Ocular manifestations of the autoinflammatory syndromes

The autoinflammatory syndromes are rare inherited disorders characterized by recurrent attacks of multi-system inflammation caused by genetic mutations that result in abnormal upregulation of key innate immune mediators. The term autoinflammatory syndromes includes a broad variety of disorders, including cryopyrin-associated periodic syndromes (CAPS) such as neonatal onset multisystem inflammatory disease (NOMID), familial cold autoinflammatory syndrome (FCAS), Muckle-Wells syndrome (MWS), periodic fever syndromes, including familial Mediterranean fever (FMF), TNF receptor-1 associated periodic syndrome (TRAPS), and Blau syndrome. Ocular manifestations are frequent and diverse in affected patients, and visual impairment and blindness are not uncommon sequelae of chronic active disease. Novel therapeutic interventions targeting specific pathophysiologic mechanisms have been extremely promising in the treatment of these disorders. The purpose of this article is to provide a review of these disorders with a focus on pathogenesis, clinical manifestations, ophthalmologic involvement, and available treatment options.     

Nd:YAG激光应用中对眼组织的损害及预防

目的:Nd:YAG激光在应用中所发生的并发症,系统分析了出现的原因,提出了治疗方法及预防措施。方法:2009-12/2012-12共计387例597眼激光爆破中对眼组织的损害:包括炎性反应,一过性高眼压,角膜内皮点状混浊,前房出血,人工晶状体损伤等,并对相关的指标进行了量化处理。结果:青光眼虹膜穿孔术:炎性反应93.7%,一过性高眼压78.9%,前房出血23.7%,虹膜后粘连2.63%,虹膜根部断离0.53%,视网膜出血0.53%。人工晶状体前膜切开术:炎性反应20%,一过性高眼压33.3%,前房出血46.7%,人工晶状体损伤33.3%。人工晶状体后囊膜切开术:炎性反应19.2%,一过性高眼压17.8%,前房出血0.3%,人工晶状体损伤26.0%。结论:Nd:YAG激光在眼前节中的治疗作用是安全确实的,其对眼组织的损害与机器性能,操作者的经验,疾病的种类及程度,患者的配合等密切相关,了解了这些因素有针对的干预可避免或减少对眼组织的损害。     

白内障超声乳化联合人工晶状体植入术对眼表的影响

目的:观察白内障超声乳化联合人工晶状体植入手术后眼表情况的变化。方法:收集2011-08/2012-10间我院眼科收治的老年性白内障患者78例78眼,经颞侧透明角膜切口行白内障超声乳化联合人工晶状体植入术。分别于术前、术后1d;1wk;1,3,6mo观察眼表情况,记录眼表刺激症状、角膜荧光素染色、泪膜破裂时间、泪液分泌实验(SchirmerⅠtest,SⅠt),并对数据进行统计分析。结果:术后1wk内,患者有明显的干眼症状,术后1d;1wk;1mo,角膜荧光素着色较术前明显增多,而泪液分泌量明显减少,差异具有统计学意义(P<0.05),术后3,6mo与术前无明显差异(P>0.05)。术后1mo内泪膜破裂时间较术前明显缩短(P<0.05),3mo时降至术前水平(P>0.05)并保持至术后6mo。结论:白内障超声乳化联合人工晶状体植入手术对眼表具有一定程度的影响,临床应积极采取措施进行预防和治疗。     

眼轴与眼球生物学相关参数的分析

目的:探讨眼轴长度(axial length,AL)与年龄、屈光状态及眼球生物学相关参数的关系。方法:对360例360只右眼正视及近视受试者采用全自动电脑验光仪、A超、角膜厚度测量仪、非接触式眼压计、OrbscanⅡ及3D-OCT分别测量屈光状态、AL、角膜厚度(center corneal thickness,CCT)、眼压(intraocular pressure,IOP)、前房深度(anterior chamber depth,ACD)、白对白距离(white-to-white distance,WWD)、角膜曲率(corneal curvature,CC)及视网膜神经纤维层厚度(retinal nerve fiber layer thickness,RNFLT),用Pearson相关系数及多元回归方法评估AL与年龄、屈光状态及眼球生物学相关参数的关系。结果:AL均值为24.15±1.26mm,Pearson相关性分析显示AL与年龄(r=-0.238,P<0.01)、等值球镜度数(r=-0.742,P<0.01)、CC(r=-0.395,P<0.01)及RNFLT(r=-0.374,P<0.01)成负相关,而与ACD(r=0.411,P<0.01)呈正相关,与CCT(r=0.099,P=0.060)及WWD(r=0.061,P=0.252)无相关性。将AL及与其具有相关性的参数进一步行多元线性回归分析,AL与年龄(P=0.001)、SE(P<0.01)、ACD(P<0.01)及CC(P<0.01)具有相关性。结论:AL随着年龄增长表现为逐渐变短的趋势。眼轴越长,近视屈光度越高,角膜越扁平,前房越深,RNFLT越薄。     

Lacrimal gland lesions in Denmark between 1974 and 2007

Purpose: To evaluate the incidence rate, distribution, patient characteristics and indications for surgical intervention of lacrimal gland lesions in Denmark between 1974 and 2007. Material and methods: All biopsied/surgically removed lacrimal gland lesions in Denmark during the period 1974–2007 were identified by searching two population‐based registries. Specimens were collected and re‐evaluated. The following data were collected: age, gender, indications for surgical intervention and local recurrence. Results: A total of 232 lesions from 210 patients with a histologically verified lesion of the lacrimal gland were included. The incidence rate of lacrimal gland lesions was 1.3/1 000 000/year. The overall annual age‐ and gender‐adjusted incidence rate more than doubled during the study period, owing to an increase in non‐malignant lesions. Approximately half of the lesions were neoplasms (119) and 55% (66) of these were malignant. Dacryops constituted 10% (24), inflammatory lesions 27% (62), normal tissue 12% (27), benign tumours 23% (53) and malignant tumours 29% (66). Patients with malignant neoplasms were significantly older than patients with benign neoplasms (63 versus 48 years, p < 0.001). The indication for surgical intervention was suspicion of a tumour in more than 90% of the neoplastic lesions and in 30% of the non‐neoplastic lesions. Conclusion: Lacrimal gland lesions that require surgical evaluation are rare in the Danish population and represent a wide spectrum of diagnoses, mostly benign. The overall incidence rate of biopsied lacrimal gland lesions is increasing.     

眼表各部位烧伤程度对修复时间的影响

目的观察羊膜移植术治疗眼表烧伤过程中,角膜缘、角膜、结膜不同部位烧伤程度对眼表修复时间的影响。方法回顾性分析羊膜移植术治疗的61例（77眼）Ⅲ度～Ⅳ度眼表烧伤的临床资料,观察自羊膜移植手术至角膜上皮完整覆盖、荧光素染色无着色所需时间。采用编秩后的方差分析进行两两组间比较。结果角膜缘烧伤程度不相同的组间的修复时间的差异有统计学意义;在角膜缘烧伤程度相同的前提下,角膜、结膜不同烧伤程度组间的修复时间的差异无统计学意义。结论角膜缘部位的烧伤程度在眼表修复过程中起重要影响作用。     

Effects of SofZia‐preserved travoprost and benzalkonium chloride‐preserved latanoprost on the ocular surface – a multicentre randomized single‐masked study

Purpose: To assess the effect of SofZia‐preserved travoprost on ocular surface conditions in comparison with benzalkonium chloride (BAK)‐preserved latanoprost. Methods: A prospective randomized multicentre single‐masked comparative study. Patients with open‐angle glaucoma or ocular hypertension who had been treated with BAK‐preserved latanoprost 0.005% (Xalatan^®) monotherapy for at least 3 months. Patients were enrolled at 23 facilities. Patients were randomly divided into the X‐X group, continuous use of Xalatan^®, or the X‐T group, switching from Xalatan^® to SofZia‐preserved travoprost 0.004% (TravatanZ^®), and followed for 3 months. The superficial punctate keratopathy (SPK), conjunctival epitheliopathy, hyperaemia, tear break‐up time (TBUT) and intraocular pressure (IOP) were examined for each patient in a masked manner. Changes in the frequency of keratoconjunctival epitheliopathy were evaluated 3 months after study initiation. Intra‐ and intergroup comparisons of changes in SPK, conjunctival epitheliopathy, hyperaemia, TBUT and IOP were also carried out. Results: Two hundred twenty patients participated and 215 completed the 3‐month study. The frequency of keratoconjunctival epitheliopathy significantly decreased in the X‐T group (p = 0.036) and the intergroup difference was also significant (p = 0.001). SPK scores and TBUT were significantly improved in the X‐T group (p = 0.034, 0.049), also with significant intergroup differences in the cornea excluding the inferior area and TBUT. There were no significant intergroup differences in changes of the hyperaemia scores and the IOP reduction. Conclusion: Switching to SofZia‐preserved travoprost after BAK‐preserved latanoprost resulted in a lower incidence of keratoconjunctival epitheliopathy, especially in the cornea, with no clinically relevant changes in hyperaemia and IOP.     

Clinical and cytopathologic correlation in chronic inflammations of the orbit and ocular adnexa: A review of 55 cases

Fine-needle aspiration cytology has been used for the diagnosis of neoplastic lesions of the orbit and ocular adnexa with some success. However, inflammatory conditions have not received much attention. This is a retrospective study of fine-needle aspirations of chronic inflammations of the orbit and ocular adnexa over a 15-year period from January 1988 through December 2002. Clinical records and stained smears were reviewed. There were 55 chronic inflammations, presenting as masses, cysts, abscesses, discharging sinuses and dermal plaques and nodules. Forty-two were granulomatous inflammations comprising chalazion (18), tuberculosis (5), Cysticercus cellulosae (3), ruptured epidermal cysts (2), actinomycosis (1) and leprosy (13). Thirteen patients had chronic non-specific inflammations. Fine-needle aspiration cytology is a useful diagnostic procedure in chronic inflammations of the ocular adnexa. Specific diagnosis is possible in many granulomatous inflammations, allowing appropriate, individualized therapy to be initiated.     

Unmasking of Ocular Bobbing Associated with Jaw Movement following Inferior Rectus Surgery

MG phenomenon refers to involuntary lid movements associated with jaw movements. We report a case unilateral vertical movement of the globe in a case of monocular elevation deficit. The above mentioned movement may be an unreported variant of oculo-trigemial synkinesis.