A Case of Refractory Childhood Glaucoma Secondary to Weill-Marchesani Syndrome: Management with Combined CO2 Laser-Assisted Sclerectomy Surgery and Trabeculectomy.

A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature, short and stubby hands and feet, language disorders and mental retardation. He developed bilateral angle closure glaucoma, ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome. The child was successfully treated by combined CO2 laser-assisted sclerectomy surgery and trabeculectomy.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis.

AIM: To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone. METHODS: We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate. RESULTS: In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD=-0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success. CONCLUSION: Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.

[Application of Ultrasound Biomicroscopy in Longterm Follow-up Post Modified CO2 Laser-assisted Sclerectomy Surgery].

Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO2 laser-assisted sclerectomy surgery(CLASS).Methods This was a case series study.A combination of modified CLASS and preoperative laser iris management was administered to 28 eyes.Visual acuity,intraocular pressure(IOP),and slit-lamp examinations,visual field testing,and gonioscopy were carried out at baseline and until 24 months postoperatively.UBM examination was performed at 1,3,12 and 24 months postoperatively.Results Compared with the mean preoperative IOP [(30.61±10.59)mmHg],the IOP at each time point after operation was significantly lowered [(15.15±5.87),(12.56±3.24),(13.15±2.73),(13.75±2.55)and(13.75±2.46)mmHg at 1,3,6,12 and 24 months,respectively;all P<0.001].Complete success rates and qualified success rates at 12 months and 24 months were 60.71%,89.29% and 53.57%,85.71%,respectively.UBM images can present "dolphin head sign" after successful CLASS.The thickness of trabeculo-Descemet's window was(0.13±0.03)mm,which had no significant correlation with postoperative IOP at 12(r=-0.278,P=0.144)and 24 months(r=0.026,P=0.895).UBM examination revealed a severe scleral lake diminution(a change > 50%)in 1 eye(3.57%)at 12 months and 3 eyes(10.71%)at 24 months.There was no statistical significance detected between the size of the scleral lake and IOP after CLASS.Non-founctional blebs were found in 16 eyes(57.14%)at 12 months and 25 eyes(89.28%)at 24 months.Two eyes(7.14%)demonstrated severe peripheral anterior synechiae at 24 months,requiring surgical intervention.Conclusions UBM can effectively observe the morphology of the scleral lake,anterior chamber angle and filtering blebs in post-operative follow-up after modified CLASS,and give early warning of complications.It plays an important role in ensuring the success of CLASS.

Altered amplitude of low-frequency fluctuations and default mode network connectivity in high myopia: a resting-state fMRI study.

AIM: To analyze changes in amplitude of low-frequency fluctuations (ALFFs) and default mode network (DMN) connectivity in the brain, using resting-state functional magnetic resonance imaging (rs-fMRI), in high myopia (HM) patients. METHODS: Eleven patients with HM (HM group) and 15 age- and sex-matched non-HM controls (non-HM group) were recruited. ALFFs were calculated and compared between HM group and non-HM group. Independent component analysis (ICA) was conducted to identify DMN, and comparisons between DMNs of two groups were performed. Region-of-interest (ROI)-based analysis was performed to explore functional connectivity (FC) between DMN regions. RESULTS: Significantly increased ALFFs in left inferior temporal gyrus (ITG), bilateral rectus gyrus (REC), bilateral middle temporal gyrus (MTG), left superior temporal gyrus (STG), and left angular gyrus (ANG) were detected in HM group compared with non-HM group (all P<0.01). HM group showed increased FC in the posterior cingulate gyrus (PCC)/precuneus (preCUN) and decreased FC in the left medial prefrontal cortex (mPFG) within DMN compared with non-HM group (all P<0.01). Compared with non-HM group, HM group showed higher FC between mPFG and bilateral middle frontal gyrus (MFG), ANG, and MTG (all P<0.01). In addition, HM patients showed higher FC between PCC/(preCUN) and the right cerebellum, superior frontal gyrus (SFG), left preCUN, superior frontal gyrus (SFG), and medial orbital of the superior frontal gyrus (ORB supmed; all P<0.01). CONCLUSION: HM patients show different ALFFs and DMNs compared with non-HM subjects, which may imply the cognitive alterations related to HM.

[Expressions of vascular endothelial growth factor and its receptors in rat conjunctival fibroblasts].

OBJECTIVE: To detect the expressions of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptors (VEGFR) in cultured rat conjunctival fibroblasts. METHODS: Experimental study. Conjunctiva was obtained from each eye of five Sprague Dawley (SD) rats under local anesthesia. Tissues were minced and grown in culture flask containing Dulbecco's Modified Eagle's medium (DMEM). The fibroblasts were identified by observing cell morphology, and the expression of staining of cytokeratin and vimentin by inverted microscopy and indirect immunofluorescence technique. mRNA primers were designed for VEGF(164), VEGFR-1 (Flt-1), and VEGFR-2 (Flk-1). mRNA was extracted by Trizol method. cDNA was synthesized under the action of RNA reverse transcriptase. Ladder-like pattern of DNA fragmentation appeared upon 2% agarose gel electrophoresis. The amplification curves and dissociation curves of VEGF(164), VEGFR-1(Flt-1), and VEGFR-2 (Flk-1) were detected by realtime polymerase chain reaction (PCR). The expression of VEGFR-1 on fibroblast was observed by immunofluorescence technique. RESULTS: The fluorescent staining was negative in cytokeratin of fibroblasts, but was positive in vimentin of fibroblasts. The mRNA expressions of VEGF(164), VEGFR-1 (Flt-1) and VEGFR-2 (Flk-1) were detected in fibroblast and verified by gene sequencing. The peaks of the dissociation curves were all steep and specific. The fluorescent staining of VEGFR-1 was positive. CONCLUSIONS: Our results demonstrate that the expression of VEGF, VEGF receptors, and VEGFR-1 cytokine in rat conjunctival fibroblasts suggests that anti-VEGF compounds may exert a direct influence to the growth of rat conjunctival fibroblast.

[Analysis of optical coherence tomography in early stage of optic neuritis in multiple sclerosis patients].

OBJECTIVE: To detect the changes in the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in the eyes of multiple sclerosis patients during the early stage of optic neuritis. METHODS: A prospective case series study. Suspected acute optic neuritis of multiple sclerosis (MS) patients who attended the department of ophthalmology in Peking Union Medical College hospital from Feb. 2007 to Nov. 2010 were collected. Twenty two MS patients were evaluated within the first week of the attack of acute optic neuritis. The average thickness of RNFL and GCC was measured and a three dimensional image of optic disk was reconstructed using optical coherence tomography (OCT). RESULTS: Within the first week of onset, the average thickness of RNFL and GCC of first attack eyes increased 75% and 64%, respectively. The average thickness of RNFL and GCC in relapsed eyes decreased 91.7% and 62.5% respectively. The average thickness of RNFL and GCC of the fellow eyes also increased 60% and 43% respectively, within the first week of onset. More cases of optic disk edema and thickening of RNFL were found by OCT than by direct ophthalmoscopy. CONCLUSIONS: Different changes of the thickness of RNFL and GCC and morphology of the optic disk were detected during the early stage of the initial attack or relapsed optic neuritis in MS patients. OCT could detect such differences.

[Novel exploration of emergency treatment for ueitic acute angle closure glacuma].

OBJECTIVE: To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope for the emergency treatment of uveitic acute angle closure glaucoma (ACG). METHODS: In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy (LPI). The intraocular pressure (IOP), degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint. RESULTS: The IOP values for the paracentesis plus pupillary block relief group were (9.2 ± 2.1) mm Hg, (12.4 ± 3.7) mm Hg and (14.1 ± 2.6) mm Hg at 1, 48 h and 10 d vs (24.5 ± 7.1) mm Hg, (22.2 ± 8.6) mm Hg and (19.3 ± 9.3) mm Hg respectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupillary block relief group at Day 10. Pupillary block was observed in 1(1/14) patient from the paracentesis plus pupillary block relief group and 6 (6/10) patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days. CONCLUSION: Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG. And it may offer a basis for further therapy.

[Effects of placement of orbital implant on orbital osteocytes].

OBJECTIVE: To investigate the influence of enucleation with or without orbital implant on the occurrence of apoptosis of orbital osteocytes and to explore the mechanism of orbital implant in the prevention and treatment of orbital malformations. METHODS: It was an experimental research. Twenty-one age and weight-matched New Zealand rabbits were divided into three groups: enucleation group, enucleation with implant group and the control group. At one-month-old, the left eyes of the rabbits were enucleated in the enucleation group; an orbital implant was inserted after enucleation in the implant group. The left orbits of rabbits in the control group were served as the controls. At two-month-old, all rabbits were sacrificed, apoptosis of osteocytes of the zygomatic bones was observed by photomicroscopy, electron microscopy and TUNEL staining technology. The ratios of apoptosis osteocytes were calculated and analyzed in these three groups. RESULTS: Classical apoptosis of osteocytes was found with photomicroscopy and electron microscopy. The distribution of apoptosis of osteocytes was irregular in bone sections. The ratio of apoptosis cells in the enucleation group was significantly different from that in the other two groups (P<0.01). There was no significant difference in ratios of apoptosis cells between the implant group and the controls (P>0.05). CONCLUSIONS: Apoptosis of osteocytes participates in the normal development of bony orbit. The results of this study indicate that apoptosis of osteocytes plays a role in the development of orbital malformation after enucleation and orbital implant can prevent the orbital malformation after enucleation.

[Study on a rat model of filtering bleb scarring formation].

OBJECTIVE: To investigate a rat animal model of filtering bleb scarring formation. METHODS: Thirty-five of Sprague-Dawley (SD) rats were used in this experiment. The filtration surgery was performed on one eye of each rat and the other eye served as control. The presence of postoperative bleb and clinical manifestation was evaluated. Each group of three rats were sacrificed and the eyes enucleated on day 1, 3, 7, 14, and 28. After the eyes were fixed by 10% formalin, serial paraffin sections of three eyes were labeled with HE staining and the pathological morphology was observed under a microscope. RESULTS: A conjunctival bleb was successfully formed in 35 rats lasting from 8 to 21 days after surgery. An obvious dilatation of blood vessels, infiltration of a great number of neutrophil, and a severe edema of the subconjunctival tissue were observed on day 1 and the above morphological changes plus increased infiltration of macrophages were found on day 3. The dilated blood vessels were lessened while the proliferation of fibroblast was presented with abundant endochylema in oval-shaped nucleus of fibroblasts, which were closely associated with the deposition of small amount of new loose collagen fibers on day 7. The collagen fibers became tight on day 14 and subsequently, the early scar was formed on day 28. CONCLUSION: The rat model of filtering bleb scarring formation may be useful for the investigation of preventing and treating conjunctival scarring resulted from glaucoma filtration surgery and other related eye diseases in the future.