Primary angle closure glaucoma is different from primary open angle glaucoma in the nature of epidemiology, pathogenesis, clinical course, guideline of diagnosis, therapeutic and prophylactic. The characteristics of primary angle closure glaucoma should be comprehensively understood and need evaluation by further research.

The management of open-angle glaucoma is a long-term,even lifelong procedure.A right medical decision can gain better efficacy and economic benefit and effectively avoid medical risk.Selective laser trabeculoplasty (SLT) is a therapy approved by FDA of USA and has been applied in China over decade.However,the clinical efficacy assessment is still controversial in China.For re-evaluation of the indication,methodology,technical parameters,and the efficacy of SLT will give full play to its advantage of the potential sufficient control of intraocular pressure (IOP) in glaucomatous treatment.The development of history,mechanism and effectiveness in control IOP,security and operation of SLT are reviewed.The suitable population,technique parameters,multiple centers clinical trial and the cost-effectiveness of SLT for Chinese glaucomatous patients are also proposed.

AIM:In order to study the effects of retinal glial cells on glaucomatous retinal ganglion cells damage,expression of TNF-? and TNF-R1 in retinal glial cells was observed in rat model with chronic elevated intraocular pressure glaucoma.METHODS:(1)Rats were rendered elevated intraocular pressure by ligating 2 episcleral veins with subconjunctival injection of 5-Fu.(2)Four weeks after operation,immuno-histological assays were carried out on cryostat sections.The co-expressions of TNF-?-GFAP,TNF-?-OX42,TNFR-1-GFAP,and TNFR-1-NeuN were observed via a confocal laser scanning microscope,respectively.RESULTS:(1)Elevated intraocular pressure was consistently maintained for up to 4 weeks in model group.(2)The co-expressions of TNF-? and GFAP,TNF-? and OX42 were detected in retina in treatment group,respectively.(3)The co-expressions of TNFR-1 and GFAP were also detected in retina,but the co-expressions of TNFR-1 and NeuN were not detected in retina in treatment group.CONCLUSION:TNF-? that activated retinal glial cells may play an important role in glaucomatous retinal ganglion cell damage.

Objective To observe the characteristics of morphosis parameter of the optic disc of physiologie large cup. Methods 100 eyes with physiologic large cup and 74 eyes with normal cup were examined by Heidelberg Retina Tomograph(HRT).The differences of morphosis parameters between two groups were analyzed comparatively on disc area(DA),cup volume(CV),cup/disc area ratio(C/DR),rim area(RA),cup volume(CV),rim volume(RV),mean cup depth(MeCD),maximum cup depth (MxCD),cup shape measure(CSM),height variation contour(HVC),mean retinal nerve fiber layer thickness(mRNFLt),and retinal nerve fiber layer cross-section area(RNFLcsa).The characteristics of the inferior.superior,nasal,and temporal quadrants of the physiologic large cups were analyzed.Results DA,CA,C/DR,CV,MeCD,CSM(P=0.00.respectively)and MxCD(P=0.04)were significantly larger in eyes with physiologic large cup than in eyes with normal cup.RA,RV,HVC,mRNFLt,RNFLcsa(P=0.00,respectively)were significantly smaller in eyes with physiologic large cup than in eyes with normal cup.The temporal quadrant of RV of the physiologic large cup is the narrowest.RNFLcsa decreased as the following order:superior,inferior,nasal,and temporal(P＜0.05).Conclusions Morphosis parameter of the optic discs of physiologic large cup has its own representation on characteristics.Compared to normal cups,physiologic large cups had larger discs but smaller mRNFLt.The nasal quadrant of DA was larger than the inferior quadrant.

Objective To study the cultivation of retinal progenitor cells of different ages. Methods Retinal progenitor cells of E14 and E18 SD rats were isolated,cultivated in suspension in modified DMEM/F12 serum-free medium and then differentiation was induced in vitro.Cells were observed under phase-contrast microscopy daily and identified by immunocytochemistry,scanning electron microscopy and transmission electron microscopy. Results Cultivated in DMEM/F12 serum-free medium,retinal progenitor cells formed cell spheres.After being plated,isolated cells migrated outwards and differentiated.Scanning electron microscopy demonstrated the morphology of the cell spheres and differentiated cells.Transmission electron microscopy demonstrated that there were stem cell-like cells in cell spheres and neuron-and glia-like cells after the plating.Immunocytochemistry demonstrated that most cells in spheres expressed neural stem cell marker nestin and cell division marker BrdU.After the plating,retinal progenitor cells could be induced to differentiate into various retinal cells,including Thy1.1-positive retinal ganglion cells.The percentage of retinal ganglion cells was 16.91%?4.05% at E14 and 4.65%?1.88% at E18.The differences were statistically significant(t=15.04,P

Background Glucocorticoid drugs have been used increasingly in ophthalmology.It has been established that glucocorticoid are associated with a rise in intraocular pressure (IOP) and the development of glaucoma.Selective laser trabeculoplasty (SLT) is thought to be effective in treating patients with glucocorticoidinduced elevated IOP.Objective This study was to assess the efficacy of SLT in lowering IOP in patients with glucocorticoid-induced ocular hypertension.Methods A retrospective case series study was adopted.SLT around 360° chamber angle was performed in 9 eyes of 9 patients with glucocorticoid-induced glaucoma in Eye & ENT Hospital of Fudan University,including 5 eyes of 5 patients owing to use of glucocorticoid eye drops for long-term after laser in situ keratomileusis (LASIK) and 4 eyes of 4 patients who received intravitreal injection of 0.1 ml triamcinolone acetonide (TA) (4.0 mg) for macular edema induced by central retinal vein occlusion(CRVO).All of the patients were lack of preexisting glaucoma or ocular hypertension and underwent unsuccessful maximum tolerated medical therapy before SLT treatment.The base IOP was 35-44 mmHg and glucocorticoid drugs were ceased for 2-12 months prior to the SLT.The patients were followed-up for 6 months.IOP was measured and recorded before and 1 hour,1 week,1 month and 3 months,6 months after SLT.The difference of IOP was compared by repeated measures analysis of variance and multiple comparison analysis.Results All the patients received single SLT operation.The mean IOP was (40.0±2.9) mmHg before operation,but the IOP was (37.9±8.1),(34.9±5.9),(27.6±6.7),(21.6±6.9) and (17.9±2.9)mmHg 1 hour,1 week,1 month,3 months and 6 months after SLT.The IOP at 1 month,3 months and 6 months after SLT were significantly lower than that before operation (all at P＜0.05).Two patients received a filtration surgery for uncontrolled IOP at 1 month and 3 months after SLT respectively,and another patient still used 2 kinds of lowing-IOP eye drops until the end of following-up duration.Conclusions SLT reduce IOP in 6 eyes of 9 patients with glucocorticoid-induced increased IOP from the initial 1 month through 6 months after SLT.

Background Selective laser trabeculoplasty (SLT) is a safe and effective therapy to the treatment of primary open angle glaucoma (POAG),and the clinical application is approved by American FDA.However,the relevant researching outcomes from several single-center study are in dispute owing to non-uniform approach in China.A muhicenter clinical trial is need to verify the effectiveness of SLT for Chinese POAG.Objective This study was to investigate the safety and efficacy of SLT in Chinese POAG patients.Methods A prospective,multicenter and self-controlled clinical trail was designed.Sixty-two eyes of 62 POAG patients with the age of ≥ 18 years were enrolled.Frequency SLT was performed around 360° angle using Lumenis Selecta DuetTM or Lumenis Selecta Ⅱ laser instrument,with the 100 non-overlapping spots,3 ns preset time,400 μm size of laser spot and 0.6 mJ energy.The operated eyes were followed-up for 6 months.The curative effects were checked including intraocular pressure (IOP),IOP-lowing value,number and percentage of IOP-lowing 20％ and 30％.The therapyrelated complications were recorded including the number of conjunctival congestion and cloudy of the anterior chamber.Results The preoperative IOP was (25.7±2.6) mmHg in the 62 eyes.The IOP was significantly lowed 1 day,2 weeks,4 weeks,3 months and 6 months after SLT in comparison with preoperative IOP (all at P＜0.001) with the lowest value of (16.5±4.5)mmHg in postoperative day 1.IOP was stable from 4 weeks to 6 months after operation.The mean lowing-value of IOP was 5.3-9.2 mmHg from 1 day through 6 months after SLT.The percentage of eyes 20％ drop in lOP was 83.9％,and that of 30％ drop was 58.1％ in postoperative day 1.In 6 months after SLT,percentages of eyes 20％ and 30％ drop in IOP were 56.5％ and 27.4％,respectively.Conclusions SLT is a safe and effective method of lowing IOP for POAG eyes in Chinese population.

Standardization of residency training aims to improve the overall quality of residents and bring up high-quality medical students.Research capabilities and innovative spirit of young physicians play important roles in the sustainable development of hospitals.This article describes the experience in strengthening research training in the United States residency program,provides recommendations to resolve the problems of our residency standardized training and new ideas for the domestic medical institutions to strengthen the young physicians' sense of innovation and scientific research ability.

Objective To explore the relationship between blood lipid level and primary open angle glaucoma(POAG)and intraocular pressure(IOP).Methods A retrospective case-control study was designed.80 POAG patients from EYE & ENT hospital of FUDAN university were collected as a case group from January 2015 to May 2016.Meanwhile 80 age and gender matched healthy people were collected as a control group.The differences of gender in men subgroup (POAG:44,Control:39) and female subgroup (POAG:36,Control:41) showed no statistic significance.Serum total cholesterol(TC),total triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A(Apo A) and apolipoprotein B(Apo B) were measured using Roche automatic biochemical analyzer.The analysis of the above mentioned lipid levels between POAG group and control group was conducted by independent student′s T test and multivariate logistic regression.The relationship between lipid level and IOP was analysied using Pearson correlation test.Results The TG level was (1.40±0.71)mmol/L in the POAG group,(1.00±0.37)mmol/L in the control group.The difference had statistic significance (t=4.467,P<0.001).The HDL-C level in the POAG group was (1.22±0.36)mmol/L,(1.38±0.25)mmol/L in the control group.The difference also had statistic significance (t=-3.228,P=0.002).Comparison between the men subgroup and female subgroup found that the TG level in the POAG group of men was (1.47±0.71)mmol/L,(1.01±0.36) mmol/L in the control group and the HDL-C level were (1.14±0.31) mmol/L,(1.32±0.20)mmol/L in two groups.Both the level of TG and HDL-C had statistic significance in men (t=3.717,P<0.001;t=-3.240,P=0.002).The TC,TG level in the POAG group and control group of women respectively were (4.59±0.81)mmol/L,(1.33±0.72)mmol/L and (4.21±0.64)mmol/L,(0.99±0.38)mmol/L.Both blood level were significantly higher than the control group in women (t=2.278,P=0.026;t=2.503,P=0.016).Logistic regression analysis showed that the TG level correlated with POAG (P=0.004,OR=2.831,95% CI=1.392-5.759)and both POAG in the men and women (P=0.025,OR=3.223,95% CI=1.156-8.989;P=0.045,OR=2.554,95% CI=1.020-6.395).Pearson test showed that the TG level of POAG patients was positively associated with IOP in spite of gender(P<0.05).Conclusion The peripheral blood level of TG was significantly increased in the POAG patients and significantly correlated with IOP,which indicated that the increased peripheral blood level of TG may be the independent risk factor for the POAG..

Objective A large sample of multi-factor Logistic analysis of clinical biochemical indicators from elderly cataract patients were done to find the characteristics of possible changes in potential factors for cataract-related indicators and explore the pathogenesis of cataract from the perspective of laboratory diagnosis.Methods A retrospective case control study was conducted .Cataract patients from Eye-Ear Nose Throat Hospital of Fudan University were collected during June 2011 to July 2015 and routinely tested for 14 clinical biochemistry indicators including ALB , GLU, TP, GLB, BUN, URCA, Cr, LDH, ALP, Ca, Na, K, Cl, and P.The mean age of the 3 527 cataract patients (1 804 males, 1 723 females) was (64.47 ±11.29) years.Those data were reserved by LIS (Laboratory Information System) system and were retrieved for large data analysis . The control group was filtered from hospitalized patients besides cataract patients during January 2014 to July 2015.The mean age of the 3 333 control subjects ( 1 770 males, 1 563 females ) was ( 64.04 ±9.03 ) years.Biochemical indicators between cataract group and control group were analyzed by independent student′s t-test and Logistic regression .Meanwhile , the objects were divided into 3 groups according to the age (40-59 years,60-79 years,≥80 years) for independent student′s t-test with the control group respectively .Results There are no statistical difference in age ( t=1.663,P=0.096) and gender ( t=2.63,P=0.105 0) between cataract group and control group ( P>0.05).The results of Logistic regression between cataract group and control group were as follow : ALB (OR=1.053,95%CI=1.019-1.088),BUN(OR=1.113,95% CI=1.076-1.152),Cr(OR=1.007, 95%CI=1.003-1.010),GLB(OR=1.049,95% CI=1.018 -1.081),GLU(OR=1.175,95% CI=1.139-1.211),Cl(OR=1.059,1.032 -1.088),Na(OR=1.180,95% CI =1.150 -1.212).Those might be enrolled as risk factors for cataract (P<0.05).The level of ALB, GLU, Na and Cl in cataract group according to different age groups were significantly higher ( t=8.780,t=4.670, t=9.695, t=6.415, P<0.05) than that of control in 40-59 age group;the level of ALB, BUN, Cr, GLU, Na and Cl in cataract group was significantly higher ( t=4.974, t=9.414, t=4.123, t=6.906, t=14.741, t=9.212, P<0.05) than control in 60 -79 age group; the level of BUN, Cr, GLU, Na and Cl in cataract group was significantly higher (t=6.077, t=4.906, t=2.626, t=5.459, t=3.424, P<0.05) than control in 80-age group.Conclusions The level of ALB, BUN, GLB, Cr, GLU, Na and Cl in peripheral blood of cataract patients was significantly increased which suggested that those change might associated with the pathogenesis of cataract .