Volume 41 ·  Issue 05 ·  2005

This issue focuses on the new progress in clinical and basic research of corneal diseases. In the 12th issue of 2004, the "Discussion on Standards and Norms" column of this journal published "Eye Bank Access Standard (Draft for Comment)", in order to standardize the work of eye banks in China and promote its healthy development. In order to promote ophthalmologists' understanding of this draft for comment, our journal invited Pan Zhiqiang and Zhang Wenhua to write an expert review of Standardizing the Construction of Eye Banks in China. Focusing on the present situation of eye banks at home and abroad, they analyzed the problems existing in the construction of eye banks in China, pointed out the urgency of establishing a formal, scientific and ethical eye bank system and the importance of strengthening the widespread social publicity of corneal donation. During the same period,

According to the present situation of eye banks at home and abroad, the problems existing in the construction of eye banks in China are analyzed, and the importance of reasonable and appropriate planning of eye banks construction, building eye banks network system and guaranteeing eye banks supply capacity is pointed out; At the same time, attention should be paid to the intermediate preservation of cornea, the safety of biological materials, and the widespread publicity of corneal donation. It is emphasized that the basic research on the preservation of eye bank materials should be strengthened.

The ocular surface toxicity caused by abuse of eye drops is often neglected. Its clinical manifestations are mostly non-specific, which is easy to be confused with ocular surface diseases caused by other causes. The pathogenesis of ocular surface toxicity caused by different eye drops is different. Clinical ophthalmologists should pay attention to the toxic effect of eye drops on ocular surface, and prevent and treat the toxic damage of eye drops on ocular surface.

Objective to investigate and analyze the present situation of eye bank construction in western China. Methods A questionnaire survey was conducted among ophthalmology branches and eye banks in Sichuan Province, Yunnan Province, Guizhou Province, Guangxi Zhuang Autonomous Region, Tibet Autonomous Region, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region, Qinghai Province, Xinjiang Uygur Autonomous Region, Inner Mongolia Autonomous Region and Chongqing City. The number of eye banks before March 2003, the equipment and cornea preservation methods of eye banks, the source of eye bank funds, technical personnel, the publicity activities of eye banks and the number of donated corneas obtained from January 1999 to March 2003, and the difficulties of eye banks were collected. Results The present situation of eye bank construction in western China is as follows: (1) Calculated by provinces, autonomous regions or municipalities directly under the central government, there are 8 eye banks in 6 provinces, autonomous regions or municipalities directly under the central government in western China, the average coverage rate of eye banks is 50%, and there are 2 eye banks in Chongqing and Shaanxi provinces, Sichuan Province, Yunnan Province, Gansu Province and Xinjiang Uygur Autonomous Region each have one eye bank. The other six provinces or autonomous regions have not established eye banks. (2) Each eye bank has equipment: ultra-clean workbench, slit lamp microscope, refrigerator and liquid nitrogen tank. Eight eye banks are equipped with 5 corneal endothelial microscopes and 6 computers. The active preservation methods of corneal endothelium are wet room and mid-term preservation solution, and the inactive preservation methods are glycerol dehydration or cryogenic whole eyeball refrigeration. (3) The funding sources of eye banks include government, hospital and international Orbis organization. (4) Eye bank technicians: Chongqing Eye Bank and Xi'an Eye Bank each have 2 full-time personnel, Sichuan Eye Bank, Third Military Medical University Eye Bank and Xi'an Jiaotong University Second Affiliated Hospital Eye Bank each have 1 full-time technician, PLA 474th Hospital Eye Bank, Western Gansu Eye Bank and Yunnan Central Eye Bank each have 1 or 2 part-time technicians. (5) From January 1999 to March 2003, A total of 42 publicity activities were carried out in 8 eye banks, and 156 corneas were donated, of which 126 were used in clinical practice. (6) The existing difficulties of eye banks: lack of corneal donation materials, lack of technical exchange and cooperation between eye banks, insufficient funds for diagnosis and treatment of patients, etc. Conclusion The present situation of eye bank construction in western China lags behind that in eastern China, southern China and central China, and the distribution and development of eye banks in western China are uneven.

Objective to investigate the clinical efficacy of penetrating keratoplasty (PK) combined with circular allograft limbal transplantation (KLAT) in the treatment of leukoplakia with limbal stem cell decompensation after severe corneal burn (stable phase). Methods From January 1999 to December 2001, 34 patients (35 eyes) with stable severe corneal burns were diagnosed and treated in Shandong Ophthalmology Institute and Qingdao Eye Hospital. The average course of disease was 2.8 years. The quadrant of corneal neovascularization was greater than 3/4, the diameter of the central full-thickness opacity area of the cornea was greater than 6 mm, and the preoperative visual acuity was between photosensitivity/1 m ~ several fingers/30 cm. 16 cases (16 eyes) in Group B underwent anterior segment reconstruction (total corneal transplantation with limbus). Postoperatively, systemic and local immunosuppressive agents were applied, and postoperative visual acuity, immune rejection and complications were observed. Results the follow-up time was 15~28 months, with an average of 24 months. (1) Visual acuity: 6 months after operation, the blind literacy rates of group A and group B were 95% and 88%, respectively (P =0.582); 84% and 38% at 12 months postoperatively (P =0.006); (2) Immune rejection: 9 eyes (47%) and 8 eyes (50%) of limbal stem cell (LSC) rejection in groups A and B, respectively (P =1.000); Graft endothelial immune rejection was found in 6 eyes (32%) and 11 eyes (69%) respectively (P =0.044). There was no significant difference in endothelial rejection between the two groups in different time periods (P>0.05). (3) Postoperative complications: corneal epithelial defect in 2 eyes (11%) in group A and 7 eyes (44%) in group B (P =0.049); 2 eyes (11%) in group A and 8 eyes (50%) in group B with hyphema (P =0.022); One eye (5%) in group A and six eyes (38%) in group B had postoperative low intraocular tension (P =0.032). Conclusion PK combined with KLAT is an effective method for the treatment of severe corneal burn. It can treat corneal leukoplakia and LSC decompensation simultaneously, with less postoperative complications and better long-term prognosis than anterior segment reconstruction.

Objective to investigate the possibility of using telomerase as a marker of limbal stem cells.Methods Telomere repeat amplification (TRAP) method was used to qualitatively analyze the telomerase activity of limbal and central hyaline corneal epithelial cells in 8 New Zealand white rabbits (8 eyes), and bioluminescence technique was used to quantitatively analyze the telomerase activity of limbal and central hyaline corneal epithelial cells. The mean bioluminescence value of limbal epithelial cells was 165 575, and the expression of telomerase was positive, and the difference between them was statistically significant (P =0.001). The mean bioluminescence value of limbal epithelial cells in the 5-Fu injection group was 185 396, and the mean bioluminescence value of limbal epithelial cells in the non-5-FU injection group was 145 754, and the difference between them was statistically significant (P =0.02). The bioluminescence value of positive control group was 210 832, and the bioluminescence value of negative control group was 34 793. Conclusion The positive expression of telomerase in limbal epithelial cells and the negative expression of clear corneal epithelial cells indicated that there were stem cells with strong proliferation ability in the limbus, and telomerase may be a marker of corneal stem cells.

Objective to investigate the expression levels of cytokines secreted by CD4+ T helper cell type 1 (Th1) and T helper cell type 2 (Th2) in the corneal tissue of recurrent herpes simplex stromal keratitis (HSK) in mice and its relationship with recurrent HSK. Methods BALB/c mouse model of recurrent HSK was prepared, and the cornea of mice was irradiated with ultraviolet B light to induce the recurrence of HSK. The expression levels of Th1-type cytokines (IFN-γ, IL-12) and Th2-type cytokines (IL-4, IL-10) were detected by reverse transcription polymerase chain reaction (RT-PCR) before UV irradiation and on the 3rd, 7th, 10th, 14th, 21st and 28th days after UV irradiation. Results the corneal stromal turbidity reached its peak at 7-14 days after UV irradiation. During this period, IFN-γ, IL-12, IL-10 and IL-4 mRNA were expressed in corneal tissues. Among them, IFN-γ and IL-10 were highly expressed during the occurrence and development of clinical diseases (3~14 days after virus activation), and their expression was weakened during the recovery period (14 days after), which was closely related to the degree of corneal stromal opacity; IL-12 is the most abundant cytokine in corneal tissue, and its high expression begins on the third day after virus activation, and the high expression lasts throughout the whole observation period; Conclusion In the early stage of recurrent HSK corneal injury, the expression of Th1-type cytokine and Th2-type cytokine in the corneal tissue is simultaneously related to the immune memory of T cells. The expression trend of IL-10 is parallel to that of IFN-γ, and its expression level is closely related to the disease degree of HSK. It is impossible to strictly distinguish whether the recurrent HSK is mediated by Th1 cells or Th2 cells.

Objective to investigate the clinical effect of acellular dermis in the treatment of eyelid defects. Methods 10 cases of eyelid defects (11 eyelids) were treated from November 2001 to November 2002, including 8 cases of upper eyelid, 1 case of lower eyelid and 1 case of upper and lower eyelid of ipsilateral eyes; 9 cases were caused by trauma, and 1 case was caused by congenital defect; 2 eyelids were completely defected, 8 eyelids were 2/3 defected, and 1 eyelid was 1/3 defected. Commercial allogeneic acellular dermis with a thickness of 1 mm was used to replace tarsal plate, and eyelid defects were treated by in situ reconstruction. The average follow-up observation was 8 months. Results After acellular dermis was implanted, the inflammatory reaction was slight, and there was no implant detachment or infection. The recipient conjunctiva could crawl and grow on the surface of acellular dermis. Histological examination showed that there were new capillaries and fibroblasts in the acellular dermal grafts six months after operation. According to the treatment criteria, 8 eyelids were excellent, 2 eyelids were good, and 1 eyelid was improved, with a cure rate of 91%. Conclusion Acellular dermis can not only replace tarsal plate in supporting role, but also cause mild immune and inflammatory reactions after operation, and can be used as a biological scaffold to guide the growth of recipient neovascularization and collagen fibers.

Objective to investigate the clinical characteristics and prognosis of patients with primary retinitis pigmentosa (RP) complicated with retinal vascular occlusion. Methods the clinical data of 18 patients (36 eyes) with primary retinitis pigmentosa (RP) complicated with retinal vascular occlusion were retrospectively analyzed, including fundus examination, fluorescein fundus angiography, indocyanide green angiography, electroretinogram and visual evoked potential. The clinical manifestations of 3 patients with primary RP complicated with retinal vascular occlusion were papillary atrophy, retinal vascular thinning and extensive retinal pigment epithelial atrophy. The electroretinogram examination showed that the A and b waves were waveless or nearly waveless. Most of the patients had a history of night blindness, which was in line with the clinical manifestations of primary RP and had the characteristics of vascular occlusion, such as complete or nearly complete occlusion of blood vessels in late stage, obvious atrophy of optic nerve and involvement of choroidal blood vessels. The final blindness rate was faster than that of primary RP, and there was no effective therapy. Conclusion Primary RP complicated with retinal vascular occlusion may belong to the category of blanket retinal degeneration, and progressive vascular occlusion may be its clinical manifestation.

Methods HXO-Rb-44 cell line was inoculated subcutaneously into the hind legs of nude mice. Immunohistochemical staining method was used to detect the types, numbers, distribution and intensity of positive staining cells for pro-angiogenic factors (VEGF-A, VEGF-C, VEGF-D), basic fibroblast growth factor (bFGF), vascular endothelial membrane tyrosine kinase receptor (Flt-1, Flk-1, Flt-4, Tie2 and FGFR), transcriptional regulator Hif-1, MMP-2, MMP-7, MMP-9 and matrix metalloproteinase inhibitors TIMP-1 and TIMP-2 which promote or inhibit the degradation of extracellular matrix in RB tumors. Results There were abundant capillaries and small blood vessels in RB tumors, some tumor cells were positive for Hif-1 staining, most tumor cells expressed high level of VEGF, especially VEGF-D, and vascular endothelial cells expressed Flt- Conclusion VEGF signaling pathway, up-regulation of MMP expression and down-regulation of TIMP expression play an important role in the neovascularization of RB tumors, and can be considered as a target for the treatment of RB.

Objective to investigate the effect of somatostatin analogue octreotide on retinal neovascularization and its therapeutic effect.Methods 40 mice aged 7 days were randomly divided into 5 groups, 8 mice in each group.The normal control group was kept in normal air environment without any treatment; The other four groups were kept in oxygen chamber. The experimental group was injected with octreotide 20 and 50 μ g*kg-1*d-1 subcutaneously, the experimental control group was injected with equal amount of PBS subcutaneously for 5 days, and the hyperoxic group was not injected with octreotide. The mice aged 17 days were sacrificed, and the eyeballs were removed to make specimens, and histopathological and electron microscopic observations were performed. The number of vascular endothelial nuclei that broke through the inner limiting membrane of retina was observed and counted under light microscope. The expression of somatostatin receptor 2 (SSTR2) on retina was detected by in situ hybridization. The ultrastructural changes of retina were observed under electron microscope. Results There were almost no vascular endothelial nuclei that broke through the inner limiting membrane in the normal control group by HE staining, but there were more vascular endothelial nuclei that broke through the inner limiting membrane in the hyperoxic group and the experimental control group, but the number of vascular endothelial nuclei that broke through the inner limiting membrane in the experimental group was significantly less than that in the hyperoxic group and the experimental control group Among them, the expression of high-dose experimental group was weaker than that of low-dose experimental group.Under electron microscope, hypoxia caused the destruction of visual cell layer in mice retina, and the damage of retinal ultrastructure was improved obviously after octreotide treatment. Conclusion Octreotide can effectively inhibit the formation of retinal neovascularization and prevent the damage of retinal ultrastructure caused by hypoxia to some extent.

Objective to investigate the molecular mechanism of retinal cell apoptosis and the therapeutic effect of Caspase 3 inhibitor Ac-DEVD-CHO in chicken myopia. Methods A chicken myopia model was established by eyelid suture. After intravitreal injection of Ac-DEVD-CHO, the retinal retinal cell apoptosis was detected by electron microscope, terminal deoxyribonucleotide ligase-mediated biotinylated deoxyuridinate terminal labeling (TUNEL) and flow cytometry. The expression and activity of Caspase 3 protein in retina were analyzed by immunohistochemistry, flow cytometry and color sensitivity colorimetry. Results After 12 weeks of eyelid suture, the diopter of the sutured eyes was deeper and the outer diameter of the eyeball increased compared with the control eyes. The lacquer crack-like fundus changes appeared in the sutured eyes (the incidence rate was 45.56%), and apoptotic cells were found in the inner and outer nucleus of the retina of the sutured eyes, the apoptosis rate was higher than that of the control eyes (P<After intravitreal injection of Ac-DEVD-CHO, the apoptosis rate, Caspase 3 protein and its activity of retinal cells in sutured eyes decreased, and the inhibitory effect of Ac-DEVD-CHO on retinal apoptosis increased with the increase of dose.Conclusion Caspase 3 plays an important role in the apoptosis of retinal cells in chicken myopia, and Ac-DEVD-CHO can effectively inhibit the apoptosis of retinal cells by blocking the action of Caspase 3.

Objective to investigate the effect of recombinant human erythropoietin (rHEPO) on the blood retinal barrier of mice and its protective effect on retinal photodinjury. Methods 24 BALB/c mice were injected with rHEPO intraperitoneally, and the content of erythropoietin (EPO) in the retina of mice was detected by enzyme-linked immunosorbent assay (ELISA). Twenty-four BALB/c mice were treated with light injury, and the changes of retinal cells in the experimental group (12 mice, injected with rHEPO) and the control group (12 mice, injected with normal saline) were observed by light microscopy and dUTP gap labeling (TUNEL). Results the contents of EPO in 100 μ g of retinal protein were (0.68±0.24), (1.87±0.37), (0.96±0.24) and (0.47±0.13) mU at 2, 4, 6 and 8 h after intraperitoneal injection of rHEPO, respectively (F =2.113, P<The concentration of EPO in the retina reached its peak 4 h after intraperitoneal injection of drugs. With the prolongation of light exposure time, the damage of the inner and outer segments of retinal rod cells in the control group was significantly aggravated under light microscope, and the outer nuclear layer gradually became thinner, and nuclear pyknosis and even nuclear fragmentation appeared; In the experimental group, the injury changes were slight at each observation time point, only the inner and outer segments of photoreceptor cells were disordered, and vacuoles were formed, and the cells in the outer nucleus layer were disordered, but the thickness of the cells in the outer nucleus layer was not obviously changed. There were only a few apoptotic cells in the outer retinal nucleus in the experimental group, but the number of apoptotic cells decreased significantly at 72 hours after light irradiation, and there were almost no apoptotic cells at 7 days after light irradiation. The number of apoptotic cells in the outer retinal nucleus in the experimental group was statistically significant compared with that in the control group (P<Conclusion rHEPO can pass through the blood retinal barrier of mice, and it has a protective effect on retinal light damage of mice. rHEPO is expected to be used for the treatment of retinal degenerative diseases.

Non-tuberculous mycobacteria (NTM) are one of the main pathogenic microorganisms causing postoperative infectious keratitis, among which Mycobacterium chelonae and Mycobacterium fortuitosum are the most common. The onset of NTM keratitis after LASIK is slow, there are no specific symptoms in the early stage, and eye pain and visual acuity decrease appear with the development of the disease. The typical clinical signs are multifocal spot-like infiltration of corneal stroma, and in severe cases, subvalvular abscess and corneal flap necrosis may appear. For infiltrative lesions in cornea or crystalline keratopathy under corneal flap 2~3 weeks after LASIK, NTM keratitis should be highly suspected, and its etiological diagnosis should rely on laboratory examination. The treatment methods of NTM keratitis after LASIK include drug therapy, irrigation under corneal flap and surgical treatment. The principle of treatment is: combining drug therapy with surgical treatment, Local therapy is combined with systemic therapy. At present, the most commonly used antibiotics are amikacin, clarithromycin and fluoroquinolone antibiotics.

In order to reflect the innovative scientific research achievements and clinical experience of ophthalmology in China as soon as possible, this journal has opened up a "fast track" to publish excellent academic papers in 2002, simplifying the procedure from review to official publication of papers, and shortening the publication cycle. In view of the increasing number of authors applying for the "fast track" at present, the editorial board of this journal has supplemented and improved the specific conditions for applying for the "fast track" on the basis of the operation of some time ago, and reiterated the relevant regulations of the "fast track" once again, so that academic papers with innovative content can be published as soon as possible.

Since the copyright law of our country was promulgated, it has been paid widespread attention by all circles of society. As a medical scientific and technological journal, the copyright law must be implemented to the letter. Therefore, the relevant requirements of this journal for author's signature and thanks are reiterated as follows.

The First Affiliated People's Hospital of Shanghai Jiaotong University will hold the "National Symposium on Retinal Detachment and Diabetic Retinopathy and New Ophthalmology Technology Application and Continuing Medical Education Study Class" in Shanghai in early July 2005. Nationally renowned experts will be invited to teach during the course. Main content: (1) Recent progress in vitreoretinal surgery; (2) surgical treatment of retinal detachment; (3) Pathological characteristics, grading and surgical progress of diabetic retinopathy; (4) the concept and application of integrated Chinese and Western medicine treatment in ophthalmology; (5) New progress in the treatment of uveitis, strabismus and complex cataract; (6) Ophthalmic epidemiological research, ophthalmic research design and thesis writing; (7) photodynamic therapy,

The 2005 Continuing Education Program "Progress in Ocular Plastic Surgery" will be held from May 30 to June 5, 2005 in the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, sponsored by the Department of Ophthalmology, the Ninth People's Hospital affiliated to Shanghai Second Medical University, and will recruit students from all over the country. In the past 30 years, the Department of Ophthalmology of the Ninth People's Hospital affiliated to Shanghai Second Medical University has been committed to clinical research on eye plastic surgery and eye cosmetic surgery, including eye cosmetic surgery, blepharoplasty, canthoplasty, eye socket reconstruction, eye seat implantation, ocular surface reconstruction, orbital fracture repair and reconstruction, congenital orbital deformity repair and orbital decompression, and has achieved good clinical results.

In 2005, compound tobramycin dexamethasone eye drops and eye ointment (Dianbisu), one of the first postoperative anti-inflammatory and infection prevention drugs promoted by Alcon (China) Company, has been used in ophthalmology clinical practice in China for 10 years. In order to thank ophthalmologists across the country for their long-term attention and support, Alcon (China) Company will hold the award-winning activity of "Looking for Special Witnesses". Activities: (1) Collect photos and items related to Dian Bishu from ophthalmologists across the country (such as photos, souvenirs,

In order to improve the level of clinical ophthalmologists and technicians in microcomputer visual field detection and reading, as well as the diagnosis level of glaucoma and various eye diseases, and to promote the in-depth development of ophthalmology, the editorial board of Chinese Journal of Ophthalmology decided to hold a modern microcomputer visual field detection and reading class in Shenzhen, Guangdong Province from December 20 to 26, 2005. Visual acuity (visual acuity) and visual field are the two most important aspects of visual function, and the visual field measures visual function outside the macular region. Since the 1970s, the advent, development and application of computer automatic visual field meter have significantly improved the sensitivity of visual field examination,

A 89-year-old female was admitted to our hospital on May 13, 2004 due to a painless and gradually enlarged mass on the upper eyelid of her left eye for 1 year. One year ago, the patient consciously felt a small mass on the upper eyelid of her left eye and gradually enlarged without pain.

Patients with neurofibromatosis type Ⅰ are more common in clinic, while patients with type Ⅱ are very rare, and there are few reports in China.We treated 4 patients with neurofibromatosis type Ⅱ complicated with orbital tumor in clinical work, and the reports are as follows.

Progressive systemic sclerosis, previously known as scleroderma, is a systemic connective tissue disease with frequent ocular involvement, which may have different clinical manifestations [1], but optic nerve atrophy is rare. We treated a patient with systemic sclerosis in 2003. During the progression of the disease, progressive binocular visual acuity decrease and optic nerve atrophy occurred. The report is as follows.

Blind keratopathy is often accompanied by corneal neovascularization, which seriously affects visual acuity and is very difficult to treat.Studies have shown that various pro-angiogenic factors such as vascular endothelial growth factor (VEGF) and interleukin-1 (IL-1) are regulated by nuclear factor kappa B (NF-κ B) [1]. By establishing a rat model of corneal neovascularization, we investigated the role and mechanism of NF-κ B in corneal neovascularization.