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Novel coronavirus disease with conjunctivitis and conjunctivitis as first symptom: Two cases report

Xuejie LI ; Ming WANG ; Jing DAI ; Wenjun WANG ; Yanning YANG ; Wei JIN

Chinese Journal of Experimental Ophthalmology.2020;38(0):E012-E012. doi:10.3760/cma.j.issn.115989-20200303-00133

As the frontline health care workers at the center of the novel coronavirus disease (COVIN-19) outbreak, we have found many asymptomatic COVIN-19 patients or patients with mild symptoms since December 2019. A number of COVIN-19 cases with conjunctivitis or conjunctivitis as the first symptom have been observed in our clinical work. This paper reports the diagnosis and treatment of one COVIN-19 patient with conjunctivitis as the first symptom and one COVIN-19 patient with conjunctivitis. Case one occurred conjunctivitis at the third day after closely contacted with determined COVID-19 patient and visited to eye doctor, and the symptom of conjunctivitis following the topical administration of anti-virual eyedrops for 1 week, followed by COVID-19. Her 2019-nCoV RNA detection of nasopharynx swab was positive but that of conjunctival sac swab was a negative result. Case two had a positive epidemiological history and simultaneous onset of COVID-19 and conjunctivitis.She presented positive results of 2019-nCoV RNA detection in both nasopharynx and conjunctival sac swabs, and other lab results supported the diagnosis of COVID-19 but she had a normal CT findings of the chest. The ocular symptoms were disappeared after topical administration of anti-virual eyedrops for 1 week.

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Comprehensive strategy for cataract patients with diabetes mellitus

Hong YAN ; Yue BIN

Chinese Journal of Experimental Ophthalmology.2019;37(10):769-773. doi:10.3760/cma.j.issn.2095-0160.2019.10.001

As the increases of morbidity of diabetes, the cataract patients with diabetes mellitus requiring surgery is gradually increasing.Compared with age-related cataract, cataract patients with diabetes mellitus showed earlier onset, faster developing, higher prevalence and more postoperative complications, including posterior capsular opacification, corneal-related complications and cystoid macular edema.The therapy of cataract with diabetes is relatively complicated.The blood glucose level, the severity of cataract, diabetic retinopathy and diabetic macular edema need to be considered in order to choose the optimal operation timing and corresponding therapeutic methods.Therefore, individualized treatment should be carried out based on the controlling of systemic diseases, and more attention should be paid to the following-up of diabetic retinopathy after cataract surgery.

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Purification and cultivation of mouse primary retinal microvascular pericytes based on pre-incubation

Guanghui LIU ; Cuihong LIN ; Tianye YANG ; Chaoyang XU ; Yongzheng ZHENG ; Li ZHAO ; Chun MENG ; Mingdong PAN

Chinese Journal of Experimental Ophthalmology.2019;37(10):774-778. doi:10.3760/cma.j.issn.2095-0160.2019.10.002

Objective: To establish a simple method for isolation, purification and cultivation of primary retinal microvascular pericytes (RMPs) from mice. Methods: Retinas were isolated from mice following with mechanical morcel, enzymatic digestion and filtration.The retinal fragments were incubated with low glucose DMEM with 20% fetal bovine serum after 24 hours pre-incubation.Differential digestion was used for purification of primary RMPs.Morphological examination of cells was performed by phase contrast microscopy, and further characterization was analyzed by immunocytochemistry.Functional assay was evaluated by the pericytes-endothelial cells (ECs) co-culture system.The treatment and use of experimental animals followed the regulations on the administration of experimental animals promulgated by the state science and technology commission. Results: Cells migrated out of fragments after 24 hours of incubation, and developed into small or large colonies gradually.The cells and their subpassages presented typical pericyte morphology with large irregular triangular cell bodies and multiple long processes.No contact inhibition was observed.Most cells uniformly expressed the cellular markers α-smooth muscle actin (α-SMA) and platelet-derived growth factor receptor-β (PDGFR-β), a few cells expressed the cellular markers glial fibrillary acidic protein (GFAP), but no cell expressed von Willebrand factor (vWF). The purity rate of RMPs was up to 97%.In the co-culture system, RMPs directly contacted with ECs to form the capillary-like cords in vitro. Conclusions A simple method for the isolation, purification cultivation of mouse RMPs is established, and active RMPs can be readily obtained by this method.

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Expression of proline hydroxylase 2 in the membrane of proliferative diabetic retinopathy

Han ZHANG ; Qiang LU ; Wei CUI

Chinese Journal of Experimental Ophthalmology.2019;37(10):779-784. doi:10.3760/cma.j.issn.2095-0160.2019.10.003

Objective: To investigate the expression of proline hydroxylase 2 (PHD2) in the proliferatine membrane of proliferative diabetic retinopathy (PDR) and its relationship with PDR. Methods: A prospective controlled clinical study was designed.The study included 8 PDR patients undergoing vitrectomy, 8 PDR patients receiving intravitreal injection of lucentis before vitrectomy, and 8 idiopathic macular epiretinal membrane (IMEM) patients without diabetes undergoing vitrectomy for in Inner Mongolia Autonomous Region People's Hospital which served as PDR group, lucentis group and control group, respectively proliferative membrane was obtained during the vitrectomy surgery.Hematoxylin-eosin staining was used for histologic observation, immunofluorescence was used to examine the expression of PHD2, vascular endothelial growth factors (VEGF), glial fibrillary acidic protein (GFAP) and platelet endothelial cell adhesion molecule-1 (PECAM 1/CD31). The fluorescence intensities of PHD2, VEGF and GFAP in proliferative membrane were compared among different groups.This study followed the Helsinki declaration and was approved by Medical Ethics Committee of Inner Mongolia Autonomous Region People's Hospital (No.20160603). Written informed consent was obtained from all subjects before entering the study. Results: The morphology of PDR proliferative membrane was diversity, which consist of neovascularization, fibroblast-like cells, macrophages, neutrophils and lymphocytes, etc.The IMEM morphology proliferative membrane was mainly comsist of glial cells, with a small amount of fiber cells and macrophages.The membrane of lucentis group was observed with vascular atrophy and few fibroblast-like cells, vascular endothelial cells.PHD2, VEGF, GFAP and CD31 were all strongly positive expressed and co-expressed in the proliferative membrane of PDR.Besides, the glial cells aggregated in the film of non-perfused region, and the expression of GFAP in this area was obviously stronger than that in the well-perfused region; PHD2, VEGF, GFAP and CD31 were all weakly expressed in the proliferative membrane of lucentis group.Only in cell area, the expression of PHD2, VEGF and GFAP were weak in proliferative membrane.The fluorescence intensity of PHD2, VEGF and GFAP in proliferative membrane of control group were significantly different among the groups (all at P<0.001), and the fluorescence intensities of PHD2, VEGF and GFAP were significantly increased in the hyperplasia membrane of PDR group compared with those in lucentis group and control group (all at P<0.001). Conclusions PHD2, VEGF, GFAP and CD31 are all strongly expressed in the proliferative membrane of PDR.Lucentis can obviously decrease PHD2 expression.There may be pathways between VEGF and PHD2.Weak expression of PHD2 in IMEM membrane indicates that PHD2 is involved in the formation of IMEM.

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Influences of different reserved diopters during cataract extraction combined with TECNIS Symfony intraocular lens implantation on visual quality of presbyopia correction

Jilin TAN ; Yan QIN ; Changpeng WANG ; Jian YE

Chinese Journal of Experimental Ophthalmology.2019;37(10):785-791. doi:10.3760/cma.j.issn.2095-0160.2019.10.004

Objective: To compare the efficacy and visual quality of biocular cataract surgery combined with TECNIS Symfony intraocular lens(IOL) implantation in the correction of presbyopia with three different methods of reserved diopters. Methods: A prospective cohort design was adopted.From October in 2016 to December in 2018, 120 patients 240 eyes with binocular cataract surgery implanted TECNIS Symfony IOL were divided into regular group, micro-near-vision group and micro-monovision group according to different reserved diopters, 40 patients 80 eyes in each group.The binocular IOL reserved diopter is + 0.10--0.20 D in regular group.The binocular IOL reserved diopter is -0.20--0.50 D in micro-near-vision group, meanwhile, the dominant eye reserved diopter is + 0.10--0.20 D, and the non-dominant eye reserved the myopia of -0.50--0.75 D in micro-monovision group.Defocus curves of single eye and binocular were measured and full distance visual acuity were analyzed 3 months after surgery.MTF values were detected by iTrace and compared between different groups.Visual function questionnaire of multifocal intraocular lenes (MIOLs)were analyzed and spectacle independence rate of presbyopia correction and disturbing photic phenomena were compared 3 months after surgery.This study protocol was approved by the ethics committee of Chongqing Aier Mega Eye Hospital, and this study followed the Declaration of Helsinki. Results: Compared with regular group, the whole defocus curve of micro-near-vision group actually shifted to the right by 0.35 D, with almost no change in shape.The shape of the binocular defocus curve of micro-monovision group changed significantly compared with that of regular group, that is the wave peak became significantly wider, and the downward trend was more gentle.Spectacle independence rate of the three groups were all 100.00%, spectacle independence rate of intermediate distance in Micro-monovision group was 100.00%, which was higher than that of regular group(80.00%) and micro-near-vision group(90.00%), and the differences were statistically significant (χ²=37.04; P<0.01). The MTF value of the dominant eye was higher than that of the non-dominant eye in the Micro-monovision group, and the difference was statistically significant(t=3.74, P=0.001). There was no statistically significant difference in the occurrence rate of disturbing photic phenomena among the three groups(P>0.05). Conclusions Different reserved diopter design during cataract extraction combined with TECNIS Symfony IOL implantation suits different patients.Among the three different reserved diopters methods, the effect of micro-monovision method can obtain the highest spectacle independence rate, and provide satisfactory binocular far to near full-distance visual acuity.

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Comparison of lens anterior capsular changes between femtosecond laser-assisted phacoemulsification and conventional phacoemulsification for cataract patients with diabetes

Zongsheng ZENG ; Guangbin ZHANG

Chinese Journal of Experimental Ophthalmology.2019;37(10):793-798. doi:10.3760/cma.j.issn.2095-0160.2019.10.006

Objective: To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes. Methods: A non-randomized control study was carried out.Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center.The patients were divided into 2 groups based on the different surgeries.Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5.3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform.Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5.3 mm continuous circular capsulorhexis under the guidance of Alcon VERION.Anterior capsule opacification (ACO) was graded according to Werner's method.The area of anterior capsular opening was calculated by using Image Pro Plus 6 software.The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month, 3 months and 6 months after operation. Results: Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0.003, P=0.958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (F_group=73.602, P<0.001; F_time=378.895, P<0.001), and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation (all at P<0.001). At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes (67.4%) in the femtosecond laser group and 26 eyes (61.9%) in the conventional phacoemulsification group, and there was no significant difference between two groups (P=0.133). At 3 months after surgery, the incidence rate of grade Ⅱ of ACO was 11.6% (5/43) in the femtosecond laser group, which was lower than than that in the conventional phacoemulsification group(66.7%, 28/42), showing a significant difference between them (P<0.001). At the 6th month after operation, the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14.0%(6/43), which was lower than that in the conventional phacoemulsification group(73.8%, 31/42), with a significant difference between them (P<0.001). Conclusions Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule.

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Analysis of different proteins in primary open angle glaucoma based on aqueous proteome

Aihua LIU ; Liming WANG ; Yingjuan LYU ; Wei LIU ; Xiaorong LI ; Lijie DONG

Chinese Journal of Experimental Ophthalmology.2019;37(10):799-806. doi:10.3760/cma.j.issn.2095-0160.2019.10.007

Objective: To analyze the changes of protein expression in aqueous humor of patients with primary open angle glaucoma (POAG), and to explore the biological markers and potential therapeutic targets associated with disease occurrence. Methods: A retrospective case-control study was adopted.Ten patients with age-related cataract and 10 patients with POAG combined with cataract.were collected at the Tianjin Medical University Eye Hospital from October 2016 to December 2017.In the process of surgery, 100 μl of aqueous humor were collected with 1 ml syringe and No.1 needle through the surgical access.Those proteins extracted from aqueous humor were analyzed by quantitative proteomic mass spectrometry.The differential significance test was performed by Maxquant significances A. The differential proteins of the two groups were screened and determined with the conditions of P<0.05 and difference multiple>2.The biological big data was annotated by the function of GO and KEGG.The study was approved by the Ethics Committee of the Tianjin Medical University Eye Hospital (No.2013KY[L]-10). Patients and their guardians all signed the informed consent. Results: Ninty-seven differential proteins were detected in this proteomic analysis, including 48 up-regulated proteins and 49 down-regulated proteins.GO analysis significantly differs in protein function involved in many aspects, some different proteins including lipopolysaccharide-binding protein (LBP), cluster of Differentiation 163(CD163), C-reactive protein (CRP), annexin A1 (ANXA1) were involved in inflammation; redox-related proteins were glutathione S-transferase P (GSTP1), thioredoxin (TXN), some different proteins related with cell adhesion movement were cartilage oligomeric matrix protein (COMP), desmocollin-2 (DSC2) and laminin subunit beta-2 (LAMB2); procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 (PLOD1), solid protein (tenascin, TNC) are associated with fibrosis; some different proteins related to nerve growth were reelin (RELN), semaphorin-3F(SEMA3F), semaphorin-4B(SEMA4B). Metabolism-related proteins included pyruvate kinase (PKM), carb oxypeptidase N subunit 2 (CPN2) and so on.KEGG analysis indicated that the expression of NrF2/ERK signaling pathway and TGF-β/NF-κB signaling pathway were different between the two groups. Conclusions The expression of GSTP1 and TXN in the aqueous humor of POAG is significantly decreased, which may regulate cell adhesion and activity and expression of extracellular matrix by regulating NrF2/ERK1/2 and TGF-β/NF-κB signaling pathways.GSTP1 and TXN may serve as a potential biomarker and therapeutic target of POAG.

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Comparative analysis of Lea Symbols chart and ETDRS chart in Chinese preschool children's vision examination

Lei SONG ; Jianmin HU ; Xuelan CHEN ; Lijuan CHEN

Chinese Journal of Experimental Ophthalmology.2019;37(10):807-813. doi:10.3760/cma.j.issn.2095-0160.2019.10.008

Objective: To compare cooperation degree and visual acuity difference between Lea Symbols chart and ETDRS chart in Chinese preschool children. Methods: A prospective self-control study design was performed.Two hundred and forty-one children aged from 42 months to 78 months in Quanzhou Quangang Experimental Kindergarten were enrolled and the mean age was (61.9±10.3) months.Among them, 132 pre-school children had normal refractive index.All children completed comprehensive ophthalmological examinations and measurement of monocular visual acuity using Lea Symbols chart and ETDRS chart.All monocular visual acuity scores were recorded in LogMAR form.This study followed the Declaration of Helsinki and this study protocol was approved by Medical Ethics Committee of The Second Affiliated Hospital of Fujian Medical University (No.2017[62]). Written informed consent was obtained from all guardians before entering the study. Results: The cooperation degrees of Lea Symbols chart and ETDRS chart were 96.7% and 95.0% in 42-78 months of children, respectively, with no significant difference between the two visual acuity tables (χ²=1.669, P>0.05). The visual acuity measured by Lea Symbols chart was positively correlated with that measured by ETDRS chart (r_s=0.726, P<0.001). The measurement consistency of the two chart was good (Kappa=0.531). Among 132 normal refractive children, the visual acuity level measured by Lea Symbols chart was higher than that measured by ETDRS chart (W=-7.461, P<0.001); the measurement consistency of the two visual acuity chart was good (Kappa=0.467). There was no significant difference between the two charts in measuring the binocular vision difference (W=-0.889, P=0.374); the visual acuity levels of boys measured by Lea Symbols chart and ETDRS chart were higher than those of girls, and the difference was statistically significant (U=-3.352, -4.679; both at P<0.001); the visual acuity values measured by Lea Symbols chart and ETDRS chart were negatively correlated with age (r_s=-0.423, -0.437; both at P<0.001); the visual acuity measured by Lea Symbols chart was higher than that measured by ETDRS chart in different age groups, and the differences were statistically significant (all at P<0.001). Conclusions The measurement of visual acuity by Lea Symbols chart and ETDRS chart can be achieved with a high cooperation degree in 42 months and older children.The visual acuity measured by Lea Symbols chart is higher than that measured by ETDRS chart.In the preschool children's vision screening, we should pay attention to the difference between the two kinds of visual charts, and be careful to judge the abnormal vision.

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Comparison of tear index and tear film function between type 2 diabetic patients and normal subjects

Xinrong ZOU ; Lina LU ; Yi XU ; Bo ZHANG ; Haidong ZOU

Chinese Journal of Experimental Ophthalmology.2019;37(10):814-819. doi:10.3760/cma.j.issn.2095-0160.2019.10.009

Objective: To compare the tear related indexes of patients with type-2 diabetes and the healthy subjects, analyze the functions of tear film of these two groups and provide significant theoretical evidences for the causes of the increased prevalence of dry eye in patients with type-2 diabetes and their pathogenesis. Methods: A case-control study was designed.During the epidemiological investigation of dry eye in communities, 79 patients with diabetes and 74 normal healthy subjects were randomly selected as participants in this case-contol study.Dry eye tests including tear film break-up time (BUT), SchirmerⅠtest (SⅠt) and corneal fluorescein staining were performed.The tears were collected to detect mucoprotein-5AC (MUC-5AC), matrix metalloproteinase 9 (MMP-9), receptor of advanced glycation endproducts (RAGEs) and the content of insulin.The diagnosis standard referred to Experts Consensus on Clinical Diagnosis and Treatment of Dry Eye published in 2013.The study was followed the Declaration of Helsinki.This study protocol was approved by Medical Ethics Committee of the Shanghai General Hospital, Shanghai Jiaotong University(No.2016KY005), and written informed consent was obtained from all subjects. Results: There were significant differences between 79 diabetes patients and 74 normal healthy subjects in the value of BUT, SⅠt and corneal fluorescein staining (all at P<0.05). The value of BUT and SⅠt in patients with diabetes were lower than those in the control group, while the corneal fluorescein staining scores of patients were higher than those of normal healthy subjects, with significant differences (P<0.05). In addition, compared with normal healthy subjects, the diabetic patients were higher in the value of MMP-9 and RAGEs, but lower in the content of insulin and MUC-5AC, with significant differences (P<0.05). There were significant differences in gender, diabetes duration, MMP-9, and MUC-5AC between the dry and non-dry eyes in the diabetic group (P<0.05). Women were more likely to develop dry eyes with a significant difference (t=4.35, P=0.04). The duration of diabetes in dry eye group was higher than that in non-dry eye group, with a significant difference (t=2.56, P=0.01); the value of MMP-9 in dry eye group was (1 052.37±157.68)pg/ml, which was significantly higher than that in non-dry eye group ([459.11±258.67]pg/ml)(t=11.92, P<0.01); the value of MUC-5AC in dry eye group was (867.83±121.82)pg/ml, which was significantly lower than in non-dry eye group ([972.93±153.52] pg/ml)(t=-3.30, P<0.01). There was no statistical difference in age and insulin between the two groups.Pearson correlation analysis showed that MMP-9 was negatively correlated with BUT (r=-0.349, P<0.01), and positively correlated with corneal fluorescein staining (r=0.181, P=0.026). MUC-5AC was positively correlated with SⅠt (r=0.367, P<0.01). Conclusions Dry eye prevalence is significantly related with the decrease in MUC-5AC and the increase in MMP-9 in community-based diabetic patients.

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Ocular surface damage in dry eye patients with seborrheic dermatitis

Chunjie MAO ; Tiangeng HE ; Zhiyong SUN ; Xiangda MENG ; Hua YAN

Chinese Journal of Experimental Ophthalmology.2019;37(10):820-823. doi:10.3760/cma.j.issn.2095-0160.2019.10.010

Objective: To observe the ocular surface function changes of dry eye patients with seborrheic dermatitis and discuss the significance of seborrheic dermatitis in ocular surface damage. Methods: A cohort study was performed.Forty-nine patients (49 eyes) who were initial diagnosed with dry eye enrolled in General Hospital of Tianjin Medical University from October 2015 to March 2016 were divided into 2 groups, including 21 patients with seborrheic dermatitis and 28 patients without seborrheic dermatitis.Gender, age, meibomian gland dysfunction (MGD), eyelid margin scores, eyelid secretions scores, meibomian gland imaging scores, conjunctival congestion scores, ocular surface disease index (OSDI), Schirmer Ⅰtest (SⅠt), break-up time of tear film (BUT), fluorescent integral score were examined and compared.The study was followed the Declaration of Helsinki and was approved by General Hospital of Tianjin Medical University (No.IRB2015-YX-069). Written informed consent was obtained from all subjects before entering the study. Results: There were not significant differences in gender and ages (χ²=1.536, P=0.215; t=0.642, P=0.524). The rate of MGD in seborrheic dermatitis group was 57.15%, which was significantly higher than that in the non-seborheic dermatitis group (25.00%), with significan difference between the two groups (χ²=5.222, P=0.022). There were significant differences in eyelid margin scores, eyelid secretions scores, meibomian gland imaging scores, fluorescent integral scores between the two groups (Z=2.105, 3.303, 3.368, 3.036, all at P<0.05). The OSDI in the seborheic dermatitis group was 26.43±8.05, which was significantly larger than that in the non-seborheic dermatitis group (16.75±5.74); the BUT in the seborheic dermatitis group was (6.14±1.98)s, which was significantly shorter than that in the non-seborheic (8.75±1.38)s (t=4.918, 5.434; both at P<0.05). Conclusions Seborrheic dermatitis may aggravate ocular surface dysfunction in dry eye patients.

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