Ophthalmology in China

The history of blindness prevention and eye health in China

Zhao Jialiang

2020, 29(5): 321-325. doi:10.13281/j.cnki.issn.1004-4469.2020.05.001

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Prevention of blindness and eye health is an important public health and social issue referred to people’s livelihood. Since new China was found, especially recent 20 years of “Vision 2020” initial implement, prevention of blindness and eye health has achieved a great of achievements. This paper is intended to briefly review the history of blindness prevention and eye health, in order for promoting the development of the universal eye health, and to accommodate the needs for establishing the power socialist country. It can be divided into several parts: before the founding of new China (before 1949), from the initial stage of the establishment of new China to the early stage of reform and opening up (1970s), the early stage of reform and opening up to the early 21st century, and the early 21st century to the present. (Ophthalmol CHN, 2020, 29: 321-325)

Significance and challenge of gene diagnosis for inherited retinal degenerations based on next-generation sequencing

Lei Bo

2020, 29(5): 326-330. doi:10.13281/j.cnki.issn.1004-4469.2020.05.002

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Next-generation sequencing (NGS) technology has revolutionized genomic research with the characteristics of high throughput and low cost. NGS makes the molecular genetic diagnosis possible and established a solid groundwork for the diagnosis and treatment of inherited retinal degenerations. Nevertheless, due to lacking of genetic and bioinformatics knowledge, many ophthalmologists overlook the significance of gene testing, the selection of detection methods, the interpretation of test results, and the limitations of detections. The significance and challenges of gene diagnosis based on NGS for inherited retinal degeneration were discussed in the article. （Ophthalmol CHN, 2020, 29: 326-330）

A survey on ocular manifestations of eye professionals diagnosed COVID-19 in Wuhan, China

Zhang Hui1, Qiao Chunyan1, Chen Changzheng2, Song Yanping3, Liu Zhonghua4, Xing Yiqiao2, Xiao Zefeng5, Ke Min6, Luo Jihong7, Ye Ya3, Tian Ning1, He Mingguang8, Ying Guishuang9, Han Ying10, Wang Ningli

2020, 29(5): 332-338. doi:10.13281/j.cnki.issn.1004-4469.2020.05.003

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Objective To investigate the infection-related factors, ocular manifestations and transmission routes of coronavirus disease 2019 (COVID-19) in the hospitals with eye professionals diagnosed symptomatic COVID-19 in Wuhan. Design Cross-sectional case-control questionnaire survey. Participants A total of 28 eye professionals who contracted COVID-19 in Wuhan, and 96 non-infected control subjects who were randomly selected with a 1 to 3-4 ratio within each case’s own hospital from February 26, 2020 to March 20, 2020. Method The "questionnaire network" was used to design the questionnaire and the data were downloaded from the background of the "questionnaire network". Main Outcome Measures The general information of eye professionals, their 2019-novel corona virus (2019-nCoV) PCR results, ocular symptoms, and treatments. Results A total of 28 eye professionals were diagnosed COVID-19 from January 16, 2020 to February 29, 2020 with an average age of 41.9±11.7(29-70) years old, from 10 general and ophthalmic hospitals in Wuhan. The control group included 96 eye professionals with an average age of 35.1±5.5(26-52) years old. There were 19 female subjects(67.9%), 14 doctors (50%), 12 nurses (42.9%), 2 technicians (7.1%) in the case group. 19 subjects(67.9%) worked in ophthalmology department and 9 subjects(32.1%) worked in anti-epidemic front line, which was no significant different compared with the control group. There are 8 severe cases(28.6%) (including 3 deaths and 1 critical case) in the case group. Reverse-transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal swabs were positive for 2019-nCoV in 15 cases(53.6%). 25.7% of infected medical workers found the working environment poorly ventilated. The questionnaire was completed in 26 cases (92.9% response rate) and 96 controls (100% response rate). There was a higher rate of concurrent ocular symptoms in 11 cases(42.3%) with COVID-19 than those (15.6%) in the control group (P=0.003). Among them, 10 cases(90.9%) with eye itching significantly higher than the control group (73.3%) (P=0.001), 4 cases (36.4%) with tearing significantly higher than the control group (13.3%) (P=0.02), 7 cases (63.6%) with foreign body sensation, 2 cases(18.2%) with eye redness, and 2 cases (18.2%) of blurred vision in case group. Among 4 subjects tested for 2019-nCoV PCR of conjunctival swabs, 1 subject (3.6% of total 28) was positive. Ocular symptoms were found in 9 cases(45%) of 20 mild cases and in 2 cases(33.3%) of 6 severe cases. There was no significant correlation between COVID-19 severity and ocular symptoms. Conclusion This questionnaire survey found that 42.3% of COVID-19 patients had ocular symptoms. Conjunctival sac 2019-nCoV test existed positive confirmed that there was 2019-nCoV in conjunctival sac. Eye professionals who are at a high risk of COVID-19 infection, need to pay attention to conjunctivitis symptoms patients and strengthen ocular medical protection to prevent the nosocomial spread of COVID-19. （Ophthalmol CHN, 2020, 29: 332-338）

The applicability of Titmus and Yan's third-generation stereoscopic test charts in preschool children

Chen Wei, Tong Huan, Pu Jianing, Feng Jingjing

2020, 29(5): 339-343. doi:10.13281/j.cnki.issn.1004-4469.2020.05.004

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Objective To explore the applicability of Titmus and Yan's third-generation stereoscopic test charts in preschool children. Design Cross-sectional survey. Participants Stratified and clustered 1021 children aged 3-6 years from 5 kindergartens in Haidian District, Beijing. Methods All children were examined for visual acuity, ocular deviation, Titmus stereo vision and Yan's third-generation stereo vision. Successful inspection was defined as being able to recognize the qualitative plates pattern or clearly stating that there was no hidden pattern in the qualitative plates. Successful inspection rate of children of different ages was measured. The differences in the stereo acuities of children of different age groups and the differences in the results of two stereo vision examinations were compared. Main Outcome Measures Stereo acuity. Results Test ability of the Titmus stereo charts was 91.2% while the Yan's third-generation stereoscopic test charts was 86.0% for 3 years-old children. Successful inspection rate of two tests increased with age. Among children who can complete the test, Titmus stereo acuity charts that can be achieved by more than 90% of children were 100″ for 3 years-old children, 80″ for 4 years-old children and 60″ for 5-6 years-old children, while Yan's third-generation stereo acuity charts was 60″ in all age groups. The percentage of 60″ by Titmus test was gradually increased with ages and statistically different between the 3-4 years-old children (χ2=55.578, P=0.000), 4-5 years-old children (χ2=7.989, P=0.005). The percentage of 60″ by the Yan's third-generation stereopsis charts was over 90% in 3 years-old children and was not statistically different between any two adjacent age groups. There were statistically significant differences between the two stereoscopic tests (χ2=68.284, P=0.000). With the increase of age, the difference between the two tests decreased and there was no statistical difference in 5 years-old (P=0.070) and 6 years-old group (P=0.146). Conclusion Titmus charts has high test ability for under-age children. The normal reference values of the two tests for preschool children were different. The normal reference value of the two tests in 5 years-old or more children tends to be unified. (Ophthalmol CHN, 2020, 29: 339-343)

Effects of orthokeratology decentration on myopia progression in myopia children

Chen Minfeng, Liu Xinting, Zhang Fen, Wang Yanli, Mao Xinjie

2020, 29(5): 345-349. doi:DOI：10.13281/j.cnki.issn.1004-4469.2020.05.005

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Objective To investigate the effects of orthokeratology decentration on myopia progression. Design Retrospective case series. Participants 132 children from June 2016 to October 2018 in the Optometry Hospital of Wenzhou Medical University who met the criteria and insisted on wearing orthokeratology lens for 24 months. Methods The axial length before wearing the lens and after wearing the lens for 2 years was compared. A tangential difference map from the tangential map before the orthokeratology and after wearing for 3 months was built. The tangential difference map was imported into Matlab to depict the shaping circle and locate the center of the circle. The distance between the circle center and corneal vertex was decentration distance. The decentration distance was measured and the direction of decentration was analyzed. According to the orthokeratology lens decentration degree (<0.5 mm, 0.5~1.0 mm, >1.0 mm), it could be divided into low-decentration, medium-decentration and high-decentration groups. The relationship between the elongation of axial length and orthokeratology decentration was measured. Main Outcome Measures Baseline age, baseline spherical equivalent refractive power, orthokeratology decentration, and elongation of axial length. Results After wearing the orthokeratology lenses for 2 years, the axial length (25.58±0.74) mm increased compared with baseline axial length (25.19±0.80) mm, (t=-12.72, P<0.001). There were no significant differences of baseline age, baseline spherical equivalent refractive power, baseline axial length, and pupil area in decentration groups. The changes (0.39±0.32) mm of axial length in this 2 years was negative correlated with the baseline age [(11.49±1.96) years, r=-0.352, P<0.001], decentration distance [(0.67±0.32) mm, r=-0.377, P<0.001] and pupil area [(19.78±7.04) mm2, r=-0.180, P=0.039], but positive correlated with the baseline spherical equivalent refractive power [(-3.67±1.26) D, r=0.316, P<0.001]. Conclusion The decentration was inevitable after wearing orthokeratology. The orthokeratology decentration was negatively correlated with the elongation of axial length; it might show an effect on myopia control. （Ophthalmol CHN, 2020, 29: 345-349）

The relationship between the position and severity of traumatic corneal scar and the effect of RGP corrected visual acuity

Luo Fei, Wei Zhenyu, Wang Hui, Lv Lan, Liang Qingfeng

2020, 29(5): 350-354. doi:10.13281/j.cnki.issn.1004-4469.2020.05.006

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Objective To evaluate the clinical effect of rigid gas permeable (RGP) contact lens in correcting irregular astigmatism caused by different position and severity of traumatic corneal scar formation. Design Prospective case series. Participants 44 cases (44 eyes) of patients with traumatic corneal scar in Beijing Tongren Hospital with poor visual acuity corrected with framed glasses and without important fundus damage. Methods Patients wore RGP for at least 8 hours a day. All patients were examined including visual acuity, slit-lamp biomicroscopy, fundus photography, keratometry, and corneal topography. According to the position of corneal scar, the patients were divided into central cornea scar (26 eyes), peripheral cornea scar (16 eyes) and limbal corneal scar (2 eyes) three groups. According to the severity, the patients were divided into corneal nebula (11 eyes), corneal macula (24 eyes) and corneal leucoma (9 eyes) three groups. According to the status of lens, the patients were divided into phakic eyes (17 eyes), intraocular lens eyes (8 eyes) and aphakic eyes (19 eyes) three groups. There was no statistical difference in the astigmatism value of corneal topography among each group. Paired t-test was used for comparing the best corrected vision acuity (BCVA) before and after 6-month RGP therapy. Main Outcome Measures LogMAR BCVA. Results After wearing RGP for 6 months, the BCVA in the central, peripheral and limbal groups was (0.40±0.34), (0.21±0.28) and (0.18±0.04), respectively. The BCVA wearing RGP was compared with that of frame glasses, and the difference in central and peripheral groups was statistically significant (t=2.907, P=0.003; t=2.213, P=0.011; t=0.772, P=0.052). After wearing RGP for 6 months, the BCVA in the corneal nebula, pannus and leucoma groups was (0.18±0.22), (0.36±0.33) and (0.37±0.36), respectively. The BCVA wearing RGP was compared with that of frame glasses, and the difference in corneal pannus group was statistically significant（t=1.232, P=0.261; t=2.251, P=0.025; t=0.663, P=0.507). After wearing RGP for 6 months, the BCVA in phakic, intraocular lens and aphakic group was (0.28±0.36), (0.39±0.31) and (0.23±0.25), respectively. The BCVA wearing RGP was compared with that of frame glasses, and the difference in all three groups was statistically significant（t=2.021, P=0.022; t=2.718, P=0.009; t=2.059. P=0.017). Conclusion Compared with frame glasses correction, patients with central and peripheral traumatic corneal scar are more suitable to be corrected by RGP for good vision. Corneal pannus compared corneal nebula and leucoma is more suitable to be corrected by RGP for good vision. （Ophthalmol CHN, 2020, 29: 350-354）

Morphological correlation between sacral margin and meibomian gland in patients with meibomian gland dysfunction

Zang Yunxiao, Li Siyuan, Zhu Lei, Zhang Peng, Lu Hongshuang, Feng Jun, Tian Lei, Yang Ke, Jie Ying

2020, 29(5): 355-360. doi:10.13281/j.cnki.issn.1004-4469.2020.05.007

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Objective To investigate the morphology correlation between palpebral margins and meibomian glands in patients with meibomian gland dysfunction (MGD) based on the established morphology scoring system. Design Cross-sectional study. Participants A total of 30 MGD patients before Lipiflow heat pulse treatment in Tongren Hospital were classified and included. Methods The meibomian glands were photographed using the Keratograph 5M, and the eyelid margins were photographed using an anterior segment bioslit lamp microscope. The lid margin abnormalities were recorded: oriflces, Marx line, quality of exPressed excreta, rounding of lid margin, vascularity, telanglectasia and irregularity. The meibomian glands abnormalities were recorded: dropout, white patches, cystoid dilation, atrophy, tortuous and bifurcation. White patches refer to the hyper reflexive changes in meibomian glands taken by oculus keratgraph 5M which may indicate possible acinar changes and aging changes. Oriflces was graded as normal circular oriflces, capping in the oriflces, pouing in the oriflces and epithelial plugging in the oriflces. Morphological scores were calculated by the morphological classification methods. This cross-sectional study was figured out correlations by Spearman to calculate the P values. Main Outcome Measures The scores of lid margins and meibomian glands morphological characters, the correlation coefficient (r) of lid margins and meibomian glands morphologies. Results There was a positive correlation between meibomian gland opening morphology and secretion characteristics (r=0.590, P=0.001). There was a positive morphology correlation between the calcification and the openings of meibomian glands (r=0.439, P＝0.015). There was a negative correlation between the atrophy or bifurcation and the secretion traits of the meibomian glands (r=-0.349, -0.374，P=0.048, 0.042). Other items were not correlated. In the palpebral margin morphologies, the correlation between the keratinization scores and the total scores of the palpebral margins was the strongest (r=0.842，P=0.000). There was a significant positive correlation between the keratinization and the morphological changes of the meibomian glands openings (r=0.517, P=0.003). In the meibomian gland morphology, the correlation between the calcification scores and the total meibomian gland scores was the strongest (r=0.535, P=0.002). Conclusion There were morphological correlations between meibomian glands and lid margins. For morphological assessment of MGD patients, white patches were more reasonable for the assessment of meibomian glands. Telanglectasia was more reasonable for the assessment of lid margins, which is associated with the changes of the meibomian gland openings. (Ophthalmol CHN, 2020, 29: 355-360）

Comparative analysis of angle morphology in different quadrants of primary angle closure suspect eyes

Wang Bingsong, Jia Hongyan, Cao Kai, Liu Ziqing, Zhao Aiping, Wang Tao

2020, 29(5): 361-364. doi:10.13281/j.cnki.issn.1004-4469.2020.05.008

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Objective To compare the degree of angle closure and the difference of quantitative biological parameters in different quadrants in primary angle closure suspect (PACS) eye. Design Prospective case series. Participants 112 cases of PACS. Methods Only one eye of each subject that met the inclusion criteria was selected for analysis. Firstly, gonioscopy was performed in selected eyes and the angle status of the superior, inferior, nasal and temporal quadrants was recorded and compared. Then the selected eyes were examined by anterior segment optical coherence tomography (AS-OCT), and the biological parameters of anterior chamber angle at nasal and temporal sides were measured and compared. Main Outcome Measures The angle configuration at four quadrants, angle open distance at 500 μm (AOD500), trabecular iris area at 500 μm (TISA500), iris curvature (Icurv), iris thickness at 2000 μm (IT2000) at the nasal and temporal sides. Results The percentage of angle closure in the superior quadrant (98.21%) was higher than that in the inferior quadrant (75.89%), nasal quadrant (64.29%) and temporal quadrant (76.79%) (χ2= 40.225, P<0.001). The width of the temporal angle AOD500(0.12±0.06) mm was larger than that of the nasal side (0.11±0.06) mm (P<0.001), the area of the temporal angle TISA500(0.07±0.03) mm2 was larger than that of the nasal side (0.06±0.03) mm2 (P=0.008), the Icurv in the temporal angle (0.41±0.11) mm was larger than that of the nasal side (0.37±0.1) mm (P=0.001) and the IT2000 of temporal angle (0.46±0.07) mm was smaller than that of nasal angle (0.49±0.06) mm (P<0.001). Conclusion The configuration of anterior chamber angle in different quadrants of the same eye is different in PACS eyes. The superior angle was more closed than angle in other quadrants, the iris of temporal angle was thinner than that of nasal angle, and the temporal angle is wider than the nasal one. （Ophthalmol CHN, 2020, 29: 361-364）

Comparison of five devices to measure intraocular pressure and analysis correlation with corneal biomechanical properties

Hu Die, Zhou Longfang, Peng Yusu, Lan Jie, Ge Qingshu, Xie Pingzhong, Xie Lixin, Pan Xiaojing

2020, 29(5): 365-369. doi:10.13281/j.cnki.issn.1004-4469.2020.05.009

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Objective To compare consistency of five methods of tomometry in normal subjects: non-contact tonometer (NCT), Goldmann applanation tonometer (GAT), Icare pro rebound tonometer (RBT), Tono-pen AVIA tonometer (TPT) and corneal visualization scheimpflug technology (CST), and to analyze the correlation between intraocular pressure (IOP) and corneal biomechanical properties. Design Diagnostic methods evaluation. Participants 44 healthy volunteers. Method All volunteers were measured IOP with five tomomers by one same doctor at the same time. Central cornea thickness（CCT） and cornea first applanation time (Time A1) were measured by CST. The IOP difference was measured by one way ANOVA and paired t test. Consistency test were measured with Bland-Altman test. The correlation between IOP and the CCT or Time A1 was analyzed with Pearson test. Main Outcome Measures IOP, average value of IOP differences, correlation coefficient. Results The mean IOP with the GAT, NCT, RBT, TPT, CST was 15.9±3.3 mmHg, 14.8±2.9 mmHg, 16.9±3.3 mmHg, 14.7±2.5 mmHg, and 16.1±3.0 mmHg, respectively. There was a statistically significant difference between NCT and GTA, TPT and GAT (P=0.01, 0.00). There was no statistically significant difference between RBT and GAT, CST and GAT(all P＞0.05). Greater NCT, TPT, RBT and CST were significantly associated with greater GAT(r=0.63, 0.37, 0.63, 0.55； all P＜0.05). Bland-Altman analysis showed that between NCT and GAT the 95% limits of agreement（95% LoA）were (-6.4, 4.2) mmHg, the mean difference were -1.1 mmHg; that between TPT and GAT the 95% LoA were (-6.3, 3.9) mmHg, the mean difference were -1.2 mmHg; that between RBT and GAT, the 95% LoA were (-6.2, 8.3) mmHg, the mean difference were 1.0 mmHg; that between CST and GAT, the 95% LoA were (-5.6, 6.2) mmHg, the mean difference were 0.3 mmHg. The mean CCT was 550.5±29.2 μm. The mean time A1 was 7.63±0.36 ms. Greater TPT significantly associated with greater CCT (r=0.40, P=0.01). Greater GAT, NCT, RBT, TPT and CST significantly associated with greater TIME A1 (r=0.53, 0.64, 0.55, 0.46, 0.99； all P＜0.05). Conclusions RBT and CST have no significant difference with GAT. NCT and TPT are slightly lower than GAT. CST has the best consistency with GAT. TIME A1 is an important factor that affects intraocular pressure measurement. Greater TIME A1 associates with greater intraocular pressure value. (Ophthalmol CHN, 2020, 29: 365-369)

Clinical characteristics of autosomal recessive bestrophinopathy associated with angle-closure glaucoma

Xiao Hui, Luo Jingyi, Zhong Yimin, Liao Lingling, Wu Nina, Ling Yunlan, Liu Xing

2020, 29(5): 370-374. doi:10.13281/j.cnki.issn.1004-4469.2020.05.010

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Objective To study the clinical features of autosomal recessive bestrophinopathy (ARB) associated with angle-closure glaucoma(ACG) or angle closure(AC). Design Retrospective case series. Participants Sixteen eyes of 8 patients who were identified of ARB associated with ACG/AC with genetic testing at the Zhongshan Ophthalmic Center from 2017 to 2019. Methods The clinic data, ocular biological parameters, fundus image and visual function were analyzed. Main Outcome Measures The clinic features and characteristics of ocular biological parameter measurement, retinal and optic nerve changes and visual function changes. Results The mean age of ARB-related ACG/AC patients was 26.13±6.77 years-old (15~34 years-old). The best corrected visual acuity ranged from 0.1 to 0.8, and the average intraocular pressure (IOP) was 28.81±8.03 (15~45) mmHg. The average anterior chamber depth (ACD) was 2.09±0.14 mm, and the average axial lengths (AL) was 21.85 ± 0.65 mm. The closed range of anterior chamber angle was over 180 degrees in 13 eyes, and the mean vertical cup to disc ratio (C/D), the average retinal nerve fibre layer (RNFL) thickness and the mean visual field defect value (MD) was 0.9±0.10, 62.53±149.06 μm and 21.02 ±12.02 dB, respectively. The closed range of anterior chamber angle was less than 180° in 3 eyes, and the mean vertical C/D, the average RNFL thickness and the MD was 0.4±0.06, 117±1.73 μm, and -5.56±1.53 dB, respectively. Multiple subretinal yellow substance deposits of different sizes and quantities were distributed in the posterior pole. All of the patients showed extensive serous retinal detachment and extension of photoreceptor outer segment in the posterior pole，and hyper-reflection between the sub-retinal pigment epithelium space were found by SD-OCT image. Twelve eyes (75%) showed intraretinal schisis, focal choroidal excavation (FCE) was found in one eye. EOG Arden ratio was below 1.55 in all patients. Conclusion The onset age of ARB with ACG/AC patients are younger than primary angle-closure glaucoma. Bilateral narrow or closed anterior chamber angle accompanied with scattered vitelliform retinopathy and extensive serous retinal detachment in the posterior pole is the characteristics of ARB with ACG/AC patients. （Ophthalmol CHN, 2020, 29: 370-374）

Clinical analysis of progressive outer retinal necrosis with acquired immunodeficiency syndrome

Kong Wenjun1, Wei Wenbin2, Xie Lianyong1, Chen Chao1, Du Kuifang1

2020, 29(5): 375-379. doi:10.13281/j.cnki.issn.1004-4469.2020.05.011

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Objective To investigate the systemic condition, fundus characteristics, treatment methods and prognosis of progressive outer retinal necrosis (PORN) with acquired immunodeficiency syndrome (AIDS). Design Retrospective case series. Participants 6 cases (11 eyes) of PORN with AIDS in Beijing You'an Hospital from 2015 to 2019. Methods Visual acuity, fundus, optical coherence tomography (OCT) and varicella zoster virus (VZV)-DNA, CD4+ T lymphocytes in blood and human immunodeficiency virus (HIV) viral load were analyzed. 3 eyes underwent intravitreal injection of ganciclovir and (or) phosphonate combined with systemic therapy. The follow-up was for 3~26 months. Main Outcome Measures Fundus changes of AIDS combined with PORN, VZV-DNA values in aqueous humor, fundus changes after intravitreal injection, peripheral blood CD4+ T lymphocyte count, and HIV viral load. Results The 6 patients were all males, average age 27.6±3.2 years old. 9 eyes (81.8%) had a best corrected visual acuity of ≤ 0.2 at the first diagnosis. 11 eyes showed painless vision loss. The fundus showed progressive peripheral circular retinal necrosis, yellow-white necrotic foci with clearer multifocal borders progressed concentrically, no or slight vitreous reaction, 6 eyes with exudative retinal detachment. Early lesions on OCT only affect the outer layer of the retina, and later the outer layer becomes thinner. The levels of VZV-DNA in the aqueous humor of the 11 eyes were all positive. CD4+ T lymphocyte count in peripheral blood of patients was average (10.8±2.5)/μl. The HIV viral load was average (246289±462.7) copies/ml. The treatment period of combined with systemic antiviral therapy, intravitreal injection of ganciclovir and (or) sodium phosphonate in 3 eyes was 72~123 days, and their fundus lesions were controlled and vision was improved (1 eye recovered from light perception to hand movement, 1 eye returned to 0.1 from count fingers, and 1 eye remained at 0.5). Conclusion PORN is the most serious eye opportunistic infection in AIDS patients; the fundus shows early lesions involving the outer layer of the retina, no or slight anterior chamber and vitreous reaction. Compared with other AIDS opportunistic eye infections, PORN progresses faster and has a poor prognosis. Viral nucleic acid detection in the eye fluid can help diagnosis. （Ophthalmol CHN, 2020, 29: 375-379）

Clinical application of atrophic eyeballs permanently filled with silicone oil as ocular prostheses

Chen You, Zhao Tong, Sun Chuan, Wang Zhijun

2020, 29(5): 380-384. doi:10.13281/j.cnki.issn.1004-4469.2020.05.012

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Objective To study the clinical efficacy of retained atrophic eyeballs permanently filled with silicone oil after open ocular trauma repair as ocular prostheses. Design Retrospective case series. Participants 22 patients (22 eyes) involved were retained eyeballs after exploratory and reparative surgery combined with long-term silicone oil retention due to open ocular trauma and ocular content loss in China-Japan Friendship Hospital from October 2010 to May 2017. Methods The patients were performed with shallow lamellar keratectomy (underneath Bowman’s membrane layer) combined with total conjunctival flap coverage and wore prosthetic eye pieces directly after conjunctival flap healed with corneal stromal layer. All patients were followed up from 8 months to 3 years to exam if there were any complications such as conjunctival wound disruption, conjunctival flap retraction or epithelial implantation cysts. Numeric rating scales (NRS) of pain was used to evaluate the relief of corneal irritation before and after operation. Exophthalmos and palpebral fissure height before and after operation were compared. Rating scales of satisfaction was used to evaluate the patients’ satisfaction with appearance improvement. Main Outcome Measures Situation of wound healing under slit lamp examination, NRS of pain, palpebral fissure height and exophthalmos measurement, rating scales of satisfaction. Results Conjunctival flap healed firmly with corneal stromal layer was 20/22 eyes. Epithelium implantation cysts at the limbus appeared in 2 eyes, and the cysts were incised and sutured at the inner and outer epithelial margins of the cysts. All patients had no pain and foreign body sensation after wearing prosthetic eye pieces. NRS of pain were all zero. Palpebral fissure height on preoperation and postoperation was (3.45±1.37) mm, (9.73±1.70) mm, respectively. Exophthalmos on preoperation and postoperation was (6.77±1.41) mm, (11.50±1.57) mm, respectively. The postoperative appearance was improved significantly. Rating scales of satisfaction were 4 to 5 (median 5). Preoperative NRS of pain were 0 to 6 (median 1.5), and postoperative NRS of pain were all zero. The corneal irritation symptom all disappeared in 3 patients whose preoperative NRS of pain were more than 4. Conclusion To the retained atrophic eyeballs with long-term silicone oil retention due to open ocular trauma and ocular content loss, wearing prosthetic eye pieces after shallow lamellar keratectomy combined with total conjunctival flap coverage can significantly improve the ocular appearances and relieve the corneal irritation symptoms. （Ophthalmol CHN, 2020, 29: 380-384）

Evaluation of surgical effect of heart dacron graft combined with tarsal plate shortening for paralytic ectropion by the ectropion severity score

Zhang Xifang, Chen Tao

2020, 29(5): 386-390. doi:10.13281/j.cnki.issn.1004-4469.2020.05.013

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Objective To evaluate the surgical effect of heart dacron graft combined with tarsal plate shortening in the treatment of paralytic ectropion by the ectropion severity score (ESS). Design Retrospective case series. Participants Seven patients diagnosed with paralytic ectropion in Beijing Tongren Hospital between May 2017 and June 2019. Methods All of the participants received heart dacron graft combined with tarsal plate shortening for the correction of ectropion suspension． The heart dacron graft with suitable size was fixed medially to the inner canthus ligament and nasal orbital rim, and laterally to the temporal orbital rim. The preoperative and postoperative degree of ectropion was evaluated by the ESS based on photograph, depending on the range and degree of lower eyelid ectropion, the present of sclera show, conjunctival show, excess tear film, redness of the eye, round canthus and punctum lacrimale. The maximum score was 8 points. This photograph-based scoring was made by one researcher and reviewed by another superior physician.Main Outcome Measures ESS and postoperative complications. Results Among 7 patients (7 eyes) participated in this preliminary study, 71% were male (5 eyes). The mean age was 70±9 years-old. The mean follow-up time was 19±10 months (range 6-36 months). The end point follow-up ESS score (median 0, range 0-1) was significantly improved compared to preoperative score (median 8, range 4.5-8, Z=-0.756, P=0.017). There was no under correction nor recurrence, and the success rate was 100%. No shift or dislocation of the implanted graft occurred. The patients were satisfied with the surgical appearance. Conclusion Heart dacron graft combined with tarsal plate shortening is an effective method for the correction of paralytic ectropion. ESS is a photograph-based and useful tool to evaluate the severity of paralytic ectropion. （Ophthalmol CHN, 2020, 29: 386-390）

Clinical histopathologic constituent analysis of 167 cases of ciliary body mass treated by local resection from 2010 to 2019

Gao Fei, Xu Xiaolin, Zhang Xu, Zhang Zhibao, Wei Wenbin

2020, 29(5): 391-395. doi:10.13281/j.cnki.issn.1004-4469.2020.05.014

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Objective To analyze the clinical histopathologic constituent of 167 cases of ciliary body mass treated by local resection. Design Retrospective case series. Participants 167 ciliary body masses treated by local resection in Beijing Tongren Hospital in 2010-2019. Methods The pathological records of ciliary body masses were reviewed retrospectively to record the general clinical information and pathological diagnosis. The constituent ratio of the histopathologic types of ciliary body masses was calculated. Main Outcome Measures The constituent ratio of the histopathologic types. Results This group of 167 ciliary body masses were arranged in order of constituent ratio: 44 cases of melanocytoma (26.3%), 32/2 cases of nonpigmented epithelium adenoma/adenocarcinoma (20.4%), 29 cases of melanoma (17.4%), 14 cases of schwannoma (8.4%), 12 cases of leiomyoma (7.2%), 11 cases of glioneuroma (6.6%), 9 cases of medulloepithelioma (5.4%), 7 cases of pigmented epithelium adenoma (4.2%), 2 cases of hemangioma (1.2%), 2 cases of inflammation(1.2%), nevus, lymphoma and granular cell lesion 1 case (0.6%) each. Malignant lesions accounted for 24.6% (41/167) and benign lesions accounted for 75.4% (126/167). Masses originated from ciliary body epithelial layer accounted for slightly more than a third (36.5%), and masses originated from ciliary body stroma accounted for slightly less than two thirds (63.5%). The top three of epithelial layer originated masses were nonpigmented epithelium adenoma, medulloepithelioma, pigmented epithelium adenoma. The top three of stroma originated masses were melanocytoma, melanoma, and schwannoma. The number of pigmented masses and nonpigmented masses was equal (49.7% and 50.3%). The top three of pigmented masses were melanocytoma, melanoma and pigmented epithelium adenoma. The top three of nonpigmented masses were nonpigmented epithelium adenoma, schwannoma and leiomyoma. Conclusion In this group of ciliary body masses, the top three histopathologic types were melanocytoma, nonpigmented epithelium adenoma and melanoma. On the whole, malignancy accounted for a small proportion, close to a quarter, suggesting that we should give priority to local resection of the mass, when choosing the treatment scheme, and cannot easily carry out enucleation. （Ophthalmol CHN, 2020, 29: 391-395）

Analysis of primary lesions in 65 patients with orbital metastatic tumors

Yu Xiuting1, Yan Huan2, Xiao Lihua3

2020, 29(5): 396-399. doi:10.13281/j.cnki.issn.1004-4469.2020.05.015

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Objective To study the primary tumor type, clinical features and prognosis of orbital metastatic tumors. Design Retrospective case series. Participants 65 patients with orbital metastatic tumors in the Third Medical Center of PLA General Hospital from 2006 to 2017. Methods The clinical records of the participants were reviewed and analyzed. Main Outcome Measures Sex, age, affected eye, primary tumor location. Results Of the 65 patients, 38 were male. The average age at the time of patient visit was 0.6-83 years-old, median 46 years-old. There were 26 cases of right eye, 29 cases of left eye and 10 cases of both eyes (3 from breast cancer, 3 from neuroblastoma, 3 from leukemia and 1 from gastrointestinal tract tumors). The primary sites of orbital metastatic tumors were breast (12 cases), lung (11 cases), leukemia (10 cases), adrenal gland (8 cases), gastrointestinal tract (6 cases), liver (4 cases), kidney (2 cases), thymus (2 cases), bladder, prostate, uterus, joints, lower limbs (1 case each), and 5 cases of unknown origin. The most common primary tumors in adults were breast cancer, lung cancer and gastrointestinal tumors. Conclusion In this study, the age distribution of orbital metastatic tumors is wide. The top three primary tumors in adults are breast cancer, lung cancer and gastrointestinal tumors. （Ophthalmol CHN, 2020, 29: 396-399）

Application of ENOX2 protein as a diagnostic molecular marker for orbital tumors

Zhang Jingxue, Wu Shen, Yan Xuejing, Liu Qian, Ma Jianmin

2020, 29(5): 401-405. doi:10.13281/j.cnki.issn.1004-4469.2020.05.016

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Objective To investigate whether ENOX2 protein can be detected in the serum of patients with orbital tumors, and observe whether the expression of the protein is tissue specificity, and explore the relationship between the expression characteristics of ENOX2 protein and the types of ocular tumors. Design Prospective case series. Participants 43 patients with orbital mass in Beijing Tongren Hospital from November 2015 to April 2016. Methods Serum of enrolled patients was collected. The enrolled patients underwent tumor resection and postoperative pathological examination. The ENOX2 protein detection was carried out using 2D electrophoresis. And the accuracy of ENOX2 protein detection was evaluated based on pathological diagnosis. Main Outcome Measures The detection results and molecular characteristics of ENOX2 protein in patient's serum. Results The final pathological diagnosis showed that there are 27 cases patients of benign tumor, 16 cases of malignant tumor (1 case of basal cell carcinoma, 3 cases of lymphoma, 6 cases of meibomian adenocarcinoma, 2 cases of squamous cell carcinoma, 3 cases of retinoblastoma, 1 case of melanoma). Based on the verification of ENOX2 protein results and pathological diagnosis results, we found and the ENOX2 positive rate of orbital malignancy tumor was 94% (3/3 in limphoma, 100%; 2/2 in squamous cell carcinoma, 100%; 6/6 in meibomian adenocarcinoma, 100%; 2/3 in retinoblastoma, 66.70%). The molecular features of ENOX2 protein in meibomian adenocarcinoma were discovered for the first time (molecular weight is 37 kDa, isoelectric point is 4.9). Conclusion ENOX2 protein can be used as a potential serum marker for the early diagnosis of orbital tumors and has certain specificity. (Ophthalmol CHN, 2020, 29: 401-405)

Ideological education research in ophthalmological resident standardized training

Chen Yan, Hu Jianyan, Tao Hangyang, Wu Qiang

2020, 29(5): 405-408. doi:10.13281/j.cnki.issn.1004-4469.2020.05.017

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Objective To explore the practical results and influencing factors of ideological education in ophthalmology standardization training. Design Retrospective teaching research and questionnaire. Participants A total of 57 doctors who were trained in the ophthalmology department of Shanghai Sixth People's Hospital from June 2010 to June 2019 were included in the study. Methods Questionnaire was used to evaluate the results and influencing factors of ideological education in ophthalmology standardization training. The questionnaire was divided into 6 problems and 5 main factors affecting ideological training. Each problem was divided into five grades with a score of 1-5. Main Outcome Measures Questionnaire score. Results 4.89 points for whether it helps to improve the ability to deal with the doctor-patient relationship; 3.04 points for facts of influencing the ideological teaching, 2.28 points for the hospital's development; 2.18 points for the diversification of the hospital's carrying out forms; 3.18 points for the number of trained doctors' participating; and 1.81 points for the difficulties in carrying out the course of ideological and political education. The results of the investigation on the 5 main factors affecting the effectiveness of ideological education in standardized training courses: 89.50% of them thought that the practice of ideological education was less; 82.50% thought that the overall quality of ideological education had a great influence on the teaching effect of ideological education; 17.50% thought that social facts had great influence; 57.90% thought that the leaders in hospital did not pay enough attention; only 3.5% thought that the existing methods of ideological teaching methods in the hospital were single. Conclusions The practice of ideological education is helpful to improve the humanistic quality of doctors and the ability to deal with the relationship between doctors and patients. The main factor affecting the effect of ideological education is the lack of practice and the overall quality of the overall quality of Ideological education teachers. （Ophthalmol CHN， 2020， 29： 405-408）

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