A Study of Clinical Characteristics and Treatment of Mooren‘s Ulcer

Objective: To investigate the clinical characteristics and to compare the effects of several therapies of Mooren's corneal ulcer.Methods: 550 consecutive cases of Mooren's corneal ulcer inpatients were analysed, including the age, sex, laterality of the eye, ulcer location , perforative rate, cure rate of surgeries, recurrent rate, and the effects of conjunctiva excision, lamellar keratoplasty (LKP), LKP and plus cyclosporin A eye drop.Results: The average age of onset of the cornea! ulcer was 48.4 years old, the ratio of the male to the female patients was 1:0.74, the bilateral disease was 30% of the total cases, 31.5% of the bilateral disease occurred in the younger group, and 68.5% of the bilateral ulcer occurred in the older group, ulcers located at the limbus of the palpebral fissure were 70% of the total cases, perforative rate was 13.3% , 43.2% of the perforation occurred in the younger group, and 56.8% of the perforation occurred in the older group, recurrent rate of the post-opertion was 25.6%,     

Clinical Review: Familial Mediterranean Fever—An Overview of Pathogenesis,Symptoms, Ocular Manifestations,and Treatment

Familial Mediterranean fever is an autoinflammatory multisystem disease, which most commonly affects patients from the Mediterranean basin. This review discusses the common polymorphisms in the MEFV gene as well as the role of pyrin in disease pathogenesis. Patients with familial Mediterranean fever typically develop peritonitis, pleuritis, arthritis, and fever. In addition, a number of authors have reported ophthalmic features. These case reports and series are further explored in this review. Colchicine has transformed the prognosis for patients with familial Mediterranean fever. The rationale for the use of colchicine, as well as the evidence for newer biologic agents is also covered.     

An Experimental Study of the Tumour Necrosis Factor Level in Aqueous Humor after Transscleral Fixation of Intraocular Lens

Purpose: The tumour necrosis factor (TNF) level in aqueous humor after transscleral fixation of intraocular lens (IOL) implantation in rabbits and discuss the effect of TNF on postoperative anterior ocular inflammation.Methods: Twenty - seven pigmented rabbits were divided into three groups. Group 1: transscleral fixation of posterior chamber (PC) IOL implantation;Group 2; Lens of rabbits was removed without IOL implantation; Group 3; the comtrol group, without surgical intervention. On the 1st, 3rd, 7th and 14th postoperative days,aqueous humor samples were obtained. An modified double antibodies indirect sandwich ELISA was used to detected for the presence of TNF. The data were analyzed by using analysis of variance of SAS software. Results: It was found that TNF level in aqueous humor was increased after transscleral fixation of IOL implantation. TNF level reached its maximum on the 14th postoperative day in the IOL implanted group. TNF level on 1st, 3rd, 7th and 14th days postoperatively was signifi     

Sankara Nethralaya—Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN—DREAMS 1): Study Design and Research Methodology

Purpose: To describe the methodology of the Sankara Nethralaya—Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN—DREAMS 1), an ongoing population-based study to estimate the prevalence of diabetes and diabetic retinopathy in urban Chennai, Tamil Nadu, South India, and also to elucidate the clinical, anthropometric, biochemical and genetic risk factors associated with diabetic retinopathy. Methods: In this ongoing study, we anticipate recruiting a total of 5830 participants. Eligible patients, over the age of 40 years, are enumerated using the multistage random sampling method. Demographic data, socioeconomic status, physical activity, risk of sleep apnea, dietary habits, and anthropometric measurements are collected. A detailed medical and ocular history and a comprehensive eye examination, including stereo fundus photographs, are taken at the base hospital. Biochemical investigations (total serum cholesterol, high-density lipoproteins, serum triglycerides, hemoglobin, glycosylated hemoglobin HbA1c) and genetic studies of eligible subjects are conducted. A computerized database is created for the records. Conclusion: The study is expected to result in an estimate of the prevalence of diabetes and diabetic retinopathy and a better understanding of biochemical and genetic risk factors associated with diabetic retinopathy in an urban South Indian population. Worldwide, the prevalence of diabetes mellitus, in particular type II diabetes, is rising at an alarming rate. The World Health Organization (WHO) and International Diabetes Federation (IDF) have predicted that the number of cases of adult-onset diabetes would more than double by 2030 from the present level of 171 million to 366 million—an increase of 214%. In developed countries, this increase in diabetic population would be around 42% and in developing countries, particularly in India, it is even higher; i.e. 150%. In India, the prevalence of diabetes mellitus in the urban population is around 12.1%, as reported by the national urban diabetes study conducted in six major cities. Studies have shown the prevalence of diabetes to be higher among the high-income groups (25.5%) as compared to low-income groups (12.6%). The assessment of socioeconomic status was based on income, education, occupation or caste—which are not representative of the actual socioeconomic status. In the present study, however, the sample was stratified on socioeconomic scoring. This scoring was calculated on the basis of several parameters such as the residence being rented or owned, the number of rooms in the house, the highest educational status, the highest salary, the highest occupation, material possessions (cycle, TV, audio, car, etc.) and house/land value. To the best of our knowledge, this kind of comprehensive socioeconomic scoring has not been done before for prevalence studies on diabetic retinopathy in the general population.     

Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy—the Kailuan Eye Study

AIM: To observe the efficacy and safety of pars plana vitrectomy (PPV) with eye position guided fluid-air exchange and air tamponade in the treatment of rhegmatogenous retinal detachment (RRD). METHODS: RRD patients without severe proliferative vitreoretinopathy (PVR) C1 or more were enrolled. All patients underwent PPV combining with air tamponade. During operation, the primary retinal break(s) were placed at lower site and subretinal fluid was aspirated through the break(s) at the same time when eye position guided fluid-air exchange (FAX) was proceeding. Sufficient laser spots were made to seal the retinal break(s) after FAX, and filtered air was left in vitreous cavity as tamponade agent finally. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure. RESULTS: A total of 37 eyes (20 males and 17 females) with a follow-up time of ≥6mo were included. The range of RRD was 5.6±1.8h, and the number of retinal breaks was 1.9±1.2. The breaks located at inferior quadrants (between 3:00 and 9:00) in 5 cases (13.5%), and both superior and inferior breaks were found in 3 cases (8.1%). A total of 25 cases (67.6%) with macular detached involvement, 9 cases (24.3%) with intraocular lens, and 8 patients (21.6%) were treated with phacoemulsification and intraocular lens implantation together. The success rate of primary retinal reattachment was 100% (37/37). At 6mo postoperatively, BCVA (logMAR) was increased from 1.13±1.07 to 0.23±0.15 (P<0.001). Phacoemulsification combined with intraocular lens implantation was performed in 2 patients (5.4%), and one of them underwent macular epiretinal membrane peeling in addition (2.7%). Furthermore, high intraocular pressure was found in 4 cases (10.8%). CONCLUSION: PPV with air tamponade by eye position guided fluid-air exchange can achieve a high reattachment success rate in the management of patients with RRD, and it has the advantages of short postoperative prone time and fewer operative complications.     

Repetitive,Low—dose Tissue Plasminogen Activator for Clearance of Experimental Vitreous Hemorrhage

Purpose:To investigate the effectiveness of repetitive,low-dose tPA for clearance of experimental vitreous hemorrhage.Methods :The model vitreous hemorrhage was produced by intravitreal injection of 0. 05ml of autologous citrated whole blood in 14 rabbits (28 eyes). One week after the creation of vitreous hemorrhage,the eyes were randomly separated into 3 groups. Groups 1 and 2 received two injections of 5 or 25μg of tPA,respectively, with one injection in a 7-day interval. Group 3 received two injections of PS in the same way.Results:The clearance of vitreous hemorrhage in tPA-treated groups was significantly faster than that in the control group (P<0. 05, or P<0. 01). However, there was no statistically significant difference between the two tPA-treated groups. Not any retinal toxicity was detected by ERG, light microscopy, and transmission electron microscopy examinations.Conclusions: Repetitive injections of low-dose tPA were effective in the treatment of experimental vitreous hemorrhage. Whether i     

Periorbital dirofilariasis—Clinical and imaging findings: Live worm on ultrasound

Ocular dirofilariasis is a zoonotic filariasis caused by nematode worm,Dirofilaria. We present a case of dirofilariasis affecting the upper eyelid in a 2-year-old child presenting as an acutely inflammed cyst, from southern Indian state of Kerala. Live adult worm was surgically removed and confirmed to be Dirofilaria repens. Live worm showing continuous movement was seen on the pre-operative high-resolution ultrasound. Ultrasound can be helpful in pre-operative identification of live worm. Imaging findings reported in literature are very few. We describe the clinical, ultrasound, and magnetic resonance imaging (MRI) findings.     

An Immunohistochemical Study of Langerhans Cells,T-Cells and the HLA Antigen in Human Cornea

The distribution of Langerhans cells (LC),T-cell subsets andHLA antigen in 12 normal and 7 morbid corneas,including 4 of suppurativecorneal ulcer and 3 of uveogenic endophthalmitis,was investigated withmonoclonal antibodies.The results revealed that a small amount of LC andT-cell subsets were present in the limbal region of normal corneas,whilelarge numbers of LC and OKT_4~+ were observed in the corneas of suppurativeulcer.HLA-A,B,C antigens were expressed on the epithelial cells andkeratocytes of the normal corneas,while the HLA-DR antigens wereexpressed on the surface of LC at the limbus.Eye Science 1993;9:121-125.     

[Online First]Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy— the Kailuan Eye Study

AIM: To explore the influencing factors of type 2 diabetic patients with mild non-proliferative diabetic retinopathy (NPDR) in the Kailuan area of Tangshan, Hebei Province, China. METHODS: In this non-interventional, retrospective study, 683 patients with type 2 diabetes mellitus were included in the Kailuan Diabetic Retinopathy Study involving participants with diabetes in the community-based longitudinal Kailuan Study. Based on the undilated ultra-wide field (200°; UWF) images and partial dilated digital fundus images, the diabetic retinopathy (DR) of the surveyed population was graded. Interobserver agreement was estimated by using Cohen’s Kappa statistics. The main outcome indicators included age, gender, height, weight, body mass index, blood pressure, circumferences of neck circumference, waist and hip, current smoking, levels of fasting plasma glucose (FPG), hypersensitive C-reactive protein, creatinine, and cholesterol, etc. According to different lesions’ locations of patients with mild NPDR, logistic regression models were used to estimate the odds ratios (ORs) and their 95% CIs of each risk factor. RESULTS: The study group of 683 patients included 570 males and 113 females. The mean age of the patients was 62.18±9.41y. Compared with dilated fundus examinations, there was fair agreement with the level of DR identified on UWF images in 63.91% of eyes (k =0.369, 95%CI, 0.00-0.00). Detected by UWF images, there were 98 patients with mild NPDR having peripheral retinal lesions, 35 patients with mild NPDR having posterior lesions, 44 patients with mild NPDR whose lesions were detected both in and out the standard two fields area, and 336 patients with non obvious DR. Parameters that conferred a statistically significant increased risks for mild NPDR with having peripheral retinal lesions were neck circumstance (OR, 1.124; 95%CI, 1.044-1.211), and with posterior lesions were FPG (OR, 1.052; 95%CI, 1.007-1.099). CONCLUSION: UWF is an effectiveness means of DR screening. Moreover, it is necessary to evaluate peripheral diabetic retinal lesions which can help to assess the severity of DR. The phenomenon that nonuiform and inhomogeneous distribution of DR lesions has been found. And the influencing factors in mild NPDR are differing by different lesions’ locations.     

Study of the Influence of Angiostatin Intravitreal Injection on Vascular Leakage in Retina and Iris of the Experimental Diabetic Rats

The breakdown of the blood-retinal barrier or increased vascular permeability is an early complication of diabetes and a major cause of diabetic macular edema[1,2]. It is found that the increase of retinal vascular permeabil- ity precedes the appearance of clinical retinopathy at early stages of diabetic retinopa- thy[3,4]. Diabetic macular edema is a major cause of vision loss in diabetic patients. Although the pathogenic mechanism on the breakdown of the blood-retinal barrier and the increas…     

Looking for Ocular Tuberculosis: Prevalence and Clinical Manifestations of Patients with Uveitis and Positive QuantiFERON®-TB Gold Test

Purpose: To report on the prevalence of ocular TB and positive QuantiFERON^®-TB Gold (QFT-G) test in uveitis patients and describe their clinical manifestations.

Methods: We performed a prospective study of 108 new human immunodeficiency virus-negative uveitis patients. All patients underwent a tailored screening protocol for uveitis and received QFT-G test and tuberculin skin tests (TST).

Results: QFT-G test was positive in 39/108 (36%) of patients, while TST ≥15 mm was positive in 16/108 (15%) patients. None of the patients were identified with active systemic TB. Out of 39 QFT-G-positive patients, 25 (64%) were of unknown cause, which represents a higher proportion than encountered in QFT-G-negative cases (29/69; 42%; p<0.03). Retinal occlusive vasculitis was frequently observed in patients with positive QFT-G outcomes (10/39 vs 3/69; p = 0.001) and was commonly associated with high QFT-G levels, young age, and male gender.

Conclusions: Out of all patients with uveitis, none had active systemic TB but 36% were positive for QFT-G test. QFT-G-positive patients frequently had uveitis of unknown cause and exhibited clinical features of occlusive retinal vasculitis.     

Early Vitrectomy for Severe Proliferative Diabetic Retinopathy in Eyes with Useful Vision: Clinical Application of Results of a Randomized Trial—Diabetic Retinopathy Vitrectomy Study Report 4

Six patients are described, each of whom underwent early vitrectomy for advanced, active, proliferative diabetic retinopathy (PDR) in an eye with useful vision. These cases were selected to illustrate the spectrum of retinopathy severity for which early vitrectomy should be considered and the favorable outcome that can follow this procedure. None of the eyes that had an unfavorable result after early vitrectomy is presented. The eyes most suitable for early vitrectomy are those in which both fibrous proliferations and at least moderately severe new vessels are present, and in which extensive scatter photocoagulation has already been carried out or is precluded by vitreous hemorrhage.