Objective Imageology diagnosis of orbital tumor is very critical for the determination of nature of tumor in childhood patients. It is very necessary to comprehensively assess the results of clinical manifestations and imageology for the identification of orbital tumor. This study was to evaluate the clinical value of ultrasonography and color Doppler imaging (CDI) in the diagnosis of orbital tumors in children. Methods The clinical data, B-type echograms and CDI of 39 children with orbital tumors including capillary hemangioma, lymphangioma, venous hemangioma, rhabdomyosarcoma, dermoid cyst, varicosity etc. Were analyzed retrospectively. Results Among 39 cases of orbital tumors in children, 8 cases of capillary hemangioma and 2 cases of rhabdomyosarcoma showed the signals of artery blood flow from CDI ultrasound examination. No blood flow signal was obtained in 12 cases with dermoid and 8 cases with lymphangioma. The venous blood flow signals were examined from CDI examination in 3 out of 6 cases of venous hemangioma. Dynamic blood flow changes were seen from CDI in 3 cases with varicosis. Conclusion Combination of B-type ultrasonography and CDI is useful for the diagnosis of orbital tumors in childhood patients.

Objective:To measure the choroidal thickness (CT) in the macular area of patients with amblyopia in severe congenital ptosis and to compare the thickness with that of severe congenital ptosis without amblyopia.Methods:A cross-sectional study was performed.Total of 83 eyes of 60 severe congenital ptosis patients were enrolled from January to October in the year 2019 in the Shanxi Eye Hospital, including 29 patients 37 eyes with amblyopia and 36 patients 46 eyes without amblyopia.Thirty-seven eyes of 37 normal people were included in the control group.All subjects underwent mydriatic optometry and the spherical equivalent (SE) was calculated.IOL-Master was used to measure the axial length (AL), and EDI-OCT was used to measure the CT in the macular area.The CT was measured at 13 points: directly beneath the fovea (SFCT) and at 1 mm, 2 mm and 3 mm intervals to the nasal, temporal, superior and inferior to the fovea.The points of CT measurements were named according to their positions and distances relative to the fovea, and represented by SFCT, N1, N2, N3, T1, T2, T3, S1, S2, S3, I1, I2, I3 respectively.The SE, absolute astigmatism degree, AL and CT at each point were compared among the groups.The corrected AL covariance analysis was used to compare the CT at different measurement points among the groups.Spearman rank correlation analysis was used to evaluate the correlation between CT and AL or SE, and unitary linear regression analysis was used to evaluate the influence of age on AL in each group.This study was approved by the Ethics Committee of Shanxi Eye Hospital.All the subjects signed informed consent.Results:Compared with the non-amblyopia group and control group, the SE and absolute astigmatism value was larger, and the AL was shorter in the amblyopia group (all at P<0.05). The mean SFCT was (388.85±54.85), (301.48±56.68), and (287.08±61.88)μm in the amblyopia group, non-amblyopia group, and control group, respectively.Except for I3, the CT values of the rest parts in the amblyopia group were greater than those in the non-amblyopia group and the control group (all at P<0.05). Except for S3 and I3, the CT values of the rest parts in the amblyopia group were greater than those in the non-amblyopia group and the control group after adjusting the AL ( P<0.05). In all the three groups, the CT value was high in the subfovea and was thin in the nasal side.The SFCT was negatively correlated with AL (amblyopia group: rs=-0.340, P=0.045; non-amblyopia group: rs=-0.340, P=0.020; control group: rs=-0.463, P<0.001) and positively correlated with SE (amblyopia group: rs=0.350, P=0.039; non-amblyopia group: rs=0.412, P=0.004; control group: rs=0.450, P=0.005) in each group.Age was the influencing factor of AL in the non-amblyopia group and the control group ( β=0.243, 0.225; both at P<0.001). Conclusions:In comparison with severe congenital ptosis without amblyopia, the SE and absolute astigmatism degree are larger, the AL is shorter, and the CT values at most areas are higher in the severe congenital ptosis with amblyopia.CT value may be associated with the development of amblyopia in severe congenital ptosis.

Objective:To explore the surgical outcomes and surgery-related complications of balanced orbital decompression and endoscopic transnasal inferomedial wall decompression for Grave's ophthalmopathy (GO).Methods:A cohort study was performed.The 56 GO patients who underwent balanced orbital decompression or endoscopic transnasal inferomedial wall decompression in the Tianjin Medical University Eye Hospital from December 2016 to December 2019 were enrolled.The follow-up time was 6 months.Patients were divided into two groups according to the operation modes.Thirty-three eyes of 24 subjects were given deep lateral wall rim-sparing orbital decompression and transcaruncular medial wall decompression, and 51 eyes of 36 cases were given endoscopic transnasal inferomedial wall decompression.The demographics, surgical details, imaging data, postoperative changes of exophthalmos, best corrected visual acuity (BCVA), orbital pressure and diplopia, surgery-related complications and further treatment were analyzed and compared.This study followed the Declaration of Helsinki and was approved by the Ethics Committee of Tianjin Medical University Eye Hospital [No.2020KY(L)-39]. All subjects signed informed consent.Results:The exophthalmos was (21.03±3.11)mm before operation, which was significantly higher than (17.06±2.55)mm after operation in the balanced orbital decompression group ( P<0.05). The exophthalmos was (20.51±3.53)mm before operation, which was significantly higher than (16.28±2.96)mm after operation in the endoscopic transnasal inferomedial wall decompression group ( P<0.05). No significant difference in the mean reduction of proptosis was found between the two groups ( P>0.05). All the subjects were accompanied with increase of intraorbital pressure before operation.The intraorbital pressure returned to normal at 6 months after operation.The postoperative BCVA of subjects with dysthyroid optic neuropathy (DON) were significantly higher than preoperative values ( Z=-3.524, -4.376; both at P<0.01). The postoperative improvement values of BCVA were 0.48 (0.25, 0.67) and 0.72 (0.40, 0.80) in the balanced orbital decompression group and the endoscopic transnasal inferomedial wall decompression group, respectively, with a significant difference between the two groups ( Z=-2.481, P=0.016). The incidence of complications in the balanced orbital decompression group was 21.2% (7/33), which was significantly lower than 47.0% (24/51) in the endoscopic transnasal inferomedial wall decompression group ( χ2=5.748, P=0.017). Conclusion:The two kinds surgical methods can effectively reduce the degree of exophthalmos and orbital pressure.Endoscopic transnasal inferomedial wall decompression can provide better improvement of visual function in patients with DON, but has a higher risk of surgery-related complications in comparison with the balanced orbital decompression.

Objective:To investigate the effects of sclerostin (SOST) and WNT/CTNNB1 signaling pathway on the cell cycle, migration and invasion of human uveal melanoma (UM) cells and its related mechanism.Methods:UM tissues from 20 cases of epithelioid UM and 16 cases of spindle cell type UM were collected.The contents of SOST, Wnt-1 and Catenin beta-1 proteins in the collected tissues were detected by immunohistochemical staining.Three human UM tissue derived cell lines OCM-1 (primary spindle cell type), Mum-2B (metastatic epithelioid) and Mum-2C (metastatic spindle cell type) were selected and divided into three groups, blank control group not transfected, empty vector group transfected with SOST negative control vector and SOST siRNA group transfected with SOST siRNA.After 24-hour transfection, the mRNA and protein expression levels of SOST, CTNNB1, WNT protein family 1 (WNT1), CCND1, matrix metalloproteinase (MMP)2 and MMP9 were detected by real-time fluorescence quantitative PCR and Western blot, respectively.The invasion and migration ability of the transfected cells were measured by transwell method, and the cell cycle distribution was detected by flow cytometry.Another 9 female BALB/c nude mice were selected and randomized into OCM-1 group, OCM-1 empty vector group and SOST shRNA group, inoculated with OCM-1 without lentivirus infection, OCM-1 with blank lentivirus infection and OCM-1 with SOST shRNA lentivirus infection, respectively.Six weeks after inoculation, the in situ formation of tumor was observed.The interaction between SOST and low density lipoprotein receptor related protein(LRP)-5/6 in OCM-1 cells was explored by co-immunoprecipitation assay.The study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (2018KY[L]-20).Results:Immunohistochemical staining results showed that the SOST expression level was higher and the expression levels of Wnt-1 and Catenin beta-1 were lower in spindle cell type UM tissues than in epithelioid UM tissues, and the differences were all statistically significant (all at P<0.01). The real-time fluorescence quantitative PCR results showed that the relative expression of SOST mRNA was significantly lower and the relative expressions of CCND1, WNT1 and MMP9 mRNA were significantly higher in SOST siRNA groups than in corresponding empty vector groups in the three cell lines (all at P<0.05). In OCM-1 and Mum-2C cell lines, the relative expressions of CTNNB1 mRNA were significantly higher in SOST siRNA groups than in empty vector groups (all at P<0.01). Western blot results showed that the relative expression of SOST protein was significantly lower and the relative expressions of Wnt-1, Catenin beta-1, cyclin-D1, MMP2 and MMP9 proteins were significantly higher in SOST siRNA groups than in empty vector groups (all at P<0.01). Transwell assay showed that the cell invasion and migration ability of SOST siRNA group was significantly higher than that of blank control group and empty vector group in the three cell lines (all at P<0.01). Flow cytometry showed that the proportion of G1-phase cells and the G1/S-phase ratio were significantly lower in SOST siRNA group than in blank control groups and empty vector groups (all at P<0.01). The eyeball volume of OCM-1 group, OCM-1 empty vector group and SOST shRNA group was (42.7±4.6), (49.0±22.9) and (135.2±32.7)mm 3, respectively, showing a significant overall difference ( F=19.963, P<0.01). The eyeball volume of SOST shRNA group was larger than that of OCM-1 group and OCM-1 empty vector group, and the differences were statistically significant (both at P<0.05). Co-immunoprecipitation results showed that SOST could interact with LRP-5 and LRP-6 by binding to them, respectively. Conclusions:Silencing SOST can promote the invasion and migration of UM cells, and increase the proportion of UM cells in the division phase.Silencing SOST can promote tumor growth in eyes of nude mice.SOST may play this function by interacting with the membrane receptor LRP-5/LRP-6 and then regulating the WNT/CTNNB1 signal pathway.

Objective:To investigate the effect of tumor necrosis factor-α (TNF-α) on the differentiation of orbital fibroblasts (OF) in thyroid-associated ophthalmopathy (TAO) and its regulation mechanism.Methods:Six patients (six eyes) diagnosed with TAO were collected in Tianjin Medical University Eye Hospital from December 2019 to August 2020.Adipose connective tissue was collected during the orbital decompression surgery.OF was isolated and cultured using the tissue block method and vimentin was identified by immunofluorescence.Lipogenic differentiation of OF was induced and identified by oil red O staining.Complete culture medium containing 0, 0.1, 1.0 and 10.0 μg/L TNF-α was used to induce the dedifferentiation of orbital mature adipocytes.Primary culturing cells, 14-day differentiation cells and 20-day dedifferentiation cells were collected.The relative mRNA expression levels of peroxisomal proliferation-activated receptor (PPARγ), extracellular regulatory protein kinase1 (ERK1), ERK2 and fat-coated protein1 (perilipin1) were detected by real-time fluorescent quantitative PCR.The relative protein expression levels of PPARγ, P-ERK1/2 and perilipin1 were detected by Western blot.Results:Human TAO-derived OF were successfully cultured in vitro, spindle-shaped or polygonal, tightly arranged in a vortex pattern, and immunofluorescence staining for vimentin was positive.After OF adipogenic differentiation, lipid droplet structures could be seen in the cytoplasm of some cells, and the stained lipid droplet structures in the cytoplasm could be seen by oil red O staining, which confirmed that the cells obtained after differentiation were adipocytes.Dedifferentiation of adipocytes was induced by 0.1, 1.0, and 10.0 μg/L TNF-α.With the extension of induction time, the volume of lipid droplets in the cytoplasm and the number of cells containing lipid droplets decreased.Lipid droplets disappeared in the cytoplasm on the 20th day of dedifferentiation, and the cells became long spindle-shaped and tightly arranged, dedifferentiated into fibroblast-like cells.Real-time fluorescence quantitative PCR detection results showed that the relative expression levels of PPARγ, ERK1, ERK2 and perilipin1 mRNA in 14-day differentiation group were 4.26±0.09, 2.01±0.09, 3.23±0.10 and 8.69±0.33, respectively, which were significantly higher than 1.00±0.09, 1.05±0.19, 1.00±0.10 and 1.05±0.07 in primary group, and 1.06±0.03, 1.15±0.11 and 6.27±0.09 in 20-day dedifferentiation group (all at P<0.05). Western blot analysis showed that the expression levels of PPARγ, ERK1/2 and perilipin1 proteins in 14-day differentiation group were 1.07±0.03, 1.00±0.03 and 1.13±0.02, respectively, which were significantly higher than 0.37±0.02, 0.29±0.02 and 0.00±0.00 in primary group, and 0.20±0.02, 0.38±0.06 and 0.00±0.00 in 20-day dedifferentiation group (all at P<0.001). Conclusions:TNF-α has a dedifferentiation effect on TAO orbital adipocytes.The mechanism may be related to the downregulation of ERK1/2-PPARγ-perilipin1 signaling pathway.

Objective:To evaluate the influence of the clinical staging and different risk factors for the prognosis of ocular adnexal lymphoma.Methods:An ambispective cohort study was conducted.Seventy-four patients diagnosed with primary ocular adnexal lymphoma by pathology at Tianjin Medical University Eye Hospital from November 2010 to December 2018 were enrolled.TNM staging was performed according to local tumor extent, lymph node or systemic involvement.Ann Arbor staging was carried out according to lymph node involvement and extranodal extension.The pathological subtype was classified according to World Health Organization classification of lymphoma.The outcome of disease progression or death was analyzed.Kaplan-Meier method was used for univariate survival analysis.Cox proportional hazard model was employed for multivariate survival analysis to predict the risk factors affecting prognosis, hazard ratio ( HR) and 95% confidence interval ( CI) were estimated.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2021KY[L]-32). Written informed consent was obtained from all patients before entering the cohort. Results:For TNM staging, there were 68 cases in stage

OBJECTIVETo determine the efficacy of endoscopic transnasal orbital balanced decompression technique for the treatment of severe Graves' orbitopathy.

METHODSSix cases (12 eyes) of severe Graves'orbitopathy were included in this study. All patients were undergone endoscopic transnasal orbital balanced decompression technique (orbital inner and lower wall decompression+ lateral orbital decompression) for severe Graves'orbitopathy and serious affecting visual function or appearance.

RESULTSThe follow-up ranged from 12 months to 2 years and 4 months. Postoperatively, the visual acuity markly improved from 0.23 ± 0.08 to 0.48 ± 0.13 (t=-5.749, P<0.001). Proptosis measured by exophthalmoter distictly reduced from (22.08 ± 1.08) mm to (15.67 ± 1.44) mm (t=17.924, P< 0.001). The palpebral fissures obviously reduced from (12.03 ± 0.91) mm to (8.62 ± 0.75) mm (t=9.600, P< 0.001), and orbital volume evidently increased from (26.84 ± 0.62) cm³ to (31.56 ± 1.10) cm³ (t=-16.567, P<0.001). Compared with the preoperative result, the orbital pressure was significantly decreased after operation (t=-6.759 (Y=100 g), t=-11.850 (Y=200 g), t=-6.189 (Y=300 g), P<0.001). Diplopia was appeared in 3 cases, and disappeared 3 to 5 months after surgery.

CONCLUSIONEndoscopic transnasal orbital balanced decompression technique is effective for the treatment of severe Graves'orbitopathy.

Decompression, Surgical ; methods ; Endoscopy ; Exophthalmos ; pathology ; Graves Ophthalmopathy ; surgery ; Humans ; Orbit ; surgery ; Postoperative Period ; Visual Acuity

Objective: To analyze the effect and adverse reactions of radiotherapy in patients with primary orbital lymphoma. Methods: A total of 28 patients with primary orbital lymphoma from Tianjin Union Medical Center, the First Central Hospital of Tianjin and Tianjin Dagang Oil Company Hospital between March 2006 and August 2012 were retrospectively analyzed. All the patients received orbital tumor dissection or biopsy, then received radiation therapy. Three patients received chemotherapy with CHOP protocol before radiotherapy. Radiotherapy was delivered routinely with 3D-conformal radiation therapy (CRT) technique with daily 2-2.5 Gy for 5 times per week and 3-5 fields. Total dosage was 20-50 Gy. There were 18 cases of 30 Gy, 1 case of 22 Gy, 1 case of 25 Gy, 1 case of 20 Gy, 1 case of 28.8 Gy, 3 cases of 40 Gy, 1 case of 42 Gy, 1 case of 46 Gy and 1 case of 50 Gy. Results: All the patients had complete remission (CR) after radiotherapy during follow-up. One patient recurred after radiotherapy of 4 months and received CR with radiotherapy again. One patient died of lung infiltration. Acute complications during radiotherapy were conjunctivitis (28 cases, 100.0%) and keratitis (1 case, 3.6%), long-term complications with ophthalmoxerosis (10 cases, 35.7%) and decreased visual acuity (1 case, 3.6%). Conclusion Radiotherapy is an effective method for primary orbital lymphoma, and the adverse reactions can be tolerated for most patients.