GDx在青光眼早期诊断中的作用

目的:评价GDx检测RNFL厚度各参数的敏感性,特异性,准确性,阳性预测值,阴性预测值,阳性似然比,阴性似然比;比较正常人和青光眼患者GDx各参数的不同;确定GDx参数对青光眼早期诊断最有价值的指标和GDx早期诊断青光眼的能力。方法:用GDx对94例188眼正常人和88例173眼青光眼患者RNFL进行检测。将青光眼患者按视野的平均缺损程度分为早、中晚期青光眼两组。用t-test和方差分析,比较正常人RNFL参数与早、中晚期青光眼的不同;绘制GDx参数ROC曲线,比较GDx参数中ROC曲线下面积的大小;用逐步判别分析确定GDx参数中对早期青光眼诊断最有意义的指标。结果:正常人94例,平均年龄为:41.7±8.5岁;青光眼(早、中晚期)患者平均年龄:52.8±14.6岁。早期青光眼122眼,中晚期青光眼51眼,视野平均缺损(meandefect,MD;Octopus1-2-3自动视野计测量)为-1.6～23.2dB。正常人RNFL各参数与各期青光眼患者比较差异有非常显著意义(P<0.01)。GDx的TSNIT参数的敏感性和特异性为:74.0%和74.0%,准确性:86.8%,阳性预测值:73.0%,阴性预测值:76.0%,阳性似然比:2.96,阴性似然比:0.33。SA参数的敏感性和特异性为:71.1%和84.6%,准确性为77.5%,阳性预测值:80.9%,阴性预测值:76.1%,阳性似然比:4.62,阴性似然比:0.34。IA参数的敏感性和特异性为:76.3%和82.4%,准确性:78.8%,阳性预测值:80.0%,阴性预测值:79.1%,阳性似然比:4.34,阴性似然比:0.35。NFI参数的敏感性和特异性为:80.3%和67.0%,准确性:73.4%,阳性预测值:69.2%,阴性预测值:78.8%,阳性似然比:2.43,阴性似然比:0.29。GDx的TSNIT和NFI两个参数综合评价的敏感性和特异性为:76.3%和74.0%,准确性:93.3%,阳性预测值:87.7%,阴性预测值:63.2%,阳性似然比:3.05,阴性似然比:0.32。GDx两个参数综合评价时,NFI+IA结合评价的敏感性最高(88.4%),特异性最高的是SA+IA(84.6%)。如果NFI+TSNIT+SA+IA综合评价其敏感性和特异性达最高,分别是86.7%和85.6%。在特异性相同的情况下,GDx诊断早期青光眼的敏感性为66.4%,准确性:58.5%,阳性预测值:92.0%,阴性预测值:77.5%,阳性似然比:2.56,阴性似然比:0.45。中晚期青光眼诊断的敏感性为:86.3%,准确性:77.4%,阳性预测值:48.4%,阴性预测值:95.3%,阳性似然比:3.45,阴性似然比:0.18。GDx的NFI≥20时,敏感性和特异性分别为78.3%和78.7%,准确性为78.7%,阳性预测值为77.3%,阴性预测值为80.0%,阳性似然比为3.68,阴性似然比为0.28。GDx的NFI≥23时,敏感性和特异性为75.1%和84.0%,准确性为79.8%,阳性预测值为81.3%,阴性预测值为74.9%,阳性似然比为4.69,阴性似然比为0.30。GDx的NFI≥27时,敏感性和特异性分别为64.7%和91.0%,准确性为35.7%,阳性预测值为86.8%,阴性预测值为73.7%,阳性似然比为7.19,阴性似然比为0.39。GDx各参数ROC曲线下面积分别为NFI:0.84,IA:0.79,TSNIT:0.78,SA:0.77,IES:0.76。通过逐步判别分析,筛选出NFI和IA对区分早期青光眼贡献最大(F检验:P<0.01),用IA和NFI进行分析,诊断早期青光眼的敏感性和特异性分别为:88.4%和74.6%。结论:GDx为临床上提供定量检测视网膜神经纤维层厚度参数;NFI和IA是区分正常人和早期青光眼最有效指标。GDx可有助于临床上青光眼的早期诊断。     

Division of viscoelastic substances for ophthalmological surgery

Individual properties of a viscoelastic substance for ophthalmologic applications are intimately tied to its chemical and rheologic characteristics. Independent comparative data for vicoelastic substances are not readily available or interpretable. MATERIAL AND METHODS: Twenty-six different commercially available viscoelastic substances were investigated using the Advanced Rheometric Expansion System and the Rheometric Scientific 800 device to analyze elastic and viscous modulus, complex viscosity (dynamic frequency dependance) and viscosity at the zero shear rate by extrapolation using the Ellis fit. RESULTS: Viscosity (cps) at zero shear rate (s-1, mean of six different samples): Sodium hyaluronate products: Amivisc Plus: 128; AMO Vitrax: 41; Biolon: 243; Dispasan: 130; Dispasan Plus: 782; Healon: 243; Healon GV: 2451; Healon 5: 5525; Microvisc (Morcher Oil): 1162; Microvisc Plus: 3663; Morcher Oil: 1253; Provisc: 207; Rayvisc: 78; Viscoat: 58; Viscorneal (Allervisc): 733; Viscorneal Plus (Allervisc Plus): 1176; Visko: 206; Visko Plus: 1683. Hydroxypropylmethylcellulose (HPMC) products: Acrivisc: 7; Adatocel: 8; Coatel: 6; HPMC Ophthal H: 94; HPMC Ophthal L: 7; Ocucoat: 6; PeHa-Visko: 5; Visco Shield: 60. CONCLUSION: Sodium hyaluronate as well as HPMC viscoelastic substances demonstrated remarkable differences in rheological properties from each other. In some cases, the results of this independent investigation differed from the values provided by the companies. A new division of commercially available viscoelastic substances into subgroups is presented, which provides a scientific base for various practical viscosurgical aspects. These real rheologic properties of each substance allow the ophthalmic surgeon to choose the viscoelastic substance that is most suitable for the surgical situation.     

Division of viscoelastic substances for ophthalmological surgery

Individual properties of a viscoelastic substance for ophthalmologic applications are intimately tied to its chemical and rheologic characteristics. Independent comparative data for vicoelastic substances are not readily available or interpretable. Material and methods: Twenty-six different commercially available viscoelastic substances were investigated using the Advanced Rheometric Expansion System and the Rheometric Scientific 800 device to analyze elastic and viscous modulus, complex viscosity (dynamic frequency dependance) and viscosity at the zero shear rate by extrapolation using the Ellis fit. Results: Viscosity (cps) at zero shear rate (s^–1, mean of six different samples): Sodium hyaluronate products: Amivisc Plus: 128; AMO Vitrax: 41; Biolon: 243; Dispasan: 130; Dispasan Plus: 782; Healon: 243; Healon GV: 2451; Healon 5: 5525; Microvisc (Morcher Oil): 1162; Microvisc Plus: 3663; Morcher Oil: 1253; Provisc: 207; Rayvisc: 78; Viscoat: 58; Viscorneal (Allervisc): 733; Viscorneal Plus (Allervisc Plus): 1176; Visko: 206; Visko Plus: 1683. Hydroxypropylmethylcellulose (HPMC) products: Acrivisc: 7; Adatocel: 8; Coatel: 6; HPMC Ophthal H: 94; HPMC Ophthal L: 7; Ocucoat: 6; PeHa-Visko: 5; Visco Shield: 60. Conclusion: Sodium hyaluronate as well as HPMC viscoelastic substances demonstrated remarkable differences in rheological properties from each other. In some cases, the results of this independent investigation differed from the values provided by the companies. A new division of commercially available viscoelastic substances into subgroups is presented, which provides a scientific base for various practical viscosurgical aspects. These real rheologic properties of each substance allow the ophthalmic surgeon to choose the viscoelastic substance that is most suitable for the surgical situation.     

Book reviews

Book reviewed in this article: Clinical Pathways in Vitreoretinal Disease :Scott M Steidl and Mary E Hartnet Germany Reviewed by:IAN GUTTERIDGE, Department of Optometry and Vision Science, The University of Melbourne Ocular Differential Diagnosis, 7th edition :Fredrick Hampton Roy Philadelphia: Lippincott Williams & Wilkins Reviewed by: DR DAVID M COCKBURN Sandringham VIC Atlas of Ocular Blood Flow: Vascular Anatomy, Pathophysiology and Metabolism :Alon Harris Christian P Jonescu‐Cuypers Larry Kagemann, Thomas A Ciulla and Günter K Krieglstein Philadelphia: Butterworth Heinemann, 2003 Reviewed by:DR ALEX GENTLE, Department of Optometry and Vision Sciences, The University of Melbourne Contact lens complications: etiology, pathogenesis, prevention, therapy :Hans‐Walter Roth Stuttgart‐New York: Georg Thieme Verlag: 2003 Reviewed by: CHARLES MCMONNIES, djunct Professor, School of Optometry and Vision Science, The University of New South Wales Vitreous Microsurgery, 3rd edition :Steve Charles, Adam Katz and Byron Wood Lippincott: Williams and Wilkins Reviewed by IAN GUTTERIDGE, Department of Optometry and Vision Science, The University of Melbourne     

Phospholipid molecular species of frog rod outer segment membranes

Phosphatidylcholine (PC) and phosphatidylethanolamine (PE) were isolated from frog retinal rod outer segment (ROS) membranes and their major molecular species determined. Saturated fatty acids are predominantly located on position-1 and polyunsaturates on position-2, although this assignment is not absolute. One-fifth of the species of PC are of the saturated and monoenoic type, compared to only trace amounts of these species in PE. On the other hand, PE contains at least 50% dipolyunsaturated species, while PC has 6%. The predominant molecular species of frog PC are: 18:0-22:6 omega 3 (39%), 16:0-22:6 omega 3 (17%), 16:0-16:1 (6%), 16:0-18:1 (5%) and 16:0-16:0 (4%). The major molecular species of frog PE are: 22:6 omega 3-22:6 omega 3 (21%), 18:0-22:6 omega 3 (18%), 18:1-22:6 omega 3 (14%), 22:4 omega 6-22:6 omega 3 (10%), 22:5 omega (3 + 6)-22:6 omega 3 (10%), 16:0-22:6 omega 3 (7%) and 20:4 omega 6-22:6 omega 3 (5%). The specific molecular species are discussed in relation to their effect on fluidity and asymmetry of ROS disc membranes.     

下泪小点烧灼治疗重度水液缺乏型干眼的临床疗效

目的： 评价高温烧灼封闭下泪小点治疗重度水液缺乏型干眼的临床疗效。 方法： 前瞻性非随机对照 研究。选择2019年6月至2020年10月在福建医科大学附属第二医院眼科就诊的使用人工泪液和局部 抗炎保守治疗后疗效不佳的重度水液缺乏型干眼患者29 例（ 58 眼）。根据是否患有干燥综合征分为 2组：干燥综合征干眼（ SS）组17例（ 34眼）和非干燥综合征干眼（非SS）组12例（ 24眼）。采用高温热 烧灼封闭双眼下泪点,记录泪小点烧灼前2 个月、 1 d及烧灼后2 周、 2 个月时患者的眼表疾病指数 （ OSDI）、泪膜破裂时间（ TBUT）、角膜荧光素染色（ FL）和泪液分泌试验（ SⅠT）结果。数据分析采用 独立样本t检验、配对样本t检验及单因素重复测量方差分析。 结果： 2 组烧灼前各项干眼相关指标差 异无统计学意义。烧灼后2周和2个月与烧灼前1 d比较, SS组OSDI评分、 TBUT及FL评分差异均有 统计学意义（ F=69.58, P<0.001; F=49.45, P<0.001; F=34.07, P<0.001）;非SS组OSDI评分、 BUT、 FL评分及SⅠT值差异均有统计学意义（ F=57.89, P<0.001; F=72.83, P<0.001; F=47.44, P<0.001; F=28.35; P<0.001）,但SS组SⅠT值差异无统计学意义。烧灼2 个月后,非SS组OSDI评分、 TBUT、 FL评分、 SIT值均较SS组改善更明显（ t=2.22, P=0.04; t=-3.32, P<0.001; t=2.90, P=0.01; t=-4.00, P<0.001）。 SS组和非SS组均未发生明显眼部并发症,最常见的并发症为泪道再通,再通率为5.2%。 结论： 下泪小点烧灼封闭治疗重度干眼可改善重度干眼的症状和体征,是一种简单、经济且安全有 效的方法,对非干燥综合征干眼患者效果更佳。
     

Human meibum and tear film derived (O-acyl)-omega-hydroxy fatty acids in meibomian gland dysfunction

PurposeThe molecular basis of the tear film and lipid layer alterations in meibomian gland dysfunction (MGD) is unknown. This study aimed to identify and compare (O-acyl)-omega-hydroxy fatty acids (OAHFAs) derived from human meibum and tears in MGD.MethodsOf 195 eligible subjects (18–84 years, 62.6% female), 183 and 174 provided samples for tears and meibum, respectively. Subjects were classified into four groups: Normal, Asymptomatic MGD, MGD, and Mixed. Samples from the right eye of each subject were infused into the SCIEX 5600 TripleTOF mass spectrometer in negative ion mode. Lipid intensities identified with Analyst1.7 TF and SCIEX LipidView1.3 were normalized by an internal standard and total ion current, then statistically compared in MetaboAnalyst 4.0.ResultsIn meibum and tears, 76 and 78 unique OAHFAs were identified, respectively. The five most frequent and abundant OAHFAs were 18:2/16:2, 18:1/32:1, 18:1/30:1, 18:2/32:1, and 18:1/34:1. Two OAHFAs, 18:2/20:2 and 18:2/20:1, were identified only in tears. Initial univariate analysis revealed three differently regulated OAHFAs in meibum and eight in tears. Partial Least Square Discriminant Analysis showed 18:1/32:1, 18:2/16:2, 18:1/34:1 and 18:0/32:1 in tears, and 18:2/16:2, 18:1/32:1 and 18:2/32:2 in meibum, had variable importance in projection scores >1.5 and contributed the most to the separation of groups. In both meibum and tears, all OAHFAS except 18:2/16:2 were reduced in MGD compared to the normal group.ConclusionMGD is accompanied by differential expression of specific OAHFAs in meibum and tears. These results suggest OAHFAs play a role in the altered biochemical profile of the tear film lipid layer in humans with MGD.     

Book Reviews

Book reviewed in this article:
Pediatric neuro-ophthalmology: M Brodsky, R Baker and L Hamed
The eye: basic sciences in practice: JV Forrester, AD Dick, P McMenarnin, WR Lee
Questions you should ask your surgeon: Guy Maddern
Pediatric neuro-ophthalmology: Robert L Tomsak
Ophthalmic pathology – an atlas and textbook: WH Spencer. 4th edn
Lens disorders: a clinical manual of cataract diagnosis: N Phelps Brown, A J Bron     

我国白内障摘除手术效果及影响因素分析

目的探讨我国开展白内障摘除手术的效果及其影响因素。方法病例对照研究。对全国白内障复明手术信息报告系统中2017年1至12月全国31个省(直辖市、自治区)上报的接受白内障摘除手术的2078479例患者信息进行统计描述。分析白内障摘除手术后3 d、3个月患者视力改善情况及年龄、性别、术前矫正视力、既往病史、手术方式等对白内障摘除手术效果的影响。手术效果根据术后最佳矫正视力分为效果良好、效果一般、效果差。采用Wilcoxon秩和检验及多分类logistic回归模型等进行统计学分析。结果2078479例患者中,女性1197942例(57.64%),男性880537例(42.36%);患者年龄为(69±11)岁;白内障类型以年龄相关性白内障(1928440例,92.78%)为主。术前、术后3 d、术后3个月矫正视力填写完整的病例分别有1608385、1126961、389020例。手术后患者视力状况有了明显改善,术后3 d、术后3个月与术前矫正视力(最小分辨角对数转换后)的差值中位数分别为-0.48、-0.52,四分位数间距分别为0.60、0.73,术后3 d、术后3个月与术前比较差异均有统计学意义(Z=551599.30,206815.35;均P<0.01)。多因素分析显示,发生术后并发症(效果一般:OR=0.50,95%CI为0.46~0.55;效果良好:OR=0.31,95%CI为0.28~0.33)、术前瞳孔状态异常(效果一般:OR=0.52,95%CI:0.44~0.61;效果良好:OR=0.55,95%CI为0.47~0.63)、术前眼压异常(效果一般:OR=0.86,95%CI为0.79~0.93;效果良好:OR=0.45,95%CI为0.42~0.49)、既往高血压病史(效果一般:OR=0.90,95%CI为0.85~0.95;效果良好:OR=0.88,95%CI为0.83~0.93)和糖尿病病史(效果一般:OR=0.86,95%CI为0.80~0.93;效果良好:OR=0.92,95%CI为0.86~0.99)是影响手术效果的危险因素;术前矫正视力好(术前矫正视力0.2~0.4,效果一般:OR=2.20,95%CI为2.06~2.34,效果良好:OR=5.25,95%CI为4.94~5.59;术前矫正视力0.5~0.7,效果一般:OR=1.08,95%CI为0.96~1.21,效果良好:OR=6.35,95%CI为5.69~7.08;术前矫正视力≥0.8,效果一般:OR=0.73,95%CI为0.60~0.89,效果良好:OR=6.58,95%CI为5.51~7.86)、小切口囊外白内障摘除术(效果一般:OR=3.19,95%CI为2.35~4.33;效果良好:OR=6.79,95%CI为5.13~8.97)和超声乳化白内障吸除术(效果一般:OR=2.12,95%CI为1.60~2.81;效果良好:OR=3.34,95%CI为2.59~4.32)为手术效果的保护因素。结论我国白内障患者行白内障摘除手术后视力状况有明显改善,但仍有部分患者处于中度视力损伤状态;手术效果受术前矫正视力、术前眼压、术前瞳孔状态、手术方式、术后并发症等多种因素影响。     

The Malaysian cataract surgery registry: incidence and risk factors of postoperative infectious endophthalmitis over a 7-year period

AIM: To report the incidence, risk factors and visual outcomes for postoperative endophthalmitis (POE) based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR). METHODS: Data was collected from the web-based MOH CSR. All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified. Exclusion criteria were traumatic cataract or previous ocular surgery. Demographic data, ocular co-morbidities, intraoperative details and postoperative visual acuity (VA) at final ophthalmological follow-up were noted. All eyes were taken for analysis. Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions. RESULTS: A total of 163 503 subjects were screened. The incidence of POE was 0.08% (131/163 503). Demographic POE risk factors included male gender (OR: 2.121, 95%CI: 1.464-3.015) and renal disease (OR: 2.867, 95%CI: 1.503-5.467). POE risk increased with secondary causes of cataract (OR: 3.562, 95%CI: 1.740-7.288), uveitis (OR: 11.663, 95%CI: 4.292-31.693) and diabetic retinopathy (OR: 1.720, 95%CI: 1.078-2.744). Intraoperative factors reducing POE were shorter surgical time (OR: 2.114, 95%CI: 1.473-3.032), topical or intracameral anaesthesia (OR: 1.823, 95%CI: 1.278-2.602), posterior chamber intraocular lens (PCIOL; OR: 4.992, 95%CI: 2.689-9.266) and foldable IOL (OR: 2.276, 95%CI: 1.498-3.457). POE risk increased with posterior capsule rupture (OR: 3.773, 95%CI: 1.915-7.432) and vitreous loss (OR: 3.907, 95%CI: 1.720-8.873). Postoperative VA of 6/12 or better was achieved in 15.27% (20/131) subjects with POE. CONCLUSION: This study concurs with other studies regarding POE risk factors. Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.     

Comparison between central corneal thickness and IOP in patients with macrodiscs with physiologic macrocup and normal-sized vital discs

BACKGROUND: Macrodiscs with physiologic macrocups and elevated intraocular pressure (IOP) are frequently suspicious for glaucoma. Patients with an elevated c/d ratio and an IOP of more than 21 mmHg are often treated for glaucoma. We investigated a possible relationship between macrodiscs, IOP and central corneal thickness. METHODS: Using the Erlangen glaucoma registry, 341 out of 1,096 consecutive patients with unremarkable and repeated visual field (Octopus 500, G1-3, MD<2.1) were selected. Most of these patients had been sent as glaucoma suspects. The following data were collected: corneal ultrasound pachymetry (Tomey, AL-2000), IOP profile, visual acuity and central corneal power. The morphometric analysis was performed by planimetry using the Littmann formula. Optic nerve heads with a disc area of more than 3.1 mm(2) were defined as macrodiscs. RESULTS: Patients were subdivided into the following groups: group A: healthy macrodiscs, IOP <22 mmHg (87 patients); group B: healthy macrodiscs, IOP >21 mmHg (66 patients); group C: normal-sized healthy discs, IOP <22 mmHg (93 patients); group D: normal-sized healthy discs, IOP >21 mmHg (95 patients). Mean corneal thickness was: group A: 575+/-36 microm, group B: 596+/-37 microm, group C: 557+/-31 microm and group D: 585+/-38 microm ( P=0.003). Mean central corneal power measured: group A: 41.7+/-1.3 D, group B: 42.4+/-1.3 D, group C: 43.0+/-1.2 D and group D: 42.8+/-1.2 D ( P<0.05). The maximum of IOP was: group A: 17.6+/-3.1, group B: 26.2+/-4.1, group C: 17.2+/-3.4 and group D: 29.7+/-5.5 mmHg. Optic disc size measurements were: group A: 3.91+/-0.66, group B: 3.65+/-0.6, group C: 2.56+/-0.30 mm(2) and group D: 2.39+/-0.39 microm, respectively. CONCLUSIONS: Macrodiscs with elevated IOP have a higher corneal curvature (mean: +0.7 D) and a thicker central cornea (mean: +21 microm) compared to macrodiscs without elevated IOP. An exact evaluation of optic disc morphology in combination with pachymetric and keratometric measurements in relation to IOP could avoid an overtreatment in patients with suspect primary open-angle glaucoma.     

Inter-device reproducibility of the scanning laser polarimeter with variable cornea compensation

OBJECTIVE: To evaluate the interdevice reproducibility of retinal nerve fibre layer (RNFL) thickness measurements obtained with the commercially available GDx-VCC, a scanning laser polarimeter with variable (individualized) corneal compensation. METHODS: A prospective instrument validation study in which 13 GDx-VCC devices were tested. One eye each, from three normal subjects were used to test each of the devices, on the same day, by an experienced operator. Variability and reproducibility for each of five GDx parameters were calculated. RESULTS: For each of five tested GDx parameters, the coefficient of variation and 95% confidence interval range (microm), for the 13 devices, respectively, were: TSNIT avg: 5.1%, 3.84 microm; Superior avg: 5.3%, 4.82 microm; Inferior avg: 6.1%, 5.50 microm; TSNIT standard deviation: 8.6%, 2.92 microm; and nerve fibre indicator (NFI): N/A, 5.69. Item reliability (Cronbach's alpha) for the five GDx parameters are: TSNIT-Avg: 0.97, Sup-Avg: 1.00, Inf-Avg: 0.84, TSNIT-SD: 0.99, NFI: 0.99. CONCLUSIONS: With the commercially available GDx-VCC, our results indicate that RNFL measurements appear reproducible across devices.     

Book Reviews

Book reviewed in this article: Clinical optics (2nd edition) :AR EOrington, J Frank Oxford: Blackwell Scientific Publications, 1991 Optical dispensing workshop. A dispenser's guide to workshop practice :P Druery Sydney: TAFE Student Learning Publications, 1990 Problems in Optometry :Editor in Chief, Richard London Philadelphia Color atlas of ophthalmic surgery: corneal and refractive surgery :KW Wright Editor Philadelphia: Lippincott, 1992 The fine art of prescribing glasses (without making a spectacle of yourself) (2nd edition) : Benjamin Milder and Melvin L Rubin     

Book Reviews

Book reviewed in this article:
Retina: 2nd Ed., Stephen J Ryan, ed. St Louis: Mosby, 1994
Ultrasound Biomicroscopy of the Eye: Charles J Pavlin, F Stuart Foster
Ophthalmic Surgery Complications: Prevention and Management: Judie F Charlton, George W Weinstein, editors
Ophthalmic Medical Assisting: an Independent Study Course: Robert L Stampler, Paul J Wasson, Editors     

Novel ocular findings in oculodentodigital dysplasia (ODDD): a case report and literature review

Background: Oculodentodigitaldysplasia (ODDD; MIM no. 164200) is a rare hereditary disorder caused by mutations in the gene GJA1.Ocular disorders included microcornea, cornea opacity and glaucoma. However, few studies described fundus findings.

Materials and methods: Ophthalmic examination included visual acuity measurement, intraocular pressure (IOP) measurements, slit-lamp biomicroscopy, B-scan ultrasonography, Ultrasound biomicroscopy (UBM), spectral-domain optical coherence tomography (SD-OCT), ERG and retcam fluorescein angiogram. In addition, blood samples were taken from this patient for mutation analyze of GJA1.

Result: The ophthalmic features of this patient were microcornea, cornea opacity, glaucoma as expected. Interestingly, the patient had a normal axial length with refractive status of emmetropia, but extremely retinal dysplasia and severe choroid thinning was noted. Flash electroretinogram (ERG) was extinguished in both eyes. This study identified a novel mutation c.91A>T in the GJA1 gene associated with fundus abnormalities. Bioinformatics and structural modeling suggested the mutation to be pathogenic.

Conclusion: Our research expanded not only the mutation spectrum, but also the clinical characteristics of ODDD. To the best of our knowledge, this is the first report on anatomical and functional chorioretinal changes in ODDD patients. These novel ocular features highlight the importance of fundus morphological and functional evaluation in ODDD.

Abbreviations: ODDD: oculodentodigital dysplasia; OCT: optical coherence tomography; ERG: electroretinogram; TACT: teller acuity card test; UBM: ultrasound biomicroscopy; MW: molecular weights; AL: axial length; Cx43: connexin 43; RPE: retinal pigment epithelium; RGCs: retinal ganglion cells; FEVR: familial exudative vitreoretinopathy; ROP: retinopathy of prematurity     

Pharmacokinetic analysis of platelet-activating factor in the tears of guinea pigs with allergic conjunctivitis.

PURPOSE: The aim of this study was to examine the levels of platelet-activating factor (PAF) and lyso-PAF in tears from experimental animals developing allergic conjunctivitis (AC). METHODS: AC was induced in guinea pigs by application of ovalbumin in eye drops. Tear samples were collected from 5 actively sensitized animals and from 5 unsensitized control animals before the challenge, and 1, 2, 4, and 6 h postchallenge. C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF levels in the tear samples were determined using liquid chromatography-tandem mass spectrometry. RESULTS: The concentrations of C16:0-PAF, C16:0-lyso-PAF, and C18:0-lyso-PAF were measurable in both unsensitized and sensitized groups, whereas C18:0-PAF was undetectable in tear samples from either group. The levels of C16:0-PAF, C16:0-lyso-PAF, and C18:0-lyso-PAF in sensitized animals increased throughout the time course of the experiment, whereas there was no corresponding increase in the levels of these molecules in the unsensitized group. There were strong correlations between the concentrations of C16:0-PAF and C16:0-lyso-PAF, both in the sensitized and in the unsensitized group, and the concentrations of C16:0-lyso-PAF and C18:0-lyso-PAF within each group. CONCLUSIONS: The data from this study demonstrated that the levels of PAF and lyso-PAF increase in tears in a guinea pig model of AC development and implicate a role for PAF for the development of AC.     

Punctal Ectropion repair using the Raus–Garito clamp

Purpose: To evaluate the results from the correction of ectropion of the punctum lacrimale in lower eyelids with a new surgical clamp.

Design: Prospective study.

Methods: Eighty eight eyelids in 55 patients with mild and moderate ectropion were included in the study. An excision of a diamond of tarso-conjunctiva with retractor reattachment and concomitant correction of horizontal lid laxity, if present, was performed.

Results: Resolution of tearing was obtained in 77 eyes. In 11 eyes, persistent tearing was reported.

Conclusion: Conclusion:Conclusion: Repair of early to intermediate ectropion of the lacrimal punctum using the Raus–Garito clamp is associated with a good functional and cosmetic outcome.     

Giant Orbital Hydrocystoma in Children: Case Series and Review of the Literature

Objective: To describe the clinical features, ancillary diagnostic studies, and treatment outcomes in a cohort of pediatric patients with giant orbital hydrocystomas.

Design: Retrospective case series.

Participants: Pediatric patients with giant orbital hydrocystomas treated in the practice of one surgeon (PDL).

Methods: A retrospective review of the clinical charts of pediatric patients with orbital hydrocystoma was performed and diagnostic information collected. Results were reviewed and compared with reported clinical data in the literature.

Main Outcome Measures: Clinical presentation and histopathological findings of pediatric orbital hydrocystomas.

Results: Three pediatric cases of giant orbital hydrocystoma were encountered, each with an unusual feature, including deep orbital location, occurrence following trauma, and eccrine pathology.

Conclusion: Giant orbital hydrocystomas may present in the pediatric population. Ophthalmologists should be cognizant of this entity when evaluating a child with a large, cystic orbital mass.     

Platelet-activating factor in human normal tears

PURPOSE: To measure the concentrations of platelet-activating factor (PAF) and lyso-PAF in tears of human eyes. METHODS: Unilateral tear samples were collected from the conjunctival cul-de-sac of 12 healthy volunteers without any past histories of ocular surface diseases and 10 patients with allergic conjunctivitis (AC) by graduated disposable microcapillaries. C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF levels were determined by liquid chromatography-tandem mass spectrometry (LC/MS/MS). RESULTS: The concentrations of C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF in tears from healthy volunteers were 0.44 +/- 0.39, 51.7 +/- 63.4, 61.9 +/- 75.9, and 10.7 +/- 14.7 ng/ml, respectively. Higher, but not significantly different, concentrations of all the four kinds of PAF molecules were detected in tears from AC patients. Significant correlations were demonstrated between the concentrations of C18:0-PAF and C18:0-lyso-PAF (r = 0.906; p < 0.01 in normal healthy volunteers and r = 0.939; p < 0.01 in AC patients), and between those of C16:0-PAF and C16:0-lyso-PAF (r = 0.944; p < 0.01 in normal healthy volunteers and r = 0.806; p = 0.015 in AC patients). Moreover, C18:0-PAF concentrations correlated significantly with those of C16:0-PAF (r = 0.885; p < 0.01 in normal healthy volunteers and r = 0.927; p < 0.01 in AC patients), while C18:0-lyso-PAF concentrations correlated significantly with those of C16:0-lyso-PAF (r = 0.972; p < 0.01 in normal healthy volunteers and r = 0.891; p < 0.01 in AC patients). CONCLUSIONS: To our knowledge, this is the first report of the concentrations of different species of PAF (C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF) in human tears.