Table of Content

25 November 2019, Volume 28 Issue 6

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Emphasis on the standardized diagnosis and treatment of dry eyes

JIE Ying, LI Si-yuan

2019, 28(6):  401-403.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.001

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As a chronic disease with an increasing incidence, dry eye has seriously affected quality of life. With the appearance of some examination equipment and treatment methods, the level of diagnosis and treatment of dry eye has been continuously improved. However, there are still many problems in the clinical diagnosis and treatment of dry eye, such as focusing on objective signs and ignoring subjective symptoms, blindly believing in equipment results without paying attention to the most basic slit lamp examination, abusing treatment drugs without looking for patients' underlying causes, etc. This paper believes that in the process of dry eye diagnosis and treatment, we should start with subjective symptoms, choose the appropriate examination method and sequence, and according to the patient's type and severity select the befitting treatment plan, in order to reach the goal of standardized treatment of dry eye.

Multi-center clinical trial of efficacy and safety of domestic capsular tension ring for cataract surgery to maintain capsular tension

2019, 28(6):  404-408.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.002

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Objective To evaluate the clinical efficacy and safety of the domestic CTR model capsular tension ring for cataract surgery to maintain capsular tension. Design Multicenter, randomized, open, positive and parallel controlled clinical studies. Participants 119 cataract patients aged over 18 years and with grade 1-3 cataract nuclear hardness, which need to maintain capsular tension. Methods Participants were randomly assigned to the study group (59 cases) or the control group (60 cases). The phacoemulsification and the implantation of a capsular tension ring and intraocular lenses (IOL) were performed. The subjects in study group were implanted with the domestic CTR model capsular tension ring (Eyebright Medical Technology (Beijing) Co., Ltd., China), while the subjects in control group were implanted with a TENSIOBAG model capsular tension ring (Carl Zeiss Medical Technology Co., Ltd., Germany). Follow-up evaluation at 1~2 days, 1 week, 1 month, 3 months, 6 months, and 1 year or above after surgery. Statistical analysis was performed using t-test, Wilcoxon rank sum test, chi-square test, CMH chi-square test, exact probability test, and exact probability method to compare the efficacy and safety between the two groups. Main Outcome Measures The best corrected distant visual acuity(BCDVA), uncorrected distant visual acuity(UCDVA), diopter, postoperative IOL decentration, capsule contraction and the counts of corneal endothelial cells. Results At all the follow-up times after the operation, there was no statistically significant difference between the two groups (all P>0.05) in the BCDVA, the UCDVA and their changes from the baseline. At 6 months and 1 year after the operation, there was no statistically significant difference between the two groups (all P>0.05) in the diopter and the changes from the baseline. There was no statistically significant difference between the two groups (all P>0.05) in IOL decentration. In the study group, no IOL decentration was found at 1-2 days, 1 week, 1 month, 3 months and 1 year or above after the operation; one case with slightly decentration was found at 6-month visit but the IOL centered at 1-year-or-above visit. No IOL decentration was found in the control group at all the follow-ups. There was no capsule contraction in the two groups during the follow-up period. In terms of safety, there was no statistically significant difference between the two groups (all P>0.05) in the results of slit lamp examination and intraocular pressure at the follow-ups and no pupillary blockage was found. There was no significant difference between the two groups (all P>0.05) in corneal endothelial cell density at 1 year or above after the operation. Conclusion The efficacy and safety of  domestic CTR model capsular tension ring (Eyebright Medical Technology (Beijing) Co., Ltd., China) for capsular tension maintenance in cataract surgery is comparable to TENSIOBAG model capsular tension ring (Carl Zeiss Medical Technology Co., Ltd., Germany).

Preliminary study on improving the detection of demodex by modified Coston method in demodex blepharitis patients

ZHANG Yang1, WEI Zhen-yu1, WANG Zhi-qun1, CAO Kai1, LIANG Qing-feng1, LU Xin-xin2

2019, 28(6):  409-413.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.003

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Objective To analyze the diagnostic efficiency and reproducibility of modified Coston method, and to compare the detection characteristics of conventional Coston method and modified Coston method in demodex blepharitis patients. Design Diagnostic technique evaluation. Participates 131 patients visiting Beijing Tongren Eye Center, suspected of demodex blepharitis, were continuously collecting in 2018. Methods One eyelash at each of the three positions (medial, central, and lateral side) of palpebral margin from each eyelid (selecting the eyelash closest to the orifice of the meibomian gland) were sampled by both conventional and modified  Coston method. The conventional Coston method was to pull out the eyelashes directly, while the modified Coston method was a spiral pull-out manipulation rotating around the hair follicle. After the eyelashes were removed, the microscopic examination was performed and the total number of demodex of different stages were calculated. From January to July, 78 patients were collected for comparing the detection characteristics between conventional and modified method. 53 patients from August to December were collected for analysis of reproducibility of the modified Coston method. All lashes were sampled by a technician with relevant experience. SPPS 20.0 was applied for descriptive statistics of various parameters, comparing positive rate and detection amount, and calculating intraclass correlation coefficient (ICC) value; R language software was applied to compare area under curve (AUC) values of different sampling combinations. Main Outcome Measures ICC, AUC, positive rate, detection rate and detection amount of demodex folliculorum. Results The ICC of modified method was 0.874, AUC was 0.944. There was no statistically significant difference between the AUC values of sampling of central and lateral sides and that of sampling 3-5 lashes (P<0.05), and the former was most reproducible (ICC=0.897). The positive rate and total detection amount of modified method (82.1%, 499.7 mites) were higher than that of conventional method (66.7%, 437.28 mites) (P=0.028，0.000). Conclusion The modified Coston method of rotating manipulation before epilation with better repeatability can increase the detection rate of demodex. Simplified sampling combination of 2 lashes from central and lateral sides per eyelid had similar diagnostic performance compared with 3 lashes sampled in traditional Coston method.

One year therapeutic effect of riboflavin-ultraviolet corneal collagen crosslinking using femtosecond laser for keratoconus

HOU Si-meng, ZHOU Yue-hua, ZHANG Jing, CAO Kai, ZHENG Yan, XU Chen, GE Shan-shan

2019, 28(6):  413-420. 

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Objective To evaluate the safety and effect of femtosecond-assisted intrastromal corneal cross-linking (F-CXL) for keratoconus. Design Prospective case series. Participants Twenty two patients (30 eyes) diagnosed as progressive keratoconus accepted F-CXL in Tongren Eye Center from Oct. 2015 to May. 2016. Methods All eyes were scheduled to receive the riboflavin-ultraviolet corneal collagen crosslinking using a femtosecond laser pocket under surface anesthesia objective measurements, including corneal topography, corneal pachymetry, demarcation line, corneal biomechanical property and endothelial cell count were evaluated preoperatively and at 1 day, 1 week, 1 month, 3 months, 6 months and 12 months postoperatively. Main Outcome Measures Best corrected visual acuity (BCVA), thinnest corneal thickness(TCT), corneal steep K-reading (Ks）、corneal flat K-reading (Kf), average K-reading (Avek), corneal central thickness (CCT)、corneal hysteresis (CH), corneal resistence factor (CRF), corneal endothelial cell count, demarcation line and images by confocal microscope. Results No serious complications happened during or after the surgery. However, some eyes experienced mild or moderate discomforts 1 day after surgery which were well relieved after 3 days. During 12-month follow-up, there was no significant increase in topographic parameters including Ks, Kf, Avek and reductions in CCT, CH, CRF. Desides, F-CXL performed the best from 3 months to 6 months postoperatively and then weakened gradually. Spearman analysis showed the preoperative Ks greater than 53.08 D was associated with more improvement in Ks but age, baseline BCVA and baseline TCT were found unrelated to the amount of change in Ks, Avek, Cyl and CCT. Corneal stromal demarcation line could be identified from 1 week in 18 eyes (60%) and then got more clear and intact, the mean depth of which was (302.56±31.02) μm at 3 months. In addition, corneal confocal microscopy revealed that activated keratocytes and newly-formed, compact collagen fibers could be observed after 1 month. During the follow-up, no significant reduction in corneal endothelium cell count proved the safety of this technique. Conclusion F-CXL is an effective and safe method to halt the advancement of progressive KC which is a solid preliminary basis of the combined surgery, despite further studies and close monitoring required.

Influence of orthokeratology combined with visual training on accommodation of myopic children without symptomatic dysfunction

YANG Yang1, LI Jun2, WANG Li1, LI Peng3, LIU Wen-lan1, YAN Jin1

2019, 28(6):  421-425.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.005

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Objective To investigate the effect of orthokeratology combined with visual training（OCVT） on accommodation in myopic children without symptomatic dysfunction. Design Prospective case series.  Participants 120 children without symptomatic dysfunction, average ages 11.18±1.89 years, average spherical equivalent refraction-3.17±1.13 diopters(D). Methods All subjects were divided into three groups according to their selected therapy in clinic, including OCVT group (37 cases), orthokeratology group (Ortho-k, 43 cases) and single vision spectacle lense group (SVL, 40 cases). These subjects were followed up at least for 12 months. The changes of accommodation from baseline visit to 12-month visit were compared between the three groups. A more detailed analysis by median age were made in the OCVT group. Main Outcome Measures Accommodative amplitude (AA), accommodative sensitivity (AS), accommodative lag (Lag), negative relative accommodation (NRA) and positive relative accommodation (PRA). Results A total of 103 participants completed the study, which including 31 cases in OCVT group, 37 cases in Ortho-k group and 35 cases in SVL group. The baseline of AA, AS, Lag, NRA, PRA were（14.21±2.05）D,（8.87±1.80）cpm,（0.71±0.38）D,（1.80±0.38）D,（-1.85±0.42）D in the OCVT group respectively.  After 1 year intervention, AA, AS, Lag, NRA, PRA improved to（15.34±2.16）D,（11.16±2.18）cpm,（0.31±0.27）D,（2.15±0.35）D,（-2.08±0.45）D respectively, the improvement effect was better than that of the Ortho-k group and the SVL group（all P＜0．05）. When split by median age group, the changes in AA, AS, Lag, NRA, PRA of younger subjects and older subjects were not significantly different（all P＞0.05）. Conclusion  OCVT is a good way to improve the accommodation of myopic children without symptomatic dysfunction, but the best type and time of the visual training need further research.

Long-term efficacy and safety of transscleral suture fixation of intraocular lens with a reverse scleral tunnel

WANG Zao-wen, WANG Er-qian, CHEN You-xin

2019, 28(6):  426-429.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.006

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Objective To evaluate the long-term efficacy and safety of the reverse scleral tunnel method in transscleral suture fixation of intraocular lens(IOL). Design Retrospective case series. Participants Fourteen eyes of 11 patients undergoing transscleral suture fixation of IOL with reverse scleral tunnel method between January 2016 and December 2017 in Peking Union Medical College Hospital. Methods The core techniques of surgery was making a reverse scleral tunnel from corneal limbus to conjunctival fornix which was 2.5 mm in width and 3.0 mm in length. The intrascleral suture was buried in the reverse scleral tunnel. Mean follow-up duration was 29.4±2.3 months. Main Outcome Measures Preoperative and postoperative uncorrected visual acuity (UCVA) and best corrected visual acuity(BCVA), long-term stability of IOL position and postoperative complications. Results UCVA (LogMAR) improved from 1.28±0.42 at baseline to 0.40±0.35 at last visit (P<0.001). BCVA (LogMAR) improved from 0.74±0.35 at baseline to 0.24±0.31 at last visit (P<0.001). In the follow-up period, the IOL position remained stable in all subjects. There were no postoperative complications such as suture knot exposure, chronic conjunctival hyperemia, infectious endophthalmitis, and IOL dislocation. Conclusion The reverse scleral tunnel method is a long-term effective and safe method in transscleral suture fixation of intraocular lens.

Clinical study of ocular surface damage caused by demodex infection after LAISK

LU Li-xin, ZANG Yun-xiao, LI Si-yuan, FENG Jun, YANG Ke, TIAN Lei, ZHU Lei, JIE Ying

2019, 28(6):  430-433.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.007

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Objective To investigate the clinical features of ocular surface of patients with demodex infection after laser-assisted in situ keratomileusis (LASIK). Design Retrospective case series. Participants 56 patients with demodex blepharitis who were admitted to Beijing Tongren Hospital from September 2017 to May 2018. They were divided into LASIK group (n=9) and control group (n=47). Methods The ocular surface examination was performed on two groups of patients using Keratograph5M ocular surface comprehensive analyzer and tear secretion test, including cornea fluorescence staining (FL), tear film break-up time (TBUT), and red eye analysis (conjunctival hyperemia index, CHI), meibomian gland photography and tear secretion test (Schirmer I test, SIt). Main Outcome Measure Corneal FL score, non-invasive TBUT, CHI, meibomian gland score and basic tear secretion. Results The FL value of the LASIK group (1.3±1.0) was significantly higher than that of the control group (0.38±0.15) (P<0.01). TBUT (10.55±5.8) s, CHI (1.7±0.5), SIt (16.4±3.8)mm, and meibomian gland score (1.42±1.0) in LASIK group were no significant difference with the TBUT (9.93±5.3) s, CHI (1.74±0.67), SIt (14.0±11.2)mm, and meibomian gland score (1.45±1.03) in controls (all P>0.05). Conclusion Demodex blepharitis in patients after LASIK is more likely to secondary to corneal epithelial punctate lesions and aggravate ocular surface damage.

Effective factors of one-year visual outcomes after intravitreal injection of ranibizumb for wet age-related macular degeneration

YAN Shu, SHAO Ling, DU Min, SHEN Ce-ying, LI Yan, LIU Yu, CHAO Yang-yang, YANG Kai-zhuan

2019, 28(6):  433-437.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.008

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Objective To investigate one-year visual outcomes after intravitreal injection of ranibizumb for wet age-related macular degeneration(wAMD) and its influencing factors. Design Retrospective case series. Participants  Fifty cases (50 eyes) of  wAMD  in Zhengzhou Second People Hospital form May 2015 to February 2017. Methods All subjects received  eye examination, including best corrected visual acuity (BCVA), funds color photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography(OCT-A). The scheme of intravitreal injection ranibizumb consisted of once a month for three month, followed by an PRN scheme. The one year BCVA  and the change of BCVA  from pretherapy to  post-treatment were observed. The correlation between the one year BCVA , improvement and baseline factors that include age, gender, baseline BCVA, macular subretinal hemorrhage, intraretinal fluid, subretina fluid, pigment epithelium detachment, central foveal thickness (CFT), area of  choroidal neovascularization (CNV),  type of CNV (predominantly classic, min classic and  latent ) were analyzed. Main Outcome Measures BCVA, macular subretinal hemorrhage, intraretinal fluid, subretina fluid, pigment epithelium detachment, CFT, area of CNV and the type of  CNV.  Results Before therapy , BCVA was (53.4±14.5) letters, and 1 year after therapy, BCVA was (61.3±20.5) letters, improvement letters was  (7.9±8.5) (t=-6.564, P<0.01). Multiple linear regression shows that baseline BCVA was opsitive associated with  BCVA outcomes at 1 year (B=0.483, P=0.001); area of  CNV  and type of CNV was  negative associated with  BCVA outcomes at 1 year ( B=-0.211, P=0.005; B=-0.202, P=0.005). That area of  CNV and type of CNV was negative associated with improved BCVA score at 1 year  (B=-0.509, P=0.005; B=-0.488, P=0.005). BCVA outcomes of 1 year of predominantly classic CNV was worst and latent was best, the improved BCVA at 1 year of predominantly classic CNV was least and  min classic CNV was most (P<0.05). Conclusion Predominantly classic CNV and  bigger area of CNV have little improvement of one-year BCVA and poor prognosis. People who with better baseline BCVA will have better BCVA at one year.

Epidemiological study of macular thickness in Yongnian County population: Handan Eye Study

WU Jian, CAI Xiao-gu, LIN Cai-xia, WANG Ning-li

2019, 28(6):  438-445.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.009

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Objective To measure the association of macular thickness with sex, age and refractive status in middle-aged and elderly population of Handan Eye Study (Yongnian County in Hebei Province). Design Population-based cross-sectional study. Participants 5394 participants in Handan Eye Study 2012-2013 with the mean age of 57.8±11.2 years. Methods A detailed interview, general examinations and ophthalmic examinations were performed. Using optical coherence tomography (OCT) to measure the macular thickness, and separate to nine sectors of the ETDRS grid. Main Outcome Measures Macular thickness. Results 4735(87.8%) of 5394 participants in macular thickness measurements were available. The mean macular thickness of central foveal subfield, average pericentral ring and the average peripheral ring was 237.73±22.67 μm, 310.26±18.47 μm, and 278.36±14.48 μm, respectively. There was significant difference in macular thickness between different genders (P<0.001). The mean macular thicknesses of central foveal subfield, average pericentral ring and the average peripheral ring in the male were 242.40±22.32 μm, 314.82±18.39 μm, and 280.37±14.33 μm, and the mean  macular thicknesses of central foveal subfield, average pericentral ring and the average peripheral ring in the female were 234.03±18.47 μm, 306.64±17.72 μm, and 276.76±14.40 μm, the thinner overall average macular thickness was associated with female sex. In the fovea, there was a non-monotonic curved relationship between macular thickness and age in both sexes with a maximum at about 60 years (P<0.001). The pericentral ring and the peripheral ring in different age groups were significantly different (P<0.001). These thickness gradually decreased with age. Macular thickness was significantly associated with refraction, where mean change in retinal thickness per 1.00 D increase in spherical equivalent refraction (SER) was -0.6±0.2 μm in the fovea, 0.2±0.1 μm in the pericentral ring and 0.5±0.1 μm in the peripheral ring. Conclusion In Yongnian adult population, macular thickness was declined with age in both women and men in all macular regions, and the rate of change in macular thickness varied at different ages. Women had thinner macular than men. Higher SER was associated with thinner retina in central foveal subfield and thicker retina in the pericentral and the peripheral ring in both women and men.

Correlation between photoreceptor layer integrity in baseline and visual prognosis in central serous chorioretinopathy

XIAO Yuan-yuan, HOU Si-meng, CHEN Chang-xi, CAO Kai, MA Dan-dan, LI Yi-bin

2019, 28(6):  446-450.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.010

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Objective To evaluate the correlations between baseline morphological changes in optical coherence tomography (OCT) in patients with central serous chorioretinopathy (CSC) and their visual prognosis. Design Retrospective case series. Participants 136 patients (148 eyes) with resolved CSC in Beijing Tongren Hospital. Methods All the patients underwent routine fundus fluorescence angiography (FFA) + indocyanine green angiography (ICGA) and OCT examination using Spetralis HRA-OCT. According to the results of FFA+ICGA, the CSC patients received half dose photodynamic therapy or laser photocoagulation or micropulse photocoagulation respectively. Baseline changes of outer nuclear layer thickness in OCT were semi-automatically analyzed, and the integrity of photoreceptor layer in OCT was qualitatively analyzed. Severity of photoreceptor layer defect was defined as 4 grades: grade 0, in which the detached retina was detected in continuity with well-preserved photoreceptor layer; grade 1, in which the outer segment defects could be seen while the ellipsoid zone and myoid zone were well preserved; grade 2, in which the outer segment and the ellipsoid zone were heavy damaged and the myoid zone defects can be detected; and grade 3, in which the outer photoreceptor layer atrophy was detected. The linear mixture regression was used to analyze the relationship between macular morphologic changes in OCT and best corrected visual acuity (BCVA) at final visit. Main Outcome Measures Severity of photoreceptor layer defect, outer nuclear layer thickness, BCVA (LogMAR). Results Among 148 eyes, the severity of photoreceptor layer defect of 90 eyes was grade 0, of 29 eyes was grade 1, of 18 eyes was grade 2, and of 11 eyes was grade 3, while the percentage of them with LogMAR <0.2 at baseline was 22.3% (33 eyes), and 54.1% (80 eyes) at final visit after treatment. The results of linear mixture regression analysis showed that the severity of photoreceptor layer defect correlates to better BCVA (β=-0.242, P<0.001). Conclusion The severity of photoreceptor layer defect in CSC is the key factor correlated to better visual prognosis, and can be a biomarker that indicates the interference treatment.

Correlation between serum lipoprotein ratio and diabetic macular edema

WANG Zhen-yan, CHEN Xiao-li, LI Xue-yao, ZHOU Shao-ying, SONG Yong-ji, CHEN Wei-min

2019, 28(6):  451-453.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.011

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Objective To study the relationship between serum lipoprotein ratios(ApoB/ApoA-1) and diabetic macular edema (DME). Design Retrospective case series. Participants 279 patients with diabetic retinopathy (DR) hospitalized in Department of Ophthalmology and Internal Medicine from March 2016 to March 2018. Methods Fundus examination and macular optic coherence tomography(OCT) scan were carried out for 279 inpatients, 82 cases of DME were found to be case group (group DME), the remaining 197 cases were control group (non DME group)，and 80 healthy controls were also set up. According to the degree of macular edema, 82 patients in the case group were divided into mild group (group I), moderate group (group II) and severe group (Group III). The height, weight, glycosylated hemoglobin and ApoB, ApoA-1 were measured in all patients, and the body mass index (BMI), ApoB/ApoA-1 ratio were calculated, and the data were compared in different groups. Main Outcome Measures BMI glycosylated hemoglobin concentration, ApoB/ApoA-1 ratio and macular edema classification. Results The differences of BMI, HbAIc, ApoB/Apoa-1 ratio among DME group, non DME group and healthy control group were statistically significant（all P<0.001）. The ratio of apoB / apoa-1 in patients with mild, moderate and severe macular edema was 1.01±0.07, 1.18±0.04, and 1.32±0.08, respectively (F=142.04, P<0.001). It was found that the severity of DME was positively correlated with the ratio of ApoB/Apoa-1 (r=0.725, P<0.001), after eliminating the influence of confounding factors by partial correlation analysis. Conclusion The increased serum lipoprotein ratio is a high risk factor for DME. Reasonable control of blood lipids and their components may help reduce the risk of DME. ApoB/ApoA-1 ratio can be used as an important monitoring index in the prediction and treatment of DME.

Changes of choroidal thickness in the treatment of macular edema with anti-vascular endothelial growth factor

LI Jia, ZHANG Xue-tong, WANG Ji-hong

2019, 28(6):  454-457.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.012

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Objective To evaluate the changes of subfoveal choroidal thickness after intravitreal injection of anti-vascular endovascular growth factor (VEGF) drugs for macular edema caused by diabetic retinopathy (DME) and macular edema secondary to retinal vein occlusion (RVO-ME) using optical coherence tomography enhanced depth scanning mode (EDI-OCT). Design Retrospective case series. Participants Thirteen eyes with DME and fifteen eyes with RVO-ME who underwent intravitreal anti-VEGF drug injection from December 2014 to November 2018 were selected. Methods The subfoveal choroidal thickness (SFCT) was measured by EDI-OCT before and 1, 3 and 6 months after operation to evaluate the changes of SFCT after intravitreal injection of anti-VEGF drugs for DME and RVO-ME. Main Outcome Measure SFCT. Results The value of SFCT in DME group 1, 3 and 6 months after operation was (224.85±50.03)μm, (215.62±47.70)μm, (207.54±46.85)μm respectively, and was lower than that before operation (P=0.0004, 0.0002, 0.0001); SFCT decreased in 3 and 6 months after operation compared with 1 month after operation (P=0.003, 0.001); SFCT decreased in 6 months after operation compared with 3 months after operation (P=0.026). The value of SFCT in RVO-ME group 1, 3 and 6 months after operation was (260.67±42.29)μm, (254.33±40.54)μm, (239.73±37.08)μm respectively, and was lower than that before operation (P=0.0003, 0.0002, 0.0002); SFCT decreased in 3 months after operation compared with 1 month after operation (P=0.599); SFCT decreased in 6 months after operation compared with 1, 3 months after operation (P=0.0002，0.0003). Conclusion SFCT decreased significantly after intravitreal injection of anti-VEGF drugs for DME and RVO-ME. Dynamic monitoring of SFCT values may be helpful in detecting the changes of the disease.

Fundus characteristics of 343 cases of patients with acquired immunodeficiency syndrome

LIU Xi-yao, MAO Fei-fei, LI Dan, LU Dan, WANG Sheng-nan, SUN Hui-yu

2019, 28(6):  458-462.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 06. 013

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Objective To investigate the characteristics of fundus lesions in patients with acquired immunodeficiency syndrome (AIDS) and their relationship with systemic concomitant diseases. Design Retrospective case series. Participants 343 AIDS patients admitted to Beijing Ditan Hospital from March 2015 to December 2016. Methods A total of 343 AIDS patients were examined by systemic and ophthalmic examination, including visual acuity, intraocular pressure, slit lamp, binocular indirect ophthalmoscope and fundus photography, and their clinical characteristics were observed. According to their fundus manifestations, they were divided into the following groups: cytomegalovirus retinitis (CMVR) group, human immunodeficiency virus (HIV) retinopathy group and control group. Main Outcome Measures Visual acuity, fundus, CD4+T cell count, peripheral blood HIV viral load. Results Among the 343 patients, 46 eyes showed CMVR and 74 eyes showed HIV retinopathy. More patients in the control group received HAART more than 6 months. CD4+T cell count was 53.86±101.14 /μl in the CMVR group, 33.69±47.06 /μl in the HIV retinopathy group, and 120.28±175.80 /μl in the control group. CD4+T cell count lower than 50 /μl was a risk factor for CMVR (P=0.000). Tuberculosis infection occurred in 65 cases, cryptococcal meningitis in 20 cases, and syphilis in 68 cases. A total of 39 eyes had visual acuity less than 0.3. Ophthalmic examination found optic disc edema in 19 eyes, optic nerve atrophy in 14 eyes, vitreous opacity in 28 eyes, cataract in 8 eyes, cured CMVR in 12 eyes, and retinal detachment in 12 eyes. Optic disc edema was associated with cryptococcal meningitis and syphilis infection (P=0.000). Optic nerve atrophy was associated with cryptococcal meningitis and cured CMVR lesions (P=0.000), and CMVR was associated with retinal detachment and vitreous opacity (P=0.000). Conclusion Low CD4+T cell count is a risk factor for CMVR. Ophthalmologist should pay attention to the fundus damage caused by accompanied diseases with AIDS.

Estabishment of retinoblastoma implantation model in nude mice vitreous cavity

ZHAO Bo-wen1, LI Bin1, BAI Hai-xia2, YU Jing1, GAO Fei1, ZHANG Zhi-bao1, LIU Qian1

2019, 28(6):  463-466.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.014

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Objective To establish animal model of retinoblastoma by injecting the tumor cells into the vitreous cavity of nude mice and to observe growth status of the tumor. Design Experimental research. Participants Thirty BALB/c nude mice. Methods The cell suspension of human retinoblastoma cell line Y79, WERI-RB1 and SO-Rb50 were prepared, the cell concentration was adjusted to 1.0×108/ml, then 3 μl of the tumor cell suspensions were injected into the right vitreous cavity of 10 nude mice in the each cell line group (group A, B, and C, respectively). Main Outcome Measures tumorigenic rate, tumorigenic time, and the growth status of the tumor. Results In Y79 cell line group (group A), all of the models of retinoblastoma were successfully established by injecting the cell suspensions of cells into the mice vitreous cavities. The growth cycle was 3 days to 10 weeks. In WERI-RB1 cell line group (group B), 88.9% of the models were successfully established. The growth cycle was 16 days to 14 weeks. In SO-Rb50 cell line group (group C), 88.9% of the models were successfully established. The growth cycle was 19 days to 10 weeks. There were 7 cases of optic nerve invasion in group A, 2 cases in group B, and 6 cases in group C. There were 5 cases of anterior chamber invasion in group A, none in group B, and 4 cases in group C. There were 5 cases of iris/ciliary body invasion in group A, none in group B, and 4 cases in group C. No choroid invasion was found in the three groups. There were 3 cases of corneal neovascularization in group A, none in group B, and 3 cases in group C. Conclusion The animal model of retinoblastoma can be established by injection the tumor cells into vitreous cavities of the nude mice. Increased invasiveness was seen in Y79 and SO-Rb50 cell lines than WERI-RB1 cell lines.

One year efficacy of modified Wies procedure for involutional lower eyelid entropion

QIN Yi, ZHOU Jun, HE Lei, LU Hai, SHI Xiang-yu

2019, 28(6):  463-466.  doi:10.13281/j.cnki.issn.1004-4469.2019.06.015

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Objective To observe the efficacy of the modified Wies procedure for involutional lower eyelid entropion. Design Retrospective case series. Participants Twenty-seven patients (31 eyes) with involutional lower eyelid entropion in Beijing Tongren Eye Center. Methods All patients were underwent the modified Wies procedure (transverse blepharmotomy and lower eyelid retractor advancement to tarsal plate and skin) by the same surgeon. While follow-up was （14.6±3.5） months (12-17 months), outpatient reviews and telephone interviews were conducted to assess operative effect and patients satisfaction with the surgery. Main Outcome Measures Morphology of eyelid, position of eyelid, with or without epiphora. Results The only patient with both eyes previous surgery was found recurrence at 14 months. The other 26 patients had no overcorrection, recurrence or undercorrection during the follow-up period, and the palpebral margin was in good shape without complaints of discomfort. Conclusion The modified Wies procedure is simple to master, performing with minimal operative time and reasonably successful in managing entropion of lower eyelid. Prioritize should be given to this procedure for involutional lower eyelid entropion.