Endophthalmitis ; diagnosis ; etiology ; Humans ; Klebsiella pneumoniae ; pathogenicity ; Male ; Middle Aged ; Substance Abuse, Intravenous ; complications

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.

AIM: To compare the effectiveness of diode transscleral cyclophotocoagulation(CPC)and transscleral cyclocryotherapy(CCT)for the intraocular pressure(IOP)control and postoperative complications of absolute glaucoma.

METHODS: This was a prospective case observation study. Totally 85 cases with absolute glaucoma which were admitted by Tianjin Eye Hospital were randomly assigned in 2 groups to receive either CPC or CCT. IOP, the numbers of anti-glaucoma medication, inflammatory reaction of anterior segment and postoperative ocular pain which was evaluated by Visual Analogue Scale(VAS)in two groups were recorded at eight points in time: the day before surgery and 1d, 3d, 1wk, 2wk, 1mo, 3mo and 6mo after surgery. The generalized estimated equation was used to compare all the indexes before and after operation and the difference of success rate between the two surgical methods.

RESULTS: Compared with CPC group, IOP of CCT group decreased less than that before surgery at 1, 3d, 1, 2wk, 1mo after surgery, VAS score decreased less than that before surgery at 3d, 1, 2wk, 1mo after surgery, and the number of anti-glaucoma drugs decreased less than that before surgery at 1, 3d, 1, 2wk after surgery(P<0.05). Compared with CPC group, the complete success rate of CCT group was higher than that at 1d after surgery at 3d, 1, 2wk, 1, 3, 6mo after operation, but only the difference of 3, 6mo after surgery was statistically significant(P<0.05). Compared with CPC group, anterior chamber flash grade of CCT group increased more than that before surgery at 3d, 1, 2wk, 1mo after surgery, conjunctival congestion grade increased more than that before surgery at 1, 3d, 1, 2wk after surgery, corneal edema grade increased more than that before surgery at 3d, 1, 2wk, 1mo after surgery(P<0.05).

CONCLUSION: Compared with CPC, the rate of IOP reduction after CCT was slower, the inflammatory reaction of anterior segment and discomfort of eyeball were more severe and lasted longer. Therefore, the duration of anti-inflammatory drugs and anti-glaucoma medications should be extended after the surgery.

Ketone body metabolism plays a significant role in the development and progression of diabetic retinopathy(DR), which closely related to the system and local metabolic disorders as a major microvascular complication of diabetes mellitus. Previous research has established a close relationship between dyslipidemia and DR progression. Ketone bodies, comprising β-hydroxybutyrate, acetoacetate, and acetone, are metabolic products generated from fat breakdown when glucose metabolism is impaired. Studies have revealed that ketone body metabolism is intricately linked to multiple pathophysiological processes in DR, including oxidative stress, inflammatory responses, and neurodegeneration within retinal cells. This article provides a review exploring the impact of ketone body metabolism on the pathogenesis of DR, and systematically reviews the latest research progress on the impact of ketone bodies on the core pathological links such as retinal vascular barrier destruction, glial cell activation and angiogenesis through metabolic reprogramming, epigenetic modification and cell signal transduction, so as to provide a theoretical basis for in-depth understanding of the metabolic driving mechanism of DR.

The neural crest represents a dynamic population of embryonic stem cells, playing a pivotal role in the development of the eye. Through interactions with the surrounding neuroectoderm, superficial ectoderm and mesoderm, the neural crest contributes to the formation of numerous ocular structures, encompassing the corneal stroma and endothelium, trabecular meshwork, iris stroma, ciliary muscle, vitreous and choroidal vessels, and Müller cells. Aberrant migration and development of neural crest cells within the eye can instigate a complex series of ocular diseases. Such diseases include anterior segment like Axenfeld-Rieger syndrome, Peters anomaly, aniridia, primary congenital glaucoma, and Nail-Patella syndrome. Defects that impact the posterior segment may lead to CHARGE syndrome and Branchio-oculo-facial syndrome. Further, rare neurocristopathies such as Waardenburg syndrome, Treacher-Collins syndrome, and Char syndrome can also present with ocular abnormalities. In this review, we explore the ocular diseases that arise from abnormal neural crest cell development, and delve into the related genes involved in neural crest migration and development. We further discuss how mutations and defects in these genes can precipitate ocular diseases.

Graves ophthalmopathy(GO)is the most common and relatively complicated orbital diseases, and the incidence rate is increasing year by year. Severe GO may present with exposure keratopathy, diplopia and compressive optic neuropathy, which seriously affects influences patients quality of life. At present, orbital decompression is an effective method in the treatment of moderate and severe GO, and with the continuous expansion of indications for orbital decompression, more and more patients with mild and moderate GO with exophthalmos require surgical treatment to improve the appearance. There are many different surgical techniques for orbital decompression, and which one can achieve patients' maximum benefit is a frequently encountered clinical problem for ophthalmologist. With the gradual increase of the amount of surgery, complications become increasingly prominent, which affect postoperative satisfaction of patients. In order to deepen the understanding of complications, avoid or reduce the occurrence of complications, and optimize the operation plan, this paper reviews the relevant literature at home and abroad in recent years, and summarizes the selection of operation methods and operation related complications of orbital decompression in GO patients.

Objective To discuss the etiology, clinical features, imaging manifestations, treatment principles and prognosis of the orbital infectious diseases. Methods Thirty-four patients with orbital infectious diseases hospitalized in Tianjin Medical University Eye Hospital from August 2011 to October 2017 were collected and retrospectively analyzed. We analyzed clinical data of patients including the etiologies, types of the infection, imaging manifestations, treatments and prognoses. Relsults There were 21 patients with orbital abscesses, 13 patients with orbital cellulitis only, no abscess formation. The main cause of the orbital infectious patients disease was related to paranasal sinusitis, others included furuncles of eyelid skin, dacryocystitis, trauma, entophthalmia, odontogenic infection, nosocomial infection and systemic diseases. Twenty-two cases were operated, and 12 cases were treated conservatively. Thirty (30/34) cases acquired well prognoses without serious complications, except 1 occurred central retinal artery and vein occlusion, and 3 were treated by ophthalmectomy and lost their visual function permanently. The CT imaging of orbital infectious diseases showed the swelling, increased density, diffuse inflammation and unclear boundaries of the involved tissues. The imaging of orbital abscesses showed that in addition to inflammation, the abscesses and the masses were obvious in the orbit. MR generally showed long T1 and long T2 signals. Conclusion There are many causes of orbital infectious diseases, and the course progresses rapidly. With the help of imaging examination, it can accurately locates the infection, and shows the type and range, and comprehensively evaluates the disease in combination with clinical features. Anti-infection and etiological therapy are crucial factors, if necessary, surgery and multiple department treatment should be combined to avoid serious complications.

BACKGROUNDThe role played by the nitric oxide (NO) signaling pathway in the aqueous humor dynamics is still unclear. This study was designed to investigate the expression and distribution of NO synthase (NOS) isoforms and guanylate cyclase (GC) in human ciliary body, trabecular meshwork and the Schlemm's canal.

METHODSTwelve eyes after corneal transplantation were used. Expression of three NOS isoforms (i.e. neuronal NOS (nNOS), inducible NOS (iNOS) and endothelial NOS (eNOS)) and GC were assessed in 10 eyes by immunohistochemical staining using monoclonal or polyclonal antibody of NOS and GC. Ciliary bodies were dissected free and the total proteins were extracted. Western blotting was performed to confirm the protein expression of 3 NOS isoforms and GC.

RESULTSExpression of 3 NOS isoforms and GC were observed in the ciliary epithelium, ciliary muscle, trabecular meshwork and the endothelium of the Schlemm's canal. Immunoreactivity of nNOS was detected mainly along the apical cytoplasmic junction of the non-pigmented epithelium (NPE) and pigmented epithelial (PE) cells. Protein expressions of 3 NOS isoforms and GC were confirmed in isolated human ciliary body by Western blotting.

CONCLUSIONSThe expression of NOS isoforms and GC in human ciliary body suggest the possible involvement of NO and cyclic guanosine monophosphate (cyclic GMP, cGMP) signaling pathway in the ciliary body, and may play a role in both processes of aqueous humor formation and drainage.

Objective: To evaluate the efficacy of preoperative intravitreal conbercept injection (IVC) before pars plana vitrectomy for severe proliferative diabetic retinopathy (PDR). Methods: A non-randomized controlled study was adopted.Fifty-seven severe PDR patients were collected in Tianjin Eye Hospital from January 2015 to June 2016.The patients were divided into two groups, 30 eyes in the preoperative IVC group, and 30 eyes in the simple PPV group (control group). Operation time, intraoperative bleeding, LogMAR BCVA and complications were compared.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital (No.TJYYLL-2015-14) and this study followed the Declaration of Helsinki. Results: The average operation duration was (95.4±15.8)minutes in the preoperative IVC group, which were significantly shorter than (107.0±11.3)minutes in the control group, with a significant difference between them (t=-3.28, P=0.00). The incidence of endodiathermy was lower in the preoperative IVC group (16.67%, 5/30) than that in the control group (43.33%, 13/30), with a significant difference between them (χ²=5.08, P=0.02). The mean BCVAs were significantly different among the two groups of different time points (F_group=0.59, P=0.45; F_time=61.80, P<0.01). The mean postoperative LogMAR BCVA was 0.95±0.46 in the preoperative IVC group, which was improved compared with the preoperative results (1.37±0.45), the difference was statistically significant (t=5.62, P<0.01). The mean postoperative LogMAR BCVA was 1.03±0.53 in the control group, which was improved compared with the preoperative results (1.46±0.50), the difference was statistically significant (t=5.50, P=0.00). There was no significant difference between the mean postoperative BCVA of two groups (t=-0.673, P=0.500). The number of postoperative complication was reported in 6 eyes (20%) in the preoperative IVC group, while 15 eyes (50%) were reported in the control group, the difference was statistically significant (χ²=5.93, P=0.02). Conclusions Conpared with vitrectomy, vitrectomy assisted by intravitreal conbercept injection for severe PDR can shorten the operation time, reduce the intraoperative bleeding, improve the visual acuity and reduce the incidence of postoperative complications.

AIM: To observe the characteristics of microperimetry in patients with glaucoma, and investigate the correlation between microperimetry and best corrected visual acuity(BCVA), standard automatic perimetry and optical coherence tomography(OCT)index.METHODS: This case-control study included 45 patients(76 eyes)with glaucoma(glaucoma group), among which 15 patients(25 eyes)with primary open-angle glaucoma and 30 patients(51 eyes)with chronic angle-closure glaucoma, and 40 healthy individuals(76 eyes)were included in the control group. MAIA microperimetry, Humphrey perimetry, and BCVA tests were performed in all examined eyes. Correlation analysis was performed using the structural indices measured by OCT.RESULTS: The mean sensitivity(MS)in macular area measured by microperimetry and the ganglion cell complex(GCC)and retinal nerve fiber layer(RNFL)thickness measured by OCT were decreased in glaucoma patients when compared to the control group. Additionally, the mean defect(MD)measured by Humphrey perimetry(10-2 visual field test), focal loss volume(FLV), global loss volume(GLV)measured by OCT, and 63% bivariate contour ellipse area(BCEA )measured by MAIA microperimetry were higher than those of the control group. The MS was negatively correlated with MD, FLV, GLV and BCVA(LogMAR)in the glaucoma group(rs=-0.839, -0.665, -0.530, and -0.424, all P<0.01). In contrast, MS was positively correlated with GCC and RNFL in the glaucoma group(rs=0.437, 0.500, all P<0.01). MAIA microperimetry had a shorter detection time. Receiver operating characteristic(ROC)curve analysis showed that MAIA microperimetry had moderate accuracy for the diagnosis of glaucoma.CONCLUSIONS: MAIA microperimetry has high sensitivity and can detect retinal sensitivity reduction in areas of structural damage tested by OCT. The microperimetry values were correlated with BCVA, standard automatic perimetry parameters, and OCT parameters. MAIA microperimetry combined with OCT will increase the early diagnosis rate of glaucoma.