Volume 41 ·  Issue 07 ·  2005

The main purpose of strabismus treatment should be to change or restore the pathological state of eye movement and perception, and the goal of surgery should include eliminating diplopia and confused vision, so that not only the appearance and psychological state of patients can be improved, but also a considerable number of patients can restore binocular visual function, and some patients can expand the peripheral binocular visual field. The clinical examination should be in-depth and meticulous.Only when the visual axis deviation is corrected and the patient obtains binocular vision, the effect of strabismus treatment can be consolidated. (Chinese Journal of Ophthalmology, 2005, 41:577-580)

To analyze the possible reasons for the large difference in the cure rate of strabismus surgery in China, it is proposed that the clinical evaluation of the treatment effect of strabismus should start from the perspective of perceptual state and movement, strictly grasp the standardized evaluation standard of treatment effect, further specify and refine the evaluation standard of the cure for strabismus types with higher clinical incidence, and comprehensively consider the subjective satisfaction of patients. (Chinese Journal of Ophthalmology, 2005, 41: 581-582)

In the article "Study on multifocal electroretinogram in Amblyopic Patients" (hereinafter referred to as "multifocal Study on Amblyopia") published in the Chinese Journal of Ophthalmology, No. 10, 2004 (pp. 655-662), the authors measured the amplitude density and incubation period of the first-order and second-order responses of multifocal electroretinogram (mfERG) in 28 patients with anisometropic amblyopia, 25 patients with strabismic amblyopia and 14 patients with refractive error amblyopia, and compared them with those of normal children (30 patients, including 6 patients with monocular eye trauma) [1]. The conclusion was that "the mfERG of amblyopic patients was significantly changed, indicating that the retinal ganglion cells of amblyopic eyes were damaged, but the transmission of neural information was not prolonged [1]". In this study, the amplitude density of the second-order responses of mfERG in various amblyopic patients was not only reduced, but also the amplitude density of the first-order responses was lower than normal.

Objective to investigate the clinical characteristics, surgical methods and therapeutic effects of V-sign strabismus. Methods 63 patients with V-sign strabismus who underwent lower oblique muscle attenuation and conventional horizontal rectus muscle recession and/or shortening surgery were collected. The strabismus degree before and after surgery, the strabismus degree difference between upper and lower eye positions, the oblique muscle function and binocular vision function were retrospectively analyzed. The average follow-up time was 8.2 months. Results 62 patients (98.4%) with binocular or monocular lower oblique muscle hyperfunction (+2 or +3) underwent lower oblique muscle attenuation and conventional horizontal rectus muscle recession and/or shortening surgery; One patient was complicated with hyperfunction of lower oblique muscle in both eyes (+1), and only the horizontal rectus muscle was receded and shortened. The difference of strabismus between upper and lower eye positions was 25.6 △ 4.5 at the end of follow-up △ The preoperative horizontal strabismus of 48 patients with V sign of exotropia was 37.2 △ At the end of follow-up, it was (esotropy) 3.4 △ Among them, 38 cases (79.2%) had strabismus degree<±10; △ Preoperative horizontal strabismus was 50.6 in 15 patients with V sign of esotropia △ At the end of follow-up, it was (esotropy) 2.4 △ 11 cases (73.3%) had strabismus degree<10 △ The stereoscopic function was recovered in 21 cases (33.3%) after surgery. Conclusion V-sign strabismus patients are mostly complicated with inferior oblique muscle hyperfunction. Weakening inferior oblique muscle function can effectively correct V-sign strabismus, and conventional strabismus correction method can effectively correct horizontal strabismus; The stereoscopic function of patients recovered well after operation. (Chinese Journal of Ophthalmology, 2005, 41: 585-589)

Objective to investigate the stereoscopic vision of patients with acquired external rotational strabismus before and after superior oblique sagittal displacement. Methods the data of 14 patients with acquired external rotational strabismus who underwent superior oblique sagittal displacement were retrospectively summarized and analyzed, and the eye position, eye movement, rotational strabismus degree and binocular stereoscopic vision of patients before and after operation were compared. Results All patients complained of obvious diplopia of inferior rotational field before operation, and the visual effect was natural and clear after operation. After operation, the external rotation of the upper gaze disappeared, weakened or produced a little internal rotation (external rotation 4° ~ internal rotation 3°), the external rotation of the direct gaze was weakened (external rotation ≤8°), and the external rotation of the lower gaze was weakened (external rotation ≤14°). The difference in stereoscopic vision was statistically significant (P<0.05), from peripheral stereoscopy to macular stereoscopy to normal foveal stereoscopy (P<0.05). Conclusion the sagittal displacement of superior oblique muscle can be used to treat acquired external rotational strabismus with obvious symptoms of anterior and inferior rotational diplopia; The operation not only eliminates the symptoms of rotational diplopia, but also improves the stereoscopic vision function of patients to varying degrees. (Chinese Journal of Ophthalmology, 2005, 41: 590-593)

Objective to investigate the clinical phenotype and pathogenic genes of a family of congenital extensive extraocular muscular fibrosis syndrome (CFEOM). Methods Clinical examination, whole genome scanning and linkage analysis were performed on all patients in a family of CFEOM. Results 4 patients in this family had typical clinical manifestations of CFEOM. linkage analysis showed that microsatellite markers D12S1648, D12S345, D12S1692, D12S59, D12S1090, D12S2194, D12S1048, D12S1668 were co-segregated with the disease phenotypes of all patients in the family, and the maximum LOD was obtained at D12S1090 (2.12). Sequencing of KIf21A gene showed no mutation, but only a single base polymorphism was found in exon 21. Conclusion This family belongs to autosomal dominant CFEOM1, and the pathogenic gene is located in the region about 4 cM between the 12p11.2-q12 microsatellite markers D12S1648 and D12S1668 in the chromosome band. KIF21A gene may not be the pathogenic gene in this family. (Chinese Journal of Ophthalmology, 2005, 41: 594-599)

Objective to investigate the clinical manifestations and diagnostic methods of congenital extraocular muscle fibrosis syndrome (CFEOM) in families and sporadic cases.Methods the clinical characteristics of 6 families with CFEOM and 7 sporadic cases,including genetic characteristics,gender,age at first diagnose,clinical manifestations,ptosis characteristics,abnormal innervation were retrospectively summarized and analyzed.Results All 6 families with autosomal dominant heredity characteristics were extensive fibrosis syndrome.The involvement of inferior rectus muscle was the most obvious.Except one patient with single ocular involvement, all other patients had both ocular involvement; Among the 29 patients in the diseased family, 2 cases had no ptosis, 7 cases had no abnormal innervation symptoms, among the 7 sporadic patients, the ratio of male to female was 2: 5, 3 cases had monocular involvement; There were 3 cases of fixed esotropia, 3 cases of extensive fibrosis syndrome with lower rectus fibrosis, and 1 case of extensive fibrosis syndrome with superior rectus fibrosis; One case had unilateral ptosis, and four cases had no symptoms of ptosis; Conclusion CFEOM patients are rare in clinic, and the clinical manifestations are complex and diverse. Fully paying attention to and mastering the clinical characteristics and combining genetic analysis is the basis of correct clinical diagnosis. The current classification method is not perfect, and more in-depth research on its pathogenesis is needed. (Chinese Journal of Ophthalmology, 2005, 41: 600-605)

Objective to investigate the efficacy and safety of intravitreal injection of triamcinolone acetonide in the treatment of retinal detachment with choroidal detachment. Methods the patients with retinal detachment with choroidal detachment without effective treatment were selected. 0.1 ml (4 mg) of triamcinolone acetonide suspension was injected into the vitreous cavity through the flat part of the ciliary body before operation. After injection, the uveitis reaction and the disappearance of choroidal detachment were observed, and the retinal detachment reduction operation was performed 5~10 days later. Results The symptoms of 13 eyes with uveitis reaction were alleviated to varying degrees, and the detection rate of laceration increased from 2/13 eyes before injection to 7/13 eyes after injection. Most eyes with choroidal detachment disappeared within 10 days after injection. 5 eyes were treated with scleral buckling, 6 eyes were treated with vitrectomy combined with intraocular filling, and 2 patients abandoned surgical treatment. The average follow-up after surgery was 4.45 months, and the retinal reposition was finally completed in the patients undergoing surgery. Conclusion Intravitreal injection of triamcinolone acetonide can quickly, safely and effectively treat retinal detachment of choroidal detachment, alleviate the reaction of uveitis, and improve the operative reduction rate of retinal detachment of choroidal detachment. (Chinese Journal of Ophthalmology, 2005, 41: 606-609)

Objective to investigate the clinical characteristics of keratoconus. Methods the medical records of patients who underwent penetrating keratoplasty, superficial keratoplasty and deep lamellar keratoplasty in our hospital from January 1993 to March 2002 were retrospectively investigated. From January 2000 to March 2002, 233 patients with keratoconus visited our hospital, 216 male and 17 female. The family history, systemic complications, age of onset, changes of refractive status, disease course, changes of corneal topography, axial and anterior chamber depth were investigated. Results the clinical manifestations of the patients basically followed the pattern of myopia-astigmatism-refractive inability to correct-scar or acute cone. The average age of myopia was 13.8 years, of which 67.1% (147/219 cases) were 11-15 years old. 189 patients answered accurately from myopia to inability to correct (visual acuity<(0.1), 85.2% (161/189 cases) occurred within 6 years. Acute conus occurred in 47 cases in one eye, and corneal perforation occurred in 4.3% (2/47 cases) of acute keratoconus patients. Of the 34 patients with corneal stromal scar, 32 cases (94.1%) occurred within 8 years after the onset of the disease. The corneal topography showed that the corneal cone had a pattern of paracentric-gradually expanding to the periphery along the maximum axis of astigmatism-finally expanding along the minimum axis of astigmatism and moving towards the center. The average axial length of the patients was (25.9 ± 1.4) mm, and the average anterior chamber depth was (4.3 ± 0.3) mm. A-ultrasound measurement data of axial length of 311 eyes were found, of which 279 eyes (89.7%) had axial length>24 mm. The onset and degree of the disease in both eyes were different. 2 patients had Down syndrome, 2 patients had intellectual retardation. No patient with family history of keratoconus was found. Conclusion Keratoconus is closely related to axial myopia, and the anterior chamber depth of incubation period patients with keratoconus is deeper than that of normal patients.

Objective to investigate the effect of confocal microscopy on judging the outcome of fungal keratitis after treatment with antifungal drugs, and to provide objective basis for adjusting clinical medication and choosing treatment plans.Methods Among 328 patients with fungal keratitis diagnosed and treated in our hospital from January 2001 to May 2003, 58 eyes (58 eyes) with hyphae found by confocal microscopy and ulcer diameter ≤5 mm were routinely treated with antifungal drugs.Confocal microscopy was performed on specific sites of lesions before treatment, 7, 14, 28 days after treatment and 7 days after drug discontinuation, respectively, to observe the changes of local hyphae density, inflammatory cell density and morphology and corneal stromal cells, so as to judge the therapeutic effect and adjust the medication according to the situation; The patients whose mycelium and inflammatory cells were not detected by confocal microscope were completely discontinued after 1 week of consolidation therapy, and were followed up for 2 months to observe whether there was any recurrence of fungus. Results 53 patients were obviously improved after 7 days of drug treatment, and the lesions were reduced. Confocal microscope showed that the mycelium sites were reduced, the mycelium density was reduced, the inflammatory cells were significantly reduced, the morphology tended to be uniform, and the normal morphology of corneal stromal cells appeared. At 14 days, 37 cases of ulcer healed, 23 cases of confocal microscope showed no hyphae and inflammatory cells; At 28 d, the corneal epithelium of all patients was completely healed, and 22 cases still showed a small amount of hyphae or inflammatory cells in shallow stroma under confocal microscope, while the other 31 patients showed no hyphae or inflammatory cells. There was no recurrence in the above 53 patients during the follow-up period. In the other 5 cases, the disease aggravated within 7 d. Under confocal microscope, the hyphae density increased obviously, the inflammatory cells increased, and the corneal stroma destruction extended, which suggested that the effect of drug treatment was not good, so they were admitted to hospital for keratoplasty. Conclusion Confocal microscopy is an ideal means to judge the outcome of fungal keratitis after drug treatment, and can provide an objective basis for clinical adjustment of medication. (Chinese Journal of Ophthalmology, 2005, 41:614-619)

Objective to investigate the effect of latanoprost eye drops on the proliferation of human eyeball fascial sac fibroblasts cultured in vitro.Methods Human eyeball fascial sac fibroblasts were cultured in vitro.Latanoprost eye drops (0.005%) were diluted gradually at a ratio of 1:10, so that the drug concentration was 5.00, 0.50, 0.05 μ g/ml to 5×10-8 μ g/ml. The cell proliferation under different concentrations of drug was detected by thiazole blue colorimetry, and the morphological changes of the cells were observed under light microscope.Results Latanoprost eye drops in the higher concentration group (5.00 μ g/ml) had obvious killing effect on human eyeball fascial sac fibroblasts, almost all the cells died, and the absorbance (A) value decreased significantly compared with the control group (P<0.01); Compared with the control group (P>0.05), there was no significant difference in the dose-response curves of latanoprost eye drops at 24, 48 and 72 h (P>0.05). Conclusion Latanoprost eye drops could not promote the proliferation of human eyeball fascial sac fibroblasts cultured in vitro, and had cytotoxicity at higher concentration, but had no obvious effect on cell proliferation at lower concentration (Chinese Journal of Ophthalmology, 2005, 41: 620-624)

Objective to compare and observe the changes of retinal morphology and ultrastructure in rhesus monkeys with myopia induced by optical defocus and shape deprivation.Methods 15 healthy rhesus monkeys aged 1.0~1.5 months, one eye as experimental eye: wearing-3.00 D lenses (9 eyes) or scattering lenses (6 eyes) caused optical defocus or shape deprivation; The refractive state and axial changes of monkey eyes were observed by corneal topography, cycloplegic optometry and A-ultrasound at different times after treatment. The changes of retinal thickness were dynamically observed by coherence optical tomography (OCT) and compared with histological measurements; Three months later, the ultrastructural changes of retina in optical defocus, form deprivation myopia and control eyes were observed under light microscope and electron microscope. Results All the experimental eyes of 15 monkeys developed myopia. The retinas of optical defocus and form deprivation myopia showed that the outer segments of rods were longer, the membrane disc of cone was reduced, the membrane disc space was enlarged, and the retinal neuroepithelial layer was thinner than that of control eyes (all P<0.05); There was no statistically significant difference between the OCT measurements of retinal neuroepithelial layer and pigment epithelial layer thickness and the histological measurements after correction (P>0.05). Conclusion The ultrastructure of the retina in experimental myopia is significantly different from that in control eyes, but the ultrastructure changes of the retina in optical defocus and form deprivation myopia are very similar. The significance of this change in the occurrence and development of myopia needs to be further explored. (Chinese Journal of Ophthalmology, 2005, 41: 625-630)

Objective to investigate the protective effects of hypoxic preconditioning on photoreceptor cells of mice retina after light injury and to explore its possible gene regulation mechanism. Methods Fifty-four BALB/c mice were randomly divided into simple light irradiation group, hypoxia preconditioning group and normal control group. The first two groups of animals were continuously irradiated in a self-made light box for 3 h to make animal models of light damage. The changes of retinal tissue structure in each group were observed by light microscope and dUTP gap labeling mediated by nucleotide terminal transferase. The expression of c-fos and caspase-1 in mice retina was detected by immunohistochemistry. Results the histological changes of the retina appeared early and obviously in the light-exposed group, and the retinal pathological changes appeared to varying degrees after light-exposed, and the damage mainly occurred in the photoreceptor cell layer.With the prolongation of the time after light-exposed, the apoptosis number of photoreceptor cells increased, and the retinal photo-damage gradually aggravated, and the positive expression of c-fos and caspase-1 appeared to varying degrees in this layer; Compared with the light-exposed group, the damage of retinal photoreceptor cell layer was milder in the hypoxic preconditioning group, and the positive expression of caspase-1 was significantly reduced, while the c-fos was not significantly changed compared with the light-exposed group. In the normal control group, the retinal tissue structure was clear, the outer nuclear layer was arranged regularly, and there was no positive expression of c-fos and caspase-1. Conclusion Hypoxic preconditioning has a neuroprotective effect on photoreceptor cells by inhibiting the expression of apoptosis-related genes, and caspase-1 is involved in the protective mechanism of hypoxic preconditioning. (Chinese Journal of Ophthalmology, 2005, 41:631-635)

In the examination of eye movement in both eyes, it is difficult to determine the grading criteria of hyperfunction and deficiency of each extraocular muscle. The inconsistency of grading criteria directly leads to the lack of comparability of research results. The judgment of hyperfunction and deficiency of extraocular muscle is of great significance in the classification diagnosis of strabismus and the muscle selection during the design of surgery. For example, for patients with sign A exotropia, whether the superior oblique muscle is hyperactive and its degree is the key to decide the design and success of surgery. If the hyperfunction of superior oblique muscle is missed, the surgical effect will be poor; For patients with exotropia with insufficient internal rotation, if the insufficient internal rotation is ignored and the surgical method to strengthen the function of medial rectus is not adopted, the surgical effect will not be satisfactory.In combination with clinical work for many years, we have explored a set of relatively perfect grading methods to judge the degree of hyperfunction and insufficiency of six extraocular muscles in both eyes, for clinical reference and application, hoping to make the grading standards of hyperfunction and insufficiency of extraocular muscles standardized and unified, and continuously improve the level of diagnosis and treatment of strabismus in China.

Comrade Zhang Shufang, an outstanding member of the Communist Party of China, a representative of the 10th National Congress of the Communist Party of China, a famous medical expert in China, and a professor at Beijing Tongren Ophthalmology Center of Capital Medical University, died at the age of 85 at 9 a.m. on May 12, 2005 in Beijing due to ineffective treatment.

Keratoconus is a kind of non-inflammatory eye disease with corneal thinning and protrusion to form a conical shape [1]. There is no cell infiltration and little neovascularization. The clinical manifestations of keratoconus in the early stage are mainly myopia and irregular astigmatism, and corneal thinning, edema, scar, Fleischer ring and Vogt stripes can appear in the middle and late stage.

In the 1990s, foreign scholars applied MRI technique to the study of extraocular muscle, which brought the clinical understanding of extraocular muscle anatomy, eye movement and the etiology of strabismus into a new field. Miller [1] used MRI technique to study the walking of extraocular muscle in normal people, and found that the walking of extraocular muscle in the abdomen was stable relative to the orbit in different gaze positions, and thus put forward a new eye movement model, namely the extraocular muscle Pulley model.

A 54-year-old male was admitted to the hospital on April 22, 2003 due to distension and pain in his left eye, and visual acuity decreased for 1 year and aggravated for 7 days. Two years ago, the patient felt that dark shadow appeared in front of his left eye, but was not treated; One year ago, he felt pain in his left eye, and was diagnosed as glaucoma in the local hospital, and was treated with intravenous mannitol instillation. About half a year ago, B-ultrasound examination found space-occupying lesions in the left eyeball, which was treated with intraocular pressure lowering drugs. No abnormalities were found in the whole body examination. Eye examination: visual acuity in the right eye was 0.6, and no light perception in the left eye; Mild corneal edema in the left eye, pupil membrane closure, iris swelling, posterior adhesion, and lens opacity; The intraocular pressure was 16 mm Hg (1 mm Hg =0.133 kPa) in the right eye and 67 mm Hg in the left eye. Color Doppler flow imaging showed that a mass was found in the inner nasal side of the left eyeball, with a volume of 1.1 cm ×0.9 cm ×0.8 cm, with a moderately strong echo like a spherical mass, and an arterial blood flow signal was observed in the interval; Membranous echoes can be seen in the vitreous body, and blood flow signals can be displayed.

At present, in the field of cataract extraction surgery, viscoelastic agent is commonly called ophthalmic viscoelastic device (OVD) [1], and it has become an indispensable invisible tool in phacoemulsification cataract aspiration.The ideal viscoelastic agent should have many functions such as supporting the formation of sufficient anterior chamber space, improving the success rate of continuous linear annular capsulorhexis, assisting in tissue separation, keeping the pupil dilated, effectively stopping bleeding, isolating corneal endothelial cells from injury factors, providing implantation space for intraocular lens, and protecting lens capsule pocket, etc. The so-called viscoelastic agent technology is to give full play to its performance through flexible application of various viscoelastic agents with different physical and chemical properties, so that viscoelastic agent can become an important "soft instrument" to assist surgical operation and reduce eye tissue damage in modern high-level phacoemulsification cataract aspiration.