双眼先天性无虹膜一例

患儿,男,10岁.自幼双眼视力差,畏光.于2008年3月15日就诊.患儿为足月顺产,父母非近亲结婚,家族中无遗传病史.全身检查:一般情况好,智力及发育无异常.眼部检查:视力右眼0.3,矫正0.8(-3.75DS/ 2.50DC×170°);左眼0.2,矫正0.7(-4.25DS/ 2.75DC×10°);双眼眼位正常,各方向运动自如.     

Infectious keratitis in Vietnam: etiology, organisms, and management at Vietnam National Eye Hospital

AIM:To report the etiologies,risk factors,treatments,and outcomes of infectious keratitis(IK)at a major Vietnamese eye hospital.METHODS:This is a retrospective review of all cases of IK at Vietnam National Eye Hospital(VNEH)in Hanoi,Vietnam.Medical histories,demographics,clinical features,microbiological results,and treatment outcomes were reviewed.RESULTS:IK was diagnosed in 1974 eyes of 1952 patients,with ocular trauma being the greatest risk factor for IK(34.2%),frequently resulting from an agriculturerelated injur y(53.3%).The mean duration between symptom onset and presentation to VNEH was 19.3±14.4 d,and 98.7%of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH.Based on smear results of 1706 samples,the most common organisms identified were bacteria(n=1107,64.9%)and fungi(n=1092,64.0%),with identification of both bacteria and fungi in 614(36.0%)eyes.Fifty-five of 374 bacterial cultures(14.7%)and 426 of 838 fungal cultures(50.8%)were positive,with the most commonly cultured pathogens being Pseudomonas aeruginosa,Streptococcus pneumonia,Fusarium spp.,and Aspergillus spp.Corneal perforation and descemetocele developed in 391(19.8%)and 93(4.7%)eyes,respectively.Medical treatment was successful in resolving IK in 50.4%eyes,while 337(17.1%)eyes underwent penetrating or anterior lamellar keratoplasty.Evisceration was performed in 7.1%of eyes,most commonly in the setting of fungal keratitis.CONCLUSION:Ocular trauma is a major risk factor for IK in Vietnam,which is diagnosed in almost 400 patients each year at VNEH.Given this,and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration,greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.     

医源性眼巩膜双穿孔伤一例

1 病例 患者女,汉族,63岁.右眼视物不清3年确诊老年性白内障于2006年8月5日人院,检查:全身检查无异常;右眼视力光感,光定位和色觉正常;前房正常深浅,瞳孔3 mm,对光反射存在,晶状体乳白色浑浊,眼压15.55 mmHg(1 mmHg=0.133 kPa).     

Prevalence and risk factors of dry eye disease in young and middle-aged office employee:a Xi’an Study

AIM:To estimate the prevalence of and risk factors for dry eye disease(DED)in young and middle-aged office employee in Xi’an.METHODS:This cross-sectional study of the prevalence of and risk factors for DED investigated 486 young and middle-aged Chinese office employee in Xi’an.DED symptoms and potential risk factors were assessed using the ocular surface disease index combined with a risk factors questionnaire,and tear function was evaluated using the tear film break-up time and Schirmer’s test.Possible risk factors for DED were estimated by binary Logistic regression analysis.RESULTS:DED was diagnosed in 100 females and 96 males,giving a prevalence of 40.3%[95%confidence interval(CI)=36.0%-44.7%].The multivariate binary Logistic regression model indicated that the possible risk factors for DED were being female(OR=1.592,95%CI=1.034-2.451,P=0.035),being aged≥40 y(OR=1.593,95%CI=1.034-2.454,P=0.035),using a VDT daily for>6 h(OR=1.990,95%CI=1.334-2.971,P=0.001),the presence of central air conditioning(OR=1.548,95%CI=1.053-2.276,P=0.026),and self-reported dryness of the mouth and nose(OR=1.589,95%CI=1.071-2.357,P=0.021).CONCLUSION:There is a high prevalence of clinically diagnosed DED in young and middle-aged video displayterminal(VDT)users.Interventions against the modifiable risk factors should be taken to prevent the occurrence and development of DED in this population.     

Spasm of the near reflex:a common diagnostic dilemma?

AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally,due to prolonged screen use SNR and AS may become more frequent in the future.     

Corneal stromal mesenchymal stem cells: reconstructing a bioactive cornea and repairing the corneal limbus and stromal microenvironment

Corneal stroma-derived mesenchymal stem cells(CS-MSCs) are mainly distributed in the anterior part of the corneal stroma near the corneal limbal stem cells(LSCs). CS-MSCs are stem cells with self-renewal and multidirectional differentiation potential. A large amount of data confirmed that CS-MSCs can be induced to differentiate into functional keratocytes in vitro, which is the motive force for maintaining corneal transparency and producing a normal corneal stroma. CS-MSCs are also an important component of the limbal microenvironment. Furthermore, they are of great significance in the reconstruction of ocular surface tissue and tissue engineering for active biocornea construction. In this paper, the localization and biological characteristics of CS-MSCs, the use of CS-MSCs to reconstruct a tissue-engineered active biocornea, and the repair of the limbal and matrix microenvironment by CS-MSCs are reviewed, and their application prospects are discussed.     

Incidence of endophthalmitis after phacoemulsification cataract surgery: a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^th,2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.     

Preliminary studies of constructing a tissue-engineered lamellar corneal graft by culturing mesenchymal stem cells onto decellularized corneal matrix

AIM:To construct a competent corneal lamellar substitute in order to alleviate the shortage of human corneal donor.METHODS:Rabbit mesenchymal stem cells(MSCs)were isolated from bone marrow and identified by flow cytometric,osteogenic and adipogenic induction.Xenogenic decellularized corneal matrix(XDCM)was generated from dog corneas.MSCs were seeded and cultured on XDCM to construct the tissueengineered cornea.Post-transplantation biocompatibility of engineered corneal graft were tested by animal experiment.Rabbits were divided into two groups then underwent lamellar keratoplasty(LK)with different corneal grafts:1)XDCM group(n=5):XDCM;2)XDCM-MSCs groups(n=4):tissue-engineered cornea made up with XDCM and MSCs.The ocular surface recovery procedure was observed while corneal transparency,neovascularization and epithelium defection were measured and compared.In vivo on focal exam was performed 3 mo postoperatively.RESULTS:Rabbit MSCs were isolated and identified.Flow cytometry demonstrated isolated cells were CD90 positive and CD34,CD45 negative.Osteogenic and adipogenic induction verified their multipotent abilities.MSC-XDCM grafts were constructed and observed.In vivo transplantation showed the neovascularization in XDCMMSC group was much less than that in XDCM group postoperatively.Post-transplant 3-month confocal test showed less nerve regeneration and bigger cell-absent area in XDCM-MSC group.CONCLUSION:This study present a novel corneal tissue-engineered graft that could reduce post-operatively neovascularization and remain transparency,meanwhile shows that co-transplantation of MSCs may help increase corneal transplantation successful rate and enlarge the source range of corneal substitute to overcome cornea donor shortage.     

Comparison of correcting myopia and astigmatism with SMILE or FS-LASIK and postoperative higher-order aberrations

AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ²=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ²=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ²=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ²=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.     

眶内巨大鼻窦囊肿手术治疗三例报告

1 病例 例1:患者男,38岁.因左眼眶内发现肿物3年多并进行性增大,经多家医院诊治未愈于1998年4月6日来本院.患者一般情况好,全身检查未见特殊.左眼眶内侧缘高高隆起约35 mm.触及一表面光滑、无压痛、不活动、与皮肤不粘连、有波动感的肿块,大小约40 mm×40 mm.眼球被严重挤压向外侧眶下缘突出约30 mm.双眼视力1.5,无复视.右眼检查正常.     

Minimal-invasive Therapie der Epiphora durch Ballonkatheterdilatation und Stentimplantation

ZusammenfassungHintergrund Untersuchung der klinischen Effizienz der Ballonkatheterdilatation bzw. Stentimplantation bei Obstruktionen des Tränengangsystems.Methode Bei insgesamt 63 Patienten wurden wegen Epiphora 69 Tränenapparate mittels Ballonkatheterdilatation bzw. Stentimplantation behandelt. In 55 Fällen lag der Symptomatik eine Stenose, in 14 Fällen ein Verschluss des Tränengangsystems zugrunde. In allen Fällen erfolgte präinterventionell die diagnostische Dakryozystographie zur Beurteilung des Stenosegrades und der Lokalisation. Ergebnisse Die Intervention war bei 61 Tränenapparaten technisch erfolgreich. Innerhalb des Nachbeobachtungszeitraumes von maximal 3,5 Jahren betrug die klinische Erfolgsrate bei den Tränenwegsstenosen 83,6%, bei den Verschlüssen 42,9%.Schlussfolgerungen Die Dakryozystoplastie in Form der durchleuchtungskontrollierten Ballondilatation sowie ggf. nachfolgender Stentimplantation stellt im Vergleich zur operativen Therapie ein minimal-invasives Verfahren dar, das bei vergleichbaren technischen und klinischen Erfolgsraten zunehmend als Alternative zur Behandlung der symptomatischen Tränenwegsstenosen und Verschlüsse eingesetzt werden kann.     

Elemental concentrations in ocular tissues of various species

An investigation was undertaken to expand the data base for elemental concentrations within eye tissues of different species. This report provides data on the distribution of calcium, copper, iron and zinc in human, dog, bovine, bird, amphibian and fish ocular tissues. The variation between different eyes of the same individual and different individuals was calculated for each metal. Elemental concentrations between the left and right eyes of an individual were usually closer in value than between two eyes of different individuals.