Volume 41 ·  Issue 06 ·  2005

This paper analyzes the development trend of refractive surgery, emphasizes the necessity of establishing the concept that refractive surgery is performed on healthy eyes, and considers that ensuring good visual quality is the prerequisite and goal of the safety and effectiveness of refractive surgery at present, and scientific measurement and effective prediction before operation are the basis of the safety and effectiveness of refractive surgery. It is suggested that further attention should be paid to the research of safety and effectiveness of refractive surgery.

The animal model of myopia is an important tool in myopia research, but there are many differences and controversies in animal selection and treatment methods.The selection of animal model of myopia can not only determine the success of experimental research, but also determine whether the experimental results are accurate and correct.Therefore, it is necessary to discuss several controversial issues in animal model of myopia, and put forward some opinions for reference only.

Objective to investigate the characteristics and influencing factors of the changes of the posterior corneal surface after excimer laser in situ keratomileusis (LASIK). Methods the curvature radius, irregularity coefficient and anterior chamber depth of the posterior corneal surface were observed by Orbscan Ⅱ in 61 myopic patients who underwent LASIK before and 1 week, 1 month and 3 months after surgery. The relationship between the anterior expansion of the posterior corneal surface and the influencing factors at 1 week after surgery was analyzed by multiple regression, and the difference of curvature radius of the best suitable spherical surface (PBFS) and the posterior corneal surface height difference (PED) were used as the indexes of anterior expansion of the posterior corneal surface. Results The anterior chamber depth before and 1 week, 1 month and 3 months after LASIK was (3.2448±0.2806), (3.2770±0.2810), (3.2579±0.2932) and (3.2651±0.2875) mm, respectively. The radii of curvature of PBFS were (6.5095 ± 0.2177), (6.3731 ± 0.2127), (6.4257 ± 0.2358) and (6.4354 ± 0.2266) mm, respectively; The irregularity coefficients in the range of 5.0 mm on the posterior corneal surface were 0.622 ± 0.142, 0.978 ± 0.244, 0.884 ± 0.207 and 0.881 ± 0.174, respectively, which increased significantly in each postoperative period compared with that before operation (P<Multiple regression analysis showed that the anterior expansion of the posterior corneal surface at 1 week postoperatively was positively correlated with the preoperative diopter (r =0.0173, P =0.005), and negatively correlated with the corneal thickness at 1 week postoperatively (r = -1.495, P =0.001). Conclusion LASIK corrected myopia directly changed the anterior corneal surface, and also caused the changes of the posterior corneal surface correspondingly. The posterior corneal surface became steep and irregular after operation, but did not develop gradually within 3 months.

Objective to investigate the similarities and differences between corneal epithelial hyperplasia and apoptosis of rabbits with 20% ethanol infiltration for 40 s and mechanical curettage of corneal epithelium in excimer laser subkeratomileusis (LASEK). Methods 42 New Zealand white rabbits were randomly divided into 7 groups, and the corneal epithelium was cut with 8 mm diameter LASEK special keratomileusis knife, 20% ethanol infiltration for 40 s, and the corneal epithelium with 8 mm diameter in the center of the opposite eye was mechanically curetted. Frozen corneal sections were examined by Ki-67 immunohistochemistry and TUNEL, and central anterior corneal stromal cells were counted. Results the central corneal epithelial hyperplasia reached the peak 5 d after ethanol infiltration, and the peripheral corneal epithelial hyperplasia reached the peak 1 d after operation. TUNEL staining of corneal stromal cells under the epithelial incision was positive at 4 h after operation, and the number was the most; There was no significant difference in the corneal central anterior stromal cell count and the blank control ratio between the groups (P =0.68). The peak of peripheral corneal epithelial proliferation reached 3 days after mechanical curettage of corneal epithelium, which was higher than that after ethanol infiltration; A large number of central anterior stromal cells were positive for TUNEL at 4 h after operation; The number of precentral stromal cells was minimal 1 d postoperatively (P<Conclusion Compared with mechanical curettage of corneal epithelium, 20% ethanol infiltration for 40 s has less corneal damage and faster recovery, and the corneal epithelium after ethanol infiltration has a protective effect on stromal cells.

Objective to investigate the effect of ethanol on corneal wound healing in excimer laser subkeratomileusis (LASEK). Methods Twenty-four healthy white rabbits (48 eyes) were divided into two groups, one eye was subjected to mechanical deepithelialization, and the other eye was subjected to 20% ethanol for 30 s to remove corneal epithelium. The same protocol was performed by excimer laser resection, and the normal control group was set up to observe the number and morphology of corneal cells in superficial corneal stroma; The expressions of transforming growth factor β 1 (TGF-β 1) and basic fibroblast growth factor (bFGF) were detected by RT-PCR and immunohistochemistry.Results the expressions of TGF-β 1 and bFGF in the cornea of the ethanol group and the mechanical group decreased compared with the normal control group by RT-PCR. At 1 week, the two groups increased compared with the normal control group (P<0.01), the ethanol group was higher than the mechanical group (P<0.01); The peak was reached 1 month after surgery (P<0.01), but the difference between the ethanol group and the mechanical group was not statistically significant (P>0.05); The RT-PCR products of TGF-β 1 and bFGF decreased significantly at 3 months after operation, and there was no significant difference between the two groups or compared with the normal control group (P>0.05). The correlation coefficients between the number of corneal cells in superficial stroma and TGF-β 1 and bFGF in the ethanol group were 0.744 and 0.738, respectively, and that in the mechanical group were 0.664 and 0.785, respectively. Conclusion The expression of TGF-β 1 and bFGF in the process of wound healing showed a dynamic process of "decrease-increase-normal"; 20% ethanol has a certain effect on corneal wound healing in the early stage of LASEK, but it is extremely short-lived, and it is relatively safe to be applied in operation.

Objective to evaluate the early postoperative complications and cost-effectiveness of non-penetrating trabeculectomy (NPTS). Methods the clinical data of 147 patients (215 eyes) with primary open-angle glaucoma after filtration surgery were retrospectively analyzed, including the visual acuity, intraocular pressure and complications in the early stage (during hospitalization), among which 104 eyes in the NPTS group and 111 eyes in the modified trabeculectomy (MT) group were analyzed. Results (1) Early visual acuity fluctuation: 25 eyes (24.0%) in the NPTS group and 26 eyes (23.4%) in the MT group with postoperative visual acuity decline of more than two lines, there was no statistically significant difference in visual acuity change between the two groups (P>0.05). (2) Early intraocular hypotension: 39 eyes (38.2%) in the NPTS group and 10 eyes (9.2%) in the MT group with intraocular pressure ≤5 mm Hg (1 mm Hg =0.133 kPa) on the first day after surgery, there was statistically significant difference between the two groups (P<0.01); The patients with intraocular pressure ≤5 mm Hg at the time of discharge were 18 eyes (27.5%) and 19 eyes (17.3%), respectively, and the difference between the two groups was statistically significant (P<0.05). (3) Anterior chamber bleeding: 20 eyes (19.2%) in NPTS group and 10 eyes (9.0%) in MT group; Two eyes in each group needed anterior chamber irrigation; There was a significant difference in the incidence of anterior chamber hemorrhage between the two groups (P<0.05). (4) Early shallow anterior chamber: 2 eyes had shallow anterior chamber of Ⅱ ° and 5 eyes had shallow anterior chamber of Ⅰ ° in NPTS group; In the MT group, there were 5 eyes with Ⅱ ° shallow anterior chamber and 5 eyes with Ⅰ ° shallow anterior chamber; There was no difference in the incidence of different degrees of shallow anterior chamber between the two groups (P>0.05). (5) Other complications: trabecular penetration in one eye in NPTS group was changed to trabeculectomy; Six eyes had dilated pupils after operation; Acute intraocular pressure increased in 1 eye; One eye had anterior iris adhesion of the inner filter; (6) Cost-effectiveness analysis: The absolute risk reduction rate (ARR) for adverse events in the NPTS group was 3.0%, and the number of cases needed to treat to prevent one adverse event (NNT) was 33.2, which cost 116,000 yuan more than that in the MT group; For serious adverse events, the absolute risk reduction rate of NPTS group =1.8%, NNT =55.5 cases, and the cost of NPTS group is 194,000 yuan more than that of MT group. Conclusion NPTS may play a certain role in reducing the occurrence of serious adverse events after anti-glaucoma surgery, but compared with MT, its cost in reducing complications is higher; Therefore, ophthalmologists in primary hospitals should focus on mastering MT operation techniques.

Objective to investigate the surgical technique and curative effect of intraocular lens posterior cataract in children treated with intraocular lens after intraocular lens implantation. Methods 51 cases (57 eyes) of intraocular lens implantation were treated with intraocular lens posterior cataract after intraocular lens implantation. Visual acuity, intraocular pressure and corneal endothelial cell density were recorded, and the occurrence of anterior chamber reaction and complications were observed. The average follow-up time was 30 months. Results A circular transparent area with a diameter of about 3~4 mm was formed in the center of posterior lens capsule in all eyes, and the success rate of posterior cataract resection was 100%. The anterior chamber was stable and the intraocular lens was not damaged. The best corrected visual acuity of patients who could cooperate with visual acuity examination after operation recovered to the best level before the occurrence of posterior cataract, and some patients exceeded the best level; Among them, 44.4% and 51.9% had the best corrected visual acuity ≥0.3 at 1 week and 3 months after surgery, respectively. During the follow-up period, there were no complications such as incision leakage, corneal edema, vitreous hernia in pupil area, intraocular lens injury, retinal detachment, intraocular hypertension and reopacity in the incision area of posterior lens capsule. Conclusion Transparent corneal incision cannula perfusion and posterior cataractectomy of ciliary body flat can treat posterior cataract after intraocular lens implantation in children safely, effectively and conveniently.

Objective to investigate the clinical characteristics, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS). Methods the patients with uveitis from January 1996 to June 2001 were examined in detail, the patients with lumbosacral pain history were examined by X-ray imaging of sacroiliac joint, and the diagnosis was made according to the New York AS diagnostic criteria revised in 1984. At the same time, the clinical observation and analysis of the uveitis associated with it were made. Results There were 44 patients with uveitis associated with AS, 41 males and 3 females. The onset age of uveitis was (33 ± 15) years old, and 34 cases with a history of uveitis>40 days, all of which had a history of uveitis recurrence; Among them, 18 cases (52.9%) had a recurrence interval of ≥1 year, and 23 cases (67.6%) had bilateral involvement, all of which showed acute non-granulomatous anterior uveitis; The duration of uveitis was (27 ± 12) d; Among them, 41 patients (93.2%) had a history of low back pain, and all of them were sacroiliitis by X-ray imaging; After treatment with glucocorticoid and cycloplegic ophthalmic solution, the best corrected visual acuity of 33 eyes (82.5%) out of 40 eyes was ≥1.0. Conclusion Uveitis associated with AS mostly occurs in men, showing acute, recurrent and non-granulomatous anterior uveitis, and the diagnosis can be confirmed according to typical clinical features and X-ray imaging changes; The main therapeutic methods were cycloplegic and glucocorticoid ophthalmic solution. Most patients had good prognosis.

Objective to investigate the related factors and preventive methods of infectious endophthalmitis after phacoemulsification cataract aspiration. Methods the data of 63 372 patients (84 497 eyes) who underwent phacoemulsification cataract aspiration and intraocular lens implantation in McGonagall ophthalmology centers in China from 1993 to 2003 were retrospectively analyzed. Results Infectious endophthalmitis was found in 14 eyes (0.02%), 11 eyes (78.6%) occurred before 1999, 5 eyes (35.7%) had posterior lens capsule rupture during operation, 11 eyes underwent aqueous humor and/or vitreous pathogenic examination, and 7 eyes (63.6%) had positive culture, including 3 eyes (42.8%) with Staphylococcus epidermidis, 1 eye (16.7%) with Pseudomonas aeruginosa, 1 eye (16.7%) with Bacillus, and 2 eyes (33.4%) with fungi (yeast and Candida albicans). Rupture of posterior lens capsule is one of the main risk factors of intraocular infection. Strict routine operation before, during and after operation can reduce the occurrence of postoperative infectious endophthalmitis.

Objective to investigate the type of gene mutation in Chinese patients with lattice corneal dystrophy (LCD). Methods Eight patients with LCD without systemic amyloid deposition from July to November 2002 were treated in our hospital. Whole blood leukocyte DNA was extracted from venous blood, and the target fragment of BIGH3 gene was amplified by polymerase chain reaction (PCR) technique, and the DNA was directly sequenced. At the same time, the slit lamp microscope was examined and the external ocular image of the slit lamp microscope was taken. The venous blood samples of 32 normal subjects were collected and tested as controls. Results The R124C mutation (417 base C→T) in exon 4 of BIGH3 gene was detected in 3 cases, which showed heterozygous, and the clinical manifestation was typical LCD type Ⅰ; H626R mutation in exon 14 (base A → G at position 1924) was detected in 5 other cases, which was also heterozygous. The clinical manifestation of this type was between LCDⅠ and LCDⅢ or ⅢA, and it was an intermediate type. Conclusion There are both R124C mutation and H626R mutation in Chinese LCD patients, so H626R mutation is not a unique type in Britain and France, but may also be a gene mutation type in Asian patients.

Objective to investigate the inhibitory effect of cationic liposome-mediated γ-interferon (IFN-γ) gene on the proliferation of human ocular fascial sac fibroblasts cultured in vitro.Methods The liposome-mediated method was used to transfect human ocular fascial sac fibroblasts cultured in vitro.The recombinant plasmid pcDNA3 was used as a control, and the resistant clones were screened and amplified by G418.The expression of IFN-γ gene was detected by RT-PCR,immunohistochemistry and indirect immunofluorescence assay by flow cytometry.The cell cycle analysis was performed by flow cytometry.The effect of IFN-γ gene on fibroblasts was detected by tetramethylazo salt assay.Results The fibroblasts transfected with pcDNA3 IFN-γ gene expressed IFN-γ gene at the level of transcription and protein, and the transfected IFN-γ gene can significantly inhibit the proliferation of human ocular fascial sac fibroblasts cultured in vitro.Conclusion The transfected IFN-γ gene can inhibit the proliferation of human ocular fascial sac fibroblasts.

Objective to investigate the expression of heat shock protein 27 (HSP27) in retinal ganglion cells (RGCs) of rat glaucoma model and its relationship with the corresponding antibodies in serum. Methods 49 Wistar rats were randomly divided into intraocular hypertension group (32 rats), sham control group (12 rats) and normal control group (5 rats). At least 3 groups of veins and perilimbal blood vessels on the sclera surface of rats were electrocoagulated to reduce the aqueous humor venous reflux, and the rat glaucoma model was established. The rats were sacrificed at 1, 2, 3, 4 and 8 weeks after operation, respectively. Before sacrifice, intraocular pressure was measured, and 2ml of blood was drawn for enzyme-linked immunosorbent assay to analyze the corresponding antibody levels in serum produced by HSP27 protein antigen in retinal tissue. At the same time, paraffin sections were performed on the retinal tissue of rats, and the expression and distribution of RGCsHSP27 were detected by immunohistochemistry, and the results were statistically analyzed. Results the intraocular pressure of right eye in the intraocular hypertension group increased significantly after operation, and the intraocular pressure was (27.52±6.63) mm Hg (1 mm Hg =0.133 After that, intraocular pressure was basically stable, and the intraocular pressure of the right eye in the hypertension group was significantly different from that in the preoperative and left eyes of the sham group (P<The titer of anti-HSP27 antibody in serum increased slowly at 1 week, reached a peak at 2 and 3 weeks after operation, and then gradually decreased to close to normal level. At 2 and 3 weeks after operation, the serum HSP27 antibody content in the intraocular hypertension group was significantly different from that in the sham control group and the normal control group (P<0.01 and P<The positive expression rate of HSP27 in RGCs was significantly different at all postoperative time points between right eyes and left eyes in the hypertension group, right eyes and left eyes in the sham control group and right eyes and left eyes in the normal control group (P<0.01). The positive expression of HSP27 in RGCs gradually increased with the increase of intraocular pressure and the prolongation of intraocular hypertension duration, and the positive expression of HSP27 also appeared in the retinal nerve fiber layer.

Since the first case of acquired immunodeficiency syndrome (AIDS) was diagnosed in 1981, the number of cases infected with human immunodeficiency virus (HIV) has been increasing continuously worldwide. HIV/AIDS is spreading at an alarming rate in China, so every medical worker including ophthalmologists must strengthen their understanding of HIV/AIDS. This article gives a comprehensive introduction to the ocular manifestations of HIV/AIDS, focusing on the manifestations and treatment of the posterior segment of HIV/AIDS, including HIV retinitis, opportunistic infections, rare tumors and neuroophthalmological manifestations; The clinical manifestations of the anterior segment of the eye, the characteristics of the ocular manifestations of HIV/AIDS in developing countries and the key points of prevention in ophthalmology clinical practice are briefly introduced.

Posterior chamber intraocular lens implantation in phakic eyes is an intraocular lens implantation on the basis of lens retention. It has the advantages of reversibility, retention adjustment and small damage. It has demonstrated its superiority in the correction of high myopia, hyperopia and astigmatism, and is a new method for the correction of refractive error. This article summarizes its safety and effectiveness in the correction of moderate and high myopia, in order to provide reference for clinical application.

Chinese Medical Association: On the occasion of the 90th anniversary of the founding of the Chinese Medical Association and the 23rd National Member Congress, I would like to express my warm congratulations to the Chinese Medical Association and my cordial condolences to the medical scientists and technicians all over the country! 　　

In vitreous surgery, proper illumination of surgical visual field is particularly important [1, 2]. Because of the particularity of intraocular anatomy, it is difficult for current illumination equipment to meet the proper requirements, especially when performing anterior vitreoretinal surgery. The limitation of illumination increases the iatrogenic damage to lens and retina during anterior vitreous surgery.

Eccentric cutting is an important reason for the decrease of visual quality after excimer laser refractive corneal surgery. We used wavefront-guided excimer laser in situ keratomileusis (LASIK) to correct it, and the good results were obtained.

excimer laser epithelial keratomileusis (LASEK) is a new surgical procedure for the treatment of myopia. It not only reduces the severe pain symptoms after excimer laser keratomileusis, but also reduces the incidence of haze under the corneal epithelium. At the same time, there are no complications related to excimer laser insitu keratomileusis (LASEK) corneal flap and interlaminar flap, especially for patients with thin cornea, high myopia, large pupil and other patients who are not suitable for LASEK. However, with the extensive clinical development of this operation, its complications have gradually attracted the attention of ophthalmology. From December 2002 to January 2004, 178 cases (347 eyes) of LASEK were performed in our hospital, and 3 cases (5 eyes) had severe delay in corneal epithelial healing after operation.

Retinal lipidemia is rare, and the pathogenesis is often accompanied by acute necrotizing pancreatitis, which has not been reported in domestic literature. The author has treated one case as follows.

The patient was a 58-year-old male who came to our hospital on March 21, 2003 due to the appearance of a mass under the skin after punching injury on the temporal side of the left orbit and gradually enlarged for 5 years. The whole body examination showed no abnormalities. Ocular examination showed that the corrected distance vision of the left eye was 0.8 and the near vision was J4. The mass was palpable under the skin on the temporal side of the left orbit with a volume of about 5 cm ×5 cm, which was hard in texture, connected to the orbital bone, inactive, irregular in surface, no adhesion to the skin, no tenderness, local redness, swelling, heat and pain, etc. There was no exophthalmos, ocular movement disorder, no diplopia (Figure 1). CT examination showed that the inferior skin boundary of the lateral orbital bone of the left eye was clear and homogeneous, with local bone resorption destruction (Figure 2). The admission diagnosis was: left orbital tumor (cholesterol granuloma to be examined). The left orbital tumor was removed under general anesthesia on March 25, 2003. During the operation, it was found that the subcutaneous mass on the temporal side of the left eye originated from the lateral and superior orbital bone, without obvious envelope, adhered to the surrounding tissues, and the local orbital bone was erosive and destroyed. The volume of the extracted tumor was about 2 cm ×2 cm ×3 cm, and the cut surface was fish-like.

Mucoepidermoid carcinoma is a common malignant tumor of salivary gland, which can also originate from esophagus, lung, upper respiratory tract, pancreas, prostate, thyroid, etc. [1]. Cases occurring in the eye are relatively rare, and there is no complete report of ocular mucoepidermoid carcinoma in China, and eyelid mucoepidermoid carcinoma is even rarer. One patient with eyelid mucoepidermoid carcinoma was admitted to our hospital, and the report is as follows.

Professor Zuo Keming, former director, chief physician and researcher of the Department of Ophthalmology of Beijing Hospital, died in the early morning of February 13th, 2005 at the age of 105.

At about 3 o'clock in the morning on April 11, 2005, Professor Miao Tianrong, an old man in the field of ophthalmology in China, Professor of Ophthalmology of Wenzhou Medical College, former Director of Ophthalmology Teaching and Research Department of Wenzhou Medical College, Ophthalmology Research Department of Wenzhou Medical College, and Director of Ophthalmology Department of the First Affiliated Hospital of Wenzhou Medical College, died at the age of 93 due to ineffective treatment.

photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK) and laser subepithelial keratomileusis (LASEK) have been carried out in China for many years. At present, there are more than 600 sets of excimer laser therapy instruments in China, and more than 1,000 doctors and technicians engaged in this operation. After the period of understanding, understanding and mastering, it has entered the development stage. The effectiveness, predictability and safety of treating refractive errors, especially for treating myopia and astigmatism have been confirmed.