Background In patients with syphilis,one of the common manifestations is uveitis.However,the lack of understanding on syphilic posterior uveitis may result in misdiagnosis and delayed treatment.Objective This study was to assess ocular clinical features,treatment and prognosis in patients who had latent syphilis and presented with posterior uveitis as the initial symptom.Methods A serial cases-observational study was designed.Twelve patients(19 eyes)who were diagnosed as syphilis from September 2011 to January 2013 were retrospectively analyzed.All patients were characterized by initial posterior uveitis before the final diagnosis.The clinical manifestation,management and prognosis were evaluated and analyzed.All patients were informed of this study and consented with the use of their data for this retrospective study.Results The patients presented with initial clinical signs of acute or chronic posterior uveitis and lacked systemic syphilis symptom.Bilateral posterior uveitis were found in 7 patients and unilateral in 5 patients.The dust-like and grey-white opacification in vitreous was seen by threemirror contact lens in all the patients.Mild hyperemia of the optical disc was found in 10 eyes with the unclear peripapillary boundary.Yellow-white lesions were observed in retinas of 7 eyes and retinal punctuate hemorrhage was in 1 eye.Fundus fluorescein angiography demonstrated fluorescine staining or hyperfluorescence of optic disc in all of the 19 eyes,and fluorescein leakage from vein in 18 eyes,retinal pigment epithelium dye pooling in 6 eyes and cystoid macular edema in 11 eyes.Rapid plasma reagin (RPR) test and treponema pallidum hemagglutination assay (TPHA) were performed and presented positive results in all patients.The visual acuity improved in 19 eyes and partly elevated in 2 eyes following a standard therapy for neurosyphilis was used,including penicillin and/or small doses of glucocorticoid.Conclusions The serological examination for syphilis should be considered for patients with unexplained uveitis.Early diagnosis and prompt treatment are important for the improvement of prognosis in syphilitic posterior uveitis.

To observe the protective effect of Huangban Granule, a compound of traditional Chinese herbal medicine, on rats with retinal damage induced by light.

Objective To study the effect and safety of posterior Tenon subtenon triamcinolone acetonide (TA) injection as treatment for diffuse diabetic macular edema.Methods Forty-two patients (54 eyes) with diffuse diabetic macular edema were diagnosed by fundus fluorescence angiography and optical coherence tomography,posterior Tenon subtenon injection of TA 20 mg for treatment.All eyes were examined before treatment and the different time points after treatment by testing visual acuity,intraocular pressure,thickness of macular fovea.Results Preoperative visual acuity was 0.26 ± 0.15,postoperative was 0.29 ± 0.13,0.34 ± 0.14,0.43 ± 0.16,0.41 ± 0.13,0.38 ± 0.17 at 2 weeks,1 month,2 months,3 months and 6 months,respectively,visual acuity improved significantly,there was no significant difference between 2 weeks postoperative and preoperative (P ＞ 0.05),the remaining time points compared with preoperative differences were statistically significant (P ＜ 0.01).Preoperative thickness of macular fovea was (473.9 ±121.8) μ m,postoperative was (462.6 ± 93.3) μ m,(342.8 ± 87.1) μ m,(302.6 ± 67.8) μ m,(321.1 ±79.1) μ m,(355.2 ± 47.6) μ m at 2 weeks,1 month,2 months,3 months and 6 months,respectively,there was no significant difference between 2 weeks postoperative and preoperative (P ＞ 0.05),the remaining time points compared with preoperative differences were statistically significant (P ＜ 0.01).The intraocular pressure at 2 months were significantly higher than preoperative (P ＜ 0.05).No other complications were observed.Conclusion Posterior Tenon subtenon injection of TA as treatment for diffuse diabetic macular edema is safe and effective,which can inject repeatly.

Background Pars plana vitrectomy (PPV) is a main method of treating severe proliferative diabetic retinopathy (PDR) , but intraoperative bleeding often occurs, which affects the intraoperative process and final prognosis.Intravitreal injection of ranibizumab (IVR), a vascular endothelial growth factor (VEGF) monoclonal antibody,has been used in PPV,so the evaluation of therapeutic effect and safety of PPV associated by IVR is very important.Objective This study was to evaluate the effect of IVR-assisted 23G PPV on patients with severe PDR.Methods The clinical data of 82 eyes of 77 patients with severe PDR who received 23G PPV from August 2012 to December 2013 were respectively analyzed,including 49 eyes undergone IV R-assisted 23G PPV (IVR combined with PPV group) and 33 eyes undergone 23G PPV only (simple PPV group).IVR (0.5 mg/0.05 ml) was performed on the eyes 5-7 days before PPV in the IVR combined with PPV group,and only PPV was carried out in the simple PPV group.Operative duration, endodiathermy times, incidence of iatrogenic retinal holes, best corrected visual acuity (BCVA) (LogMAR), postoperative bleeding, re-operation rate, Ⅰ phase attached rate of retinas, occurrence rate of neovascular glaucoma and temporary ocular hypertension rate were compared between the two groups.Results The average operation duration was (71.90-± 26.42) minutes in the IVR combined with PPV group, which was significantly shorter than (96.76±25.15) minutes in the simple PPV group (t =-4.300, P＜0.05).Endodiathermy time in the IVR combined with PPV group was significantly less than that in the simple PPV group (0.76±0.14 versus 2.18±1.64) (x2 =-4.284,P＜0.01).The BCVA at postoperative 3 months was (0.70±0.50) and (0.74±0.50) in the IVR combined with PPV group and simple PPV group,which was significantly improved in comparison with before operation (1.73±0.50,1.70±0.470) respectively (t=-0.151,0.118,both at P＜0.01),but no significant difference in the postoperative BCVA between the two groups (t =-0.318, P =0.758).The incidence of iatrogenic retinal holes was significantly lower in the IVR combined with PPV group than that in the simple PPV group (6.12％ versus 21.20％) (x2 =4.193 ,P=0.041).In addition,the postoperative bleeding rate was also significantly different between the IVR combined with PPV group and the simple PPV group (2.04％ versus 15.15％) (x2=6.580, P=0.010).No significant differences were seen in the incidence of re-operation rate, I phase attached rate of retinas,occurrence rate of neovascular glaucoma and temporary ocular hypertension rate between two groups (all at P＞O.05).Conclusions IVR before 23G PPV can reduce the risk of intravitreal bleeding during operation and after surgery,shorten operation duration and lessen the incidence of iatrogenic retinal break.The BCVA after IVR-assisted PPV improves as good as simple PPV.

To observe the protective effects of drug-contained serum of Lingqi Huangban Granule (LQHBG), a compound traditional Chinese herbal medicine, on oxidative stress-induced injury in rabbit retinal pigment epithelial (RPE) cells in vitro.

Objective: To investigate the effects of Ginkgo biloba extract (EGb 761) on the morphology and function of retinal ganglion cells (RGC) in guinea pigs with optic nerve transection. Methods: Seventy-five albino guinea pigs were randomly divided into five groups: normal control group, sham-operated group, untreated group, normal saline group and EGb 761 group. No operation was performed in the normal control group. Optic nerve was merely exposed in the sham-operated group, but transected at 1.0 mm from posterior pole of the eye ball in the untreated, normal saline and EGb 761 groups. Guinea pigs in the EGb 761 group or the normal saline group received daily intraperitoneal injection of EGb 761 (100 mg/kg) or corresponding volume of normal saline from 7 days before experiment to 28 days after experiment. Three guinea pigs in each group were sacrificed for apoptosis assay (TUNEL method) of RGC. Pattern electoretinograms (PERGs) were recorded 14 and 28 days after transection, respectively. At the end of the examination, six guinea pigs were killed for histological examination and RGC count. Results: No TUNEL-positive cells were observed in the normal control, sham-operated and EGb 761 groups, but there were TUNEL-positive cells in the untreated group and the normal saline group. The numbers of RGCs in the untreated and normal saline groups were less than those in the normal control and sham-operated groups at 14 days or 28 days (P<0.05). Although the number of RGCs in the EGb 761 group was less than those in the normal control and sham-operated groups (P<0.05), it was more than those in the untreated and normal saline groups (P<0.05). N(95) amplitude in EGb 761 group was higher than those in the untreated and normal saline groups (P<0.05) and close to those in the normal control and sham-operated groups (P>0.05) at 14 days or 28 days. The number of RGCs was positive correlated to N(95) amplitude (r=0.859, P=0.001 5). Conclusion: EGb 761 can inhibit the apoptosis of RGCs in guinea pigs after optic nerve transection, thus protect the morphology and function of RGCs.

Objective To evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus.Methods This is a prospective uncontrolled case study.The data of 140 consecutive primary 23G vitrectomy patients (145 eyes) were enrolled in this study.There were 56 males (59 eyes) and 84 females (86 eyes),with the mean age of (56.34 ± 9.98) years and axial length of (23.99± 2.57) mm.There were 139 phakic eye and 6 aphakic eyes.All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus.To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball,lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex,the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries.Pearson correlation analysis was used to analyze the relationship between age,anteroposterior axis of eyeball,lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex.Results Surgical related complications included retinal tears close to the scleral incision sites (3/145 eyes,2.1％) and lens injury (3/121 eyes,2.5％).No other surgical complications occurred,such as retinal hemorrhage,supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment.Based on CT images,the average scleral distance from limbus to the plane passing through the lens posterior apex,anteroposterior axis of eyeball and lens thickness was (6.72± 0.81),(24.39± 0.97),(4.22 ± 0.47) mm,respectively.The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation (r=0.328 9,P=0.000 6).Conclusion Primary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe.

Objective:To investigate and evaluate the safety of intravitreal injection of recombinant human endostatin (rh-endostatin) with different concentrations in rabbit eyes.Methods:Thirty healthy adult New Zealand white rabbits were enrolled with the right eyes selected as experimental eyes, and were randomly divided into five groups by random distribution of computer numbers, with 6 eyes in each group.The rabbits in the normal control group were given no treatment, and the rabbits in the normal saline group, 0.125 mg rh-endostatin group, 0.250 mg rh-endostatin group and 0.500 mg rh-endostatin group were treated with 100 μl of normal saline, 0.125 mg/100 μl, 0.250 mg/100 μl and 0.500 mg/100 μl rh-endostatin according to grouping, respectively.The anterior segment and fundus of the experimental eyes were examined using slit lamp biomicroscope and indirect ophthalmoscope, and the intraocular pressure (IOP) of the experimental eyes were measured with iCARE handheld tonometer before injection and 1 day, 3, 7, 14, 30 and 60 days after injection.Optical coherence tomography (OCT) examination was performed before the intravitreal injection and 7, 30, and 60 days after injection, respectively.Flash electroretinogram was performed before intravitreal injection and 14 days and 60 days after injection.The rabbits were sacrificed by euthanasia at 60th day after injection.Three experimental eyes of each group were dissected and made into paraffin section, and histopathological staining was used to detect the retinal structural changes.The retinal tissue was separated from the other three study eyes in each group, and the transmission electron microscope was employed to observe the ultrastructural changes of the retina.All animal experiments were performed in adherence to the Regulations of the State and the Animal Center of Yangzhou University Medical College for the Use of Animals in Research.Results:After intravitreal injection, no obvious anterior or posterior chamber change was observed by slit lamp microscopy in all groups at any time point.Flocculent seepage was observed in one eye of the 0.125 mg and 0.500 mg rh-endostatin group, respectively, which was then absorbed completely on the 7th and 14th day.OCT examination showed no abnormal light reflection or morphological changes in fundus of day after injection in all the groups.There was no significant difference in IOP, a-wave and b-wave amplitude among all the groups at different time points ( Fgroup=0.134, 0.101, 0.476; Ftime=1.709, 2.479, 1.706; all at P>0.05). Neither light nor electron microscopy showed any retinal damage in any group. Conclusions:Intravitreal injection of rh-endostatin is safe at the dosage of 0.125-0.500 mg in rabbits.

Idiopathic macular hole (IMH) refers to full thickness defects of retinal neuroepithelial layer in macular area without clear reasons,and the combination of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) is a standard procedure for macular hole.This technique can improve anatomical success and reduce the tangential forces,and thus accelerating the macular hole closure.With increasing use of ILMP and vital dye,the controversial issue of the intentional ILMP has arisen.First,the earliest change in the macula after ILMP is postoperative swelling of the arcuate retinal nerve fiber layer and dissociated optic nerve fiber layer occurs later in the postoperative period;second,retinal thickness modification,such as the thinning of retinal nerve fiber layer (RNFL),ganglial cell layer (GCL) and inner plexiform layer (IPL);third,displacement of foveal area toward optic disc and decrease of the foveal avascular zone area decrease retinal sensitivity and changes of the focal macular electroretinogram.This article reviewed the effects of ILMP during macular hole surgery on retinal anatomical and functional outcomes.

Objective: To reveal the pathogenic mutations in Chinese families with idiopathic congenital nystagmus(ICN) Methods: Six families with ICN were recruited from Subei People's Hospital.DNA was extracted from peripheral blood samples of all participants.All coding and exon-intronic boundary regions of the targeted gene FRMD7 were amplified with PCR and sequenced using Sanger sequencing to detect potential pathogenic mutations.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Subei People's Hospital (NO.2015KY-126). All patients or their guardians signed informed consent. Results: Three mutations (c.902A>G, c.1944T>A and 1945G>T) were screened in two families after co-segregation validation of intrafamilial genotype-phenotype, c.1944T>A and 1945G>T were newly detected mutations which were not detected in 100 normal controls.No significant mutations were found in the FRMD7 coding region and adjacent splicing sites in the probands of the other four families. Conclusions Two novel pathogenic mutations of FRMD7 are discovered, which expands the pathogenic mutational spectrum of FRMD7 gene causing ICN.