92 comfirmed cases of malignant glaucoma hospitalized from 1979 to 1989 at Zhongshan Ophthalmic Center are retrospectively studied. The risk factors and new clinical discoveries in its pathogenesis are analyzed with comments. The developments in the managements of the disease during the 10 years are summerized with recommendation of principles for its diagnosis and treatment. The authors also put forth suggestions with regard to the nomenclature and classification of malignant glaucoma.

In the past five years,nearly 7,000 SCI papers have been published on glaucoma all over the world.Among these papers, only 40 came from mainland China.Though we have made greater progress in glaucoma scientific research than before,the gap between China and science-and-technology developed countries is remarkable.To improve efficacy and quality in our future scientific research in glaucoma,we should have a clear view and better understand on dominant areas and directions in glaucoma research worldwide today.

Medication is one of the important methods in treatment of glaucoma, but misunderstandings of some problems during glaucoma medication still exist, such as how to use and evaluate the drugs and when to use the drugs etc. These are reviewed and discussed in this paper.

Background Primary angle-closure glaucoma (PACG) is the most common type of glaucoma in China.A screening to identify the possible angle closure is important in the prevention and treatment of PACG.Objective This study was to determine the characteristics and the optimal parameters measured by the scanning peripheral anterior chamber depth analyzer (SPAC) in the screening of occludable angle of a sample of adult Chinese population.Methods A cross-sectional study was performed in Handan from February to April in 2013.One hundred and eighty Chinese adults were enrolled with the age of 40 years and older and acceptable criteria during 5-year following-up duration of the Handan Eye Study.Routine eye examinations were carried out in all subjects under the informed consent,including visual acuity,optometry,anterior ocular segment examination under the slit lamp microscope,and then SPAC measurement and gonioscopy were performed in a dark room.Occludable angle was defined as posterior trabecular meshwork being invisible in ≥ 180° range under the static gonioscope.Occludable angle by SPAC was estimated using available central chamber depth (ACD) and a combined indicator,numerical grade was 5 or fewer and/or the categorical grade was S or P,separately.Receiver operating characteristic (ROC) curve was calculated to assess the performance of these parameters in detecting eyes with occludable angle for the population-based sample,and area under curve (AUC) was drown to compare the screening efficiencies between available ACD and combined indicator.Results In 180 subjects,occludable angles were found in 62 and open angles were in 118.Compared to the subjects with open angle,the subjects with occludable angle showed the older age (P＜0.001),more females (P＜0.05),lower visual acuity (P＜0.001),greater hyperopic diopter (P＜0.05),smaller ACD value (P＜0.001) and shorter axial length(P＜0.001).In eyes with occludable angle by using SPAC,the ACD showed an AUC of 0.832.Using a cutoff of 2.7 mm for ACD,the sensitivity and specificity were 85.48％ and 68.64％,and under the cutoff of 2.8 mm,the sensitivity and specificity was 90.32％ and 61.02％,respectively.For the combined parameters,the sensitivity and specificity was 62.90％ and 90.68％,respectively and the AUC was 0.768.Conclusions When gonioscopy is used as a reference,a cutoff of 2.8 mm ACD by SPAC shows the highest sensitivity for the screening of occludable angle in Chinese population.

Background Early diagnosis of primary angle-closure glaucoma (PACG) and screening or case detection of high risk population have become a major challenge in the prevention and treatment of PACG.Commonly used methods for evaluation of anterior chamber depth (ACD) and anterior chamber angle nowadays have their shortcomings.Scanning peripheral anterior chamber depth analyzer (SPAC) measures ACD and evaluates the risk of angle closure.Also,SPAC is handy,objective and noninvasive.Objective This study was to evaluate the repeatability (within-rater differences) and reproducibility (between-rater differences) of SPAC to measure anterior chamber-related parameters and agreement of SPAC to estimate occludable angle between two operators.Methods A prospective cross-sectional study was designed.Thirty subjects with shallow ACD (modified van Herick grading≤ 3 and Shaffer grading≤2) aged 35 years and older,who met the inclusion criterion were enrolled as shallow anterior chamber group and 30 age-and gender-matched normal adults (modified van Herick grading≤3 and Shaffer grading≤2)from the follow-up research of the Handan Eye Study in February 2013.After an elementary eye examination,a randomly selected eye of each subject in both groups received three consecutive SPAC measurements by each of the two examiners,respectively to obtain ACD,central corneal thickness (CCT) and corneal radius of curvature (CRC).Meanwhile,the identity of occludable angle as the numerical grade was 5 or fewer and/or the categorical grade being S or P was also obtained.The repeatability of each examiner was evaluated by the repeatability limit (RL) and the reproducibility of the two examiners was evaluated by intraclass correlation coefficient (ICC).The agreement of occludable angle estimation between two operators was evaluated using Kappa coefficient.Results The RLs percentage for ACD,CCT and CRC ranged from 0.36％ to 3.29％,and 0.90％ to 4.72％ in the normal control group and shallow anterior chamber group from operator A,and those from operator B were 0.38％ to 2.55％,and 0.51％ to 3.42％.The ICCs for ACD,CCT and C RC of SPAC were 0.966,0.859,0.989 and 0.915,0.905,0.971,respectively from operator A and operator B.The Kappa coefficients for the identity of occludable angle between two operators were 1.000 and 0.520 in the normal control group and the shallow anterior chamber group,respectively.Conclusions Measurements of the three parameters provided by SPAC in normal and shallow anterior chamber subjects show a good repeatability and reproducibility.The results of identity of occludable angle from two examiners have a good agreement for normal subjects and a moderate reproducibility for subjects with shallow ACD.

Background Angle closure is the pathological basis of primary angle-closure disease (PACD).Understanding different types of angle closure mechanisms is significant for evaluation of risk factors,prevention,diagnosis and treatment of PACD.Ultrasound biomicroscopy (UBM) is commonly used for investigating the types of angle closure mechanisms in clinical works.However,UBM is a contact examination,which limits its application.Anterior segment optical coherence tomography (AS-OCT) is a non-contact examination of anterior segment imaging,through which qualitative and quantitative evaluations of the anterior chamber angle can be made.Objective This study was to investigate the reproducibility of mechanism categories of angle closure based on AS-OCT images and UBM images.Methods Cross-sectional study was performed.PACD outpatients from September to October in 2013 in Beijing Tongren Hospital were enrolled and received both UBM and AS-OCT examinations.UBM images were obtained in superior,inferior,nasal and temporal quadrants of the anterior chamber.AS-OCT images were obtained in the anterior segment quadrant mode at 0-180,45-225,90-270,and 135-315 degree meridians.UBM and ASOCT images were categorized into three dominant angle closure mechanisms:pupil block,anterior located ciliary body and thick peripheral iris roll,separately.And the same mechanism of at least two UBM/AS-OCT images of one eye was defined as the angle closure mechanism of this eye.If both eyes of one PACD patient were eligible for inclusion,the right eye was selected for analysis.The reproducibility of two examinations was evaluated by Kappa coefficients.Results Finally 40 PACD patients (40 eyes,27 right eyes and 13 left eyes) were enrolled for analysis.Based on UBM images,12 eyes (30.0％) were classified as pupil block,23 eyes (57.5％) as anterior located ciliary body and 5 eyes (12.5％) as thick peripheral iris roll.Based on AS-OCT,12 eyes (30.0％) were classified as pupil block,21 eyes (52.5％) as anterior located ciliary body and 7 eyes (17.5％) as thick peripheral iris roll.The Kappa coefficient for the classification of angle closure mechanisms was 0.870.Conclusions Criterion of angle closure mechanism categories based on AS-OCT images was established.Mechanism categories obtained from AS-OCT and UBM images showed a good reproducibility.

Lots of blinding diseases are caused by retinal ganglion cells apoptosis, but there is no the effective and ideal therapy in clinic currently. Recent study showed that stem cells can be an alternative renewable source of retinal ganglion cells, and they may be potential to repair the visual function. These results provide a new model of optic nerve regeneration for the treatment of these blinding diseases. But, some problems in clinical applications are waiting for further solving. Applications of stem cells in optic nerve regeneration is reviewed in this paper.

Objective To explore the mechanism of epinephrine in down-regulating intraocular pressure.Methods The third passage bovine trabecular meshwork cells were divided into control group and epinephrine treated groups in random fashion.Different dosages of epinephrine(10-4、10-5 and 10-6mol/L) were added in cultures and incubated for 14 days.AQP1 expressions was stained by immunocytochemistry method,and the cell area was measured by computer image analytical system.Results The expressions of AQP1 and cell areas in epinephrine treated groups was significantly lower than control group(P

Studies on glaucoma have been focused only on optic nerve damage and aqueous humor dynamic for many years. In recent years, with the advances in understanding of glaucoma and visual sciences, and the development of a neurological cross-discipline, new interdisciplinary problems have been raised. Notably, the question of whether glaucoma is only an optic nerve disease. Is it a disease that begins from the eye, and then involves the whole visual pathway? Or is it a particular central nervous system disease, which manifests itself in the eye? The answers to these problems are inconclusive so far, but there are reasons to believe that glaucoma is a disease with multi-level, multi-factor damage to the entire visual pathway involved. Its mechanisms are complex and involve cross-synaptic damage, visual pathway blood disorders, blood-brain barrier disorders, and so on. As we come to understand that glaucoma is an ocular and central never system neurodegenerative disease, we may better understand the pathogenesis of glaucoma and therefore establish comprehensive treatment strategies for this disease.

Objectives To investigate the clinical feature, diagnosis and surgical treatment for macular corneal dystrophy. Design Retrospective case series. Participants 18 patients(36 eyes)with macular corneal dystrophy. Methods The clinical data of patients were studied, including history, visual acuity, slit lamp microscopy, surgical method and follow-up. Main Outcome Measures Slit-lamp microscopic images of corneal dystrophy and graft. Results The patients with macular corneal dystrophy experienced progressive loss of vision. With slit lamp microscope, opacities were observed in the entire thickness of the stroma. Irregular grey-white nodules were noted in the central superficial stroma and peripherial deep stroma. Penetrating keratoplasties were performed in 14 cases (18 eyes). The follow-up was 6-112 months. At the last follow-up, all the grafts were clear. Conclusion Macular corneal dystrophy has typical clinical features. The diagnosis is mainly based on typical clinical manifestations. Penetrating keratoplasty is an effective approach for the treatment of patients with severe macular corneal dystrophy. (Ophthalmol CHN, 2006, 15:169-172 )