Effects of immunosuppressants after penetrating keratoplasty: meta-analysis of randomized controlled trials

AIM: To assess the effectiveness of immunosuppressants in the prophylaxis of corneal allograft rejection after high-risk keratoplasty and normal-risk keratoplasty. METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CNKI, VIP and reference lists of articles. Date of most recent search: 18 June, 2011. All randomised controlled trials (RCTs) assessing the use of immunosupressants in the prevention of graft rejection, irrespective of publication language. Two authors assessed trial quality and extracted data independently. Only dichotomous outcomes (clear graft survival, ratio of immune reactions and side effects) were available and were expressed as relative risk (RR) and 95% confidence intervals (CI). RESULTS: Seven studies were included in this review. In the comparing of mycophenolate mofetil (MMF) with placebo, the results showed MMF could significantly reduce immune reactions compared with placebo (RR 1.08 95% Cl 0.95 to 1.21), but no effect on clear graft survival (RR 1.11 95% Cl 0.90 to 1.35). In clear graft survival and immune reactions, MMF and cyclosporine A (CsA) showed similar effect (RR 1.11 95% Cl 0.90 to 1.35, and RR 1.48, 95% Cl 0.56 to 3.93, respectively). Tacrolimus (FK506) and steroid showed similar effects on clear graft survival and immune reactions (RR 0.32, 95% CI 0.02 to 6.21, and RR 1.00, 95%CI 0.88 to 1.14, respectively). No drug relative side effect has been found. CONCLUSION: MMF may reduce immune reactions in both normal-risk and high-risk rejection of penetrating keratoplasty. CsA and FK506 showed similar effects as MMF. However, due to the lack of large clinical trials, the evidence remain weak, the quality of evidences were rated as very low to moderate. Large, properly randomised, placebo-controlled, double masked trials are needed to evaluate the effect of immunosuppressants.     

对比视盘损伤可能度、杯盘比和青光眼可能性评分诊断原发性开角型青光眼的能力

目的利用海德堡视网膜断层扫描仪-Ⅲ(Heidelberg retina tomography-Ⅲ,HRT-Ⅲ)对受试者进行视盘损伤可能度(disc damage likelihood scale,DDLS)分期,评价DDLS分期是否比杯盘比(cup to disc ratio,C/D)和青光眼可能性评分(glaucomaprobability score,GPS)更准确地诊断原发性开角型青光眼(primary open-angle glaucoma,POAG)。方法将POAG患者60例、可疑开角型青光眼患者31例和正常人54人纳入本研究。在双盲情况下检查眼底并确定C/D。完成对受检者的OCTOPUS-900视野计和HRT-Ⅲ检查后,分别得到视野平均缺损值和GPS值。根据受检者的HRT-Ⅲ地形图,对照DDLS评分表,对受检者的视盘进行DDLS分期。建立受试者操作特征曲线(receiver operating characteristic curve,ROC),计算DDLS分期、C/D和GPS的受试者操作特征曲线下面积,并计算最佳临界值的敏感度、特异度。结果正常组、SOAG组、POAG组的DDLS分期、C/D、GPS值逐渐增高,且两两比较差异均有统计学意义(均为P<0.01)。DDLS分期、C/D和GPS的ROC曲线下面积分别为0.932、0.874、0.960。DDLS分期的最佳临界值为5,其敏感度为93.3%,特异度为85.2%;C/D的最佳临界值为0.5,其敏感度为81.7%,特异度为77.8%;GPS的最佳临界值为0.36,其敏感度为91.7%,特异度为85.2%。结论利用HRT-Ⅲ的DDLS分期,是一种比C/D更好的诊断POAG视神经损害的方法,与GPS的诊断价值相当。     

TGFBI gene mutation analysis in a Chinese pedigree of Avellino corneal dystrophy

AIM: To analyze phenotype and genotype of a Chinese pedigree with Avellino corneal dystrophy (ACD). METHODS: Complete ophthalmic examinations were per- formed on all the family members. Exons of TGFBI were amplified by polymerase chain reaction, sequenced, and compared with a reference database. RESULTS: A single heterozygous G>A(R124H) point mutation was identified in exon 4 of TGFBI in three affected members and two unaffected children who were offsprings of the affected members, but not in the other family members. CONCLUSION: Mutation R124H in TGFBI was identified in this pedigree and appeared to be the disease causing mutation. Atypical phenotype and low penetrance was observed in this pedigree.     

Diagnostic values of questionnaires of Convergence Insufficiency Symptom Survey and College of Optometrists Vision Development Quality of Life in the screening of convergence insufficiency

AIM: To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire (COVD-QOL) and the Convergence Insufficiency Symptom Survey (CISS) in detecting convergence insufficiency and to compare their diagnostic value in clinical applications. METHODS: Using the diagnostic test method, 62 adult patients with convergence insufficiency (age: 24.74±3.75y) and 62 normal participants (age: 23.61±3.13y) who visited the Optometry Clinic of West China Hospital of Sichuan University from April 2021 to January 2023 were included. All subjects completed the CISS and COVD-QOL. Statistical analysis of the sensitivity and specificity of the CISS and COVD-QOL and comparison and joint experimental analysis of their diagnostic efficacy were performed. RESULTS: The sensitivity of the CISS and COVD-QOL for convergence insufficiency was 64.5% and 71.0%, respectively, while the specificity was 96.8% and 67.7%, respectively. Compared to the CISS alone, the combination of the CISS and COVD-QOL demonstrated lower sensitivity and specificity. The areas under the receiver operating characteristic curve of CISS, COVD-QOL and CISS combined with COVD-QOL were 0.806, 0.694 and 0.782, respectively. CONCLUSION: Considering the low sensitivity of the CISS and the low specificity of the COVD-QOL, it is recommended to supplement these questionnaires with other screening tests for the detection of convergence insufficiency.     

Prevalence of color vision deficiency among Chinese college students and their quality of life

AIM: To investigate the prevalence of color vision deficiency (CVD) among college students and their quality of life (QoL) in a Chinese college. METHODS: This cross-sectional study was performed in Sichuan University in Chengdu, China. The questionnaire containing participants'' demographic data, as well as CVD related QoL was distributed to students who were screened as CVD [by Color Vision Examination Plates (Version 6)] in 2022 freshman entrance examination. Color blindness QoL (CBQoL) and utility analysis were used to evaluate the QoL of CVD students. RESULTS: There were 381 of 17 303 (2.20%) students screened as CVD, including 368 (4.11%) males and 13 (0.16%) females. A total of 317 students completed the questionnaire, the response rate was 83.20%. Only 166 participants (52.3%) knew they have CVD before the physical examination for college entrance examination, while a total of 145 participants (45.74%) hoped to be diagnosed earlier. The medians of CBQoL score and utility were 5.85 (range 2.2-6) and 1 (range 0-1), respectively. The proportions of students whose QoL is affected by CVD were 67.63% (211/312) and 42.27% (134/317) measured by CBQoL and utility analysis respectively. CONCLUSION: The prevalence of CVD in males is much higher than that in females. The time when CVD students first became aware of their CVD is relatively late. The QoL of the study population is quite high, while a large proportion of students'' QoL are affected by CVD. It is suggested that as a congenital defect, CVD screening in China should be earlier, and appropriate guidance and support are needed for CVD patients to help them better adapt to life, study, and work.     

甲状腺相关眼病组织病理学研究

目的:探讨甲状腺相关眼病组织病理学改变。方法:收集我院2000/2005经症状、体征、甲状腺功能和CT证实为甲状腺相关眼病,并行眼眶减压术或复视矫正术的TAO患者共21例,行HE染色,Masson染色和阿辛蓝染色,观察TAO的病理学改变。结果:HE染色可见脂肪间隙增宽,间质伊红红染,纤维隔形成,肌纤维断裂,纤维化,淡染,部分溶解,空泡形成,Masson染色可见肌肉间质蓝染,脂肪组织血管增多,间质蓝染;阿先蓝染色可见脂肪间质蓝染。结论:甲状腺相关眼病主要组织病理学改变有脂肪间隙增宽,纤维隔形成,血管新生;肌纤维不同程度肌浆凝集,肌纤维断裂,纤维化,淡染,部分溶解,空泡形成。急性期可见糖胺聚糖沉积,肌束间炎性细胞浸润。     

眼部组织细胞增生症诊疗进展

眼部组织细胞增生症是一组罕见的成人及儿童均可发病的异质性疾病，其临床及影像学表现无特异性，临床上该类疾病的诊疗存在巨大困难。随着对组织细胞增生症分子机制的研究，BRAF^V600E突变基因的发现使人们对组织细胞增生症有了进一步的认识，也使多数患者能够得到针对性的治疗。诊断的金标准发展为组织病理活检联合突变基因的检测，治疗方式不再是单一的手术切除治疗，靶向治疗对MAPK-ERK通路中突变基因阳性的患者也有极好的疗效。但是眼部组织细胞增生症类型众多且常常涉及多个系统，临床表现多样，对其早期、正确地诊断仍面临挑战。因此本文就近年眼部组织细胞增生症的诊疗进展进行文献复习，总结眼部组织细胞增生症的临床病理特征并对最新的治疗进展进行综述，旨在提高临床医生对该疾病的诊疗水平。     

免疫调节剂治疗鼻部炎症性疾病专家共识(2023，深圳)

鼻部炎症性疾病临床主要包括变应性鼻炎(AR)、非变应性鼻炎(NAR)和慢性鼻窦炎(CRS),其发病机制尚未完全阐明，涉及遗传学、免疫调节、炎症介质、环境因素、微生物群状态等多方面，传统药物治疗后部分患者症状仍无法缓解或出现不必要的副作用，且容易反复发作或呈慢性持续状态，因其发病多与免疫失衡相关，免疫调节是一个有效的治疗方案。近年来，免疫调节剂的品种和应用越来越广泛，主要包括化学合成制剂、生物制剂、人和动物免疫系统的产物、中药及其制剂等。但免疫调节剂治疗鼻部炎症疾病缺乏高水平的循证医学证据，使用尚不规范，因此，我们特组织该领域有经验的中青年鼻科专家，基于临床经验和循证医学证据制定了免疫调节剂治疗鼻部炎症性疾病专家共识，本共识从鼻部炎症性疾病发病机制角度出发，系统总结了鼻炎及CRS常用免疫调节剂的免疫作用机制、临床研究证据、适应证、用法用量及注意事项等，以供临床医生在选择和应用免疫调节剂时参考。     

A novel approach for 25-gauge transconjunctival sutureless vitrectomy to evaluate vitreous substitutes in rabbits

AIM: To improve the standard three-port vitrectomy for establishing and evaluating an endotamponade model in rabbits. METHODS: Three ports were prepared near the third eyelid of rabbits, and the infusion port was placed at the inferior nasal quadrant with the inserted cannula linking with a self-designed handheld rigid infusion catheter. All right eyes of rabbits underwent a modified 25-gauge vitrectomy and were subsequently filled with balanced salt solution, silicone oil, and eight-arm polyethylene glycols (8-arm PEGs) hydrogel separately for comparison. Ophthalmic examinations were performed regularly to record the changes after the surgery. RESULTS: Successful vitrectomy was achieved among 44 chinchilla rabbits. The mean operation time was 4.51±1.25min. Four eyes (9.1%) presented limited lens touch and two eyes (4.5%) showed retinal touch during surgery. Incision leakage was found in three eyes (6.8%) after surgery. There was no endophthalmitis, hemorrhage, or retinal detachment during the observation period and ophthalmic examinations after the implantation of vitreous substitutes. CONCLUSION: The modified technique of the standard vitrectomy applied in the endotamponade model in rabbits shows excellent safety and practicality.