AIM: To compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema.

METHODS: In this retrospective comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab(IVB group)was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide(IVTA-IVB group)was performed. Main outcomes were the central macular thickness(CMT)measured with optical coherence tomography(OCT), ETDRS visual acuity(VA)and intraocular pressure(IOP).

RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 μm and 546.8±165.6 μm before injections; 430.4±133.2 μm and 363.7±105.3 μm in first month; 484.8±167.4 μm and 407.3±108.7 μm in 3^rd month; 550.4±191.5 μm and 516.8±158 μm after 6mo respectively. Differences were significant in first and 3^rd months(P<0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 in first month; 59±13.7 and 59.3±13.6 in 3^rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant in first and 3^rd and 6mo(P<0.05). There was no IOP difference. IVTA-IVB group gains best VA in 3^rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo.

CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.

AIM: To evaluate the clinical efficacy of a newly designed silicone tube for the repair of canalicular lacerations.

METHODS: This was a prospective clinical study. Data were analyzed from 47 eyes of 47 patients presenting with traumatic canalicular laceration in our hospital from January 2013 to October 2015. The newly designed silicone tubes were inserted through the lacrimal punctum and left in the bicanaliculi for 3mo. Data of the lacrimal duct patency, epiphora, and eyelid shape were recorded.

RESULTS: Surgery was performed successfully in all cases. No complications associated with the silicone tubes occurred. In total, 41 patients(87.23%)achieved complete success, 4 patients(8.51%)achieved partial success, and 2 patients(4.26%)had surgical failure.

CONCLUSION: The newly designed silicone tube is an effective and atraumatic tool for the management of canalicular lacerations. The operation process is simple, and is easy to grasp for the surgeon.

AIM: To Study the anti-fungal effect of corneal collagen cross-linking combined with natamycin in vivo and in vitro, so as to provide the treatment and experimental basis for the treatment of clinical fungal keratitis.

METHODS: Three common pathogenic fungi(Aspergillus flavus, Fusarium Solani and Candida albicans)were used. The experimental group was divided into cross-linking combined natamycin group, natamycin combined riboflavin group, natamycin combined UVA irradiation group, cross-linking group and natamycin group as the control group. The drug was added to the center of the Sabouraud dextrose agar(SDA)plate coated with liquid with each fungal spores with the same maid turbidity of 1.5. Ten minutes later, it was irradiated with collagen cross-linking instrument for 10min and cultured at 28℃ for 36h, and then the inhibition zone size was measured and analyzed statistically. The rabbit model of Fusarium Solani corneal infection was prepared. The model rabbits were randomly divided into model control group, cross-linking treatment group, natamycin treatment group, cross-linking combined natamycin group, 5 rabbits in each group. And another 5 normal rabbits were taken as control, and five rabbits were irradiated in accordance with corneal collagen cross-linking therapy. The results were observed by anterior segment photography, corneal scraping and confocal microscopy, and the ultra micro structural changes of the corneas were observed by electron microscope after the treatment.

RESULTS: Corneal collagen cross-linking alone had shown no effect on each fungus in vitro. Corneal collagen cross-linking combined with natamycin produced significant anti-fungal effect(P<0.05). However, the anti-fungal effect of natamycin combined riboflavin group and natamycin combined ultraviolet light group showed no statistical difference(P>0.05)comparing with the control group. For the model of rabbit fungal infection, the course of disease was about 14d in the natamycin group and CXL combined with natamycin group, and it was about 21d in CXL group. After the treatment, all the groups healed. There were no defects in the corneal epithelium, no mycelium in the corneas, except for more corneal neovascularization. The results of the anterior segment photography showed that the treatment effect of the cross-linking combined natamycin group was better than other groups, with fewer scar tissue, better corneal healing and relatively short course of disease.

CONCLUSION: Corneal collagen cross-linking combined with natamycin treatment is able to enhance anti-fungal effect, promote corneal healing, and shorten the course of disease. So it is a promising therapeutic technique for the clinical treatment of fungal keratitis.

AIM: To observe the effect of pigment epithelium-derived factor(PEDF)on retinal neovascularization(RNV)and monocyte chemoattractant protein-1(MCP-1)expressions in mice retina of oxygen-induced retinopathy(OIR), and to investigate the protective effect of PEDF on ischemia hypoxia retinopathy and the possible mechanism.

METHODS: A total of 160 postnatal day(P)7 C57BL/6 mice were obtained. All mice except normal control group were exposed to(75±2)% oxygen environment for 5d and then kept in room air for another 5d to establish the OIR mice model. All mice in normal control group(40 mice)were exposed to room air only. At P12 and P14, respectively, mice in PEDF treatment group were injected intravitreously with recombinant human PEDF(2μg/eye,1μL)in the right eye, while mice in treatment control group were injected intravitreously with the same volume of vehicle [1μL, 10mmol/L phosphate buffered saline(PH7.4), PBS] in the right eye. All mice were euthanized at P17. Eyes were whole mounted and stained with Lectin to observe the growth of abnormal RNV; And retinal specimens were prepared for PEDF, MCP-1 protein and mRNA analysis by Western blot and real time RT-PCR respectively.

RESULTS: Changes of retinal vessels had been detected by fluorescence microscopy on flat-mounted retina. The relative RNV areas were significantly increased in OIR model group compared with those in normal control group(P<0.01). However, the relative RNV areas were significantly reduced in PEDF treatment group compared with those in PBS treatment control group(P<0.01). The specific expression of MCP-1 protein and mRNA in the OIR model group were higher than those of normal control group, presenting a statistically significance(both P<0.05). The specific expression of PEDF protein and mRNA in the OIR model group showed a considerable decline in comparison with normal control group, presenting a statistically significance(both P<0.01). And the specific expression of MCP-1 protein and mRNA in those of PEDF-treated group showed a considerable decline in comparison with PBS-treated group, and the differences were statistically significant(both P<0.05). However, there were increase of the expression of MCP-1 protein and mRNA between normal control group and PEDF-treated group, presenting no statistically significance(both P>0.05).

CONCLUSION: PEDF could inhibit oxygen-induced retinal neovascularization and down-regulate retinal MCP-1 expression under hypoxia, which may underlie its anti-neovascularization effects and play a role of protection in ischemic retinopathy.

AIM: To explore the differences of expression pattern of microRNA(miRNA)in plasma from Behçet's disease(BD)syndrome patients and normal controls, searching for diseases-relating biomarkers.

METHODS: Blood samples from 15 cases of BD patients and 15 cases of normal control were collected to extracted total RNA in plasma. The miRNAs was labeled, miRNAs array hybridization was performed and then array-scanned and analyzed. We searched verified target genes and selected meaningful miRNAs to underwent real time PCR.

RESULTS: In comparison with the healthy controls, there were 8 anomalous miRNAs, in which 3 miRNAs(hsa-miR-34c-5p, hsa-miR-144-3p, hsa-miR-483-3p)were up regulated and 5 miRNAs(hsa-miR-301a-3p, hsa-miR-224-5p, hsa-miR-454-3p, hsa-miR-17-5p, hsa-miR-199a-5p)were down regulated(all P<0.05).

CONCLUSION: The present examination suggests that aberrant levels of miRNAs could contribute to the pathogenesis of BD. Deviant expression of miRNAs may be involved in the activation of Notch1 and SMAD4 pathway in BD, which could offer a novel therapeutic approach for BD.

AIM:To explore the correlation between glucose metabolism, insulin resistance and inflammatory factors in aqueous humor and serum in patients with diabetic cataract.

METHODS:Sixty-nine patients with diabetic cataract and sixty-five patients with simple cataract were randomly selected from February 2017 to January 2018 in our hospital. The fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR)in serum, and IGF-1, IL-6 in aqueous humorand serum were compared between the two groups. HbA1c,HOMA-IR, IGF-1 and IL-6 for correlation were analyzed respectively.

RESULTS: The levels of FPG,HbA1c, HOMA-IR in serum, and IGF-1, IL-6 in aqueous humor and serum in the control group were significantly lower than those in the observation group(P<0.05). Positive correlation between HbA1c and IGF-1, IL-6 in aqueous humor and serum(P<0.05). Positive correlation between HOMA-IR and IGF-1, IL-6 in aqueous humorand serum(P<0.05).

CONCLUSION: HbA1c and HOMA-IR in diabetic cataract patients are correlated with IGF-1 and IL-6 contents in aqueous humor and serum. The above indicators can be used to determine the condition.

AIM: To observe the clinical therapeutic efficiency of 1g/L sodium hyaluronate eye drops on ocular surface disorders in patients with proliferative diabetic retinopathy(PDR)after 20G pars plana vitrectomy(PPV).

METHODS: Randomized single blind case control study was used. Patients with type 2 diabetes who were admitted to the department of ophthalmology, Xi'an No.4 Hospital for PDR and underwent 20G PPV surgery by the same surgeon were randomly divided into PDR control group(Group A)and sodium hyaluronate treatment group(Group B). Group B received continuous 1g/L sodium hyaluronate eye drops from 1d to 2mo after surgery. Before and 1wk, 1, 3mo after surgery, OSDI, SⅠt, BUT, fluorescein cornea staining(FL)and the tear film and corneal epithelial cell layer under corneal laser scanning confocal microscopy of the two groups were compared.

RESULTS:A total of 90 cases and 90 eyes were studied. In preoperative time, the two groups showed obvious dry eye syndrome, and compared with the control subjects, there were no significant difference existed between the two groups(P>0.05). In group A, ocular surface injury was further aggravated after surgery and failed to recover with time extension during the observation period.Some indexes of Group B improved at different observation time after surgery compared with those before surgery, and there were significant differences between group A and Group B after surgery(P<0.05).

CONCLUSION: Applying 1g/L sodium hyaluronate eye drops could relief the uncomfortable feeling of ocular surface in patients with PDR after 20G vitrectomy and accelerate the recovery of ocular surface disorders.

AIM: To analyze the correlation between levels of serum soluble intercellular adhesion molecule-1(sICAM-1), soluble vascular cell adhesion molecule-1(sVCAM-1)and the severity of thyroid-associated ophthalmopathy(TAO).

METHODS: A total of 120 patients with TAO admitted to the hospital from August 2016 to March 2018 were selected and included in the study. According to the clinical activity score(CAS), the patients were divided into active stage group and inactive stage group. According to the severity, they were divided into mild group, moderate group and severe group. There were 90 healthy persons were selected as the control group at the same time. The general data, serum sICAM-1 and sVCAM-1 levels were compared among groups and the correlation of sICAM-1 and sVCAM-1 levels with the severity of TAO was analyzed.

RESULTS: There were no significant differences in the clinical basic data of patients in between the different clinical active stage groups and the control group, and between the different severity groups and the control group(P>0.05). The levels of serum sICAM-1 and sVCAM-1 in the active stage group were significantly higher than those in the inactive stage group and the control group(P<0.01). The levels of serum sICAM-1 and sVCAM-1 in active stage patients of different severity groups were significantly higher than those in inactive stage patients and of control groups(P<0.01). There were no significant differences in levels of serum sICAM-1 and sVCAM-1 in inactive stage patients of different severity groups. The levels of serum sICAM-1 and sVCAM-1 in active stage patients of different severity groups increased gradually with the severity of the disease. There was no significant correlation between levels of serum sICAM-1 and sVCAM-1 in inactive stage patients and the severity of disease(r=0.102, 0.095, P=0.135, 0.167). Levels of serum sICAM-1 and sVCAM-1 in active stage patients were positively correlated to severity of disease(r=0.695, 0.824, P=0.005, 0.002).

CONCLUSION: The levels of serum sICAM-1 and sVCAM-1 in inactive patients will not increase with the severity of the disease. However, the levels in patients with active disease will increase with the severity of the disease, which can be used for clinical diagnosis and staging of TAO and monitoring of the prognosis.

AIM:To compare the curative effect between monocular lateral rectus recession(BLR)and Binocular recession resection(R & R)for basic intermittent exotropia.

METHODS:A literature review using the MEDLINE, EMBASE, The Cochrane Library, Web of Science, Clinical Trial, CBM, Wanfang Databases and paper collections of conferences was performed. Randomized controlled trials comparing the effects of BLR and R & R for basic intermittent exotropia with a duration of follow-up at least half a year were eligible for inclusion. The methodologic quality of included studies was evaluated independently by 2 authors. Statistical analysis was performed by using the STATA 14 software(StataCorp Texas USA).

RESULTS:Five prospective random controlled clinical trials involving 529 patients were included. Compared with R & R procedure,the BLR procedure group showed lower successful rate(RR:0.85; 95% CI:0.72-0.99; P=0.043)and postoperative undercorrection(RR:3.975; 95% CI:2.097-7.537; P<0.01). The P value of long-term postoperative corrected rate in Meta analysis was decreased near to 0.05 when the included references increased. There was no significant difference in overcorrection rate between the BLR and R & R procedures(RR:0.336; 95% CI:0.049-2.294; P=0.266).

CONCLUSION:Current evidences suggested that BLR procedure is related to lower successful and higher undercorrection rates for basic intermittent exotropia compared to conventional R & R procedure.

Keratoplasty is routinely used to treat end-stage corneal diseases. However, immune-mediated graft rejection remains the major cause of surgical failure. Organ transplant rejection is often due to the directional migration and homing of inflammatory cells to lymphoid tissues and local inflammatory sites, which is regulated by various adhesion molecules and chemokines. Regulatory T cells play a key role in immune regulation and are essential for maintaining peripheral tolerance. Recent studies have revealed that regulatory T cells play important roles in preventing organ transplant rejection and the development of autoimmune diseases. This review will summarize the recent research on the induction of ocular immune privilege by regulatory T cells, with special focus on how regulatory T cells mediate tolerance in the eye and clinical potential of modulating these mechanisms during corneal transplantation.