视网膜光凝术后的睫状体和脉络膜改变

探讨视网膜光凝术对睫状体和前段脉络膜的影响。方法：应用超声生物显微镜观察１０例１０眼眼底病患者视网膜光凝术治疗前后睫状体和前段脉络膜的改变。结果：１０眼视网膜光凝术前睫状体脉络膜情况正常，术后第３天出现睫状体水肿、睫状体脉络膜脱离。术后第５～７天消退。结论：视网膜光凝术能引起一过性的睫状体脉络膜脱离，应合理控制视网膜光凝术的激光量和间隔时间     

经巩膜睫状体光凝治疗难治性青光眼疗效观察

难治性青光眼是指难以用药物和手术控制的青光眼，这类青光眼过去常用睫状体破坏手术，如睫状体冷冻或睫状体电凝控制眼压，但临床效果差，并发症多。我院2003年8月～2004年3月应用810半导体激光对难治性青光眼进行经巩膜睫状体光凝(transscleral photocogulation，TSCPC)治疗，现报告如下。     

国产半导体激光对兔睫状体的病理影响

目的：探讨国产半导体激光对兔睫状体的病理学改变。方法：用国产半导体激光对正常兔眼作经巩膜睫状体光凝术后，在光镜，电镜下观察其组织反应，结果：组织病理学检显示光凝处睫状体上皮及间质均出现凝固性坏死，程度与激光击射能量有关，击射区外未发现相似变化，结论：形态学结果提示国产半导体激光对击射区睫状体有破坏作用，对周围组织无影响。     

应用半导体激光进行巩膜外睫状体光凝治疗眼压难以控制青光眼的初步报告

目的探讨经巩膜外睫状体光凝治疗眼压难以控制青光眼的临床价值。方法应用接触式半导体激光对19例（19眼）眼压为49．30±11．58mmHg青光眼患者进行睫状体光凝。结果随访5．5±3．44月眼压控制在25．62±13．64mmHg。结论接触式半导体激光行睫状体光凝是治疗各类眼压难以控制青光眼的有效、安全治疗方法。     

经内窥镜睫状体光凝术

从19世纪30年代，人们开始通过破坏睫状体来减少房水的分泌，以达到降低眼压、治疗青光眼的目的。睫状体的破坏可以由多种途径来实现，如睫状体透热术、睫状体冷冻术、睫状体光凝术等。其中，睫状体激光光凝术已经成为目前破坏睫状体、减少房水分泌的最主要的方法。1972年，Beckman和Suger首先报道了应用红宝石激光进行经巩膜睫状体光凝术     

虹膜小梁光凝联合小梁切除治疗新生血管青光眼

目的：评价氩激光虹膜小梁网光凝联合小梁切除术治疗新生血管性青光眼的效果。方法：92例新生血管青光眼，先用氩激光对虹膜及小梁网的新生血管进行激光光凝，然后再行小梁切 除术。结果：术后随访3月，82例眼压控制在21mmHg以下（1mmHg=0.133kPa），有效率达89．13％，优于睫状体冷冻术。结论：氩激光虹膜小梁网光凝联合小梁切除术是治疗新生血管性青光眼比较有效的方法。     

冷凝联合810激光治疗新生血管性青光眼

目的 探讨冷凝联合810激光治疗新生血管性青光眼的方法和效果。方法 对12例中11例严重的新生血管性青光眼患者实行分段性治疗，先行赤道部巩膜外冷凝，7天后再行睫状体810激光光凝。另1例直接行810激光光凝，术后前房积血、渗出、反应重。结果 所有病例术中及术后无严重并发症，一次治疗眼压控制10例，占83.33%，2例接受二次治疗。术后眼压控制且视力提高者占75％。讨论 赤道部巩膜外冷凝联合810激光睫状体光凝是一种治疗新生血管性青光眼的有效方法。     

二极管激光经巩膜睫状体光凝治疗外伤性青光眼23例疗效观察

目的 探讨经巩膜睫状体光凝治疗外伤性青光眼的临床价值。方法 应用接触式二极管激光对２３例２３眼眼压为２５．８１－８１．６５ｍｍＨｇ的外伤青光眼患者行睫状体光凝术。结果 随访３个月眼压控制良好。结论 二极管激光经巩膜睫状体光凝是治疗外伤性、难治性青光眼的有效、安全的方法。     

玻璃体切割联合硅油充填术后持续高眼压半导体激光治疗疗效观察

目的 探讨视网膜脱离，玻璃体切割联合硅油充填术后持续高眼压半导体激光经巩膜睫状体光凝术治疗的疗效。方法 对玻璃体切割联合硅油充填持续高眼压38例（38眼）进行治疗随访观察。结果 38例（38眼）眼压均有所控制。结论玻璃体切割联合硅油充填术后持续高眼压进行半导体激光经巩膜睫状体光凝术治疗是一种较为有效的方法。     

氩激光治疗外伤性前房角睫状体解离

报告氩激光光凝成功治疗８例外伤性前房角睫状体解离的低眼压综合征。随诊时间６～６８个月（平均２６．７个月），未见明显激光并发症。强调激光光凝技术和早期治疗的必要性。指出激光治疗前房角睫状体解离，是使前房角恢复接近正常生理解剖功能的安全有效的治疗方法。     

Rituximab and Acute Retinal Necrosis in a Patient with Scleromalacia and Rheumatoid Arthritis

Background: Rituximab is a widely used biologic agent, which has shown favourable results in the treatment of vasculitis. But immunosuppressive treatment also bears the risk of severe complications.

Methods: A patient with rheumatoid arthritis, progressive scleromalacia, and acute retinal necrosis on therapy with rituximab is reported.

Results: For the first time, a correlation between rituximab and acute retinal necrosis in a patient with progressive rheumatoid scleromalacia is shown.

Conclusions: Although rituximab is a promising biologic agent for the treatment of autoimmune diseases, it bears the risk of reactivation of viral infections, including the onset of acute retinal necrosis.     

HLA-A29 and Birdshot Chorioretinopathy

Birdshot chorioretinopathy primarily affects patients of European descent. At least 96%, if not all patients, are HLA-A29 carriers. HLA-A*29:01 and HLA-A*29:02, the two main subtypes of HLA-A29, differ only by a single mutation. In the general population HLA-A*29:02 is most frequent in whites, while HLA-A*29:01 is more frequent in Asians. The differential distribution of HLA-A*29:01 and HLA-A*29:02 has been actively debated as an explanation for the selective development of the disease in patients of European descent, but is no longer a valid argument. Another factor, probably not HLA linked, is either protective in Asians and in Africans or, conversely, triggers an autoimmune reactivity that is possibly present in whites and absent in Asians and in Africans. HLA-A*29:02 transgenic mice in which a spontaneous posterior uveitis is observed after 6 months of age provide further evidence that the HLA-A29 molecule plays a role in the pathogenesis of the disease.     

Aniridia caused by a heritable chromosome 11 deletion.

A child with aniridia, multiple anomalies, severe failure to thrive, and severe psychomotor retardation is shown to have a syndrome similar to, though more severe than, other patients with overlapping deletions of the short arm of chromosome 11 (Pediatrics 64:604, 1978). Her deletion (46,XX,del [11p] [pter yields p14::p11.3 yields qter]) was derived from her mother, who has a chromosome 11 shift (46,XX,der [11] [pter yields p14::p11.3 yields q22::p14 yields p11.3::q22 yields qter]). The significance of del (11p) in the aniridia-Wilms' tumor association is discussed, and the del (11p) basis for aniridia is compared with other genetic bases for aniridia.     

Microspherophakia

Microspherophakia is present when the crystalline lens is small and relatively spherical with increased antero‐posterior thickness. Clinical findings for a patient with idiopathic bilateral microspherophakia are described. The patient was moderately myopic with slightly reduced visual acuity. The anterior chambers (R: 1.57 and L: 1.37 mm) were shallow compared with normals (3.46 to 3.80 mm) and the crystalline lenses were thicker (R: 4.77 and L: 4.89 mm) than normal (3.3 to 3.96 mm) with steeper than normal anterior (radii of curvature R: 6.2 and L: 6.3 mm) and posterior (R: 6.3 and L: 5.6 mm) surfaces. Microspherophakia may be associated widi various syndromes and there is a strong possibility of glaucoma, particularly if the small lens is displaced.     

Holmium: YAG and neodymium: YAG laser assisted trans-canalicular dacryocystorhinostomy. Results of 317 first procedures

PURPOSE: To assess the results of the first procedures of trans-canalicular dacryocystorhinostomy according to two different lasers: Neodymium: YAG (Nd: YAG) laser or Holmium: YAG (Ho: YAG) laser. To study the efficiency of two anti-metabolite drugs: mitomycin-C (MMC) and 5 fluoro-uracile (5 FU). To analyse the rate of efficiency of the Ho: YAG laser in the canalicular obstructions. METHODS: Three hundred and seventeen patients were operated: 226 with the Nd: YAG laser, 77 with the Ho: YAG laser and 14 with both lasers; 68 were treated with an application of MMC and 40 patients with an application of 5-FU. Sixty-three patients suffered from a canalicular obstruction. RESULTS: The results are based on 289 procedures 6 months after the operation. The global rate of success was 63.32% after one intervention and 70.24% after one or two revisions. There is no statistically significant difference between Nd: YAG or Ho: YAG lasers. The use of antimetabolites did not improve the success rate. In 65% of the cases the canalicular patency is reached. CONCLUSION: Laser-assisted transcanalicular dacryocystorhinostomy is a very useful method because it does not cause cutaneous scarring and for it has a low rate of morbidity given that it causes very little surgical traumatism. Consequently, it can be used under topical anaesthesia and for patients at risk or suffering from coagulation problems. It can be undertaken in the cases of extremely narrow nasal fossae when an endonasal dacryocystorhinostomy is impossible. This procedure is less successful than external or endonasal dacryocystorhinostomy. The success rate is not modified by the use of antimetabolites or by the type of laser.     

Properties of the visual pigments of the moth Manduca sexta and the effects of two detergents, digitonin and CHAPS

The three known visual pigments (P520, P450, P357) of the moth, Manduca sexta (Lepidoptera, Sphingidae), were extracted in two different detergents (2% digitonin, 6 or 12mM CHAPS). As is the case in unextracted membranes, the metarhodopsins are quite stable in CHAPS extracts, while in digitonin the metarhodopsins of P520 and P450 decay rapidly at 15° C to opsin and free retinal. The relative absorbance ratios are: 1.0:1.6 (P520:M485), 1.0:1.1 (P450:M485), and 1.0:0.8 (P357:M470). The relative amounts of the visual pigments found in digitonin extracts is 100:25:8 (P520:P450:P357); about 60 picomoles of P520 can be extracted from one Manduca retina.     

The Forgotten Syndrome? Four Cases of Gradenigo’s Syndrome and a Review of the Literature

Background: Gradenigo’s Syndrome (GS) is defined as the clinical triad of acute otitis media, ipsilateral sixth nerve palsy, and pain in the distribution of the first and the second branches of the fifth nerve. The purpose of this study is to review the literature and report 4 cases of GS.

Methods: The study is a retrospective case series and a review of the literature. Four consecutive patients (aged 5–70 years) treated by otolaryngologists and ophthalmologists for GS in the Capital region of Denmark from 2003 to 2015 are presented. Diagnosis is based on the clinical triad, and in 3 of 4 patients, neuroimaging supports the diagnosis. Follow-up was continued until both the sixth nerve palsy and the ear infection had resolved. Diagnostic work-up and treatment profile are described.

Results: In 3 of our 4 reported patients, the presentation of GS was classic with a history of acute otitis media and ipsilateral sixth nerve palsy. One case presented as a chronic case with a sixth nerve palsy secondary to chronic suppurative otitis media (CSOM), with a relapse 6 years later.

Conclusion: GS is a rare and potentially life-threatening complication to otitis media. GS can present in an acute and chronic form, and should be a differential diagnosis in the workup of unexplained sixth nerve palsy.     

Ten Emerging Trends in the Epidemiology of Diabetic Retinopathy

Purpose: Diabetes is a major public health problem affecting 415 million people worldwide. With the increasing prevalence of diabetes, diabetic retinopathy (DR) is emerging as the leading cause of avoidable blindness worldwide.

Methods: We reviewed previous and recent literature to provide an overview of emerging trends on the burden, epidemiology, risk factors, and prevention of DR.

Results: First, there is clear evidence of a global increase in the prevalence of diabetes. Second, there is a decline in the incidence of blindness due to DR, particularly in developed countries. Third, diabetic macular edema (DME) rather than proliferative diabetic retinopathy (PDR) is the increasingly common cause of visual impairment. Fourth, DR awareness remains patchy and low in most populations. Fifth, hyperglycemia remains the most consistent risk factor for DR in type 1 diabetes across different studies and populations. Sixth, in contrast, blood pressure is an important risk factor for DR in type 2 diabetes. Seventh, the relationship between dyslipidemia and DR remains unclear, with inconsistent results from different studies and trials. Eighth, the utility of predictive models incorporating multiple risk factors for assessing DR risk requires evaluation. Ninth, photographic screening of DR using tele-ophthalmology platforms is increasingly recognized as being feasible and cost-effective. Finally, DR prevention in low-resource settings cannot follow models developed in high-resource countries and requires different strategies.

Conclusions: The ten trends we observed in the current review may guide planning of public healthcare strategies for the management of DR and prevention of blindness.     

Revision of failed dacryocystorhinostomies using the transcanalicular approach. Results of 118 procedures

PURPOSE: To assess the efficacy of transcanalicular dacryocystorhinostomy for the revision of other procedures. The results are analyzed following the use of two different types of laser: the Neodymium: YAG (Nd: YAG) laser and the Holmium: YAG (Ho: YAG) laser. To study the efficacy of using two antimetabolite drugs in this context: mytomycin-C (MMC) and 5-fluoro-uracile (5-FU). METHODS: One hundred and fourteen patients were operated on. Of these, 88 had already undergone one procedure, 25 two procedures, and 5 three procedures. The Nd: YAG laser was used in 78 procedures, the Ho: YAG in 30 procedures, and both lasers in 10 procedures. Twenty patients were treated with an application of MMC and 25 patients with an application of 5-FU. RESULTS: The results are based on 106 procedures. The total success rate was 49.06% after one revision and 58.49% after two or three revisions. There is no statistically significant difference between the Nd: YAG and Ho: YAG lasers. The use of antimetabolites did not improve the success rate. CONCLUSION: Transcanalicular dacryocystorhinostomy is a very useful method because it does not cause cutaneous scarring and it has a low rate of morbidity given that it causes very little surgical traumatism. The revision of other dacryocystorhinostomy methods using the transcanalicular approach is theoretically a positive indication because it does not dissect scarring tissues and because the osteotomy has already been performed. However, the success rate is lower than for the external and endonasal approaches. The success rate is not modified by the use of antimetabolites or by the type of laser.     

The intraoperative use of polydioxanone foil to reduce the risk of sino-orbital fistula formation in orbital exenteration

Background: Orbital exenteration is a radical surgical procedure resulting in deformity. It involves removal of the globe, optic nerve, extra-ocular muscles, orbital fat, lacrimal gland, and peri-osteum. Sino-orbital fistula (SOF) formation is a common documented post-operative complication, usually connecting the orbit and the ethmoid sinus. SOFs can cause leaks of serous fluid, and act as an entry site for pathogens into the orbit leading to socket infection and breakdown.

Methods: This retrospective study analyzed exenterations performed over a 22-year period (1993—2015) at the National Ocular Oncology Service Centre for Scotland. PDS is a crystalline, biodegradable polyether-ester that is strong with good shape-memory and flexibility. Orbital exenterations with and without the use of PDS foil were compared in terms of SOF formation.

Results: A total of 30 exenterations were performed during the study period. A total of 29 were analyzed. Choroidal malignant melanoma was the most common indication for performing orbital exenteration (n = 7, 24.14%). The most common post-operative complications seen were SOF (n = 8, 27.59%). A total of 8 out 21 (38.10%) cases not using PDS developed SOFs. By contrast, none of nine patients receiving PDS plates developed SOFs (p = 0.0332).

Conclusions: This is the first study to compare SOF rate in patients undergoing exenteration with and without the use of PDS foil. PDS foil is a safe material, which has effectively reduced the incidence of SOF formation