Metabolic cataract among the children from the Children's Health Center

The investigations concerned 385 children with a congenital cataract. It was not possible to establish the causes of the condition in 46.5 p.c. of examined children. The set of examinations which was used was sufficient for an explicit determination of the cause of the metabolic part of congenital cataracts. In galactosaemia opacification of the lens appeared in 64 p.c. of cases, in hypofunction of the parathyroids in 17.8 p.c., in hypoglycaemia in 6.6 p.c., in Lowe's syndrome in 100 p.c. of cases.     

弱视复发因素探讨

了解弱视治愈远期疗效的影响因素。方法　对259例(448眼)基本治愈的弱视患者进行了3年以上的随访观察。经散瞳验光后证实视力下降至≤0.9时为弱视复发眼。结果　本组弱视复发率为29.24%。屈光参差性弱视和斜视性弱视的复发率明显高于屈光不正性弱视的复发率;弱视程度越重,复发率就越高;中心注视性弱视复发率低于旁中心注视性弱视复发率。结论　弱视复发率因弱视类型和弱视程度不同而异。随停止治疗的时间逐渐延长,弱视复发病例逐渐减少。对于易复发的弱视类型应进行重点监测。     

Infrared micropulsed laser treatment for diabetic macular edema – Subthreshold versus threshold lesions

Purpose. To assess the effectiveness of subthreshold (invisible after placement) and threshold (barely visible after placement) 810 nm laser photocoagulation in the treatment of clinically significant diabetic macular edema. Methods. A grid of subthreshold laser spots was used to treat patients with diabetic edema. Retrospectively, the results of treatment of 20 eyes of 20 patients were compared to the results of treatment of 120 eyes of 120 patients using a grid of threshold laser lesions. Results. At six months, 60% of subthreshold treated eyes and 75% of threshold treated eyes showed anatomic resolution of macular edema. Improvement or stabilization of visual acuity was achieved in 85% of threshold or subthreshold treated eyes. Conclusion. Gentle grid treatment of regions of diabetic macular edema was effective in ameliorating the edema and limiting visual loss. Subthreshold laser was less effective in promoting resolution of edema compared to threshold lesions, though the difference was not significant in this instance.     

泪囊鼻腔吻合术置与不置填充物的对比

目的对比泪囊鼻腔吻合术后置与不置填充物的效果。方法随机抽取泪囊鼻腔吻合术分置填充物组与不置填充物组各200例(各200眼),前者填充物为凡士林纱条,后者不置任何物质。结果出血情况:置填充物组60例,不置填充物组10例;胀痛情况:置填充物组100例,不置填充物组10例;炎症反应情况:置填充物组80例,不置填充物组8例:治愈情况:置填充物组188例,不置填充物组198例;无效情况:填充物组5例,不置填充物组2例。结论泪囊鼻腔吻合术可以不置填充物,且效果良好。     

The surgical treatment of vertical strabismus in children

The paper deals with principles of surgical treatment of vertical squint caused by paresis of muscles of vertical action. The authors consider to be optimal one-stage surgical intervention consisting of enhancing the paretic muscle and weakening the antagonist of the same eye, i. e. the rectus and oblique muscles. The dosage of the surgery was calculated considering the angle of squint. A new method is proposed for calculating the position, on the sclera, of the point of fixation of inferior oblique muscle at its recession. Results of 73 operations are analysed. Orthotropia was achieved in 72.6% of patients. The authors recommend the operation to be widely used in clinical practice.     

Idiopathic, bilateral panuveitis--efficacy of general steroidotherapy and intravitreal dexamethason injection. Case report

This paper presents the comparison of different schemes of two kinds of general steroidotherapy in one case of idiopathic, bilateral panuveitis and effectiveness of intravitreal dexamethason to one eye. The effectiveness of the treatment was mainly concerned on best corrected visual acuity, the illustration of macular retinal area in OCT (optic coherence tomography), where the reduction of cystic macular oedema was detected and the pictures of fluorescein angiography. The observation and the treatment has lasted for 3 years. At the beginning, the patient received general steroidotherapy (medrol), which lasted seventy four days. Improvement of clinical symptoms lasted only four months. The similar therapy the patient obtained once more. The symptoms of illness returned, after the same period of time. Then the intravitreal dexamethason (Posurdex) was injected. The better visual acuity and improvement of clinical symptoms was observed for three months. The patient couldn't obtain posurdex once more. The physician decided to apply the different scheme of general steroidotherapy. The observation after finished treatment, lasted over one year. Clinical symptoms of the illness retracted. The fluorescein angiography of the eyes were correct and the structure of the macular retinal area presented in optical coherence tomography were regular. The observation of the patient is continued.     

Polycystic echinococcosis of the orbit

PURPOSE: To report a case of polycystic echinococcosis of the orbit caused by Echinococcus oligarthrus. DESIGN: Interventional case report. METHODS: A 14-year-old girl presented with a massive proptosis of the right eye of 9 years duration and loss of vision. The eye was phthisic, and a cystic mass was palpable. Computed tomography scan showed closely packed multiple orbital cysts with destruction of the medial orbital wall. Surgical exploration was performed. RESULTS: The phthisic eye was enucleated. Dissection of the outer fibrous capsule yielded approximately 30 intact translucent white cysts of various sizes that were suggestive of polycystic echinococcosis. The diagnosis of echinococcosis was confirmed on histopathologic evaluation. The specific diagnosis of E oligarthrus was made on the basis of the presence of straight-backed hooks and central guards. CONCLUSION: Polycystic echinococcosis of the orbit caused by E oligarthrus is rare. It may be an entirely new entity or hitherto unrecognized form of orbital echinococcosis.     

减少旁中心远视离焦镜片治疗儿童近视的疗效观察

目的　观察减少旁中心远视离焦镜片治疗儿童近视的临床效果。方法　随机数字表法选取２０１４年７月至１２月于我科门诊就诊的儿童近视患者１６０例,分为试验组和对照组,每组各８０例１６０眼。试验组配戴减少旁中心远视离焦镜片,对照组配戴普通单焦镜片。按照等效球镜的度数大小分为三组:低度近视组（－１．００～－３．００Ｄ）、中度近视组（－３．２５～－６．００Ｄ）、高度近视组（＞－６．００Ｄ）。两组患者戴镜６个月后复查,１ａ后对两组屈光度、眼轴长度等近视进展指标进行比较,根据等效球镜及眼轴进展情况,分析两组的治疗效果。结果　轻度近视组:试验组增加度数为（－０．５６±０．３０）Ｄ,显著小于对照组（－０．９１±０．３７）Ｄ,差异有统计学意义（ｔ＝５．９２,Ｐ＜０．０１）;试验组眼轴增加（０．１３±０．１１）ｍｍ,显著少于对照组（０．２８±０．１４）ｍｍ,差异也有统计学意义（ｔ＝６．６７,Ｐ＜０．０１）。中度近视组:试验组增加度数（－０．５５±０．３０）Ｄ,显著小于对照组（－０．９０±０．４１）Ｄ,差异有统计学意义（ｔ＝６．０３,Ｐ＜０．０１）;试验组眼轴增加（０．１４±０．１４）ｍｍ,显著少于对照组（０．２５±０．１５）ｍｍ,差异有统计学意义（ｔ＝４．９６,Ｐ＜０．０１）。高度近视组:试验组增加度数（－０．３６±０．１６）Ｄ,显著小于对照组（－０．８８±０．３４）Ｄ,差异有统计学意义（ｔ＝５．１５,Ｐ＜０．０１）;试验组眼轴增加（０．０６±０．０４）ｍｍ,显著少于对照组（０．２６±０．１４）ｍｍ,差异有统计学意义（ｔ＝５．０２,Ｐ＜０．０１）。结论　降低周边远视性光学离焦可以延缓近视进展,减缓眼轴增长。近视性屈光不正儿童可以通过配戴减少旁中心远视离焦的美德××镜片来减缓近视的发展。     

挫伤性脉络膜破裂的眼底荧光血管造影探讨

目的　探讨眼钝挫伤后脉络膜破裂视力损害的原因。方法　通过眼底荧光血管造影观察伤后眼底改变。结果　18 例眼球钝挫伤后脉络膜破裂中,16 例黄斑部直接损害,同时10 例有脉络膜视网膜充盈倒置,14 例有黄斑拱环模糊。结论　FFA 有助于鉴别不同层次的脉络膜损伤。伤后黄斑部直接损伤是视力损害的主要原因,脉络膜视网膜充盈倒置、黄斑拱环模糊,证明伤后视盘血供及黄斑血液循环障碍,是视力损害的重要因素     

OCULAR COMPENSATIONS*

From time to time in recent years we have read of the invention of new detectors of electromagnetic radiation. The performance of these is often compared to that of the human eye, e.g. a TV orthicon is stated to be ten times as sensitive as the eye. The figure usually refers to “detective quantum efficiency” (D.Q.E.) of the device, D.Q.E. being the ratio of information in the output of the device to that information contained in the image, and one is left with the impression that the human eye is about to become obsolete. However, the D.Q.E. of the eye is nearly constant over a range of luminance of 10⁷, while the D.Q.E. of the best detectors peaks pretty sharply over a luminance range of only 10². The latter of course has very important applications, e.g. in astronomy, but designers of such detectors would very much like to achieve greatly increased working latitudes. Again, the human eye in spite of its inaccurate physical construction as an optical instrument records image quality in accordance with its theoretical potentialities. In one special type of observation it gives a resolution performance 15–20 times as fine as its normal expectation. To achieve these performances there are elegant eye-brain compensations and some of these are discussed; particularly interesting is the feed-back relating to sharpness of retinal images. Another aspect of compensation is of clinical importance to the vision practitioner. Ophthalmic tolerances should be assessed from the frequency distribution of refractive and oculo-motor anomalies of a fully representative population, which is not usually the case at the present time. In applied optics recently, image evaluation of optical systems has undergone a radical change: systems are now designed with integrated consideration of object field, medium and detector, with consequent improvements in results. The author enquires if a similar critical investigation of the time-honoured techniques of the vision practitioners could not be made. Certainly more attention is given these days to individual occupational visual requirements, but this is derived from the same input data. There is an awareness among some of the more thoughtful practitioners that the old techniques of prescribing could be improved, and consideration is given to one or two possibilities.     

Variations in the muscular insertion, the course and elasticity of the muscles in people suffering from squint (author's transl)

Variations in the area of the insertions of the rectus muscles are quite often observed. We have been paying more attention to these changes during the past year, and therefore we measured the distance of insertion from the corneal limbus during 310 squint operations. Furthermore we noted the width of the tendon at the insertion, atypical forms of insertions and finally we tried to evaluate the factor of muscular elasticity. The findings are as follows: 1. The arithmetical mean of the distance of insertion from the limbus was slightly less than cited in literature on this subject. It was not unusual to find variations of up to 4mm, even between the same muscles of both eyes. This seems to have little influence on the primary position and on the success of surgical interventions; when they do not exceed the measures cited in our paper. The relatively great area of contact will balance these variations. 2. We could not find a correlation between anomalies of refraction and the distance of insertions of the limbus. The insertions of higher degree hyperopia was not closer to the limbus. 3. The arithmetical mean of the width of tendon conformed to the values as shown in the literature. A range up to 8 mm for the medial rectus, up to 5,5 mm for the lateral rectus and up to 2,5 mm for the vertical rectus were observed. 4. We could see variations of the insertions: upward and downward and furthermore different lines of insertions: arched and step-like. These anomalies were found 52 times among the 310 muscles measured. 5. An increased muscular rigidity was felt in 56 medial rectus and in 13 lateral rectus muscels. In 21 cases the course of the horizontal muscles was atypical, i.e., they ran from below diagonally out of the orbita.     

Comparison of extracapsular cataract extraction with implantation of the artificial lens into the posterior chamber and intracapsular cataract extraction with implantation of the artificial lens into the anterior chamber

Advantages and disadvantages of both methods are presented on the basis of comparison of 1200 cases of intracapsular cataract extraction with anterior chamber lens implantation and 600 cases of extracapsular cataract extraction with implantation of posterior chamber lens. One has to state that in general the preferential method of extracapsular cataract extraction with posterior lens implantation is connected with several complications. The main disadvantage of intracapsular cataract extraction with anterior chamber implantation is--in 66 p.c.--deformation of the pupil. From our point of view this is a problem of cosmetic nature. On the basis of comparison of disadvantages and advantages we are of opinion that both methods are equally suitable for a broad clinical use.     

Medical treatment of amblyopia: present state and perspectives

A brief review is provided on the role of experimental modulation of the visual system during its plastic period. The importance of several substances has been demonstrated. Potential clinical applications of available studies on the treatment of amblyopia are summarized. The role of the dopaminergic system and particularly of dopamine in amblyopia are also discussed. The results of the use of cytidine-5'-diphosphocholine (citicoline) in amblyopia are evaluated in detail. The advantages of and indications for an association of citicoline with part-time occlusion are also discussed. Finally, new administration modalities of citicoline, more detailed evaluation of its efficacy, and the use of new substances are briefly analyzed.     

糖尿病患者视网膜病变的筛查分析

目的 了解糖尿病(diabetes mellitus,DM)住院患者中糖尿病视网膜病变(diabetic retinopathy,DR)的发生情况,并探讨其相关危险因素.方法 回顾性临床调查研究.对2007年9月至2010年7月期间,在广西医科大学第一附属医院眼科住院的1610例DM患者采用眼底照相方法确立DR诊断,部分患者进行眼底血管荧光造影检查,计算DR发病率,并分析病程、年龄、发病年龄及血压对发病率的影响.结果 1610例(3201只眼)DM患者中DR发病率为30.2%,其中男性为27.3%,女性为35.0%.新确诊的340例DM患者中DR发病率为12.6%.3201只眼中,背景型DR 797只眼,占24.9%,增殖型124只眼,占3.9%.51～60岁年龄组以及在41～50岁间发病的DM患者,DR的发病率最高.45°眼底彩照与FFA检查结果比较,符率为78.1%.结论 以黄斑为中心单视野眼底照像作为早期DR的筛查方法是有效、实用且简便易行的.病程、年龄及发病年龄是DR发病的危险因素,随着病程延长其发病率显著增高.早期对DM 患者进行筛查、定期眼科检查,能及时发现病变、把握治疗时机,降低DR致盲率有着极其重要的意义.

Abstract：

Objective To determine the prevalence of diabetic retinopathy (DR) and to investigate the associated risk factors in patients with diabetes mellitus (DM).Methods Totally 1610 patients diagnosed DM by the WHO diagnostic criteria attending at the First Affiliated Hospital of Guangxi Medical University from 2007 to 2010.The data of disease history, visual acuity, eye disease and intraocular pressure were collected by inquiry and examination.Photography of ocular fundus was used to confirm the diagnosis of DR.According to the criteria of DR, diagnosis and statistics of DR were made and the relationship between the prevalence of DR and duration, age, the age of onset and blood pressure were analyzed.Results The prevalence of DR was 30.2% in 1610 diabetic patients,27.3% for male and 35.0% for female.The prevalence of DR of 340 newly onset diabetes was 12.6%.In 3201 eyes, the incidence of nonproliferative and proliferative DR (PDR) was 24.9% and 3.9%, respectively.The highest prevalence of DR was in the age group of 51 to 60 and the age of onset was 41 to 50 in patients with DM.Compared with FFA, the agreement rate of 45° fudus photography was 78.1%.Conclusions One-field mydriatic digital fudus photography centered at fovea is feasible and handy for screening of early diabetic retinopathy.Age, the age of onset and duration of disease are the risk factors of DR, longer the duration of DM, higher the incidence of DR.For early diagnosis and management of DR, the patient with DM should be examined regularly.It is very important to decrease the rate of blindness of DR.     

New trends in tonometry

BACKGROUND: Though the knowledge about the risk of elevated intraocular pressure for pathogenesis for development and progress of glaucoma is more than 400 years old. It took another 300 years before by means of tonometry this elevation could be quantified. After discussion of the key words it is our aim to demonstrate the latest trends in tonometry, specifically by use of modern electronics for instrument design. MATERIALS: Goldmann was the founder of the "applanation tonometry", measuring the corelation of applanated area and applied force. Here, the next step was the development of instruments, measuring independent of position or gravity to allow application also at the lying patient. Electronic area detection was the next step to avoid examinor's error. Also important was the introduction of automatic UV-desinfection to avoid contamination of the other eye or other patients. Other tonometers control the force applied by an inductive method, which also allows application independent of position. Airpuff-tonometry uses completely different measuring principles - the resulting change of corneal curvature indicates the intraocular pressure. The impedance principle is applied even through the closed eye lid. The shock waves resulting shall be measured. Direct application of a surface sensor incorporated into a concave surface contact body shall allow direct measurement of intraocular pressure independent of corneal thickness, curvature, astigmatism. This method has been tried for more than 20 years. Also exposition of the eye to count waves of different frequency was an early attempt. Here also change of reflectivity is used to calculate intraocular pressure. CONCLUSIONS: Even after use of modern electronic technology the precision of many of these new devices does not lead to better results. This specifically is shown by modern calibration methods.     

Histological characteristics of ocular structures after YAG-laser exposure of various sections of the crystalline lens in experimental studies]

This work was aimed at analysis of all the aspects, pathomorphologic included, of short-pulsed YAG laser exposure of the lens. Experiments were carried out with 79 rabbit eyes. After laser exposure the eyes were enucleated in 1-24 h and in 7-10 days. Thirty-one eyes were subjected to YAG laser ++capsule puncture. Fragmentation of intracapsular structures was carried out in 23 eyes. Combined operations were performed on 25 eyes. Every series comprised two groups, differing by the energy of laser exposure: 3-5 mJ. Histologic analysis has lead the authors to the following conclusions. The pattern and severity of pathomorphologic changes were directly related to the energy and time of laser exposure and site of the focal plane of irradiation. The major destructive shifts after YAG laser fragmentation of the cortical layer and capsulotomy are focussed at the site of exposure and involve the adjacent sections of the lens. Laser exposure of 3-5 mJ may be used to open the anterior capsule of the lens and to facilitate the cataract mass discharge in extracapsular cataract extraction. Use of combined method helps enhance induration and fragmentation of the cortical layers of the lens, rules out surgical discission of the anterior capsule of the lens, and facilitates removal of the nucleus and wash out of the lens mass.     

原发性闭角型青光眼流行病学研究进展

青光眼是全球第二大致盲眼病、不可逆性盲最主要的原因。原发性闭角型青光眼(PACG)是亚洲、特别是东亚、中国人中最常见的青光眼类型。随着社会、经济、环境的变化以及诊疗手段的进步,青光眼的流行病学特点不断变化;不同的青光眼诊断标准和分类系统也会导致不同的流行病学调查结果;流行病学的特征又指导着临床干预措施;这一切都密切相关,因此,PACG流行病学状况对青光眼的防治有着重要的意义。本文就国内外PACG流行病学相关研究进展作一综述。     

睫状体肿瘤局部切除联合玻璃体视网膜手术

目的评价睫状体肿瘤局部切除联合玻璃体视网膜手术的效果及安全性。方法睫状体肿瘤47例，肿瘤单纯局部切除术2l例作为对照组，局部切除联合玻璃体视网膜手术26例作为观察组，比较两组的临床效果及并发症发生情况。结果两组术后视力均明显改善，而观察组改善较多（t=3．77，2．22，P〈0．05）。观察组的手术时间明显长于对照组（t=9．28，P〈0．05）。观察组的并发症发生率低于对照组（X2=5．22，P〈0．05）。结论睫状体肿瘤局部切除联合玻璃体视网膜手术效果更佳，且安全性好，应是首选的手术方案之一。     

Hemorrhagic macular choroidopathy in the young subject

In a group of 182 patients of under 50 years of age with subretinal neovascularization, the syndrome of hemorrhagic macular choroidopathy of the young adult was identified in 30 cases. This syndrome is characterized by the occurrence of a juxtafoveolar idiopathic neovascular membrane in an eye normal in all other respects. The natural course of this lesion is the production of a fibroglial scar leading to a mean final visual acuity of 0.15. The syndrome remains unilateral in 75 p. cent of cases, as shown by a mean follow-up of 23.9 months. Photocoagulation of these new vessels is possible, and in a group of 19 eyes it allowed conservation of a mean acuity of 0.6. This syndrome differs from ocular histoplasmosis where widespread uni- or bilateral involvement of the pigment epithelium and choriocapillaris is found. Hemorrhagic macular choroidopathy can also be distinguished from choroiditis associated with hemorrhages. The existence or the sequellae of uveitis, even when associated with subretinal new vessels arising from an atrophic chorioretinal scar, establishes the correct diagnosis. The etiology of hemorrhagic macular choroidopathy is unknown. It is possible that multiple etiologic agents might be responsible for different clinical syndromes in relation to endemic factors.     

Quantitative analysis of 'plaque material' between ciliary muscle tips in normal- and glaucomatous eyes

Between the anterior ciliary muscle tips in normal and glaucomatous eyes, different forms of plaque material were found within the intermuscular connective tissue. These plaques derive from either the sheaths of the elastic-like fibers or the elastic tendons of the anterior ciliary muscle tips. In addition, there are plaques which have the characteristics of the hyalinized basement membranes of the trabecular beams. The quantitative evaluation of all three types of ciliary muscle (c.m.) plaques showed that in normal eyes the amount of c.m. plaques increases with age and correlates with the amount of plaques in the inner wall of Schlemm's canal. In cases of chronic simple glaucoma the amount of c.m. plaques did not significantly correlate with age, but the absolute amount of this material was significantly higher than in normal eyes. No correlation between inner wall and c.m. plaques was found, indicating that in glaucoma additional factors besides age contribute to plaque formation.