Table of Content

22 July 2020, Volume 29 Issue 4

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Current status and challenges of the gene therapy clinical trials for hereditary retinal diseases

Li Wensheng1, Chen Xiaodong2

2020, 29(4):  241-245.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 001

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Hereditary retinal degenerative (HRD) diseases are a leading cause of irreversible blindness. Retinal cell death is the main cause of vision loss in genetic disorders such as retinitis pigmentosa, Stargardt disease, and Leber congenital amaurosis. For these blinding conditions, gene therapy approached offers valuable therapeutic intervention at various disease stages. The last few years have shown rapid growth in genetic therapy advancement for the treatment of HRD. Mutation-specific genetic therapies for some retinal degenerations have now transitioned from over a decade of preclinical studies to phase I/II/III clinical trials, and success in the development of cutting-edge therapies for these diseases would change the lives of many individuals. The present review outlines advances in clinical trials for retinal degenerative disease, focusing on the progress, challenges and prospective in the development and clinical translation of gene therapy. (Ophthalmol CHN, 2020, 29: 241-245)

New concepts to explore the pathogenesis and pathogenic genes of primary angle-closure glaucoma

Yu Xiaowei, Yang Xue, Zhao Zhenni, Fan Zhigang

2020, 29(4):  246-254.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 002

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 Primary angle-closure glaucoma (PACG) is a group of complex polygenic and heterogeneous diseases, the essential pathogenesis of which is mechanical obstruction of trabecular meshwork by peripheral iris secondary to various etiologies. Clinically, the incidence of primary open-angle glaucoma (POAG) complicated by narrow angle and progressive synechia angle closure is not uncommon. If we do not deliberately scrutinize these clinical cases from the dynamic course of disease development, a confusion of clinical and basic research object could be made, which is probably an important reason that restricts the clinical and genetic studies of PACG pathogenesis due to an impure contamination of enrolled cases. From a molecular perspective, the mechanisms of anatomical angle closure can be categorized into regulation of development in ocular axial, regulation ofdevelopmentin anterior chamber angle structures, including lens and lens zonules and regulation of development in retina-choroid-sclera complex. Current studies reveal that genes which may affect the structure and development of the iris-ciliary body-lens zonules-lens are CHAT, PLEKHA7 and FEPMT2; genes that may affect the development of retina-choroid-sclera complex are TMEM98, CRB and BEST1 and genes thatmay affect ocular axial are MFRP, ABCC5, PRSS56, MMP9, NOS3 and HSP70. However, the molecular mechanism of these genes associated with the development of POAG is still unclear. Indeed, nanophthalmos can be considered a full disease spectrum of PACG, as it has all phenotypes of various clinical PACG subtypes. Therefore, investigation into the molecular mechanisms of nanophthalmos could work as an entry window into the black house of molecular mechanisms in PACG. Further, a systemic classification of PACG subtypes can be realized through a combination of genetic markers and biometric markers in PACG. (Ophthalmol CHN, 2020, 29: 246-254)

Efficacy of lumboperitoneal shunt for idiopathic intracranial hypertension

Zhao Shangfeng1, Zhang Jialiang1, Li Yong1, Wu Jiangping1, Liu Haocheng1, Sun Si1, Wang Wei1, Ma Jianmin2, Wang Jiawei3, Kang Jun1

2020, 29(4):  255-259.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 003

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 Objective To evaluate the efficacy and safty of lumboperitoneal shunt (LPS) for treatment of idiopathic intracranial hypertension (IIH). Design Retrospective case series. Participant 114 IIH patients with LPS from Beijing Tongren Hospital. Methods The medical records of patients before and after LPS surgery were reviewed. The patients were followed up for 3.4±1.2 (2-16) months. Main Outcome Measures Best corrected visual acuity (BCVA), visual field, papilledema, headache and complications. Results 62 cases (59.6%) with preoperative BCVA<0.05 reduced to 30 cases(28,8%) after LPS (P<0.05). 66 cases(70.2%) of visual field defect were improved. Mild papilledema occurred in 58 cases(50.9%) before LPS, and severe papilledema in 54 cases(47.4%), while 25 cases(21.9%) remained with mild papilledema, and 7 cases(6.1%) with severe papilledema after LPS. Headache in 67 cases (93.1%) alleviated 3 months after LPS. During the follow-up period, shunt obstruction developed in 3 cases and shunt infection in 2 cases postoperatively. 12 cases underwent shunt adjustments, with an average of 1.4 times. Conclusion The short-term follow-up in this study showed that LPS can effectively relieve the visual acuity, visual field, headache and papilledema caused by IIH. (Ophthalmol CHN, 2020, 29: 255-259)

Efficacy of triamcinolone periglobal and upper fornix injection for moderate to severe active thyroid associated ophthalmopathy

Luo Lihua1, Gao Lixin1, Wang Wei1, Miao Hui1, Ma Xiumei1, Li Dongmei2

2020, 29(4):  260-266.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 004

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 Objective To study the efficacy and complication of triamcinolone (TA) periglobal and upper fornix injection for moderate to severe active thyroid associated ophthalmopathy (TAO).  Design Retrospective case series. Participants 34 cases (60 eyes) of patients with moderate to severe TAO. Methods The patient's medical records were reviewed. All patients received a periobital injection of  TA (20-40 mg). The patients whose upper eyelid retraction ≥2 mm were given 20 mg TA into the fornix of the upper eyelid. Follow-up visit at 1 week after the first treatment, repeat the injection monthly if the symptoms were improved. When the upper eyelid position dropped to normal or consistent with the contralateral eye, the eyelid and conjunctival hyperemia and edema were stopped, the patients were observed and followed up for at least 3 months. The mean follow-up was 9.12±5.28 months. Main Outcome Measures Clinical activity score (CAS), thyroid eye disease quality of life scale (TED-QOL), marginal reflex distance(MRD1), exophthalmos, LogMAR best corrected visual acuity (BCVA), intraocular pressure, B ultrasonic extraocular muscle diameter. Results Before treatment and in the last follow-up, the CAS scores were (3.79±0.81) and (1.29±0.68)  respectively (P=0.000). The TED-QOL scale scores were (17.85±2.80) and (10.18±3.02) respectively (P=0.000). The MRD1 was (6.29±0.68) and (4.56±0.71) respectively (P=0.000). The degree of exophthalmos was (18.20±2.77)mm  and (17.65±2.90) mm respectively (P=0.000). The diameters of the superior, inferior, internal and external rectus muscles were (2.34±0.67, 3.62±1.06, 3.06±0.67, 2.71±0.79)mm, (2.15±0.50, 3.30±0.99, 2.81±0.61, 2.51±0.61)mm, respectively (all P<0.05). The BCVA (LogMAR) was (4.99±0.12) and (4.99±0.16) (P=0.289) respectively. Intraocular pressure was (16.65±2.91)mmHg and (16.78±4.30)mmHg respectively (P=0.772). The difference in the degree of upper eyelid retraction between periglobal and upper fornix injection and single periglobal injection was (1.15±0.38) mm and (2.31±0.48)mm respectively (P=0.000). The difference before and after treatment of exophthalmos between the two groups was (-0.69±0.75) mm and (-0.84±1.28)mm respectively (P=0.712). The difference before and after treatment of upper, lower, internal and external rectus muscles in the two groups were (0.22±0.52, 0.28±0.49)mm, (0.32±0.56, 0.51±0.76)mm, (0.35±0.40, 0.34±0.49)mm, and (0.23±0.56, 0.47±0.84)mm, respectively (all P>0.05). Intraocular pressure of 9/60 eyes (15%) had increased >21 mmHg after treatment. Menstrual changes were observed in 2 cases. Conclusions Periorbital injection of 40 mg TA can effectively reduce the orbital inflammation of TAO in active stage. The improvement of upper eyelid retraction in periglobal combined with upper fornix injection was more obvious than that of single periglobal injection. At the same time, the complications such as increased intraocular pressure should be paid attention. (Ophthalmol CHN, 2020, 29: 260-265)

Clinical characteristics of retinal honeycomb appearance in patients with X-linked retinoschisis

a Jing, Liu Jinghua, Li Songfeng, Ma Yan, Deng Guangda, Li Liang, Zhou Dan, Lu Hai

2020, 29(4):  267-272.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 005

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Objective To investigate the clinical characteristics of retinal honeycomb appearance in patients with X-linked retinoschisis. Design Retrospective case series. Participants 43 patients (85 eyes) diagnosed as X-linked retinoschisis in Beijing Tongren Hospital from December, 2017 to January, 2020 were included. Methods Ultra-wide-field fundus imaging and examination note were used to review and analyze the clinical characteristics of retinal honeycomb appearance. Main Outcome Measures Morphology, location, incidence of the retinal honeycomb appearance and its association with visual acuity, other peripheral fundus changes and complications. Results The retinal honeycomb appearance was found in 20 cases (46.5%), 31 eyes (36.5%). Of which, 9 cases (45%) were monocular and 11 cases (55%) were binocular. There was no statistical difference of the age at diagnosis between groups with or without honeycomb appearance. There was a definite predilection for the superior temporal quadrant (28 eyes, 90.3%), followed by the inferior temporal (16 eyes, 51.6%), the inferior nasal (5 eyes, 16.1%) and the superior nasal quadrant (4 eyes, 12.9%). The best corrected visual acuity（logMAR） of eyes with honeycomb appearance were significantly lower than eyes without honeycomb appearance (0.82±0.14 VS 0.55±0.09, t=2.153, P=0.035). The honeycomb appearance was significantly associated with both peripheral retinoschisis and outer retinal hole (r=0.377, P=0.000; r=0.278, P=0.08). Eyes with honeycomb appearance had a higher rate of inner retinal hole, vitreous hemorrhage and retinal detachment than eyes without the honeycomb appearance（74.2% VS 59.3%; 32.3% VS 20.4%; 32.3% VS22.2%）, but did not reach statistical significance. Conclusions Retinal honeycomb appearance could be found in at least 1/3 of the patients with X-linked retinoschisis. Eyes with honeycomb appearance had worse BCVA and higher rate of inner retinal holes and complications like vitreous hemorrhage and retinal detachment. (Ophthalmol CHN, 2020, 29: 267-272)

Efficacy of interferon α2a as an add-on treatment for refractory Behcet’s uveitis

Mo Jing, Wang Hong, Cao Xusheng

2020, 29(4):  273-277.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 006

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Objective To estimate the efficacy and safety of Interferon （INF）α2a as an add-on treatment for refractory Behcet’s uveitis(BU). Design Retrospective case series. Participants 36 patients (70 eyes) with refractory BU who underwent relapse under corticosteroids and conventional immunosuppressive agents in Beijing Tongren Eye Center from November 2016 to December 2019 were included. Methods The outpatient medical records were reviewed. All patients took INFα2a as an add-on treatment. Linear regression, Logistic regression and Chi-square test were used to reveal the correlation between the change of frequency of relapse, vision, dosage of corticosteroids, dosage of immunosuppressive agents and gender, age, course of BU, immunosuppressive agents, baseline vision, follow- up duration. The side effects were monitored. Main Outcome Measures  Changes in ocular relapse frequency and vision acuity, changes of the dosage of corticosteroids and immunosuppressive agents, and side effects. Results During a mean follow-up of 16.6±7.4 (12~36) months, the median frequency of relapse decreased from 7.5 (range 4~12) per year to 0 (range 0~2) per year (P=0.000). Linear regression revealed no correlation between the decreased frequency of relapse and gender, age, course of BU, immunosuppressive agent, baseline vision, follow-up duration (P>0.05). Visual improvement was observed in 25 eyes (35.7%) ,visual stability was observed in 24 eyes (34.3%), and visual deterioration was observed in 21 eyes (30%). Corticosteroids were lowered in 31 patients (86.1%), the dosage were reduced to lower than 10mg/day in 12 patients (32.9%) , and completely withdrawn in 2 patients (2.9%). Immunosuppressive agents were reduced in 20 patients (55.6%). Logistic regression revealed no correlation between the change of vision, dosage of corticosteroids, dosage of immunosuppressive agents and gender, age, course of BU, immunosuppressive agent, baseline vision, follow-upduration (P>0.05). No severe adverse events were observed. Conclusion INFα2a is effective and safe for refractory BU as an add-on treatment. (Ophthalmol CHN, 2020, 29: 273-277)

Corneal densitometry analysis and its correlation with corneal topography in keratoconus

Zhang Mengyu1, Tian Lei1，2, Guo Lili1, Zhang Yang1, Wang Zhiqun1, Chen Kexin1

2020, 29(4):  278-283.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 007

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Objective To compare corneal densitometry(CD) between keratoconus(KC) and normal cornea, and to investigate the correlation between CD and topographic parameters. Design Cross-sectional study. Participants A total of 162 keratoconic patients (162 eyes) (KC group) and 41 normal subjects (41 eyes) (NL group) were included from Beijing Tongren Hospital from 2017 to 2019. Methods CD values were obtained for the 0~2 mm, 2~6 mm, 6~10 mm, 10~12 mm and 0~12 mm zones of the anterior (up to 120 μm), posterior (posterior 60 μm), central (between the anterior and posterior) and total cornea by Pentacam HR. The Pentacam provides a topographic keratoconus classification for staging the disease in grades 1 to 4. Cases were divided into mild, grade 1; moderate, from grades 1 to 2 and grade 2; and severe, grade 3, from grades 3 to 4 and grade 4. Bonferroni multiple comparisons test or Kruskal-Wallis test was used to compare CD between different groups. Pearson’s correlation test or Spearman’s correlation test was used to determine the correlations between CD and topographic parameters. Main Outcome Measures CD values over different corneal annular concentric zones and depths, maximum keratometry (Kmax), corneal central thickness (CCT) and thinnest corneal thickness (TCT). Results The CD values of the anterior 0 to 2 mm layer for the NL group, KC group, KC mild, KC moderate and KC severe were 21.67±1.60, 21.90（18.70~98.70）, 21.6（18.70~24.80）, 21.60（19.30~29.10） and 22.80（20.00~98.70）, respectively. There were significant differences between KC group and NL group for the CD of the anterior 0 to 2 mm layer (P=0.043). There were no significant differences between KC mild, KC moderate and NL group for the CD of the anterior 0 to 2 mm layer(all P＞0.05). There were significant differences between KC severe and the other groups for the CD of the anterior 0 to 2 mm layer (all P＜0.05). There were no significant differences between groups for the CD of the remaining corneal annuluses and layers(all P＞0.05). The CD values of the anterior 0 to 2 mm layer significantly and positively correlated with the Kmax values (R=0.181，P=0.03), and significantly and negatively correlated with CCT and TCT values (R=-0.172, P=0.03 and R=-0.171, P=0.04, respectively). Conclusion The CD values of the anterior 0 to 2 mm layer are higher for the keratoconic cornea than in the normal cornea. The CD level is higher in more advanced stages. There are significant correlations between the CD values of the anterior 0 to 2 mm layer of the keratoconic cornea and the Kmax, CCT and TCT values. CD may be a useful index of KC progression. (Ophthalmol CHN, 2020, 29: 278-283)

Efficacy of modified sutureless scleral fixation of posterior chamber intraocular lens for patients with insufficient capsular support

Chen Yunxin, Chen Wangling, Xian Wenguang, Zeng Mingbing, Zheng Haisheng, Lao Wei, Liang Xiaoqian, Jin Shiyuan

2020, 29(4):  284-287.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 008

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Objective To observe the efficacy of modified sutureless scleral fixation of posterior chamber intraocular lens for patients with insufficient capsular support. Design Retrospective case series. Participants 13 cases (13 eyes) with loss of lens capsule in Hainan Provincial Ophthalmic Hospital from June 2018 to May 2019. Methods All patients underwent posterior chamber intraocular lens implantation with modified sutureless intrascleral fixation. The clinical data of patients were collected. Eye examination, including visual acuity, refrective examination, and intraocular pressure was performed before surgery and 1 day, 1 week and 1 month after surgery. Main Outcome Measures visual acuity (LogMAR), refractive status, IOP, operation time, operative complications.  Results The mean of preoperative naked eye vision was 1.58±0.08, postoperative naked eye vision was 0.70±0.11 (t=6.519, P=0.000). Preoperative refractive mean 10.54±0.35 D, postoperative refractive mean 0.73±0.39 D (t=16.284, P=0.000). The duration of the operation was 27.92±10.18 minutes. Postoperative low intraocular pressure was 1 case, and postoperative corneal edema was 4 cases, which all recovered one week after operation. No intraocular lens dislocation, iris clamping and intraocular lens exposure occurred after operation. Conclusion This short-term result shows that modified sutureless intrascleral fixation of posterior chamber intraocular lens is a simple, safe and effective surgery for the fixation of intraocular lens with insufficient capsular support. (Ophthalmol CHN, 2020, 29: 284-287)

Efficacy of femtosecond laser assisted phacoemulsification combined with trifocal intraocular lens implantation in cataract after vitrectomy

Li Qiumei1, Liu Chang1, Li Xinxin2, Nie Danjie3, Li Shaowei1

2020, 29(4):  288-293.  doi:10. 13281/j. cnki. issn.1004-4469. 2020. 04. 009

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 Objective To evaluate the postoperative effects after femtosecond laser-assisted phacoemulsfication with trifocal intraocular lens(TIOL) implantation in patients with cataract after previous vitrectomy surgery. Design Retrospective case series. Participants 14 cataract patients (14 eyes) after PPV surgery were performed with LenSx femtosecond laser assisted phacoemulsification combined with diffraction trifocal IOL (AT LISA tri 839 MP) implantation in Beijing Aier Intech Eye Hospital. Methods The clinical data of patients were retrospectively analyzed. The average follow-up time was 12.5±7.13 months (3-24 months). The visual function index scale (VF-14) questionnaire and defocus curve were performed 3 months after surgery. Main Outcome Measures The distance, intermediate and near visual acuity, equivalent spherical mirror degree (SE), defocus curve, and patient satisfaction at 3 months after surgery. Results The average time from PPV to cataract surgery was 4.46±4.76 years. One case was loss of follow-up after cataract surgery. At the last follow-up, the LogMAR visual acuity of 10/13 eyes (76.9%) was ≤0.1. SE was < 1.0D in 11/13 eyes (84.6%). The defocus curve was smooth between +1.00 D and -4.00 D. 12/13 eyes (92.3%) were satisfied for the far and intermediate vision and 11/13 eyes (84.6%) were satisfied for reading vision. But 11/13 eyes (84.6%) complained with glares and halo. Conclusion The study of this small sample shows that femtosecond laser-assisted phacoemulsification can improve visual quality of cataract patients after PPV, and diffractive trifocal IOL can provide good distance, intermediate and near vision for patients with cataract after vitrectomy. However, it should be strictly selected and applied with caution before surgery. (Ophthalmol CHN, 2020, 29: 288-293)

Status of cataract surgery in Xinjiang, China in 2010-2018

Mijiti Maierhaba, Shen Danni, Alifu Kaidiliya, Ding Lin

2020, 29(4):  294-297.  doi:10.13281/j.cnki.issn.1004-4469.2020.04.010

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 Objective To study the status of cataract surgery in Xinjiang. Design Retrospective case series. Participants All patients with cataract surgery reported by the Cataract Operation Information Report System of the Chinese network for prevention and treatment of blindness from 2010 to 2018 in Xinjiang. Methods Data of cataract surgery were reviewed and analyzed through the Cataract Surgery Information Report System of China blind prevention and treatment network. Main Outcome Measures Cataract surgery patient age, gender, cataract type, surgical type, intraocular lens implantation rate, and cataract surgical rate (CSR). Results The proportion of cataract surgery patients in 61-80 age groups is highest (66.67%) from 2010 to 2018 in Xinjiang. The female patients (52.39%) were higher than the male patients. Phacoemulsification surgery was the most popular surgical choice for cataract removal (79.2%). The intraocular lens implantation rate was 98.76%. Reports of cataract operations in Urumqi, Kashgar, Yili and other regions increased gradually from 2010 to 2018. CSR in Xinjiang increased about five times from 2010 (387) to 2018 (1998). Conclusion CSR in Xinjiang increased significantly in 2018 compared with that in 2010. Phacoemulsification is major method for cataract surgery in Xinjiang. (Ophthalmol CHN, 2020, 29: 294-297)


Health economics evaluation study of senile cataract blindness prevention project in Hezheng County, Gansu

Tao Ran1, Chen Hui2, Liu Min1, Gao Lei1, Xu Ping3, Liu Chunxiu3, Lu Qing3, XU Yang3

2020, 29(4):  298-303.  doi:10.13281/j.cnki.issn.1004-4469.2020.04.011

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 Objective To conduct economic evaluation on the senile cataract blindness prevention project in Hezheng County of Gansu Province in 2014-2016. Design Cross-sectional study. Participants 407 senile cataract patients and 109 cataract patients received sight restoration surgeries between 2014 and 2016 in Hezheng County of Gansu Province. Method Questionnaires were distributed to all study objects and to evaluate the efficiency of the project through the method of net benefit analysis, cost benefit analysis and cost effectiveness analysis by measuring total economics benefit and cost. Main Outcome Measures direct cost, indirect cost, direct economic benefit, indirect economic benefit, total cost, total economic benefit, net benefit, cost benefit ratio, cost effectiveness ratio. Results Total economic burden caused by senile cataract in Hezheng of Gansu is 21.42 million Yuan. Total economic benefit inferred from senile cataract surgeries in the project from year 2014 to 2016 is 3398424.98 Yuan, total cost is 2939125.20 Yuan, the net benefit is 459299.78 Yuan, and the benefit cost ratio is 1.16:1. The results indicate that every invest of 10 million Yuan of the project can reduce the blindness rate of 0.027% and disability rate of 0.164% caused by senile cataract. The ratio of total cost and change of blindness rate incurred from senile cataract blindness prevention project is 36.47. The ratio of total cost and change of disability rate incurred from senile cataract blindness prevention project is 6.11. The results indicate that 364.7 thousand Yuan is needed to invest to reduce every 1% of blindness rate caused by cataract, and 61.1 thousand Yuan is needed to invest to reduce every 1% of disability rate caused by cataract. Conclusions The comprehensive cataract blindness prevention project in Hezheng of Gansu province has better return on investment and technical efficiency. (Ophthalmol CHN, 2020, 29: 298-303)

Comparison of short-term efficacy of gonioscopy-assisted ab interno canaloplasty combined with transluminal trabeculotomy and standard gonioscopy-assisted transluminal trabeculotomy

Yin Peng, Shi Yan, Wang Yiwei, Wang Huaizhou, Xin Chen, Cao Kai, Wan Yue, Wang Ningli

2020, 29(4):  304-308.  doi:10.13281/j.cnki.issn.1004-4469.2020.04.012

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 Objective To evaluate the efficacy of gonioscopy-assisted ab interno canaloplasty combined with transluminal trabeculotomy (GABiC) for primary open-angle glaucoma (POAG). Design retrospective comparative case series. Participants Thirty eyes of 30 POAG patients (18 years old or more) who has not any previous laser or surgical therapy were treated by the same surgeon from Tongren Eye Center from Jun 2018 to Jan 2019. Methods Retrospective review of patients who underwent GABiC or gonioscopy-assisted transluminal trabeculotomy (GATT) with 3 months follow-up. Main Outcome Measures IOP, medication use, complications, the rate of qualified success and complete success. Results 7 eyes in the GABiC group and 23 eyes in the GATT group. At 3 months, mean IOP was 17.0±2.2 mmHg for GABiC group and 14.7±3.0 mmHg for GATT group (P=0.081) on 0.3±0.8 and 0.1±0.4 medications(P=0.865), respectively. The absolute success rates were 86% (6/7 cases) for GABiC group and 83% (19/23 cases) for GATT group (P=1.000), and the qualified success rates were 100% (7/7 cases) for GABiC group and 96% (22/23 cases) for GATT group (P=1.000). The two groups had similar complications of IOP spike (GABiC 14%, GATT 48%; P=0.193), ciliary detachment (GABiC 100%, GATT 100%) and hyphema (GABiC 57%, GATT 87%; P=0.120). Conclusion Both surgeries were effective in reducing IOP and glaucoma medications safely. GABiC is a feasible surgical option for POAG. Further study with even longer follow-up is needed. (Ophthalmol CHN, 2020, 29: 304-308)

Observation of the evolution of filtration channels after CLASS with ultrasound biomicroscopy

Yan Xiaowei, Tang Guangxian, Zhang Hengli, Li Fan, Ma Lihua, Geng Yulei

2020, 29(4):  309-314.  doi:10.13281/j.cnki.issn.1004-4469.2020.04.013

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Objective To describe the evolution of filtering channels after CO2 laser-assisted sclerectomy surgery (CLASS) with ultrasonic biomicroscopy(UBM), and to evaluate the mechanism of lowering intraocular pressure in CLASS. Design Cohort study. Participants Continuous 25 patients (25 eyes) with open angle glaucoma performed CLASS from 2016 to 2017. Methods On 1, 3, 6, 12 months after CLASS, UBM were performed at the operation area of surgical eyes. And the best corrected visual acuity, intraocular pressure, visual field were also examined. Main Outcome Measures Morphology of the filtering blebs, thickness of the trabeculo-Descemet membrane (TDM), the size of the scleral reservoir (anteroposterior extent and height) and correlation coefficient between scleral reservoir size and intraocular pressure. Results On 1 month after CLASS surgery, L-type and H-type filtering blebs was 19 eyes (76%), 6 eyes (24%), respectively. On 12 months after surgery, L-type and H-type filtering blebs was 11 eyes (44%), 14 eyes (56%), respectively. On 1, 12 month after surgery, 4 eyes (16%),17 eyes (68%) showed a filtering bleb height＜1 mm, respectively. On 1, 12 month after surgery, the TDM thickness was (0.104±0.026) mm, (0.100±0.019) mm, respectively. The anteroposterior length of scleral reservoir was (2.12±1.04) mm, (1.81±0.74) mm, respectively. The height of scleral reservoir were (0.52±0.18) mm, (0.46±0.17) mm, respectively. On 12 month after surgery, the anteroposterior length and height of scleral reservoir were negatively correlated with intraocular pressure (r=-0.432, -0.523, all P＜0.05). Conclusions The filtering bleb height, scleral reservoir size gradually decreases after CLASS. The scleral reservoir stabilized on 3 months after CLASS, and the filtering blebs morphology stabilized on 6 months after CLASS. By 12 months after CLASS, the main aqueous humor drainage pathway has changed from subconjunctival filtration to internal drainage. (Ophthalmol CHN, 2020, 29: 309-314)

Teaching model reform experience in clinical visual electrophysiology course

Chen Tao, Zhang Zuoming

2020, 29(4):  315-316.  doi:10.13281/j.cnki.issn.1004-4469.2020.04.014

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Visual electrophysiological examination as an objective examination method of visual function is of great significance in ophthalmology clinical work. However, most ophthalmologists have little knowledge of this. This status is related to the current elite education such as continuing education in ophthalmology and postgraduate education. By summarizing the teaching practice of “clinical visual electrophysiology” for many years, this paper shares the teaching reform experience of “clinical visual electrophysiology” curriculum design, teaching implementation and curriculum assessment, which has certain reference value for the exploration of medical elite education. (Ophthalmol CHN, 2020, 29: 315-317)