[Morphologic changes in acute central serous chorioretinopathy evaluated by spectral domain optical coherence tomography].

OBJECTIVE: To describe the pathologic changes of macular in acute central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (SD-OCT). METHODS: It was a retrospective case series study. This study included 29 eyes of 29 patients with CSC. The fundus examination was conducted followed by SD-OCT to observe foveal microstructure changes. We evaluated the correlation between the thickness of the outer nuclear layer (ONL), the length of photoreceptors and best-corrected visual acuity (BCVA). RESULTS: Serous retinal detachment was found in all 29 eyes with SD-OCT. There was no obvious morphology change in ONL, the thickness of ONL was (96.94 ± 23.72) µm and did not different from that in normal control eyes (104.15 ± 11.90) µm. The thickness of photoreceptors was uniform in 11 eyes (31.9%), uniform but with defects in 6 eyes (20.7%), uneven in 4 eyes (13.8%), protruding of outer segments (OS) was observed in 6 eyes (20.7%) and flaking OS in 2 eyes (6.9%). The length from external limiting membrane to the longest outer segment in CSC eyes was 84 (52 to 148) µm and was not statistically different from that in normal eyes (69 to 82)µm. Morphology changes of retinal pigment epithelium (RPE) were found in 25 eyes, including pigment epithelial detachment of RPE (PED) in 21 eyes (72.4%), small bulge of RPE in 10 eyes (34.5%), granular deposition epi-RPE in 6 eyes (20.7%), defects of RPE in 3 eyes (10.3%). Fluorescein angiography (FA) was performed in 5 eyes and bulging RPE detected by SD-OCT seemed to correspond precisely to the leakage point on FA in 3 eyes. Age, course of disease and thickness of the ONL did not influence BCVA (logMAR). Uneven of thickness of OS was negative prognostic factors for BCVA (r = 0.382, P = 0.026). CONCLUSIONS: SD-OCT can demonstrate finer pathologic changes in acute CSC. Furthermore, 3-D image allows localization of these pathologic features to specific site using ELM line as landmark. SD-OCT is a valuable tool for the diagnosis and for predicting visual recovery in CSC.

[Viability of corneal epithelial cells and cleavage of corneal basement after ethanol effect].

OBJECTIVE: To evaluate the viability of corneal epithelial cells and to determine the anatomic cleavage on the epithelial basement membrane after various exposure times to 20% ethanol during epithelial flap preparation in laser-assisted subepithelial keratectomy (LASEK) in cadaver eyes. METHODS: Six human cadaver eyes were exposed to 20% ethanol for 20, 30 and 40 seconds (2 eyes for each group), and another one eye was used as the control. PCNA staining was performed to determine the viability of corneal epithelial cells. Immunofluorescence staining using monoclonal antibodies against collagen VII, and immunohistological staining using monoclonal antibodies against laminin were performed to detect the anatomic location of the cleavage plane on the corneal epithelial flaps created by 20 seconds exposure to 20% ethanol in cadaver eyes. RESULTS: Hematoxylin and eosin staining of epithelial flaps revealed a coherent stratified epithelium. The PCNA positive rates of the epithelial cells in the flap decreased in the 20-second group, 30-second group and 40-second group successively. Immunohistological staining to laminin was patchy in the lifted flap and the remaining corneal basement membrane. Immunofluorescence to collagen VII, the main component of anchoring fibrils remained exclusively in the corneal bed. CONCLUSIONS: Viability of the epithelial flap decreased with longer time exposure to ethanol. The cleavage plane of the ethanol-treated corneal epithelial flap is located between the lamina lucida and the lamina densa of the basement membrane where laminin forms hemidesmosome.

Effectiveness and safety of 0.15% ganciclovir in situ ophthalmic gel for herpes simplex keratitis - a multicenter, randomized, investigator-masked, parallel group study in Chinese patients.

OBJECTIVES: Parallel comparison with 0.15% ganciclovir (GCV) ophthalmic gel to evaluate the effectiveness and safety of 0.15% GCV in situ ophthalmic gel for the treatment of herpes simplex keratitis (HSK). METHODS: This was a multicenter, randomized, investigator-masked, parallel group study. HSK patients were randomly divided into two groups, with the corresponding treatment of 0.15% GCV ophthalmic gel or 0.15% GCV in situ ophthalmic gel. Symptoms and signs were observed before administration, and 3 (±1), 7 (±1), 14 (±2), and 21 (±3) days after the administration. The clinical effective rate was considered as the primary outcome. The safety profile was evaluated by AEs, visual acuity, and ocular tolerance. RESULTS: The clinical effective rate in the per-protocol (PP) dataset for the treatment group and the control group were 95.10% and 93.00%, respectively (P = 0.5282). The noninferiority test showed significant differences (P = 0.000305, P < 0.025), indicating that the tested drug was noninferior to the control. Patients in the PP dataset of both groups experienced decreases in the total scores of clinical indicators. Ocular AEs were few but similar between the two groups. There were no significant differences between patients' visions between the two groups before and after administration in the safety analysis set. In terms of drug tolerance, the rates of patients without transient blurred vision during all the visits in the treatment group were higher than those for the control group (P < 0.05). During the third and fourth visits, the rates of patients with eye itching were 4.08% and 1.22% in the treatment group, and 13.59% and 8.14% in the control group, respectively (P < 0.05). During the second visit, the rates of patients with eye irritation were 14.42% in the treatment group and 25.71% in the control group (P < 0.05). CONCLUSION: The 0.15% GCV in situ ophthalmic gel was effective and safe for the treatment of HSK, and was not inferior to 0.15% GCV ophthalmic gel. The 0.15% GCV in situ ophthalmic gel presented superior ocular tolerance.

[Surgical management of blepharoptosis: a report of 500 cases].

OBJECTIVE: To investigate the various surgical techniques and their results for different types of blepharoptosis. METHODS: 620 eyes of 500 cases with blepharoptosis who underwent surgical treatment were retrospectively analyzed. The patients were diagnosed as congenital, neurogenic, myogenic, traumatic, senile and mechanical ptosis. The used techniques included resection of levator muscle, anastomosis of frontalis muscle and levator aponeurosis, Whitnall's ligament sling, Friedenwald- Guyton's frontalis muscle fixation, levator aponeurosis reconstruction, modified Hotz's tarsectomy. RESULTS: The overall success rate was 90.3% (560/620). 60 eyes with unsatisfactory result showed overcorrection in 5 eyes and undercorrection in 55 eyes in which the patients also suffered from combined eyelid deformities in 4 eyes, entropion in 6 eyes and ectropion in 2 eyes. The success rate of resection of levator muscle for the mild and moderate congenital ptosis was 93.8%. The success rates of resection of levator muscle and anastomosis of levator aponeurosis and frontalis muscle for the severe congenital ptosis were 72.4% and 100% respectively. The success rate of Whitnall's ligament sling for the recurrent congenital ptosis was 90%. The success rates of Friedenwald-Guyton's frontalis muscle fixation, Whitnall's ligament sling and anastomosis of levator aponeurosis and frontalis muscle for the neurogenic and myogenic ptosis was 41.6%, 80% and 90% respectively. The success rates of levator aponeurosis reconstruction for the traumatic and senile ptosis were 94.7% and 100%, respectively. The success rate of modified Hotz' tarsectomy for the mechanical ptosis was 93.3%. CONCLUSIONS: The key point for successful correction of ptosis is the selection of the right indication for each technique depended on the type and severity of the ptosis. The technique skill is also very important.