak CMV-DNA levels of blood (r=-0.188, P=0.49). The mean visual acuity of CMVR children on first visit was 0.9 ±1.3 logMAR. The mean intraocular pressure o of CMVR children was 22.0±3.0 mmHg. There were 11 eyes (45.8%) with active inflammation in anterior segment, 10 eyes (41.7%) with cataract, and 8 eyes (33.3%) with involved macular lesions. Conclusion In pediatric Allo-HSCT recipients, hemophagocytic syndrome was the main primary disease of CMVR, and CMVR incidence in children is higher than in adults. An early active ophthalmic screening approach is required for pediatric Allo-HSCT recipients with CMV viremia. Early intervention treatment for CMVR children can save their vision. (Ophthalmol CHN, 2019, 28: 260-264)

The application of optical coherence tomography angiography in assessment of choroidal neovascularization secondary to pathologic myopia 

MO Jing1, ZENG Si-yan2, ZHOU Hai-ying1,LI Zhi-hua1, WEI Wen-bin1.

2019, 28(4):  265-268.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 006

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Objective To estimate the ability of OCTA in detecting choroiodal neovascularization (CNV) secondary to pathologic myopia and to assess the ability of OCTA in assessment of the activity of CNV compared to fundus fluorescein angiography (FFA). Design Diagnostic method evaluation. Participants 40 eyes with clinical diagnosis of CNV secondary to pathologic myopia in Beijing Tongren Eye Center. Methods All the eyes underwent FFA and OCTA respectively. The diagnosis of CNV and the judgment of CNV activity were compared between FFA and OCTA. Main Outcome Measures The sensitivity and specificity of OCTA, and Kappa value. Results The sensitivity and specificity of OCTA for choroidal neovascularization secondary to pathologic myopia were 96.7% and 100% respectively. The agreement for grading of CNV activity between OCTA and FFA was moderate (Kappa=0.502, P<0.001). Conclusion  OCTA demonstrate high sensitivity and specificity for detection of CNV secondary to pathological myopia, while with a moderate ability of grading CNV activity. (Ophthalmol CHN, 2019, 28: 265-268)

Associations analysis for postoperative visual acuity in idiopathic epiretinal membrane

LI Jing, YANG Yan, REN Jie, LIANG Jun, GU Wei.

2019, 28(4):  269-272.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 007

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 Objective To investigate the associated factors of postoperative visual acuity in idiopathic epiretinal membrane (iERM). Design Retrospective cases series. Participants 69 patients (69 eyes) with iERM underwent vitrectomy from January 2015 to June 2017 in Beijing Aier-Intech Eye Hospital. Methods By reviewing medical record system, the patients' age, medical history, preoperative (within 1 week before operation) and postoperative (1 month, 3 months after operation) best corrected visual acuity (BCVA) (LogMar) and images of optical coherence tomography (OCT) were retrospectively collected. The retinal thicknesses within the 6 mm diameter range of macular area were measured, and the integrity of segment ellipsoid band (ISEB) was judged on OCT images. Multivariate linear regression analysis was used to analyze the influencing factors of postoperative visual acuity. Main Outcome Measures age, gender, history of diabetes and hypertension, preoperative and postoperative BCVA, macular retinal thickness and ISEB integrity on OCT. Results The mean BCVA of 69 patients on preoperative and 1 month after surgery were 0.47±0.34, 0.41±0.25, respectively (t=1.77, P=0.081). The mean of BCVA on 3th month after surgery was 0.37±0.24, which was significantly higher than BCVA before surgery (t=2.46, P=0.017). The mean retinal thickness in the central macular area before surgery, one month after surgery, three months after surgery were 454.07±73.39, 406.65±63.86, 384.46±59.86 μm, respectively. Multiple linear regression analysis showed that BCVA of postoperative 3 months was mainly correlated with preoperative BCVA (β=2.55, P=0.015). Conclusion Postoperative visual acuity in patients with iERM is mainly related to preoperative visual acuity. Early and reasonable surgical intervention may be an effective way to maintain good visual acuity in patients with iERM. (Ophthalmol CHN, 2019, 28: 269-272)

Molecular genetics and clinical manifestations analysis of COL1A1 gene in two Chinese families with osteogenesis imperfecta 

FENG Bing-kai1, LIU Xu-yang1,2, HE Fen1, LI Dan-li1, ZHANG Da-ren2, ZHAO Lin3, FAN Ning1.

2019, 28(4):  273-279.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 008

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Objective To analyze the characteristic of molecular genetics and clinical manifestations in 2 families with osteogenesis imperfecta (OI). Design Retrospective case serie. Participants 2 Chinese OI families from Sichuan and Guangdong provinces, one of these we had reported in <Genetics & Molecular Research> and was followed up for five years in this study. Methods The families members received clinical examinations to evaluate ocular and skeleton conditions. Peripheral blood samples were collected and the DNA was extracted for pathogenic mutations identification. Main Outcome Measure Medical history, visual acuity, central corneal thickness (CCT), anterior and posterior segment examination, hearing, X-ray inspection and gene sequencing. Results These two OI families were respectively diagnosed with type Ⅰ and type Ⅳ OI, both following an autosomal-dominant pattern of inheritance and sharing same clinical findings including blue sclera, corneal thinning, recurrent fracture, hearing loss and spinal deformity, but short stature, dentinogenesis imperfecta and worse skeletal deformity were only found in family 2. Results of gene sequencing revealed a novel deletion we had reported (c.2329delG, p.Ala777Profs*330) in exon 33 of COL1A1 gene in family 1 causing a frameshift alteration after codon 777 leading to a truncated protein, and a novel heterozygous point mutation (c.725G>T, p.Gly242Val) in family 2. Conclusion Our findings identified 2 novel mutations (c.2329delG, c.725G>T) in the COL1A1 gene, which were associated with pathogenesis of OI in these 2 Chinese families. (Ophthalmol CHN, 2019, 28: 273-279)
 

The effect of bromfenac sodium eye drop on reducing eye pain before panretinal photocoagulation

JIAO Xuan, MO Bin, ZHOU Hai-ying.

2019, 28(4):  280-284.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 009

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Objective To evaluate the effect of bromfenac sodium eye drop on reducing eye pain before panretinal photocoagulation (PRP), and its timing of administration. Design Prospective case series. Participants From November 2016 to January 2018, 69 patients with severe non-proliferative diabetic retinopathy (sNPDR) or proliferative diabetic retinopathy (PDR) and required PRP were included. Methods The patients were randomized to trial group 1, trial group 2 or control group. All patients received PRP treatment 2 times. In trial group 1 and trial group 2, patients were treated with bromofenac sodium eye drop at the 3-day or 1-day before PRP treatment, respectively. In control group, patients were treated with sodium hyaluronate eye drop at the 3-day before PRP treatment. After the first and second PRP treatment, visual analogue scale questionnaire was used to evaluate the pain level during PRP treatment, including visual analogue scale/score (VAS) and present pain intensity (PPI). At the same time, the adverse reactions of topical bromfenac sodium eye drop and sodium hyaluronate eye drop were recorded. Main Outcome Measures VAS and PPI after the first and second PRP treatment. Result VAS after the first PRP treatment was 3.574±1.668 in trial group 1, 4.110±1.664 in trial group 2, and 4.255±1.900 in control group. There was no statistical difference among 3 groups, but there was a trend of gradual increase. After the second PRP treatment, VAS in trial group 1 and trial group 2 were significantly different from those of control group. The VAS score of control group was statistically different between the two PRP treatments (P=0.006). In the other two groups, there was no statistically significant difference in VAS scores between the first and second PRP treatments. In addition, there was no significant difference in PPI scores between the first and second PRP treatments among 3 groups. Conclusion Bromfenac sodium eye drop application pre-PRP treatment can alleviate laser pain of sNPDR/PDR patients. Application 3 days before PRP treatment shows better effect than 1 day. (Ophthalmol CHN, 2019, 28: 280-284)

Preliminary exploration of trabectome combined with phacoemulsification and goniosynechialysis in the treatment of primary angle-closure glaucoma

 

ZHANG Si-yao, LI Jun, LIN Li, TANG Qiong-yan, YE Chang-hua, DUAN Xuan-chu, LIN Ding.

2019, 28(4):  285-288.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 010

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Objective To observe the safety and efficacy of trabectome combined with phacoemulsification and goniosynechialysis for the patients with primary angle-closure glaucoma (PACG) combined with cataract. Design Retrospective case series. Participants Sixteen patients who has indication of glaucoma filtering surgery combined with phacoemulsification were included in this study. Methods Trabectome combined with phacoemulsification and goniosynechialysis were performed after eye examinations. During the operation, phacoemulsification and intraocular lens implantation combined with goniosynechialysis were performed first, and then trabectome was performed. The trabecular ablation ranged from 90 to 120 degrees on the nasal side. The follow-up was 6 months. Main Outcome Measures Intraocular pressure (IOP), the number of glaucoma medications, postoperative complications. Results All of the 16 patients, 14(87.5%) were followed up for 6 months. IOP was reduced from (33.4±12.4) mmHg to (13.3±1.8) mmHg with statistical significance (P =0.000). Meanwhile the number of glaucoma medications was reduced from (2.0±0.5) to (0.5±0.7) at six months with statistical significance (P=0.000). When trabecular meshwork was ablated during operation, there was no other serious complication occurred except for hyphema. One case had a temporary IOP elevation. One case had the anterior synechia. Conclusion Trabectome combined with phacoemulsification and goniosynechialysis can reduce IOP and the number of glaucoma medications significantly for the patients with PACG combined with cataract, who has indication of glaucoma filtering surgery combined with phacoemulsification. Long-term efficacy needs further verification. (Ophthalmol CHN, 2019, 28: 285-288)

Analysis of target intraocular pressure management and follow-up compliance in case management

LIANG You-ping1, LIN Hao2, LIU Lin-jie1, HUANG Xiao-qiong2, LIANG Yuan-bo2, ZHOU Wen-zhe2, CHEN Yan-yan2.

2019, 28(4):  289-293.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 011

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Objective To determine physician adherence totarget intraocular pressure(IOP) guidelines and to assess the association between insufficient follow-up and demographic and clinical parameters incase management model. Design Cross-section study. Participants 202 glaucoma patients with an average age of 50.0 ±18.9 years entered in glaucoma case management model from April 2016 to August 2017. Methods The case management model implemented in 2015 at The Eye Hospital of Wenzhou Medical University. In the model, doctor set target intraocular pressure (IOP) and make a treatment plan, and the stable patients were followed up by the case manager. The demographic data, clinical history and the documentation follow-up visits within 12 months were collected. According to the mean visual field defect (MD), the severity of the disease was classified as mild, moderate and severe. Patients who did not attend follow-up within 1 month after their scheduled follow-up date were considered to have poor follow-up. The subjects were attended on time all year was defined as good follow-up. Main Outcome Measures follow-up compliance, rate of target IOP recorded, target IOP control rate. Results 202 participants were enrolled, with an average course of disease of 34.5 months. A target IOP was present for 85.1% of patients (172/202), the study visit IOP achieved the target in 67% subjects.132(65.3%) patients had good follow-up compliance, 70 (34.7%) patients had poor follow-up compliance. Subjects with severe (OR=8.349, 95%CI=2.517-27.698) glaucomatous disease were found to have been less adherent to their recommended follow up than those patients with mild glaucomatous disease. Subjects who were older (OR=0.433, 95%CI=0.212-0.886) and live closer to hospital (OR=0.462, 95%CI=0.216-0.990) were found to be more adherent to follow-up recommendations. Conclusion The large majority of patients had a target IOP and achieved the target. But on nearly one sixth of patients didn’t record a target IOP, one third of visits, IOP exceeded the target, about one third of patients had poor follow up compliance indicating the need for active management in both doctors and patients. (Ophthalmol CHN, 2019, 28: 289-293)

Assessment of intraocular pressure change in the healthy subjects during short distance air flight

QIAO Chun-yan, XU Xin-yue, CAO Kai.

2019, 28(4):  294-296.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 012

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Objective To investigate the effect of air flight on healthy subjects intraocular pressure (IOP). Design Prospective, nonrandomized comparative trial. Participants 34 healthy volunteers during air flight from March 2018 to January 2019. Methods IOP of right eye was measured with Icare?誖Pro tonometer, and oxygen saturation (SO2) and pulse rate (RP) were measured by finger clip pulse oximeter. Baseline IOP (P0) and SO2 (S0) were measured at just entering into air plane. Measurement were repeated after just reaching cruise phase (P1, S1) and 1 hour after cruise phase (P2, S2). The correlation between SO2, RP and IOP were evaluated by Spearman rank correlation analysis. Main Outcome Measures IOP and oxygen saturation. Results P0, P1 and P2 was (14.997±1.57), (14.465±2.00), (14.719±2.01) mmHg, respectively (P>0.05). Median of S0, S1, S2 was 97%, 96%, 96%, respectively. SO2, RP, age, gender were not significant correlation with IOP (P>0.05). Conclusion IOP was not significant change during a routine short air flight for healthy adults. (Ophthalmol CHN, 2019, 28: 294-296)

Correlation analysis between change of corneal biomechanical parameters and measurement of intraocular pressure after corneal collagen crosslinking for keratoconus

ZHANG Qing-wei, ZHAI Chang-bin, ZHANG Jing, ZHENG Yan, LIU Qian, HUANG Jing, SONG Xiu-mei, ZHOU Yue-hua, WANG Ning-li.

2019, 28(4):  297-301.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 013

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Objective To describe the change of the corneal biomechanical parameter and intraocular pressure(IOP) for kerotoconus eyes before and after the collagen crosslinking procedure (CXL). Design Cohort study. Participants 23 cases of keratoconus (41 eyes).  Method All patients undergo refractive examination, central corneal thickness(CCT), non-contact tonometer (NCT) , and ocular response analyzer (ORA) before CXL surgery, and 1 week, 1, 3, 6, and 12 months after CXL surgery. Corneal hysteresis (CH), corneal resistance factor (CRF), simulated Goldmann intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc) were measured with ORA. The changes of parameters before and after CXL surgery were compared and the correlation between the changes of corneal biomechanical parameters and IOP was analyzed. Main Outcome Measures Visual acuity, optometry, CCT, IOPcc, CH, CRF. Result The preoperative CH of the keratoconus of 41 eyes was 8.044±1.264, and it decreased to 7.817±1.561 1 year after operation, which was statistically different from that before operation (t=2.48, P=0.01). The preoperative CRF was 6.846±1.353, and the postoperative 1 year was 6.687±1.233, which was not statistically different from the preoperative (t=-0.55, P=0.58). At 1 year after CXL surgery, NCT IOP was positively correlated with IOPg (r=0.724, P<0.001), IOPcc (r=0.613, P<0.001), and CRF (r=0.513, P<0.001). Conclusion At 1 year after CXL surgery, the CH value decreased compared with preoperative, and the CRF value did not change compared with preoperative. There is a medium-intensity positive correlation between NCT intraocular pressure and IOPg, IOPcc and CRF values. The change in NCT intraocular pressure value, to some extent, can reflect the change of CRF value. (Ophthalmol CHN, 2019, 28: 297-301)

Short-term comparison of visual quality between SMILE and FS-LASIK used in both eyes

LI Xiao-jing, LI Jing-zhen.

2019, 28(4):  302-306.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 014

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Objective To compare the visual quality of myopic astigmatism with small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Design Retrospective case series. Participants 19 cases of patients with myopia were included from 2015 to 2017 in Binzhou Hubin Aier Eye Hospital, in which SMILE surgery were performed on one eye (SMILE group), and FS-LASIK were performed on the other eye (FS-LASIK group) duo to corneal scarring or thin cornea. Methods All patients were followed up for 3 months. Uncorrected distance visual acuity （UCVA）, manifest refraction and corneal aberrations were measured preoperatively and at 3 months postoperatively. Main Outcome Measures UCVA, manifest refraction and corneal aberrations. Results Three months after surgery, there were no statistically significant differences in UCVA or best corrected visual acuity （BCVA） and spherical equivalence （SE） between SMILE group and (FS-LASIK group (P>0.05). The SMILE group had a significantly higher percentage of eyes whose SE range was -0.50 D to +0.50 D compared with the FS-LASIK group (χ2=0.279, P=0.59). There were statistically significant differences in higher-order aberrations, spherical aberrations induced by SMILE and FS-LASIK 3 months after surgery (t=-3.29, -3.41; P=0.02, 0.02). The SMILE group induced far fewer spherical aberrations than FS-LASIK group(t=-3.43, -3.45; P=0.01，0.01). There were no statistically significant differences on horizontal coma induced by both groups (t=-0.37; P=0.72). The FS-LASIK group induces far fewer vertical coma (t=2.71; P=0.04). Conclusion Short-term follow-up results showed that SMILE had fewer total high-order aberrations and spherical aberrations than FS-LASIK, and there was no significant difference in coma aberration between SMILE and FS-LASIK. (Ophthalmol CHN, 2019, 28: 302-306)

Epithelial inclusion cysts associated with alloplastic implants after orbital fracture repair

HOU Zhi-jia, LI Dong-mei, XU Xiao- lin, ZHOU Jun.

2019, 28(4):  307-311.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 04. 015

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 Objective To study the clinical features and the effectiveness of the treatment of the epithelial inclusion cysts associated with alloplastic implants after orbital fracture repair. Design Retrospective case series. Participants The study collected 7 patients with epithelial inclusion cysts after orbital fracture treated in Beijing Tongren Hospital between 2005 and 2017. Methods The data including demographic characteristics, site of fracture, implant used, interval between implantation of material and presentation of the orbital cyst, clinical presentation, treatment, histological examination of the cyst and follow up findings were collected and analyzed. Main Outcome Measures The clinical features and treatment results. Results 6 cases were males in all 7 patients, with a mean age of 35.0±3.8 years. There were 5 cases associated with hydroxyapatite compound materials, one case associated with silastic material, and another one associated with titanium meshwork. Orbital cysts developed between 20 months and 11 years after implantation. The clinical presentations in all cases included proptosis, restricted ocular mobility, diplopia, hyperglobus, and reduced visual acuity. The cysts were excised in all cases. The implants were completely removed in 4 cases. Histological analysis confirmed that the cysts were all lined with respiratory cells. After operation, the symptoms were relieved in all cases, no recurrence was noted. Conclusions Epithelial inclusion cyst is a rare and late complication after orbital fracture repair, which may present with various symptoms. Complete excision of the cyst wall with removal of the implants might be the best treatment to relief symptom and prevent recurrence. (Ophthalmol CHN, 2019, 28: 307-311)