Volume 41 ·  Issue 09 ·  2005

The pathogenesis, basic and clinical research status of thyroid-associated ophthalmopathy (TAO) were briefly expounded. It was pointed out that TAO is a common and complex autoimmune orbital disease closely related to thyroid gland, and its research is not perfect, so it needs to be further explored.

Objective to investigate the changes of visual acuity, intraocular pressure, visual field and central retinal artery blood flow velocity in patients with restrictive strabismus caused by thyroid-associated ophthalmopathy (TAO) after extraocular muscle retrogression release. Methods 17 patients (20 eyes) with restrictive strabismus caused by TAO were diagnosed and treated in the Department of Ophthalmology of Peking Union Medical College Hospital from January 2002 to January 2004. Among them, 1 case underwent superior rectus tendinotomy, 1 case underwent superior rectus suspension, 1 case underwent right inferior rectus retrogression combined with left superior rectus retrogression, and 14 cases (17 eyes) underwent inferior rectus retrogression. Results the visual acuity of 5 eyes improved ≥2 lines after operation, and the preoperative visual acuity was maintained in 15 eyes; There were significant differences between intraocular pressure and average visual field defects before and after surgery (P<0.01); Comparison of blood flow parameters of central retinal artery before and after operation: peak systolic blood flow velocity (PSV), end diastolic blood flow velocity (EDV) increased and resistance index (RI) decreased after operation (P<Conclusion TAO-induced restrictive strabismus can not only eliminate diplopia, improve eye movement, but also improve visual acuity, relieve intraocular pressure, and improve the velocity of blood flow in the visual field and central retinal artery.

Objective to explore the clinical indications and efficacy of eyelid suture in the treatment of severe thyroid-related ophthalmopathy. Methods Seventeen patients with exposed keratitis and corneal ulcer caused by thyroid-related ophthalmopathy which could not be treated with orbital decompression or glucocorticoid were selected from January 1990 to June 2004 and 24 patients with eyelid insufficiency after orbital decompression or orbital radiotherapy. Among them, 9 patients underwent temporary lateral eyelid suture and 32 patients underwent temporary total eyelid suture. According to the different degree of ocular inflammatory reaction, 35 patients received oral prednisone 30~50 mg/d, and the dose was gradually reduced after 7 days until the drug was stopped. The clinical efficacy was observed by cutting and suturing 1~5 months after operation. Results Seventeen patients with exposed keratitis and corneal ulcer were treated with eyelid suture and glucocorticoid. After cutting and suturing gradually 2~5 months after operation, the eyelids were completely closed, the keratitis and corneal ulcer were cured, and the visual acuity increased from 0.5 to 0.06 to 0.8 after operation. The difference of visual acuity before and after operation was statistically significant (F =18.33, P<0.05); There were 11 cases of residual corneal clouds. 24 patients with incomplete eyelid closure after orbital decompression or orbital radiotherapy were treated with eyelid suture and glucocorticoid. After 1~3 months after operation, eyelid closure was completed and keratitis was cured. The visual acuity increased from 0.1~0.7 before operation to 0.4~1.2 after operation. The difference of visual acuity before and after operation was statistically significant (F =27.98, P<The visual acuity of 9 patients undergoing temporary lateral eyelid suture increased from 0.1~0.8 before operation to 0.4~1.2 after operation, and the difference of visual acuity before and after operation was statistically significant (F =38.45, P<The visual acuity of 32 patients undergoing temporary total eyelid suture increased from 0.5 to 0.06 to 0.8 after operation, and the difference of visual acuity before and after operation was statistically significant (F =14.23, P<0.05). Conclusion Eyelid suture is a good method for the treatment of exposure keratitis and corneal ulcer complications caused by eyelid insufficiency in thyroid-related ophthalmopathy.

Objective to investigate the clinical efficacy of high-dose prednisone regimen and cyclophosphamide-vincristine-prednisone (COP) regimen in the treatment of thyroid-related ophthalmopathy (TAO). Methods Twenty-seven patients with thyroid-related ophthalmopathy diagnosed in the Department of Ophthalmology of Peking Union Medical College Hospital from August 2000 to July 2003 were selected and divided into two groups with reference to the severity of their disease and their compliance with chemotherapy drugs, 13 cases in the prednisone group and 14 cases in the COP group. There was no significant difference in sex composition and age between the two groups (P>0.05). The clinical activity scores (CAS), disease severity, extraocular muscle thickness and 24-h urine glycosaminoglycan (GAG) were compared between the two groups before and after treatment, and the clinical efficacy was analyzed. Results The CAS scores before and after treatment were 6.5±1.6 and 1.9±1.3 in the COP group and 4.4±1.8 and 1.6±1.1 in the prednisone group, respectively. The CAS scores before treatment were significantly higher in the COP group than in the prednisone group (P<0.001), the differences between the two groups before and after treatment were statistically significant (P<The thickness of extraocular muscles before and after treatment in COP group was (6.8±1.7) mm and (5.3±1.1) mm, respectively; (6.5±1.5) mm and (5.8±1.1) mm in the prednisone group; The differences between the two groups before and after treatment were statistically significant (P<Extraocular muscle thickness decreased (22.4±4.4) % and (13.3±4.6) % in COP group and prednisone group after treatment, respectively, and the difference between the groups was statistically significant (P<The 24-h urinary GAG levels before and after treatment were (40.6±10.1) mg/24 h and (15.7±5.1) mg/24 h in the COP group (7 cases) and (33.6±6.6) mg/24 h and (16.7±2.5) mg/24 h in the prednisone group (5 cases), respectively. The differences within the groups were statistically significant (P<Conclusion Both high-dose prednisone regimen and COP regimen are effective regimens for the treatment of TAO. Statistical analysis showed that COP regimen is more effective than prednisone regimen, suggesting that COP regimen may be suitable for the treatment of patients with high activity and severe disease of TAO.

Objective to investigate the relationship between the-863C/A polymorphism of the promoter region of tumor necrosis factor α (TNF-α) gene and thyroid-associated ophthalmopathy (TAO). Methods TNF-α gene-863C/A polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 76 normal controls (control group), 54 patients with TAO (TAO group) and 60 patients with autoimmune thyroid disease (AITD) without ophthalmopathy (no ophthalmopathy group). The genotypes and allele frequencies of this polymorphism were analyzed and compared in different populations. Results (1) The frequencies of CA + AA genotypes and A allele were 46.3%, 30.0% and 25.0%,respectively in TAO group, no ophthalmopathy group and control group. (2) The frequencies of A allele in TAO group were significantly higher than those in no ophthalmopathy group and control group (P =0.018,P =0.002). (3) After sex stratification, the genotypes of CA + AA and A allele in male patients in TAO group were significantly higher than those in no ophthalmopathy group and control group (P =0.018,P =0.002) (4) The frequencies of CA + AA genotype and A allele in patients with ATA grade 5+6 ophthalmopathy in TAO group were significantly higher than those in patients without ophthalmopathy group (OR =20.68, P =0.021; OR =39.67, P<Conclusion TNF-α gene promoter region-863 A allele may be a susceptible gene for TAO, especially in male patients with TAO.

Objective to investigate the effect of fresh donor limbal lamellar keratoplasty (LKP) combined with autologous bulbar conjunctiva transplantation with limbal stem cells and amniotic membrane transplantation on ocular surface reconstruction of severe symblepharon after ocular burn. Methods 26 patients (26 eyes) with severe symblepharon after ocular burn were treated in our hospital from February 1998 to February 2003. According to the degree of visual impairment, symblepharon was divided into 4 degrees, including 19 eyes with degree III and 7 eyes with degree IV. (2) partial LKP (19 eyes) or whole LKP (7 eyes) with corneal limbus using fresh donors; (3) Transplanting the autologous bulbar conjunctival flap with limbal tissue into the wound with the heaviest adhesion; (4) Pseudopterygium migrated, partially replaced bulbar conjunctiva, combined with amniotic membrane transplantation to reconstruct conjunctival sac. Follow-up for 8~36 months, the condition of conjunctival sac, eye movement, immune rejection of corneal graft and the outcome of amniotic membrane and pseudopterygium were observed. Results the ocular surface of the other 25 eyes were improved to varying degrees except for one eye who underwent permanent palpebral cleft suture due to incomplete palpebral cleft closure. (1) Symblepharon adhesions: 17 eyes (65%) had completely separated adhesions after the first operation, and diplopia disappeared; 8 eyes (31%) had recurrent band-like symblepharon adhesion in the wound area covered by simple amniotic membrane, of which 5 eyes had completely released adhesion after re-operation, and 3 eyes had residual I-degree adhesion. (2) Amniotic membrane began to autolyze at 1 week after operation, and completely disappeared at 3 months; Conclusion Fresh donor limbal LKP combined with autologous bulbar conjunctiva transplantation with limbal stem cells and amniotic membrane transplantation is an effective method for the treatment of severe sypheronitis after eye burn. Pseudopterygium can partially replace bulbar conjunctiva to reconstruct conjunctival sac, and amniotic membrane transplantation can only play a temporary role in supporting wound and promoting ocular surface recovery in the treatment of severe sypheronitis.

Objective to evaluate the long-term clinical efficacy of Ahmed glaucoma valve (AGV) implantation in the treatment of refractory glaucoma.Methods the clinical efficacy and complications of 206 patients (221 eyes) with refractory glaucoma.According to the criteria of success of AGV implantation, the cumulative success rate at different time points was calculated by life table method, and the influence of various predictive variables on failure at different time points was analyzed by Cox proportional hazard model.Results the follow-up period was 6~86 months, with an average of 37 months.The cumulative complete success rate was (88.5±2.2) %, (85.0±2.5) %, (76.4±3.1) %, (66.2±3.7) %, (55.5±4.7) %, respectively.The cumulative total success rate was (91.2±1.9) %, (88.6±2.2) %, (88.6±2.2) %, (86.8±2.5) %, (86.8±2.5) %<The early complications were transient intraocular hypotension in 43 eyes (19.5%), shallow anterior chamber in 32 eyes (14.5%), occlusion of drainage orifice in 25 eyes (11.3%), intraocular hemorrhage in 16 eyes (7.2%), etc. The middle and late complications were 24 eyes (10.9%), 11 eyes (5.0%), 11 eyes (5.0%), 10 eyes (4.5%), 10 eyes (4.5%), 5 eyes (2.3%), corneal decompensation, 3 eyes (1.4%), etc. Conclusion AGV implantation and its combined surgery are effective and safe methods for the treatment of refractory glaucoma.

Objective to investigate the fundus manifestations, systemic symptoms and prognosis of acquired immunodeficiency syndrome (AIDS) complicated with cytomegalovirus (CMV) retinitis. Methods to observe the clinical manifestations of 8 cases (15 eyes) of AIDS complicated with CMV retinitis, analyze the results of fundus, visual acuity, fluorescein fundus angiography and CD4+ T lymphocyte detection, and 2 cases (4 eyes) were treated with ganciclovir intravitreal injection. The follow-up time was 2~34 months, with an average of 16 months. Results 10 eyes (66.7%) with initial visual acuity ≤0.2, including 2 eyes without light sensing, 2 eyes with anterior light sensing, and 6 eyes with 0.04~0.20; 1 eye each in 0.8 and 0.9 (13.3%); ≥1.0 in 3 eyes (20.0%). The fundus of 12 eyes showed the characteristics of retinal vasculitis, which showed thick yellowish-white lesions distributed along blood vessels, with flaky bleeding on them and irregular yellowish-white particles on the edges, which can be described as "cheese and ketchup-like retinitis"; The vitreous body was transparent or slightly responsive. The fundus of 2 eyes showed late manifestations, retinal atrophy was gray, retinal vascular sclerosis and stenosis, retinal pigment epithelium atrophy, choroidal vascular atrophy and optic nerve atrophy were visible. One eye had retinal detachment. The CD4+ T lymphocyte count of 8 patients ranged from 0 to 36/mm3, with an average (15.0 12.9) /mm3.4 eyes had a significant improvement in visual acuity after vitreous injection. The fundus lesions resolved obviously, and the bleeding absorbed. Conclusion CMV retinitis is the most common and serious ocular complication of AIDS. The fundus manifestations are characterized by progressive and necrotizing retinitis with hemorrhage and retinal vasculitis, but the vitreous body reaction is no or slight.Serum human immunodeficiency virus (HIV) antibody test should be performed for unexplained yellow-white lesions,retinal hemorrhage and retinal vasculitis.On the contrary, HIV positive patients should undergo routine fundus examination.

Objective to investigate the clinical efficacy and adjustment range of phacoemulsification and adjustable intraocular lens implantation. Methods 75 cases (94 eyes) of cataract were treated with phacoemulsification and 1CU adjustable intraocular lens implantation. The subjective refractive status, naked eye distance vision, naked eye near vision, best corrected distance vision, near vision after correction of distance vision at 30 cm, best corrected near vision at 30 cm, and subjective adjustment range (measured by subjective approaching method and negative lens method, respectively) were observed and recorded. The follow-up time was 1 to 12 months, and the data of 1 week, 1 month and 3 months after operation were analyzed. Results 81.9% (77/94), 85.1% (80/94) and 84.0% (79/94) of naked eye near vision ≥ Jr 5 at 1 week, 1 month and 3 months after operation, respectively; After far vision correction, 78.7% (74/94), 79.8% (75/94) and 74.5% (70/94) had near vision ≥ Jr 5, respectively. The adjustment amplitude was examined by subjective approaching method and negative lens method, and the subjective adjustment amplitude was (1.96±0.63) D (0.75~4.50 D) and (1.74±0.59) D (0.75~4.50 D) at 1 week after operation, (1.89±0.54) D (0.75~3.25 D) and (1.68±0.47) D (0.75~3.25 D) at 1 month after operation, and (1.77±0.53) D (0.75~2.75 D) and (1.66±0.50) D (0.75~2.75 D) at 3 months after operation, respectively. There was no statistically significant difference between the subjective adjustment amplitude measured by the two methods at 1 week, 1 month and 3 months after operation (P>0.05). There was a positive correlation between near vision and adjustment amplitude after far vision correction (P =0.00). Conclusion The early observation results showed that the visual function recovered well after 1CU adjustable intraocular lens implantation.

Objective to investigate the clinical characteristics of Duane retroglobular syndrome (DRS) and the methods and effects of surgical treatment. Methods the data of 67 patients who underwent surgical treatment for DRS were retrospectively summarized and analyzed. The observation items included the gender and age of the patients, the type and clinical manifestations of DRS, the methods and effects of surgical treatment. Results 63 cases were involved in one eye, 4 cases were involved in both eyes, 35 cases were involved in type Ⅰ esotropia and 12 cases were involved in exotropia. 8 cases of type Ⅱ exotropia; There was 1 case of type Ⅲ esotropia and 11 cases of exotropia. 37 cases were complicated with the phenomenon of rapid upward and/or downward turning of internal turning eyes, of which 31 cases were exotropic. The compensatory head position, eyeball regression and palpebral fissure reduction were improved by single-eye medial rectus and/or lateral rectus retrogression or both-eye medial rectus retrogression, and the postoperative strabismus degree was ≤10 △ Conclusion Different types of DRS have different clinical manifestations, and the phenomenon of upward and downward turning of medial and lateral rectus is more common in patients with DRS exotropia. Lateral rectus retrogression is the main method to improve the phenomenon of rapid upward and downward turning of internal turning eye; Simultaneous retrogression of medial and lateral rectus muscles is suitable for patients with severe ocular recession and rapid upward and downward rotation; When the function of one rectus muscle was weakened, the limitation of the rotation of the eyeball to the contralateral side was improved.

Objective to investigate the therapeutic effect of orbital-globular silicon tube connection in the abdomen of paralytic muscle in the treatment of fixed strabismus. Methods 23 cases (23 eyes) of fixed strabismus were collected, including 22 cases of esotropia and 1 case of exotropia; 11 cases were totally fixed strabismus and 12 cases were subfixed strabismus (9 cases were able to rotate but could not reach the emphatic position, and 3 cases were able to rotate to reach the emphatic position). After antagonistic muscle recession surgery, the canthus orbital periosteum and the anterior sclera at the end of the paralytic muscle were connected with a silicon tube with a diameter of 1 mm through the abdomen of the paralytic muscle. The eye position and eye movement were observed for 12~36 months after surgery. Results The eye position of 23 patients returned to the emphatic position after surgery. The surgical eye could rotate to the side of the paralytic muscle by 25%, 50% and 75% of the normal amplitude in 5 cases, 2 cases and 3 cases, respectively. Conclusion The surgery of silicon tube connection with the orbital bulb under the muscle abdomen borrows the elasticity of silicone gel and plays a passive pulling role to correct strabismus, which is a feasible method for the treatment of fixed strabismus.

Quality of life, as a measurement index that comprehensively reflects various behavioral abilities of patients, covers many aspects such as human function, psychology and mental state, social activities, etc. In recent years, it has gradually become a common index to evaluate the clinical effect of disease treatment. This paper expounds the measurement methods and scales of quality of life related to cataract vision, the results and influencing factors of quality of life after cataract extraction surgery, the relationship between quality of life measurement results and other visual examination results, and the problems that should be paid attention to when measuring quality of life.

In recent years, the role of cytokines in the reconstruction of retinal function has begun to take shape. It has been found that brain-derived neurotrophic factor, ciliary neurotrophic factor, basic fibroblast growth factor and neurotrophin-4 can prevent the degeneration of retinal photoreceptor cells, enhance the repair of photoreceptor cells after injury, promote the development of retinal ganglion cells and stimulate the regeneration of ganglion cells axons. At the same time, growth factor derived from lens epithelium and cytokines secreted by human amniotic epithelial cells also have protective effects on ganglion cells.

With the aging society in China, the visual quality of the elderly and the related quality of life have attracted more and more attention from relevant departments and ophthalmologists. With the great progress of medical technology in recent 20 years, the spectrum of eye diseases of the elderly has changed. Will their visual condition change accordingly? In order to understand the visual acuity of the elderly and discuss its main influencing factors, we collected and summarized the visual acuity and ocular conditions of 904 elderly people. The results are reported as follows.

The patient was a 3-year-old female who came to our hospital on October 22, 2003 due to left eyeball protrusion for 3 years. The patient had left eyeball protrusion at birth, which gradually aggravated later, but there were no symptoms such as red eyes and eye pain, and the eyelid closed well during sleep. There was no similar medical history in the family. There was no obvious abnormality in the whole body examination. Eye examination: binocular vision examination did not cooperate; The lower eyelid of the left eye retreated and inverted, without redness or swelling; The conjunctiva is not congested, the cornea is transparent, the iris texture is clear, the pupil diameter is 3 mm, and the light response is sensitive; Fundus examination showed no abnormalities; The rotation of the left eyeball in all directions was limited, and the exophthalmos was 13 mm in the left eye, 10 mm in the right eye, and the orbital distance was 80 mm; The orbital margin was intact and no mass was palpable. No abnormality was found in the right eye.