Primary eye care for the pediatric patient

The primary care needs of the pediatric patient include the measurement of norms and deviations in the newborn (neonate) and subsequently, developmental milestones. Considerations of such norms and deviations must include familial and hereditary implications, systemic conditions and general health status. Deviations from the expected norms in the newborn and during development must be evaluated by the parent (as the true primary pediatric provider) and responsible health and eye care professionals. Such evaluation should include a sensitivity and awareness of the ocular and visual status, identification of norms and deviations and appropriate courses of action.     

Ocular and systemic pseudoexfoliation syndrome

PURPOSE: To provide an update on most recent developments regarding ocular and systemic manifestations and complications, clinical diagnosis and management, and molecular pathophysiology of pseudoexfoliation (PEX) syndrome, and to discuss future tasks and challenges in this field. DESIGN: Perspective. METHODS: Review of recent literature and authors' own clinical and laboratory studies. RESULTS: PEX syndrome is a common age-related generalized fibrotic matrix process of worldwide significance, which may not only cause severe chronic open-angle glaucoma and cataract, but also a spectrum of other serious spontaneous and surgical intraocular complications. Recent progress and advances have led to (1) improvements in clinical management by understanding the effects of the PEX process on ocular tissues, by refining diagnostic criteria, by applying new treatment regimes, and by developing preventive strategies to reduce surgical complications; (2) increasing evidence for systemic associations of PEX with cardiovascular and cerebrovascular morbidity; and (3) new insights into the molecular pathophysiology by analyzing the composition of PEX material, the differential gene expression of affected tissues, and key factors involved in pathogenesis. The current pathogenetic concept describes PEX syndrome as an elastic microfibrillopathy involving transforming growth factor-beta1, oxidative stress, and impaired cellular protection mechanisms as key pathogenetic factors. CONCLUSIONS: Future tasks and challenges comprise epidemiologic prevalence and genetic studies of PEX syndrome, prospective randomized clinical and histopathological screening studies on its systemic manifestations and associations, and intensified basic research on differential protein and gene expression, animal and in vitro models, as well as potential biomarkers for PEX syndrome and its associated glaucoma.     

Matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases in the human lens: implications for cortical cataract formation

PURPOSE: To characterize the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in human cortical cataract and to determine whether there is a correlation with the localization of cortical cataract. To evaluate the expression and activity of MMPs and TIMPs after cytokine and UV-B exposure in a human lens epithelial cell line. METHODS: Twenty-eight human donor eyes with cortical cataract and 21 normal human donor eyes were photographed. Thirteen cortical cataract and six normal lenses were immunohistochemically analyzed for MMP-1, -2, -3, and -9 and TIMP-1, -2, and -3. Twelve fresh cortical cataract and 12 normal lenses were divided into quadrants to quantify, by ELISA, the expression of MMP-1, -2, -3, and -9 and TIMP-1. Three fresh cortical cataract and three control lenses were assessed for MMP-1, -2, and -9 activity by SDS-PAGE zymography. Human lens epithelial cells (HLE-SRA-01/04) were exposed to proinflammatory cytokines and UV-B radiation to determine the protein expression profiles of MMP-1, -2, -3, and -9 and TIMP-1 and -2. RESULTS: Immunohistochemical analysis revealed specific localization of MMP-1 within lens epithelium and cortical lens fibers of cortical cataract. Normal lenses had equally low MMP-1, -2, -3, and -9 and TIMP-1, -2, and -3 immunoreactivity, expression, and activity in all lens quadrants. IL-1 and TNF-alpha upregulated the expression of MMP-2, -3, and -9, and UV-B upregulated the expression of MMP-1 in the SRA-01/04 HLE cell line. CONCLUSIONS: This is the first study to localize the expression of MMP-1 in cataracts with clinically observed opacification in vivo and to examine the expression induced by UV-B, in vitro.     

感知觉学习对斜弱视患者视功能重建的研究进展

斜视、弱视是临床上常见的眼病,国内外学者运用生物和计算机技术对斜弱视的病因、发病机制及治疗等进行了多方位探讨和研究,并取得了很大的进展。斜、弱视患者的双眼视功能分类研究能使人们能够全面、准确地理解斜弱视发生的神经机制及匹配的生物模型,对寻求斜弱视临床治疗和视功能重建的新途径有所帮助。本文介绍了感知觉学习的定义及机制,并重点探讨了影响感知觉学习效果的可能因素、感知觉学习治疗效果的持续时间及神经机制。该领域未来需要在斜弱视发病的神经机制、感知觉学习重建斜弱视视功能的具体机制、影响感知觉学习效果的因素等方面做进一步研究。近年来,人们对大脑神经可塑性及感知觉学习的研究越来越深入,并应用于临床,治疗斜弱视,重建斜弱视患者双眼视功能,取得了令人欣喜的效果,现将感知觉学习治疗相关的国内外研究进展综述如下。     

Pentacam与A型超声测量前房深度及晶状体厚度的比较

目的比较Pentacam与A型超声测量前房深度(ACD)及晶状体厚度(LT)的差异及重复性。方法对正常人49例(49只眼)分别用Pentacam与A型超声测量散瞳后的ACD及LT。结果 Pentacam测量的ACD为(3.81±0.22)mm,A型超声测量结果为(3.70±0.31)mm,两者相差0.11 mm,差异有统计学意义(P<0.01)。Pentacam测量的LT为(3.43±0.23)mm,A型超声测量结果为(3.54±0.34)mm,两者相差0.11 mm,差异有统计学意义(P<0.05)。Pentacam测量ACD及LT的组内相关系数分别为0.98～1.00和0.92～0.97,变异系数分别为0.09和0.10;A型超声测量测量ACD及LT的组内相关系数分别是0.98～0.99和0.99～1.00,变异系数分别为0.16和0.18。结论 Pentacam与A型超声测量屈光不正患者ACD、LT的差值较小,但两者能否相互替代仍需进一步研究。     

Orbscan computerized topography: attributes, applications, and limitations

An extensive electronic search was undertaken in January 2004 to identify all relevant peer-reviewed publications on Orbscan slit-scanning/Placido computerized topography. Ninety-one publications were identified. These address elevation topography and best-fit sphere, accuracy and repeatability of anterior and posterior corneal elevation and keratometric maps, comparison of Orbscan-acquired data and Placido-based computerized videokeratography instruments, pachymetry measurement and correlation with ultrasound, screening eye-bank corneas, detection of keratoconus, identifying corneal ectasia after refractive surgery, and miscellaneous applications. Studies were analyzed and critically compared in relation to attributes, applications, and limitations of Orbscan corneal topography. The review highlights advantages of this technique in assessing the cornea in health and disease and after surgery and identifies specific aspects that require further investigation and clarification.     

青少年屈光不正患者扩瞳后验光结果与配镜处方的比较分析

目的：比较青少年屈光不正患者扩瞳后电脑验光、扩瞳后试镜与配镜处方的差异,探讨青少年屈光不正验光配镜的重点和注意事项。

方法：选取334例青少年屈光不正患者(包括212例近视和122例远视),进行扩瞳后电脑验光并试镜,恢复自然瞳孔后再试镜确定配镜处方。回顾性分析扩瞳后电脑验光、扩瞳后试镜和配镜处方之间的差异。

结果：扩瞳后电脑验光和扩瞳后试镜之间,总体数据中球镜和轴向的差异具有统计学意义(P<0.05),近视组中球镜、柱镜和轴向的差异均具有统计学意义(P<0.05),远视组中轴向的差异具有统计学意义(P<0.05)。总体数据和远视组中,扩瞳后电脑验光、扩瞳后试镜与配镜处方的球镜和轴向的差异有统计学意义(P<0.05)。远视组中扩瞳后电脑验光和扩瞳后试镜的球镜均大于配镜处方,且扩瞳后试镜与配镜处方柱镜的差异也有统计学意义(P<0.05)。近视组中扩瞳后电脑验光与配镜处方的球镜、柱镜和轴向的差异均有统计学意义(P<0.05),扩瞳后试镜与配镜处方的柱镜和轴向的差异均有统计学意义(P<0.05)。Bland-Altman分析提示,无论屈光性质,扩瞳后电脑验光和扩瞳后试镜的球镜、柱镜存在较好一致性,二者之间的差异在临床上可以接受,而轴向的一致性则较差。Bland-Altman分析提示,总体数据和远视组中,扩瞳后电脑验光、扩瞳后试镜分别与配镜处方的球镜和轴向的一致性较差,柱镜则存在较好一致性。近视组中扩瞳后电脑验光、扩瞳后试镜分别与配镜处方的球镜、柱镜具有较好的一致性,轴向的一致性则较差。

结论：扩瞳后电脑验光、扩瞳后试镜结果均不能作为配镜处方。扩瞳后电脑验光与扩瞳后试镜之间的差异有统计学意义,二者的球镜、柱镜存在较好的临床一致性。扩瞳后电脑验光和扩瞳后试镜的轴向不具有一致性,二者与配镜处方的一致性也较差。所以复光试镜时要加强对轴向的反复验证。     

睡眠行为与近视发生发展关系研究进展

近视已成为全球范围的公共卫生问题。睡眠是在褪黑素调节下,人类生命过程中重要的周期性生理过程。睡眠与近视一样都会受到环境因素的影响,不同近视程度患者及正视人群在睡眠时间、睡眠质量及褪黑素水平上存在差异。本文回顾了近视发生发展与人群睡眠行为的现状研究及相关的基础实验学研究,从流行病学和生物学机制两方面,对近视发生发展与睡眠行为相关研究进行综述,以期为进一步预防控制近视发生发展提供方向。     

Study of the Retinal Imaging and Output in Premature Baby under a Computer-assisted Binocular Indirect Ophthalmoscope

 Purpose: To explore a clear retinal imaging and output and enhance the development of retinopathy of prematurity (ROP) screening, which is safe and effective for ROP screening in premature infants. Methods: A computer-assisted binocular indirect ophthalmoscope imaging and output system was equipped with camera and image processing hardware and connected to computers. The process of fundus examination was videotaped (photograph) and output. Simulated eyes were utilized to debug video head and acquire stable and clear fundus images by binocular indirect ophthalmoscope for premature infants. Results: Fundus imaging output technique was sucessfully established. The common reasons of unclear imaging and corresponding solutions were summarized. This technique can capture and output stable and clear fundus images of premature infants. Conclusion: Assisted by hardware and software processing, a compute assisted binocular indirect ophthalmoscope imaging and output system was established, which can be used for screening, research, treatment and follow-up of ROP in premature babies to resolve the difficulty in obtaining clear fundus photograph.     

Carbohydrate binding proteins galectin-1 and galectin-3 in human trabecular meshwork

PURPOSE: Galectins are a family of carbohydrate binding proteins involved in a variety of biological processes including cell-cell and cell-matrix interactions. We examined galectin-1 and galectin-3 to determine if galectins are expressed in the human trabecular meshwork and Schlemm's canal. METHODS: Human trabecular meshworks were dissected from donor eyes within 12 hr of death. Galectin-1 and galectin-3 expression was examined by RT-PCR and Western blot analysis. Immunohistochemistry of galectin-1 and galectin-3 was analyzed in normal and glaucomatous tissue. RESULTS: Expression of mRNA and protein of Galectin-1 (14 kDa) and galectin-3 (31 kDa) was found in the outflow pathway. Immunostaining revealed galectin-1 and galectin-3 throughout the meshwork, cells lining Schlemm's canal, and extracellular spaces in the inner and outer walls of the canal. Comparison of normal, POAG and PEX samples revealed no difference in location or intensity for either galectin-1 and galectin-3. CONCLUSION: Galectin-1 and galectin-3 are present in human trabecular meshwork of normal and glaucomatous eyes.     

中国脱髓鞘性视神经炎诊断和治疗循证指南(2021年)

脱髓鞘性视神经炎(DON)是主要累及视神经的中枢神经系统炎性脱髓鞘疾病。准确诊断、降低复发率、改善预后一直是临床诊疗过程中关注的重点。随着有关DON临床诊断标志物、疾病分型及不同亚型治疗研究的深入,越来越多的临床证据不断涌现,迫切需要及时制定DON的诊断和治疗循证指南,指导临床进一步规范开展工作。为此中华医学会眼科学分会神经眼科学组联合兰州大学循证医学中心/世界卫生组织指南实施与知识转化合作中心,按照循证指南制定的方法和步骤,成立指南指导委员会、指南共识专家组和指南外审专家组以及指南制定工作组,通过调研临床一线神经眼科医师、眼科医师及神经内科医师,收集并整理临床关注问题,全面检索和系统评价国内外相关研究证据,制定新的系统评价,组织召开专家共识会议,深入访谈和剖析患者偏好和价值观,最终形成16条针对DON诊断和治疗的推荐意见,主要涉及分类和诊断、急性期和慢性期治疗、随访管理等方面,并对每条推荐意见进行详细的解释说明,以期为临床有效治疗DON和降低复发率发挥指导作用。(中华眼科杂志,2021,57:171-186)     

治疗性角膜移植术后缝线侵蚀及周围脓疡微生物和临床特点

目的 分析治疗性角膜移植术后缝线侵蚀及周围脓疡的微生物学和临床特点.方法 应用总结2年内连续发生的治疗性角膜移植术后缝线侵蚀和周围脓疡共11例,真菌角膜溃疡9例和复发性角膜基质炎合并穿孔2例.对病灶及结膜囊进行细菌和真菌培养,记录病灶的特点和治疗方法 与结果.结果 11例缝线侵蚀和周围脓疡均发生于术后3个月以内,平均31.8天.其中3例细菌培养阳性,2例结膜囊和缝线病灶培养菌种一致.病灶多发生在上方和睑裂区,其中上方为4例,占36.3%;发生在睑裂区3例,占27.3%.2例司时发生排斥反应.治疗方法 为及时拆除缝线,局部应用敏感抗生素,均l周内治愈.结论 治疗性角膜移植术后缝线侵蚀及周围脓疡发生较早,与眼睑摩擦、缝线松脱、术区污染、植床的炎症等有关.大部分为非感染性,少部分感染者多为革兰氏阳性菌.主要治疗措施是拆出侵蚀和松脱缝线,局部应用敏感抗生素.及时发现、及时治疗预后良好.

Abstract：

Objective To investigate the microbial profiles and clinical features on suture erosions and abscesses after therapeutic corneal transplantation. Methods Of 11 consecutive cases of suture erosions and abscesses after therapeutic corneal transplantation were enrolled within 2 years, including 9 cases fugal keratitis and 2 cases recurrent stromal keratitis with perforation. In each case, both bacterial and fungal cultures were taken from eroded sutures and conjunctival sac. Clinical features on suture erosions and abscesses were recorded, including therapeutic regimen and results. Results All episodes of suture erosions and abscesses occurred within 3 months postoperatively, on average 31.8 days. Of the 11 cases, 3 had positive cultures and,suture and cul-de-sac cultured micro-organisms matched in 2 cases. Suture erosion and abscess were primarily located superior and palpebral fissure area, with 4 (36.3%) superiorly and 3 (27.3%) palpebrally. Graft rejection in 2 cases was determined clinically. Removal of involved sutures and sensitive topical antibiotic were employed and all cases healed within 1 week. Conclusions Suture erosions and abscesses after therapeutic corneal transplantation occur on early stage, associating with eyelid rubbing, loosening of sutures, contamination and inflammation of bed. Most cases are sterile, gram-positive bacteria are most common cultured organisms in infected ones. Therapeutic strategies are removal of involved sutures and sensitive topical antibiotic. Diagnosis and treatment in a timely fashion contribute to good prognosis.     

Effect of miR-184 and miR-205 on the tumorigenesis of conjunctival mucosa associated lymphoid tissue lymphoma through regulating RasL10B and TNFAIP8

AIM: To study the efficacy and safety of accelerated collagen cross-linking in keratoconus. METHODS: Medical records of keratoconic corneas underwent accelerated collagen cross-linking at King Chulalongkorn Memorial Hospital, Thailand between April 2015 and August 2018 were reviewed. Preoperative and postoperative data at 1y of visual acuity, auto-refraction, corneal topography, higher-order aberrations (HOA), topometric indices and corneal densitometry were evaluated. Age of 24-30 (mean age 23.43±7.26)y, maximum keratometric value (Kmax) of 55 D, and baseline best corrected visual acuity (BCVA) of 20/40 (or 0.3 in LogMAR unit) were used as cut-off values to highlight the cross-linking effects. The effect of age, preoperative Kmax and BCVA were analyzed. The association between the change of corneal densitometry and other factors including preoperative Kmax, Kmean, manifest refraction spherical equivalent (MRSE), visual acuity, thinnest pachymetry, the change in Kmax, and the change of those parameters were also analyzed. P<0.05 was considered statistically significant. RESULTS: One hundred and fifty-five patients (185 eyes) were included. Male to female ratio was 3:31. According to Amsler-Krumeich classification, stage 1 and 2 were dominant (37.84% and 35.14% respectively). At 1y, mean LogMAR uncorrected visual acuity (UCVA) improved by 0.1 (P<0.05). The number of eyes of which postoperative BCVA improved more than 0.2 LogMAR was higher in the worse baseline BCVA group (preoperative BCVA ≥0.3) compared to the better baseline BCVA group (preoperative BCVA <0.3) (78.26% vs 21.74%, P<0.05). Mean Kmax decreased from baseline by 2.36 diopters (D) (P<0.05). Seventy-three percent of the eyes of which Kmax reduced more than 2.0 D had preoperative Kmax ≥55 D. Q-value showed less prolate by 0.06 (P<0.05). Corneal HOA at 6 mm from corneal apex decreased by 0.40 (P<0.05). Corneal densitometry at 0-6 mm zone increased at 1mo and persisted 1y postoperatively (P<0.05). The relationship of the increase in densitometric value and the decrease of thinnest pachymetry at 1y were in linear fashion. Index of surface variance, index of vertical asymmetry, keratoconus index, index of height decentration decreased at 1y (P<0.05). Success rate at 1y was 90.24%. Postoperative corneal haze was found 11.35%, 30.27%, 15.67%, 10.27% and 2.16% at 1wk, 1, 3, 6mo and 1y respectively. No eyes developed corneal edema. There was one case of sterile keratitis. CONCLUSION: Accelerated collagen cross-linking in keratoconus was effective to flatten, reshape the cornea, improved visual acuity, HOA and topometric indices. Great Kmax reduction was found in advanced keratoconus. The magnitude of Kmax reduction is also greatest among previous reports.     

眶缘眶壁分层截骨术治疗眼眶及眶周畸形

目的 探讨眶缘眶壁分层截骨术治疗眼眶及眶周畸形所致的眼眶容积异常、眶缘错位、眼水平轴失衡、眼球凹陷及复视等的效果。方法 对眶距增宽症、双眼眶不对称、放疗后小眼眶、外伤后眼眶畸形等患者,取头皮冠状切口入路,按畸形发生的不同部位,选用眶缘部眶壁分层截骨、固定,或多个眶缘部眶壁复合分层截骨、固定。结果 44例患者中,眶上缘截骨5例,眶内壁截骨8例,眶下缘截骨3例,眶外缘截骨2例,眶外下缘复合截骨26例,术后无并发症。手术前后测量结果显示,骨性眶间距、双侧眼球突出度、双眶连线与双耳屏连线的交角、双眼外眦与双耳屏连线距离等均较手术前有明显改善。结论 眼眶壁和眼眶缘的分层截骨术可以有效矫正不同类型的眼眶畸形。     

扭动模式超声乳化白内障吸除的初步临床研究

目的探讨一种新的超声振动模式-扭动模式(Torsional)用于白内障超声乳化吸除的有效性安全性。方法病例来自中山大学中山眼科中心,诊断单纯性老年白内障对其进行随机分组并行超声乳化白内障吸除,一组选用扭动模式,而另一组选用常规模式,记录术中所使用的超声时间(Ultrasound Time,UST)及超声能量(Cumulative Dissipated Energy,CDE),并比较术后角膜水肿程度、角膜厚度、术后的最佳矫正视力及角膜内皮细胞的丢失率。结果术中所使用的超声时间及超声能量比较,扭动模式组较常规模式组低,对于1、2、3、4级核,平均UST扭动模式组为8.32,18.45,29.48和48.39秒,而常规模式组为10.25,25.14,36.45和61.44秒;扭动模式组平均超声能量为0.94,3.13,7.47和14.08,常规模式组为1.25,4.18,8.59,16.51,之间的差异具有统计学意义。术后的平均最佳矫正视力比较,术后1天及术后7天扭动模式组较常规模式组高,而术后1月观察差异不具有统计学意义。角膜水肿及平均角膜中央厚度比较,术后1天及7天扭动模式组较常规模式组角膜水肿轻,术后30天比较它们之间的差异不具有统计学意义。术后7天及30天平均角膜内皮细胞计数比较,扭动模式组较常规超乳模式组高,丢失率低。结论扭动模式超声乳化白内障吸除较传统超乳模式相比,是一种高效安全的超声乳化振动模式,较传统模式相比可以减少术中的超声时间及超声能量,并减少对眼内组织特别是角膜内皮细胞的损伤。     

A review of corneal biomechanics: Mechanisms for measurement and the implications for refractive surgery

Detailed clinical assessment of corneal biomechanics has the potential to revolutionize the ophthalmic industry through enabling quicker and more proficient diagnosis of corneal disease, safer and more effective surgical treatments, and the provision of customized and optimized care. Despite these wide-ranging benefits, and an outstanding clinical need, the provision of technology capable of the assessment of corneal biomechanics in the clinic is still in its infancy. While laboratory-based technologies have progressed significantly over the past decade, there remain significant gaps in our knowledge regarding corneal biomechanics and how they relate to shape and function, and how they change in disease and after surgical intervention. Here, we discuss the importance, relevance, and challenges associated with the assessment of corneal biomechanics and review the techniques currently available and underdevelopment in both the laboratory and the clinic.     

Distribution of cone pedicle and superficial capillary. A morphological study on the macular region of normal human retina

The distribution and arrangement of cone pedicle (CP) and peri-foveolar superficial capillary net works (SC) in the macular region was studied in two eyes obtained from a 24-year-old male and a 34-year-old female, light and electron microscopically. CP and SC were not seen in the central area of the macular region. Both the CP-free zone and SC-free area were ellipsoid in form and the horizontal dimensions were larger than 140 microns and 425 microns in one case and 360 microns and 630 microns in the other. The dimensions of the SC-free area measured 200 microns and 500 microns in the first case and 520 microns and 650 microns in the second. The para-foveolar circle formed by CP- and SC-free zones were concentric and the SC circle was about 50 microns larger in radius than that of CP.     

新世纪我国斜视弱视研究进展

近5年来,在中华医学会眼科学分会的指导和全体专业人员的共同努力下,我国斜视、弱视基础和临床研究取得了长足进步。我们的科研人员和临床工作者在弱视分子和神经机制研究、视觉发育的可塑性研究、弱视的脑功能成像研究、眼外肌滑车（Pulley）研究以及斜视弱视的诊断、治疗及流行病学研究方面均付出了辛苦的劳动,取得了丰硕的成果。我们期待在未来的10年中,本学科的工作能不断发展、不断提高。     

Uveal and conjunctival malignant melanoma in denmark 1943-97: observed and relative survival of patients followed through 2002

PURPOSE: To evaluate the observed and relative survival of patients diagnosed with a malignant melanoma in the ocular region in Denmark during the period 1943-97. METHODS: The study included 2,504 patients (1,292 men and 1,212 women) diagnosed with a melanoma in the ocular region, of which 2,434 cases could be topographically subclassified into 2,178 in the choroid/ciliary body, 141 in the iris, and 115 in the conjunctiva. The patients were followed through 2002 and the observed survival proportions and relative survival ratios were estimated. RESULTS: For the total ocular region and the choroid/ciliary body, the observed survival did not vary statistically significantly with the year of diagnosis. A statistically insignificant higher observed survival for women than men was found for tumors in the ocular region and the subgroups choroid/ciliary body, iris, and conjunctiva. During the 55-year study period, the 5- and 10-year relative survival remained stable for the ocular region for men at 67% and 57% and for women at 71% and 60%, respectively, and stable for the choroid/ciliary body for men at 66% and 55% and for women at 69% and 57%, respectively. The 5- and 10-year relative survival for the iris was for men 90% and 85% and for women 99% and 101%, respectively, and for the conjunctiva for men 83% and 70% and for women 93% and 82%, respectively. CONCLUSION: The observed and relative survival of patients diagnosed with a melanoma in the ocular region and choroid/ciliary body in Denmark during the period 1943-97 and followed through 2002 has remained stable. The highest observed and relative survival was found for iris melanomas, the lowest for choroid/ciliary body melanomas, and intermediate for conjunctival melanomas.