Volume 42 ·  Issue 07 ·  2006

With the popularization of the knowledge of orbital diseases, many ophthalmologists have gradually deepened their understanding of the diagnosis and treatment of ocular tumors, but there are still problems such as postoperative complications, tumor recurrence and tumor metastasis in clinic, which make patients lose the chance of cure. Standardized training in the diagnosis and treatment of ocular tumors, solid knowledge of orbital anatomy and related disciplines, and perfect follow-up are the keys to improve the curative effect.

Objective to investigate the clinical manifestations and histopathological characteristics of choroidal metastatic carcinoma. Methods the clinical characteristics, histopathological changes, the origin and histological classification of primary tumor were retrospectively analyzed in 18 patients with choroidal metastatic carcinoma. Results the clinical manifestations of most of the 18 patients were severe visual impairment. Solid subretinal mass in posterior pole was found on fundus examination, and 8 patients with retinal detachment. B-ultrasound and CT examination showed flat or irregular solid space-occupying lesions in the eye. MRI scan showed that the mass showed medium-high signal on T1W and low signal on T2W. Pathological examination showed adenocarcinoma in 11 cases, squamous cell carcinoma in 4 cases, undifferentiated carcinoma in 3 cases, lung carcinoma in 10 cases (55%) and breast carcinoma in 4 cases (22%). Conclusion the main clinical manifestations of choroidal metastatic carcinoma are obvious visual acuity decrease and flat parenchymal space-occupying lesions in fundus. Lung carcinoma is the highest incidence of primary tumor, and adenocarcinoma is the common in histopathological classification.

Objective to investigate the clinical diagnosis and surgical treatment of orbital schwannoma.Methods 38 cases of orbital schwannoma treated in the Institute of Orbital Diseases of Beijing Armed Police General Hospital from August 1999 to December 2003.Results Among the 38 cases, 15 were males and 23 were females, aged 9-65 years, with an average age of 22 years. Among them, 37 cases underwent standardized A/B ultrasound examination, 38 cases underwent CT scan, and 33 cases underwent MRI imaging.The surgical approaches included lateral orbitotomy (including modified lateral orbitotomy) in 26 cases, combined medial and external orbitotomy in 2 cases, anterior orbitotomy in 4 cases, and medial orbitotomy in 2 cases.Among them, 21 cases were intracapsular resection, 15 cases were total resection, and 2 cases were partial resection combined with postoperative radiotherapy. The average follow-up time was 23 months. The surgical complications included visual loss in 1 case, ptosis in 2 cases, and ocular movement disorder in 2 cases.Conclusion Modern imaging methods, especially MRI, can provide reliable evidence for the qualitative and localized diagnosis of orbital schwannoma before operation and the selection of surgical approach. Skilled surgical methods and techniques can improve the cure rate and reduce surgical complications.

Objective to analyze the relationship between histopathological characteristics and recurrence of primary lacrimal gland epithelial tumors, and provide reference for clinical diagnosis and treatment. Methods Paraffin specimens were collected from 128 patients with pathological diagnosis of primary lacrimal gland epithelial tumors. The three most common types were benign mixed tumors (74 cases (57.8%), adenoid cystic carcinoma (22 cases) (17.2%) and malignant mixed tumors (18 cases) (14.1%), and the relationship between histopathological characteristics and recurrence was analyzed. Results The recurrence rates of benign mixed tumors, adenoid cystic carcinoma and malignant mixed tumors were 23.0%, 18.2% and 27.8%, respectively. The pathological type and capsule integrity of benign mixed tumors were statistically significant in the recurrence of tumors. Conclusion The recurrence rate of three common primary lacrimal gland epithelial tumors was high.

Objective to investigate the inhibitory effect of matrine (Ma) on the growth of human retinoblastoma HXO-Rb44 cells in vitro and its mechanism.Methods The growth of cultured human HXO-Rb44 cells was determined by thiazole blue colorimetric assay (MTT assay) after different concentrations of Ma. The apoptosis rate and morphological changes of cells were detected by hematoxylin-eosin staining, flow cytometry and dUTP gap labeling mediated by nucleotide terminal transferase. The changes of telomerase activity were detected by telomere repeat amplification method. Results Ma could inhibit the growth of HXO-Rb44 cells within a certain concentration range (P<0.01), and the morphological changes of apoptosis in HXO-Rb44 cells were observed in a concentration-dependent manner (r = -0.961, P<0.01). Conclusion Ma could inhibit the growth and induce apoptosis of HXO-Rb44 cells within 48 h. The decrease of telomerase activity may be one of the mechanisms of apoptosis induced by Ma, which suggests that Ma has certain application prospect in the comprehensive treatment of retinoblastoma.

Objective to investigate the effect of light-free vitreous surgery and traditional vitreous surgery in the treatment of severe proliferative diabetic retinopathy (PDR) with extensive fibrovascular proliferation.Methods Eighteen patients (22 eyes) with extensive fibrovascular proliferation with predicted complicated surgical operation were treated with light-free vitreous surgery combined with membrane stripping, retinal reposition,photocoagulation and other additional surgical procedures. Twenty cases (22 eyes) of PDR patients with extensive fibrovascular proliferation were treated by the same surgeon at a similar time period. Results the vitreous surgery of both methods was smooth. However, in vitreous surgery without light guide, the fundus of phakic eyes could not be peeped into during gas-liquid exchange, so it was necessary to return to the intraocular illumination mode of traditional vitreous surgery. The retina of patients with both methods could be completely reduced, and the postoperative visual acuity improvement rate was 86.4% and 77.3%, respectively, with no statistical difference (P>0.05); The two surgical methods had fewer complications, and the difference in incidence rate was not statistically significant (P>0.05); The mean peeling time in vitreous surgery without light guide is shorter than that in traditional vitreous surgery, and the difference between them is statistically significant (P<0.05). Conclusion Both methods of vitreous surgery have better curative effect on severe PDR. The safety of peeling in vitreous surgery without light guide is higher, especially in the aspects of peeling, electrocoagulation and hemostasis and peripheral operation, etc. The efficiency of two-hand operation in vitreous surgery without light guide is higher.

Objective to investigate the necessity of retrobulbar injection of vasodilators in patients with anterior ischemic optic neuropathy (AION). Methods Thirty-nine patients (39 eyes) with clinical diagnosis of AION were examined by color Doppler flow imaging technique before retrobulbar injection of anisodamine, 15 min and 1 h after injection. The peak systolic blood flow velocity (PSV), end diastolic blood flow velocity (EDV), mean maximum blood flow velocity per unit time (TAMX), pulsatility index (PI) and resistance index (RI) of ophthalmic artery, central retinal artery, nasal and temporal short posterior ciliary artery were measured. Results Compared with healthy eyes, the parameters of posterior short ciliary artery were significantly different in AION eyes (P<0.01). After 15 min and 1 h post-bulbar injection of anisodamine, all blood flow parameters except resistance index were higher than those before injection, and the differences were statistically significant (P<0.01). Conclusion The results of detection of posterior short ciliary artery and central retinal artery showed that CDFI showed significant changes in hemodynamic parameters after 15 min and 1 h post-bulbar injection of anisodamine.

Objective to investigate the surgical methods and curative effects of medial canthus deformity after naso-orbital ethmoid fracture.Methods The clinical data and follow-up results of 83 cases (83 eyes) of unilateral naso-orbital ethmoid fracture with medial canthus deformity were retrospectively analyzed from January 1999 to January 2004. According to the difference of medial canthus displacement and skin scar, "Y-V" shaping, "Z" modification, "Mustard" method and rotating flap were selected to correct the skin and soft tissue abnormalities of medial canthus. According to the fracture or displacement of "central bone segment" after naso-orbital ethmoid fracture, the methods of suture fixation, titanium nail fixation, drilling fixation and central bone segment reduction and titanium plate fixation were selected for medial canthal ligament fixation; For patients with lacrimal duct obstruction, lacrimal duct surgery and medial canthus deformity correction were performed simultaneously; Patients with eyeball displacement or nasal bridge collapse were treated with orbital reconstruction and rhinoplasty first, and medial canthoplasty in the second stage. Eighty-three patients were followed up for 12-30 months. Results 72 patients were symmetrical with the healthy side in both horizontal and vertical positions, and the medial canthus depression was recovered with satisfactory appearance. However, 11 patients had recurrence of medial canthus displacement within 6 months after operation, and 6 patients underwent medial canthus ligament fixation and medial canthoplasty again, and the deformity was improved after operation, and there was no recurrence and displacement. Conclusion According to the fracture of orbital ethmoid bone and the severity of medial canthus displacement, different methods of medial canthus ligament fixation and medial canthoplasty were chosen to correct the medial canthus deformity with significant and stable efficacy.

Objective to investigate the significance of pupil diameter in 3 states of darkopia, claropia and medication mydriasis in evaluating pupillary autonomic neuropathy in type Ⅱ diabetic patients. Methods Type Ⅱ diabetic patients were divided into subclinical stage group and simple stage group according to the results of fluorescein sodium fundus angiography. 20 cases were randomly selected each. 20 non-diabetic lacrimal duct disease patients who went to ophthalmology department of corresponding age group were selected as normal control group. The anterior segment photos under darkopia, claropia and medication mydriasis were taken by infrared digital photography, and the pupil pictures were obtained. The pupil diameter, reduction rate and dilatation rate were converted by computer software processing. The obtained data were statistically analyzed. Results The pupil diameters of normal control group, subclinical group and simple stage group under darkopia were (6.02±0.48), (5.87±0.99) and (4.95±1.12) mm, respectively. (3.40±0.33), (3.37±0.31), (3.25±0.47) mm under the myopia; (7.37±0.59), (6.91±1.00), (5.49±1.24) mm after drug mydriasis; The reduction rates were (43 ± 7) %, (41 ± 10) %, and (32 ± 14) %, respectively; The dilatation rates were (23±8) %, (19±13) % and (11±5) %, respectively. The differences of pupil diameter, dilatation rate and dilatation rate were statistically significant between groups (P<0.01). Conclusion Autonomic neuropathy of pupil origin can occur in the early stage of type Ⅱ diabetes mellitus. The pupil diameter, dilatation rate and dilatation rate under dark vision and drug dilatation can be used to evaluate autonomic neuropathy in type Ⅱ diabetes mellitus.

Objective to investigate the application value and clinical efficacy of oblique nucleotomy and strapped delivery nucleus in cataract extraction.Methods 86 cases (97 eyes) of senile cataract were treated with oblique nucleotomy and strapped delivery nucleus by self-designed cataract linear nucleotomy and folding intraocular lens implantation. 2 eyes with anterior chamber hemorrhage; Intraocular pressure increased in 6 eyes; Eight eyes had mild corneal endothelial edema, which resolved within 5 days. 78 eyes (80.41%) had corrected visual acuity ≥0.5 at 1 week after operation, and 91 eyes (93.81%) had corrected visual acuity ≥0.5 at 3 months after operation. There were 66 eyes (68.04%) with corrected visual acuity ≥1.0 at 3 months postoperatively. There was no significant difference in mean astigmatism of cornea at 1 week and 3 months postoperatively compared with that before operation (P>0.05). Conclusion This method can effectively solve the problem of manual nucleus fragmentation and nucleus delivery in small incision cataract extraction suitable for folding intraocular lens implantation, and the operation is simple, flexible and safe.

Objective to investigate the effect of amniotic membrane on the corneal permeability of rabbits with ofloxacin eye drops. Methods 108 New Zealand white rabbits were numbered, and then randomly divided into 6 groups, 18 rabbits in each group, respectively: normal cornea group, normal cornea amniotic membrane transplantation group, mechanical curettage of corneal epithelium group, mechanical curettage of epithelium combined with amniotic membrane transplantation group, corneal alkali burn group, corneal alkali burn combined with amniotic membrane transplantation group. 0.3% ofloxacin eye drops were given every 15 minutes for 4 times. At 5, 30 min, 1, 2, 4, 6 h after the last eye drop, 3 rabbits were randomly sacrificed in each group of 18 rabbits at each time point to extract aqueous humor. The concentration of ofloxacin in aqueous humor was detected by high performance liquid phase method. Results Compared with the normal corneal epithelium group, the concentration of ofloxacin in the anterior chamber of the normal corneal epithelium transplantation group was significantly higher than that of the normal corneal epithelium group (all P<0.05). The concentration of ofloxacin in aqueous humor of the normal corneal amniotic membrane transplantation group at 5, 30 min and 1 h was not significantly different from that of the normal corneal group (all P>0.05), but the concentration of ofloxacin in the normal corneal epithelium group at 2, 4, 6 h was significantly higher than that of the normal corneal epithelium group (all P>0.05) The concentration of ofloxacin in aqueous humor at 2, 4 and 6 h in the mechanical curettage epithelium combined with amniotic membrane transplantation group was also significantly higher than that in the mechanical curettage epithelium group (all P<0.05), but there was no significant difference in the concentration of ofloxacin in aqueous humor at 5, 30 min and 1 h between the two groups (all P>0.05); The concentration of ofloxacin in the aqueous humor in the group with alkali burn combined with amniotic membrane transplantation was higher than that in the group with alkali burn within 6 h (all P<0.05). Conclusion Amniotic membrane has certain drug accumulation and sustained release effects, which increases the residence time of ofloxacin on the corneal surface and increases the drug permeability.

Retinoblastoma (Rb) is a kind of human retinal tumor. In order to study its pathogenesis, it is necessary to establish a hereditary Rb animal model. The author comprehensively analyzes the experimental results of multiple genetic engineering Rb animal models, and briefly introduces the latest research progress of using genetic engineering technology to establish Rb animal models. It is concluded that the occurrence of Rb is not only the deletion of Rb1 gene, but also the synergistic effect of other genes.

In order to promote the healthy development of academic activities of ophthalmology in China, it is necessary to maintain academic morality and standardize academic behavior<Copyright Law of the People's Republic of China,<Patent Law of the People's Republic of China>,<General Principles of Civil Law of the People's Republic of China>and other national laws and the Ministry of Education<In the spirit of Several Opinions on Strengthening the Construction of Academic Morality, and in combination with the actual situation of the Ophthalmology Branch of Chinese Medical Association and the national ophthalmology community, these regulations are specially formulated.

Ophthalmic diseases can significantly affect the quality of life of patients, and have been paid more and more attention by the society. The rapid development of science and technology has laid the foundation for the continuous renewal of ophthalmic equipment and drugs, and improved the level of clinical diagnosis and treatment.

Led by Professor Ren Qiushi, chief scientist of the National 973 Project and director of Shanghai Key Laboratory of Laser Medicine, the Institute of Laser and Photonic Biomedicine of Shanghai Jiaotong University is an institution that is in line with international standards and specializes in the basic principles and application research of laser and optoelectronic technology in the biomedical field. Based on the operating philosophy of the internationally renowned Wellman laboratories of Photo-Medicine of Harvard University and Beckman laser institute and medical clinics of the University of California, the study combines teaching, scientific research, talent training and transformation of scientific research achievements to promote the research and development of laser medicine and photonic biomedicine in China, and provide a high-level,

The book "Clinical Optical Coherence Tomography of Ophthalmology", edited by Professor Liu Xing, deputy editor by Professor Huang Shizhou and reviewed by Professor Ge Jian, recommended by Guangdong Excellent Science and Technology Monograph Publishing Foundation and funded by Guangdong Provincial Department of Science and Technology, has been officially published by Guangdong Science and Technology Press.

The book "Modern Diagnostics of Orbital Diseases" edited by Xiao Lihua has been published by Beijing Science and Technology Press. The author of this book is the third book published after Orbital Surgery and Illustrations and Color Atlas of Orbital Surgery. The author summarizes the experience of more than 20 years in the clinical work of orbital diseases, and makes a detailed analysis of various orbital diseases by using modern diagnostic methods, especially ultrasound, CT and MRI, and introduces the current diagnostic level of orbital diseases comprehensively and systematically. This book focuses on describing the imaging features of various typical orbital diseases,

The patient was a 33-year-old female who was admitted to our hospital on May 23, 2002 due to redness of her right eye for 2 months and blurred vision for 20 days. Two months ago, the patient often had redness of her right eye without obvious trigger, sometimes mild and sometimes severe, which could resolve spontaneously, without eye pain, headache and other discomfort. In the past 20 days, the above symptoms worsened, and the vision was blurred. She went to another hospital for examination, but the diagnosis was unknown. After treatment, the symptom of redness subsided, but the blurred vision did not alleviate, so she came to our hospital for further diagnosis and treatment. General physical examination: no obvious abnormalities were found. Eye examination: the corrected visual acuity of the right eye was 0.25, the naked visual acuity of the left eye was 1.0. The intraocular pressure of the right eye was 13.5 mm Hg (1 mm Hg =0.133 kPa), and the left eye was 15 mm Hg. Dust-like deposits (+) were seen behind the cornea of the right eye. The temporal anterior chamber was shallow, and occasionally aqueous humor cells were seen. The iris swelled slightly forward at 9 o'clock, and the posterior lens capsule was slightly opaque. No obvious abnormalities were found in the fundus examination. The laboratory examination was normal.

A 55-year-old male patient had "dark circles" in both eyes since birth. One year before admission, he felt blurred vision in his right eye and his visual acuity gradually declined. A swelling in his right eyeball was found in another hospital. After color Doppler ultrasound examination, it was considered to be choroidal melanoma. He was admitted to our hospital on August 1, 2005.

A 66-year-old female was found to have "remaining flesh" on the nasal side of her left eye in October 2004, accompanied by mild foreign body sensation, red eye, pain and tearing. She went to a local hospital for treatment. Ocular examination showed that the bulbar conjunctiva on the nasal side of her left eye showed localized blister-like bulge with * color, and there was no ulceration, exudation and bleeding on the surface of the tumor. According to the treatment of conjunctivitis and pterygium, there was no obvious effect.

A 74-year-old male patient was admitted to our hospital in February 2005 due to foreign body sensation, dryness and discomfort in his right eye for more than 1 year, which gradually worsened. He was admitted to our hospital in July 2000 due to primary acute angle-closure glaucoma (chronic stage) in his right eye. He underwent trabeculectomy (making a high conjunctival flap based on the limbus). After operation, the filtering blister formed and was relatively localized. The intraocular pressure was 14~17mm Hg (1 mm Hg =0.133 kPa), and the visual acuity was manual/anterior (same as before operation).

A 50-year-old female was admitted to our hospital for 4 months due to redness, swelling and foreign body sensation in her left eye. Four months ago, she reported that her left eyelid was swollen and foreign body sensation, accompanied by swelling and pain at the top of her head, itching and swelling of her eyes, which worsened at night.

The patient was an 8-year-old female who was admitted to hospital because of "blurred vision in her left eye for more than 1 year". The patient was a deaf-mute child with unknown family genetic history. Admission physical examination: VOD: 1.2/1.5, Vos: light sensitivity/anterior eye. IOP was normal. The external eye of the right eye was normal, and the iris was gray-white. Under the slit lamp microscope, the surface of the iris was radial fine villus-like tissue, and the deep brown iris tissue was vaguely transparent through the iris scaffold structure (Figure 1). The pupil was round and sensitive to light.

Based on the AcrySof platform, the thinner aspheric optical surface design can further improve the visual quality.