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.

Background Application of available technology and objective indexes are very important for the early diagnosis,monitoring and therapeutic evaluation of primary open angle glaucoma (POAG).Many studies have determined retinal damage in structure and function in POAG.However,the study on the association of structural damage and functional abnormality in early POAG is still lack.Objective This study was to evaluate the relationship between structural and functional changes of retina in early stage of POAG.Methods A prospectively pilot study was performed under the approval of Ethic Committee of Shenzhen Eye Hospital from January 2011 to June 2013.Based on Helsinki Declaration,written informed consent was obtained from subject prior to entering the cohort.Ninety-five eyes of 95 POAG patients were included as the study group,and 41 eyes of 41 non-glaucoma subjects were enrolled at the same period as controls.The structural parameters of retinas were measured using RTVue-100 OCT and Cirrus HD-OCT respectively,including macular ganglion cell complex (GCC)-Avg thickness and peripapillary retinal neural fibril layer (RNFL)-Avg thickness;and the functional parameters of retinas were obtained by Humphrey visual filed analyzer and RETI scan 3.15 system respectively,including MD of visual field and PhNR of flash electroretinogram (F-ERG).The associations between the GCC or RNFL thickness and M D or amplitude of PhNR were evaluated by linear and curvilinear regression models.Results The MD,GCC-Avg,RNFL-Avg and PhNR amplitude were (-0.68±1.72)dB,(97.17± 4.82)μm,(102.51±8.74) μm and (49.61±11.01)μV respectively in the control subjects,and those in the POAG patients were (-10.82±9.87) dB,(75.07±12.29) μm,(69.09±12.96) μm and (28.38± 11.52) μV,showing significant differences between them (t =6.549,11.118,-15.061,9.956,all at P=0.001).The curvilinear regression model appeared to better describe the relationship between GCC thickness and MD (R2 =0.595,F=97.089,P＜0.001) ;while a linear regression model seemed to be better fit for the relationship between GCC thickness and amplitude of PhNR (R2=0.437,F=103.413,P＜0.001).RNFL thickness analysis showed the similar regression models with MD and amplitude of PhNR as GCC thickness,but R2 values were higher between the RNFL thickness and MD (R2 =0.606,F =101.666,P＜0.001) or amplitude of PhNR (R2 =0.454,F=54.983,P＜0.001).Conclusions Both GCC thickness and RNFL thickness show a curvilinear relationship with MD and a linear relationship with amplitude of PhNR.Goodness-of-fit of RNFL thickness is superior to GCC thickness.

Background Noncontact tonometer (NCT) is a common application in clinical ophthalmology,while its measured value is influenced by corneal parameter.In recent years,there existed some clinical trials discussing the agreement between NCT and gold standard Goldmann applanation tonometer (GAT),but there was still lack of evidence.Objective This study was to evaluate the agreement between NCT and GAT by applying evidence based medicine (EBM) method.Metbods A systematic literature retrieval was conducted from the MEDLINE,EMbase,CBM disc and CNKI database with the limitation of publishing time until June 2016.The literatures were screened according to the inclusion and exclusion criteria.The sample size,average age,sample characteristics and follow-up time were extracted.The value of intraocular pressure measured by NCT and GAT were analyzed.The overall effect size was analyzed using Review Manager 5.3 (from The Cochrane Collaboration) as weighted mean difference (WMD).There existed heterology in this study.Radom effect mode was used to evaluate and compare the difference between NCT and GAT value.Results Twenty four articles were retrieved.Six comparison studies incorporated with 478 eyes were included for Meta analysis.After random effects model was performed for correction.Intraocular pressure measured by NCT was 0.02 mmHg larger than that by GAT (1 mmHg =0.133 kPa).There was no significant difference in the measurement value of IOP between the two instruments (WMD =0.02,95％ CI:-0.59 to 0.63,P =0.95).Funnel chart method showed that literature publication bias existed in this study.Conclusions Normal persons' IOP obtained from NCT and GAT showed a good reproducibility.More comparison studies are needed to support this result.

Background Researches have demonstrated that dexamethasone (Dex) can induce the changes of the function and structure of trabecular meshwork cells,and latrunculin A (Lat A) can enhance the outflow of aqueous humour and therefore low the intraocular pressure.Objective The aim of the present study is to investigate the effects of Dex and Lat A on the expression of protein in human trabecular meshwork cells.Methods Human trabecular meshwork cells were primarily cultured in DMEM using expand culture method and the fifth generation of cells were used to this experiment.Dex and/or Lat A were added in medium as 10~(-6)mol/L Dex group(Dex treating for 24 hours),Dex+Lat A group(10~(-6)mol/L Dex+2mmol/L Lat A for 24 hours),Lat A group(2mmol/L Lat A for 24 hours) and DMEM culture group.Two dimensional gel electrophoresis(2 DE) was used to compare the protein expressions among these four groups.Subsequently protein spots with different intensity were selected for mass spectrometry analysis.Results Four gel patterns of two dimensional gel electrophoresis of human trabecular meshwork cells from Dex,Dex+Lat A,Lat A and control groups were obtained.A good isolated result for majority of proteins in human trabecular meshwork cells was found in all of the four groups.An obvious expression difference of proteins in human trabecular meshwork cells was seen among the different culture conditions.Twenty four kinds proteins were identified by GDPiMALDI TOF MS,including cytoskeleton related proteins,heat shock proteins,redox related proteins,and proteins participating in carbohydrate metabolism.The expressions of aldehyde dehydrogenase(ADLH)and Rab were increased in Lat A group and decreased in Dex group,but HSP27 and hCRMP2 showed the contrary outcome.Conclusion This study construct the pattern of protein expression in human trabecular meshwork cells by using 2 DE.Dex and Lat A impact the protein expressions in human trabecular meshwork cells.

Objective To find out the clinical characteristics and prognostic risk factors of malignant hypertension (MHT) with pre existed chronic glomerulonephritis.Method The clinical and renal pathological data of 38 chronic glomerulonephritis patients with MHT hospitalized in our department from 1990 to 2002,and the associated factors for renal prognosis were analyzed. Results All the patients suffered from chronic glomerulonephritis.The ratio of male to female was 3 75∶1.The average age was (29 5?7 74)years old. The rates of recognition, therapy and control of hypertension before MHT onset were 75 7%, 13 5%and 5 4%respectively. IgA nephropathy was the most common pathological type.Of 38 cases,3 maintained normal renal function, 6 presented acute renal failure,13 presented chronic renal failure, and 16 had acute attack based on chronic renal failure. Twenty four patients were followed up for 1～6 months after antihypertensive therapy and renal function of 10(41 7%) was improved. 1 year renal survival rate of 20 patients was 55%. The analysis of risk factors showed that those patients who were possessed of positive hypertension family history(P=0 03), high SBP/DBP levels(P=0 023,0 047), and high scores of chronic index of renal pathology(P=0 032) had worse prognosis. The level of highest serum creatinine and the scores of chronic index of renal pathology were associated with 1 year renal survival(P=0 031,0 037).Conclusions MHT occuring in young patients with chronic glomerulonephritis is not rare, which becomes an important reason inducing rapidly decrease of renal function, especially in patients with IgA nephropathy. Actively antihypertensive therapy is helpful for renal function recovery. The low rates of recognition, therapy and control of pre existed renal hypertension may play key roles in the development of MHT. It is important to recognize and treat the hypertension at early stage of renal disease to improve the renal survival.

Background Optical nerve damage of glaucomatous eyes is associated with intracranial pressure.Conventional method of evaluating intracranial pressure is to measure cerebrospinal pressure by lumber puncture.However,the measurement of intraorbital optical nerve parameters,a novel method of evaluating intracranial pressure,is introduced in this field.Objective This study was to measure and analyze the intraorbital optic nerve sheath diameter (ONSD) and cross sectional area (ONSA) in normal population using multi-slice spiral CT.Methods This study protocol was approved by Clinical Ethic Committee of Shenzhen Chinese Traditional Medical Hospital and followed Hersinki Declaration.Informed consent was obtained from each individual prior to any medical examination.One hundred and five eyes of 105 normal persons with normal cerebral CT image were enrolled in Shenzhen Chinese Traditional Medical Hospital from January 2012 to September 2013.Cerebral volume was scanned in all the individuals by 64 slice spiral CT.The brain images were obtained for the curve planar rebuilding of intraorbital optical nerve on image post-processing workstation.The maximum and minimum of ONSD and the ONSA in axial sections at 3,6,9,12 and 15 mm far away from globe wall were measured using a standardized technique to analyze the change of optical nerve parameters at different point locations.These parameters were compared in different gender or eyes.The correlation among age and the optical nerve parameters at 3 mm far away from globe wall was evaluated by multivariate regression analysis.Results The average maximal ONSDs were (6.24±0.47), (5.56±0.44),(5.18±0.43),(4.82±0.41) and (4.69±0.41) mm;the average minimal ONSDs were (5.56±0.50),(4.97± 0.41) ,(4.55±0.35),(4.26±0.39) and (4.10±0.40) mm;the average ONSAs were (27.68±4.40),(22.02±3.35) , (18.74± 2.75) , (16.34±2.72) , (15.40±2.68) mm2 at 3,6,9,12 and 15 mm far away from posterior eyeball wall,respectively, showing significant differences in the maximal/minimal ONSDs and ONSAs among the different point locations (F =218.329,215.906,246.924, all at P =0.001).No significant differences were found in the maximal/minimal ONSDs and ONSAs between male and female or between the right eyes and left eyes (gender:t=1.805,P=0.074;t=1.930,P=0.056;t=1.329,P=0.187;eyes:t=0.724,P=0.471;t=1.562,P=0.121;t=1.424,P=0.158).No significant correlations were seen between age and maximal/minimal ONSDs or ONSAs with the coefficients of 1.873,7.415 and-0.853 correspondingly (P =0.847,0.460,0.637).Conclusions Intraorbital section of optical nerve can be rebuilt using standardized technique after scanning of 64 slice spiral CT.The cross section of intraorbital optic nerve sheath is oval in shape and the optic nerve is thinning with the increase of distance far away posterior eyeball wall in normal populatuion.

In order to understand the roles of the other subunits, we investigated expression of the NMDA receptor subunits (NR2A and NR2B) in visual cortex of normal and anisometropic amblyopia kittens with different ages in the present study. We examined the expressions of NR2A and NR2B in the visual cortex of the kittens by immunohistochemistry with polyclonal anti-NR2A antibody and anti-NR2B antibody, respectively. Using immunohisto-chemical Streptavidin Perosidase (SP) method, we observed the dynamic changes of NR2A and NR2B with microscope and computer-assisted image analyses. We found that NR2A and NR2B remained low expression after the peak of the critical period of kitten visual development; compared with normal group of the same age, NR2A expresses low. However, the difference is not significant for NR2B before maturation period of visual development. NR2B rises after the maturation period of visual development. According to this, the component of NR2A and NR2B can be affected by anisometropia. This research suggests that the difference of NR2A and NR2B expressions may affect the formation of amblyopia.
Amblyopia ; metabolism ; Animals ; Cats ; Female ; Male ; Receptors, N-Methyl-D-Aspartate ; genetics ; metabolism ; Vision, Ocular ; physiology ; Visual Cortex ; metabolism

Objective To evaluate the safety and efficacy of the CT-guided percutaneous cryoablation of osteoid osteoma in children.Methods Nine children with osteoid osteoma proved by histopathology were treated with CT-guided cryoablation from January 2007 to January 2010.There were 6 boys and 3 girls.Their mean age was ( 13.0 + 1.6 ) years ( ranging from 10.0-15.0 years ).The procedures were performed under local anesthesia.Eight G bone biopsy needles for biopsy and 17 G freezing needles were used in the procedure.CT guidance was used for procedural planning,instrument guidance,and monitoring.Each cryoablation included two freezing-thawing cycles.Follow-up was performed to assess technical and clinical outcome.A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure,and mean VAS for the group was compared pre- and post-procedure with Kruskal-Wallis rank sum test.Results Biopsy and cryoablation were successfully performed in all children.No major immediate or postponed complications were observed.Significant pain relief ( P ＜ 0.01 ) was observed in all patients after procedure.The VAS of preoperation(8 points 1 case,7 points 3 cases,6 points 4 cases,5 points 1 case) compared with that of one month after operation ( 1 point 4 cases,0 point 5 cases),the difference was statistically significant( H =32.838,P ＜ 0.01 ).These patients were allowed to fully weight-bear and function without limitation 3 days after the procedure.Pain was obviously released.Pain recurrence was not observed in all patients.Moderate fever (37.8 ℃ ) was observed in a patient one day after operation and fully recovered 2 days later.Conclusion CT-guided percutaneous cryoablation is a safe and effective minimally invasive method for the treatment of osteoid osteoma in children.

ObjectiveTo investigate the technique,safety and clinical value of CT-guided percutaneous interstitial brachytherapy for metastatic carcinoma of lymph nodes in mediastinum.Methods Eight patients with metastatic carcinoma of lymph nodes in mediastinum were treated by CT-guided interstitial implant of radioactive seeds in our department.Anterior approach were performed on all cases,125I radioactive seeds were implanted by setting CT Gantry at an oblique angle,three-dimensional reconstruction with SCT and separation the narrow gap between aortic arch and superior vena cava with fiatscalp core.Dose distributions were checked by TPS after operation.The improvement in clinical symptoms and lymph node sizes were documented in order to investigate the therapeutic effects.ResultsThe particle coverage rate was 93.5％ ± 1.5％.According to the CT scans two months later,3 patients ( 37.5％ ) had complete ablation,4 (50％) partial ablation,and 1 ( 12.5％ ) stable disease.Overall response rate (CR + PR) for this group of patients was 87.5％.The symptoms of all patients including shortness of breath (5 patients),cough (4 patients),dysphagia (4 patients) showed varying degree of improvement.No edema of head-and-neck and upper extremity was observed.There was no major vascular,tracheal and esophageal injury.A small amount of pneumothorax was observed in one patient.ConclusionsCT-guided percutaneous interstitial brachytherapy,a minimally invasive procedure associated with favorable therapeutic results,is a promising technique for treatment of metastatic carcinoma of lymph nodes with local pressure symptoms which may not respond to conventional therapy.

Background Retinitis pigmeutosa (RP) is a progressive inheritance disease.It is characterized by highly genetical and phenotypical heterogeneity.With the rapid development of genomics,new methods are applied to the genetic screening of RP.Objective This study was to characterize the clinical features of a Chinese family with autosomal RP and to screen the candidate genes.Methods Twelve members from this family were included in the study.All participants underwent complete ophthalmologic examinations.Targeted-capture next generation sequencing (NGS) based molecular genetic analysis was performed on two patients of this RP family(Ⅱ5,Ⅱ 7).The DNA sample from the two patients was separately sequenced using custom capture gene chip,which includes 59 retinal disease genes.The sequencing results were analyzed by bioinformatics technology.Identified variations were verified in the rest family members by PCR and Sanger sequencing.This study was approved by Ethic Committee of West China Hospital,and informed consent was obtained from the subjects.Results Four members of this family were diagnosed as RP,and the rest were asymptomatic.Missense mutation (c.3065T＞C,p.Phe1022Ser) in USH2A and missense mutation (c.1699G＞A,p.Ala1319Gly) in PDE6A were found in two patients (Ⅱ 5 and Ⅱ7).The variants were not co-segregated with the phenotype of this family.The causative mutation was not found by the targeted-capture NGS based eye disease chip,but it ruled out a large number of candidate genes for RP.Conclusions Our study suggests that targeted-capture NGS based eye disease chip can quickly detect mutations in known RP genes.It can be a new applicable and efficient method for molecular genetic analysis of ocular disease.