Studies of Primary Angle Qosure Glaucoma in China

The resent researches on primary angle closure glaucoma (PACG) in China were reviewed. The prevalence of PACG (0.41%) in chinese is between the Caucasian and Eskimos, and chronic type is the dominant type in PACG. However, with the economic development and medical care improvements, the prevalence condition of PACG may change; several researches discovered that the mechanism of PACG, especially the chronic type, is not only because of pupil-blocking but also closely related to the mechanism of crowding of peripheral iris and the anterior location of the ciliary body. We supposed that PACG can be divided into several subtypes based on this machnism. Also, we believe that the use of ultrasound biomicroscopy (UBM) and ophthalmic laser in China has promoted the research of PACG and improved the level of prevention and treatment of PACG. Eye Science 1997; 13 : 120- 124.     

[Online First]Dr. Father Wacław Szuniewicz, a forgotten pioneer in refractive surgery and his work in China

Father Wac?aw Szuniewicz (1891-1962) was a skilled ophthalmic surgeon, missionary and teacher. For several years he worked in China, afterwards in the United States and in Brazil. The aim of the paper is to present the unanalyzed issues of Szuniewicz’s research regarding corneal refractive surgery. Szuniewicz performed experiments on changing the corneal curvature with anterior, posterior and full-thickness incisions. The results of modifying the anterior and posterior corneal curvature were satisfactory, however, diminished significantly within months after surgery. Corneal band resections were superior in terms of efficacy, however, such an intervention commonly led to complications in animals. Szuniewicz’s work was not published during his life. Nevertheless, as a result of strong impact of his personality and ideas, he is frequently considered as a pioneer of corneal refractive surgery.     

Significance of Axial Length Monitoring in Children with Congenital Cataract and Update of Measurement Methods

Congenital cataract is the main cause of blindness in children, with significantly varying treatment effects. The development of axial length is an important factor that affects the prognosis of these children.However,when compared with the eyes of normal children,the mechanism of growth of the axial length is so complicated that the reported findings differ significantly in terms of the measuring apparatus,assessment methods,and statistical outcome,making the rule of axial length development still unclear. In this paper, we first review the process of axial length development in normal healthy children and compare different hypotheses about certain factors that could affect the development of axial length. The results of some current research about the characteristics of axial length development in congenital cataract children are then reviewed. Lastly, the advantages and disadvantages of current axial length measurements methods are compared and analyzed.The purpose of this review is to improve our understanding of the complexity and importance of axial length development and to suggest better use of axial length monitoring measurements in congenital cataract children for pediatric ophthalmologists,with the hope of offering assistance that will enhance long-term therapeutic effects for these children.     

Sharing Vision-Saving Skills, while Establishing Lifelong Friendships--In Celebration of the 30th Anniversary of the ORBIS Flying Eye Hospital's First Trip to Guangzhou, China

 Thirty years ago, the ORBIS Flying Eye Hospital (ORBIS FEH) first landed in Guangzhou on September 21st 1982, remaining in the city for 18 days. Not only was this the ORBIS FEH's first trip to China to provide training in sight-restoring techniques, but the visit also turned a whole new chapter in the history of friendship between the Chinese and American ophthalmic communities. In the ensuing 30 years, the ORBIS FEH has visited China 22 times, landing in 25 different locations. The first DC-8 aircraft, retired formally in 1994, was subsequently presented by ORBIS to China as a token of the friendship between the Chinese and American people. This plane with its praiseworthy history is currently on display at the Chinese Aviation Museum in Beijing. The ORBIS FEH, originally dedicated by the highly respected American ophthalmologist David Paton, has as its defining goal the teaching and spreading of advanced ophthalmic surgical technology throughout the world, particularly in those areas where resources are scarce. Training of local ophthalmic staff as well as treating patients is its priorities, and thus it has received a warm welcome wherever it goes. The ORBIS FEH generates a ripple effect which has led to further improvements in eye care ever.     

Updates in Orbital Tumors

Orbital anatomy, the clinical features of orbital tumors, the recent development of the diagnosis and management of orbital tumors were described. The incidence of orbital tumors in Dr. Cipto Mangunkusumo Hospital in the past years were introduced. The principle of management of orbital tumors and their prognosis were discussed.     

Prevalences and causes of vision impairment in elderly Chinese: a socioeconomic perspective of a comparative report nested in Jiangsu Eye Study

AIM: To survey the prevalence and causes of visual impairment/blindness among elderly Chinese from different socioeconomic status in community-based design. METHODS: Cluster-sampling randomly selected residents from Binhu and Funing District, two areas representing different socioeconomic levels in China with Binhu in an advanced status and Funing in less-developed area. The participants subjected to ophthalmic examination. The presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) were recorded. Visual impairment and blindness were defined according to World Health Organization criteria. The causes of visual impairment/blindness were identified by ophthalmic examination and/or questionnaire. The socioeconomic status included the per capita gross domestic product, numbers of hospital with ophthalmic service and the number of ophthalmologists per 1 million residents. RESULTS: We successfully included 12 867 participants form 2 areas in this study. The prevalence of PVA impairment (<20/63 to ≥20/400) in the better eye was 5.4% in Binhu and 23.6% in Funing, while the prevalence of blindness (<20/400) was 0.9% in Binhu and 2.3% in Funing. With BCVA, the prevalence of visual impairment was 2.4% in Binhu and 6.4% in Funing, while the prevalence of blindness was 0.8% in Binhu and 1.6% in Funing. The participants with older age and female gender had higher prevalence in visual impairment and blindness. The highest prevalences of vision impairment and blindness evaluated by BCVA at >80y age group reached 20.4% and 6.3% respectively. The prevalences of vision impairment and blindness evaluated by BCVA were 3.5% and 1.0% in male and 5.0% and 1.3% in female. The above differences were statistically significant (P<0.05). The predominant causes of visual impairment and blindness were cataract, retinal disorders and uncorrected refractive error in both areas. The socioeconomic status was associated with visual impairment and blindness. CONCLUSION: This community-based study build a sufficient sample size for an ophthalmic survey. Our data show the disparities on socioeconomic development and genders in visual impairment and blindness in China. Special emphasis of ophthalmic service should be placed on females and less-developed area.     

导航手术系统在眼眶外科中的应用

导航手术系统是计算机技术和医学影像结合的产物,是近年来发展和研究最为活跃的领域之一,其通过术前设计规划、术中导航、术后评估等步骤,旨在提高手术的精确性和安全性.本文介绍了计算机导航系统的组成、工作原理和实施步骤,并进一步综述了导航手术系统在眼眶骨折修复手术、眼眶肿瘤手术和眼眶减压手术中的应用及其进展.

Abstract：

Computer-aided surgical navigation system,which is a combination of computer technology and medical imaging,is one of the most popular and developing fields in recent years. The navigation system is aimed to improve the accuracy and security of the surgery by pre-operative planning,intra-operative navigation and post-operative evaluation. This paper introduces the essential elements,fundamental principles,and implementation steps of the navigation system;further reviews its usefulness and progress in orbital fractures reduction,orbital tumor surgery and orbital decompression.     

New ideas for medical therapy of glaucoma in the future

New drugs are developed rapidly with novel ideas of action mechanisms for the treatment of glaucoma. The most classic drugs under development are to lower the intraocular pressure (IOP). New agents were invented to lower the IOP through ① induction of metalloproteinases (MMPs), ② contraction of trabecular meshwork cells, ③ inhibition of aqueous humor secretion, and ④ activation of CB-1 receptor, The second class of drugs under development is intended to improve the ocular blood flow (OBF), particularly in retina and optic nerve head (ONH). Drugs that improve the OBF irrespective of the IOP changes could be quite useful for the treatment of normal tension or low-tension glaucoma. Neuroprotection is the latest developed mechanisms of glaucoma treatment. Although the history of neuroprotection research is very short, there are many agents under investigation in this class. They include ① blockade of N-methyl-D-aspartate receptor, ② neurotrophic agents, ③ inhibition of inducible nitric oxide synthases (iNOS), ④ inhibition of apoptosis, ⑤ protective autoimmunity, ⑥ stem cell therapy, and so on. Since all drugs for glaucoma treatment are used to stabilize the disease rather than to cure it, it is critical that an ideal drug with high therapeutic index and low cost price should be invented.     

Multimodal therapy in the management of primary orbital mesenchymal chondrosarcoma

AIM:To evaluate the ophthalmic manifestations,radiographic features,and prognosis of Chinese patients with primary orbital mesenchymal chondrosarcoma(MCS).METHODS:The study included 6 cases with primary orbital MCS treated at Tianjin Eye Hospital from January 2009 to December 2019.Patitent ophthalmic manifestations,radiographic features,diagnosis,pathology,therapeutic regimens,and prognosis were retrospectively reviewed.RESULTS:Six patitents with primary orbital MCS were identified.The mean age at the first visit was 33y(range,25-42y).All six patients displayed manifestations of exophthalmos,diplopia,limitation of eye displacement,upper eyelid oedema,decreased visual acuity and ptosis.The mean disease history and range were 5 and 2-8mo,respectively.The tumors were located in the superonasal extraconal compartment(2/6,33.3%),intraconal compartment(2/6,33.3%),and bitemporal extraconal compartment(2/6,33.3%),respectively.Radiographic features were a well-defined,orbital mass with calcification and ossification on computed tomography(CT),and marked heterogenous enhancement on dynamic magnetic resonance imaging(MRI).Five patients were treated with tumor resection and one patient received orbital exenteration.Five patients in the cohort received postoperative radiation therapy,two patients received chemotherapy,and one patient did not receive postoperative adjuvant therapy because he refused.The histopathologic classification revealed a tumour composed of a mixture of mature chondroid tissue surrounded by small,round,and undifferentiated mesenchymal cells.Immunohistochemistry revealed Bcl-2,vimetin,CD99,and S-100 were expressed were expressed.After surgeries,two patients have developed a local recurrence.The median recurrence time of 58 mo(52-64 mo).One patient had distant recurrence included the lungs occurred 52mo after the initial surgery.CONCLUSION:The possibilty of orbital MCS need to be considered when a painless,slowly growing orbital mass with calcification and ossification.From our experience,trimodality treatment of radiation therapy,chemotherapy and surgery maybe the best option.Orbital MCS has a high tendency for late recurrence,regular long-term follow-up after complete excision is mandatory.     

A recognition survey of granular corneal dystrophy type 2 genetic detection in China

AIM: To evaluate the feasibility of promoting genetic detection for granular corneal dystrophy type 2 (GCD2) by a questionnaire conducted among citizens in five cities in China. METHODS: The data were collected by questionnaire, and analyzed by Chi-square test and one-tailed t test in IBM SPSS statistics. RESULTS: Based on the survey data on the awareness of GCD2 genetic detection in this study and the positive predictive analysis report of the citizens in five cities in China, the vast majority (84.2%) of respondents had never heard of it and did not know that GCD2 patients have been prohibited from performing excimer surgery that can deteriorate GCD2 patients’ condition even leading to blindness. Though 3.4% of patients understood GCD2 very much, they have no idea that GCD2 could not be 100% accuracy diagnosed by the conventional inspection methods. CONCLUSION: It is feasible and necessary to use GCD2 genetic detection as an excimer preoperative examination project. In order to promote the development of detection project, a few improvements should be carried out in terms of the promoting efforts, costs, and research progress.     

重视儿童眼部整形手术时机和术式选择

儿童眼部畸形患者是眼部整形患者中的重要群体之一。儿童的生理、解剖与成年人有很大差异，儿童的视功能、眼眶及面部均处于发育期，其眼部畸形尤其是一些先天性畸形常伴有或最终导致视功能异常，先天或后天性的眼球缺失或发育不全则致眼眶及面部发育迟滞，因此儿童眼部整形不单纯为一种整形美容手术，更多需关注整形手术对儿童视功能及眼眶发育的影响，因此选择适当的手术时机及手术方式对于儿童眼部整形尤为重要。     

眼整形外科存在的问题及对策

眼整形外科是眼科和整形外科学科交叉产生的一门新兴专业,包括眼部美容、眼部整形和眼眶外科三部分。本文主要对三部分的关键问题进行述评:眼部美容(包括眼睑美容手术、药物注射美容和激光美容)的现状和发展;眼睑恶性肿瘤、眼睑缺损、眼睑痉挛及眼窝凹陷等眼部整形手术中存在的问题和解决措施;眼眶外科中甲状腺相关眼眶病、眼眶骨折和眼眶畸形等方面亟待解决的问题及对策,并对我国眼整形外科发展中存在的问题逐一提出解决策略。(眼科,2007,16:365-367)     

Orbital vascular anatomy

The anatomy of the orbital vascular bed is highly complex, with tremendous interindividual variations. The main source of blood supply to the orbit is by the ophthalmic artery, the first branch of the internal carotid artery. The origin, course, and branches of the ophthalmic artery, and the genesis of the variations in origin, course, and branching pattern of the ophthalmic artery are discussed. The external carotid artery normally contributes only to a small extent to the orbital blood supply via the infraorbital artery and orbital branch of the middle meningeal artery.The complex, highly variable and confusing orbital venous system can be divided into: (i) main orbital veins (superior and inferior ophthalmic veins), (ii) inconstant orbital veins (middle and medial ophthalmic veins and four collateral veins), (iii) orbital venous networks, and (iv) various venous tributaries. All these are described briefly.     

Cosmetic eyelid and facial surgery

The goal of cosmetic surgery is to reverse anatomical changes that occur in the face with aging. It is a rapidly growing subdiscipline of ophthalmic plastic surgery and includes forehead, eyelid, mid-face, lower face, and neck surgery, most performed by ophthalmic plastic surgeons. The current article reviews updates in cosmetic eyelid and facial surgery, including minimally invasive techniques such as cable suspensions, injections, and fillers.     

Endoscopic surgery for lacrimal and orbital disease

Recent interest in the application of endoscopic surgical techniques to the field of ophthalmic plastic and reconstructive surgery has occurred primarily in the areas of lacrimal and orbital disease. Examples of important innovations include endoscopic intranasal laser-assisted dacryocystorhinostomy (DCR), transcanalicular laser-assisted DCR, microendoscopy of the lacrimal drainage system, endoscopic orbital decompression, orbital endoscopy, and computer-assisted surgery. The evolution of these exciting and promising innovations is reviewed with emphasis on the need for continued critical evaluation of these techniques by rigorous clinical research prior to forming specific recommendations for their widespread general use.     

Arterial vascularization of the levator muscle of the upper eyelid

The arterial vascularization of the levator to the anterior half of the nasal edge and the posterior half of the inferior face come from the supra orbital artery or from a branch of the ophthalmic artery. The posterior third receives its arterial supply from the posterior ethmo?dal artery. The anterior portion and the lateral and medial horns get their blood supply from the lacrimal artery but the presumed supply from the palpebrae arteries has not been shown in this study. The radio-anatomic study of the muscle defines three of different arterial supplies: the lacrimal artery in the anterior part; the supra orbital or ophthalmic artery in the middle and the posterior ethmo?dal artery, posteriorly. Some arterioles traverse the entire muscle from single pedicle (supra orbital) but in a third of cases the lateral arteriole arises from the posterior ethmo?dal artery. They anastomose in the anterior portion of the muscle with the arterioles arising from the lacrimal artery through the lacrimal gland. The radio-anatomic pictures emphasize the great supply from that origin. The major practical implication of this study is the importance of better hemostasis in anterior levator surgery particularly during ptosis surgery.     

我国眼科病理学近五年研究进展

值此纪念<中华眼科杂志>创刊60周年之际,回顾我国眼科病理学伴随中国眼科学发展进步走过的时代历程,可以看出学科在稳步健康地向前发展,专业领域规模在不断扩展,各方面均取得了飞速的进步,并获得了显著的科研成果.本文对我国近5年来眼病理学科的发展现状以及在眼肿瘤、眼眶病及相关学术领域的眼病理主要研究工作现状进行回顾总结和分析,并提出了眼病理学未来的发展方向和工作目标.     

Orbital decompression for thyroid eye disease

The literature regarding orbital decompression for thyroid eye disease is vast, spanning multiple specialty areas including neurosurgery, head and neck, maxillofacial, and ophthalmic plastic surgery. Although techniques have advanced considerably over the more than 100 years during which this procedure has been performed, the 4 major approaches remain: transorbital, transcranial, transantral, and transnasal. The explosion in literature related to orbital decompression has mostly involved minor technical variations on broader surgical themes. The purpose of this review is to organize the major approaches in terms of bony anatomy and to contextualize variation in transdisciplinary techniques within a common conceptualization.     

Isolated medial orbital wall fractures with medial rectus muscle incarceration

PURPOSE: To retrospectively review and analyze cases of isolated medial orbital wall fractures with medial rectus muscle incarceration presenting to a tertiary ophthalmic plastic surgery practice from 1997 to 2005. METHODS: Retrospective chart review and literature review. RESULTS: Nine cases of isolated medial wall fracture with medial rectus muscle incarceration are presented. The most frequently encountered clinical feature was adduction deficit on the affected side. Extraocular motility improved in all patients who underwent surgery, and mean postoperative enophthalmos was minimal. CONCLUSIONS: Isolated medial orbital wall fractures with medial rectus muscle incarceration are rare. Ocular motility abnormalities were the only indication of underlying fracture in the majority of our cases. Clinicians should be alerted to the anticipated presentation of medial wall fractures with incarceration of the medial rectus muscle, including the possibility of a "white eye" and normal abduction of the traumatized eye.     

The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery: a preliminary report

PURPOSE: To describe the uses and determine the safety of a commercially available acellular dermal allograft in ophthalmic plastic and reconstructive surgery. The existing literature regarding current applications and results using acellular dermal allograft is reviewed. METHODS: The study design was a retrospective, noncomparative case series. Participants consisted of 63 consecutive patients undergoing ophthalmic plastic and reconstructive surgery using an acellular dermal matrix graft. The main intervention was placement of a dermal allograft. Outcome measures included the degree of clinical improvement and complications for each patient. RESULTS: We used AlloDerm (LifeCell Corporation, The Woodlands, TX, U.S.A.) as a posterior lamellar conjunctival spacer graft, a soft tissue interpositional graft, and an orbital implant wrapping material. Clinical improvement was noted in all cases. There were no complications attributable to the acellular dermal matrix material. CONCLUSIONS: We describe several novel ophthalmic plastic and reconstructive surgical applications using acellular dermal allograft tissue. This material may be used safely as a posterior lamellar conjunctival spacer graft, a soft tissue interpositional graft, and a wrapping material. Clinically, the allograft appears to be biocompatible, nontoxic, and nonallergenic in the orbit, eyelid, and midfacial tissues. Long-term data and studies comparing the efficacy of acellular dermal allograft with conventional materials are necessary.