Application of optical coherence tomography and keratograph in the measurements of lower lid margin thickness.

PURPOSE: This study aims to investigate the applicability of lower lid margin thickness (LLMT) measurements in adults with and without meibomian gland dysfunction (MGD) by optical coherence tomography (OCT) and keratograph. METHODS: This is a cross-sectional, observational study. A hundred and eight volunteers aged 20 to 79, including 68 MGD patients and 40 normal subjects, were recruited. Using OCT and keratograph to measure the LLMT from the posterior lash line to anterior edge or outer edge of the tear meniscus was separately performed two times by the same person. RESULTS: The mean age of normal and MGD subjects was 50.5 ± 14.2 years and 55.8 ± 15.5 years, respectively. The LLMT with OCT and keratograph in MGD patients was significantly greater than that in normal subjects (1.06 ± 0.27 and 1.03 ± 0.25 mm vs. 0.90 ± 0.20 and 0.86 ± 0.16 mm, respectively). In both normal and MGD subjects, the tear meniscus height and LLMT with OCT were both greater than that with keratograph (P < 0.05), and intraclass correlation coefficient (ICC) demonstrated a good agreement in the LLMT measurements between two devices (ICC = 0.83 and 0.79, respectively). Additionally, the LLMT in MGD patients was appeared to be positively correlated with meiboscore (rs = 0.37, P = 0.002). CONCLUSIONS: The OCT and keratograph were two reliable tools in the LLMT measurements, which may have potential applications for diagnosis and evaluation of MGD. Furthermore, we found that the LLMT measured by OCT was greater than that measured by keratograph.

Case report: A case of corneal epithelial injury associated with Pthiriasis palpebrarum.

Significance: Phthiriasis palpebrarum is an uncommon infection due to Phthirus pubis inoculating the eyelashes and surrounding tissues of the eye. Because of its rarity, it may be misdiagnosed as blepharitis or conjunctivitis clinically. Purpose: This report described a rare case of corneal epithelial injury associated with Phthiriasis palpebrarum. Case report: A 59-year-old woman presented with 1 month history of repeated episodes of itching and irritation symptoms in both eyes. A slit-lamp examination was performed, which revealed mild conjunctival hyperemia and corneal epithelial defects in both eyes. On closer examination, crab-like lice, nits, and red pinpoint excretions were seen on her eyelashes and eyelids bilaterally. Corneal fluorescein staining in both eyes was observed, and tear film break-up time (BUT) in each eye was 2 s. Numerous lice were also found attached to the scalp hair. Therefore, a clinical diagnosis of corneal epithelial injury associated with Pthiriasis palpebrarum was made. For treatment, eyelashes with nits and/or lice were removed mechanically with a fine tweezers. Then, 0.01% Hypochlorous Acid eye wash was used to clean the eyelid margin twice daily. Also, she was prescribed a combination of Vitamin A Palmitate eye gel three times a day and Tobradex® eye ointment once daily. Meanwhile, the patient was provided with suggestions on how to improve personal hygiene and environmental hygiene, including cutting of the scalp hair and the application of 0.01% permethrin rinse. One week later, no evidence of lice and nits of the eyelashes and scalp hair was found, and the patient's symptoms and signs also improved significantly. Conclusion: This rare case suggested that the eyelashes of patients presenting with itching and irritation symptoms should be carefully examined with a slit-lamp. Besides removal of the parasites, attention should be paid to the treatment of corneal epithelial injury associated with Pthiriasis palpebrarum.

Phylogeny and evolution of Cupressaceae: Updates on intergeneric relationships and new insights on ancient intergeneric hybridization.

After the merger of the former Taxodiaceae and Cupressaceae s.s., currently the conifer family Cupressaceae (sensu lato) comprises seven subfamilies and 32 genera, most of which are important components of temperate and mountainous forests. With the exception of a recently published genus-level phylogeny of gymnosperms inferred from sequence analysis of 790 orthologs, previous phylogenetic studies of Cupressaceae were based mainly on morphological characters or a few molecular markers, and did not completely resolve the intergeneric relationships. In this study, we reconstructed a robust and well-resolved phylogeny of Cupressaceae represented by all 32 genera, using 1944 genes (Orthogroups) generated from transcriptome sequencing. Reticulate evolution analyses detected a possible ancient hybridization that occurred between ancestors of two subclades of Cupressoideae, including Microbiota-Platycladus-Tetraclinis (MPT) and Juniperus-Cupressus-Hesperocyparis-Callitropsis-Xanthocyparis (JCHCX), although both concatenation and coalescent trees are highly supported. Moreover, divergence time estimation and ancestral area reconstruction indicate that Cupressaceae very likely originated in Asia in the Triassic, and geographic isolation caused by continental separation drove the vicariant evolution of the two subfamilies Cupressoideae and Callitroideae in the northern and southern hemispheres, respectively. Evolutionary analyses of some morphological characters suggest that helically arranged linear-acicular leaves and imbricate bract-scale complexes represent ancestral states, and the shift from linear-acicular leaves to scale-like leaves was associated with the shift from helical to decussate arrangement. Our study sheds new light on phylogeny and evolutionary history of Cupressaceae, and strongly suggests that both dichotomous phylogenetic and reticulate evolution analyses be conducted in phylogenomic studies.

New insights into the phylogeny and evolution of Podocarpaceae inferred from transcriptomic data.

Phylogenies of an increasing number of taxa have been resolved with the development of phylogenomics. However, the intergeneric relationships of Podocarpaceae, the second largest family of conifers comprising 19 genera and approximately 187 species mainly distributed in the Southern Hemisphere, have not been well disentangled in previous studies, even when genome-scale data sets were used. Here we used 993 nuclear orthologous groups (OGs) and 54 chloroplast OGs (genes), which were generated from 47 transcriptomes of Podocarpaceae and its sister group Araucariaceae, to reconstruct the phylogeny of Podocarpaceae. Our study completely resolved the intergeneric relationships of Podocarpaceae represented by all extant genera and revealed that topological conflicts among phylogenetic trees could be attributed to synonymous substitutions. Moreover, we found that two morphological traits, fleshy seed cones and flattened leaves, might be important for Podocarpaceae to adapt to angiosperm-dominated forests and thus could have promoted its species diversification. In addition, our results indicate that Podocarpaceae originated in Gondwana in the late Triassic and both vicariance and dispersal have contributed to its current biogeographic patterns. Our study provides the first robust transcriptome-based phylogeny of Podocarpaceae, an evolutionary framework important for future studies of this family.

Measurement of the Lid Margin Thickness in Meibomian Gland Dysfunction with Vernier Micrometer.

INTRODUCTION: To investigate the lid margin thickness (LMT) from the posterior lash line to the mucocutaneous junction at the middle position in adults with and without meibomian gland dysfunction (MGD) by vernier micrometer (VM). METHODS: This is a cross-sectional, observational study. A hundred eyes from 100 volunteers aged 20 to 79, including 56 normal participants and 44 participants with MGD, were recruited. Measurements of the LMT by VM were performed by the same person. RESULTS: The mean age of 56 normal subjects (24 males and 32 females) and 44 MGD subjects (16 males and 28 females) was 40.0 ± 13.2 years and 42.7 ± 17.1 years, respectively. There was a significant difference in the upper LMT between normal and MGD subjects (1.36 ± 0.25 vs. 1.60 ± 0.27 mm, P < 0.001), but not in the lower LMT (1.0 ± 0.23 vs. 1.10 ± 0.28 mm, P = 0.07). In both normal and MGD subjects, the upper or lower LMT was significantly positively correlated with age (P < 0.05), and the upper LMT was greater than the lower LMT (P < 0.001). In addition, the lower LMT in MGD subjects was significantly positively correlated with meibum expressibility (rs = 0.35, P = 0.02). CONCLUSIONS: The LMT was closely related to age and could be an important indicator for detecting MGD. Furthermore, we found that the upper LMT was greater than the lower LMT, and the lower LMT in MGD subjects seemed to be related to meibum expressibility.

Measurement of the Lower Lid Margin Thickness by Oculus Keratograph.

OBJECTIVES: To investigate the lower lid margin thickness (LLMT) from the posterior lash line to the anterior edge of tear meniscus with Oculus Keratograph 4 (K4). METHODS: This was a prospective, single-center, observational study. A total of 90 volunteers aged 18 to 79 years with no ocular diseases were included in this study. The LLMT of 90 subjects was measured twice by the same person with K4. To determine the reliability of K4, measuring the LLMT of 30 normal subjects was separately performed by two operators. RESULTS: The LLMT measurements with K4 between two operators demonstrated a good reproducibility (0.94±0.18 vs. 0.96±0.16 mm; intraclass correlation coefficient=0.88; P=0.18). The mean age of 90 volunteers (42 men and 48 women) was 45.5±14.1 years. The LLMT was 0.95±0.17 mm, which was a significant positive correlation with age (rs=0.57; P<0.001). In addition, there was no significant difference in the LLMT between genders (0.97±0.16 vs. 0.93±0.18 mm; P=0.32). CONCLUSIONS: We found that K4 was a reliable tool in the LLMT measurements, and the LLMT seemed to be closely related to age but not to gender.

Measurement of the Lower Lid Margin Thickness by Anterior Segment Optical Coherence Tomography.

PURPOSE: To verify the feasibility of using anterior segment optical coherence tomography (AS-OCT) to measure the lower lid margin thickness (LLMT) from posterior lash line to the mucocutaneous junction. METHODS: This was a prospective, single-center, observational study. Fifty-six volunteers between 20 and 79 years old with normal healthy eyes were included in this study. Using AS-OCT to measure the LLMT at the middle position was separately performed by two operators under the same conditions. RESULTS: The mean age of 56 subjects (24 males and 32 females) was 45.4 ± 15.7 years. The LLMT measured by AS-OCT between two operators was 0.86 ± 0.23 mm and 0.85 ± 0.22 mm, respectively. The reliability and repeatability between two operators were evaluated by intraclass correlation coefficient (ICC = 0.97). Based on one operator's measurements, the LLMT was 0.70 ± 0.10 mm at ages 20-29, 0.68 ± 0.09 mm at ages 30-39, 0.94 ± 0.12 mm at ages 40-49, 0.93 ± 0.20 mm at ages 50-59, 1.03 ± 0.15 mm at ages 60-69, and 1.24 ± 0.19 mm at ages 70-79, which indicated a significant positive correlation with age (rs = 0.74, p < 0.001). In addition, there was a significant difference in the LLMT between genders (0.94 ± 0.26 vs. 0.80 ± 0.19 mm, p = 0.03). CONCLUSIONS: A good agreement between two operators indicated that it seemed to be feasible to use AS-OCT to measure the LLMT. Additionally, we found that the LLMT appeared to be closely related to age and gender.

Comparison of two measurements for the lower lid margin thickness: vernier micrometer and anterior segment optical coherence tomography.

PURPOSE: To investigate the reliability of using anterior segment optical coherence tomography (AS-OCT) to measure the lower lid margin thickness (LLMT) from the posterior lash line to the Marx's line by comparing with a vernier micrometer. METHODS: This was a prospective, single-center, diagnostic test study. Sixty volunteers aged between 20 and 79 without ocular diseases were recruited. A vernier micrometer and AS-OCT were, respectively, used to measure the same lid margin thickness at the central lower lid. RESULTS: The mean age of volunteers was 39.1 ± 13.7 years. The LLMT in 60 subjects (25 males and 35 females) measured by a vernier micrometer and AS-OCT was 1.03 ± 0.25 mm and 0.82 ± 0.21 mm, respectively. There was a significant difference between two measurements (P < 0.001). In addition, intraclass correlation coefficient (ICC) was engaged to evaluate the reliability and agreement of two measurements (ICC = 0.83). Bland-Altman plots demonstrated that 57 of 60 spots were within 95% limits of agreement. No adverse events were detected in all subjects after the measurements. CONCLUSION: Although the LLMT measured by AS-OCT was less than that measured by a vernier micrometer, AS-OCT providing quantitative measurements and imaging data was also seemed to be a reliable method with a good agreement. It could be a substitute for a vernier micrometer in clinical practice in the future.

Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases.

BACKGROUND: Intravitreal injection has become an efficient approach for delivering drugs at therapeutic levels to the posterior segment in retinal diseases. However, the increased frequency and number of intravitreal injections have raised concerns about their side effects. As manipulation during surgery is relatively simple, details of the procedure are easily overlooked. Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures. We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide (TA) with the hope of providing an insight into this treatment. CASE SUMMARY: Case 1 was a 62-year-old woman with macular edema caused by central retinal vein occlusion in her right eye, and Case 2 was a 65-year-old man with macular edema caused by branch retinal vein occlusion in his right eye. In view of the patients' condition and economic constraints, an intravitreal injection of TA was administered. Due to inappropriate manipulation during surgery, the lens was injured. The site of lens injury and clinical manifestations were different in the two cases. Symptomatic treatment and continuous follow-up were carried out. The therapeutic effect following phacoemulsification of the cataract was satisfactory. CONCLUSION: Well-defined surgical incision under proper anesthesia, sufficient patient information and proficient anatomical skills of the physician are mandatory to prevent this rare adverse event. Careful and meticulous phacoemulsification of the cataract is suggested.

Effect of the Meibomian Gland Squeezer for Treatment of Meibomian Gland Dysfunction.

PURPOSE: To investigate the effect of the meibomian gland squeezer for treatment of meibomian gland dysfunction (MGD). METHODS: Seventy patients (140 eyes) with MGD were randomly divided into 2 groups: 36 patients who were treated by the meibomian gland squeezer as the treatment group and 34 patients were selected as the control group. Patients were evaluated at baseline, and 2-week and 1-month visits for subjective symptoms, objective signs and pain assessments, including ocular symptom scores, Ocular Surface Disease Index, tear breakup time, corneal fluorescein staining, Schirmer scores with no anesthetic (Schirmer I test), meibum quality, meibum expressibility, and Numeric Rating Scale-11. RESULTS: Sixty-five patients were followed in the study, and mean (±SD) age was 57.0 (±12.6) years. Compared with baseline, the 2 groups had varying degrees of improvement in ocular symptom scores and Ocular Surface Disease Index at the 2-week and 1-month visits; there was a statistically significant difference between groups (P < 0.001). At the 1-month visit, the treatment group showed a greater improvement in the breakup time (3.8 ± 1.6 vs. 1.8 ± 1.0 seconds, P < 0.001), corneal fluorescein staining (-2.1 ± 2.13 vs. -0.9 ± 1.3, P = 0.03), Schirmer I test (5.3 ± 2.9 vs. 2.3 ± 2.8 mm, P < 0.001), meibum quality (-7.5 ± 2.9 vs. -5.3 ± 2.4, P = 0.004), and meibum expressibility (-1.2 ± 0.8 vs. -0.7 ± 0.4, P = 0.007). In the treatment group, the mean (±SD) of total pain scores was 2.4 ± 1.0, which indicated that mild pain was still predominant under topical anesthesia. CONCLUSIONS: The meibomian gland squeezer may be safe, effective, and helpful for treatment of MGD and may offer an attractive treatment option for some patients with MGD, although it can cause mild pain or discomfort.

Effects of phacoemulsification on intraocular pressure and anterior chamber depth.

The aim of this study was to investigate the effects of phacoemulsification with intraocular lens (IOL) implantation on intraocular pressure (IOP) and anterior chamber depth (ACD) in patients with cataract or cataract associated with primary angle closure (PAC). A total of 361 patients (481 affected eyes) with senile cataract (cataract group) and 44 patients (52 affected eyes) with cataract associated with PAC (cataract with PAC group) underwent phacoemulsification with IOL implantation from July 2005 to May 2007 and were followed up for 3 to 25 months. There was a significant difference between pre-operative and post-operative IOPs (t=9.270, P<0.01) in the cataract group and in the cataract with PAC group (t=3.29, P<0.01). No significant differences were identified in pre-operative IOP (t=-2.437, P>0.05) and the IOP three months after surgery (t=2.154, P>0.05) between the two groups. There was a significant difference between the pre-operative and post-operative ACDs (t=7.781, P<0.01) in the cataract group and in the cataract with PAC group (t=4.528, P<0.01). A significant difference in ACD between the two groups (t=8.325, P<0.01) existed prior to surgery but following surgery, the ACDs of the two groups were not significantly different (t=2.86, P>0.05). Phacoemulsification with IOL implantation has IOP-lowering effects on cataract and cataract with PAC patients. The International Society of Geography and Epidemiology of Ophthalmology classification method for angle closure glaucoma was adopted in our study. Furhter studies are required to prove the safety and mechanism of lowering IOP impact of phacoemulsifation towards PAC glaucoma (PACG).

[Protective effects of Chinese herbal medicine Zuogui Pill on retina ganglion cells after optical nerve clipping injury in rats].

OBJECTIVE: To investigate the protective effects of Zuogui Pill (ZGP), a compound Chinese herbal medicine, on retina ganglion cells (RGCs) in rats after optical nerve clipping injury. METHODS: Optic nerves in Sprague-Dawley rats were crushed intraorbitally at 2 mm behind eyeball by using a forceps with a 140-gram chucking power for 30 s to induce unilateral injured model. The injured rats were fed with ZGP (ZGP group, 4.0 g/kg body weight each day) and equal volume of normal saline (injury group) respectively. Morphological changes in the retina were observed and the RGCs were quantified in the specimens. Nestin and glial fibrillary acidic protein (GFAP) expressions in the retina were detected by immunohistochemical fluorescence staining at different time points after nerve injury. RESULTS: After optical never crushing, the thickness of retina and the number of RGCs were significantly decreased in injury group as compared with the normal group. Nearly 50% of the total RGCs were disappeared at the 4th week in the injury group. The expression levels of nestin and GFAP in the retina were markedly increased after optical never crushing at the 2nd week and this lasted to the 8th week, and gradually decreased to the normal level at the 16th week. In contrast, the arrangement of retinal cells was regular in the ZGP group, and the number of survival RGCs was greater than that of the injury group. Meanwhile, the nestin and GFAP expressions in retina were significantly enhanced as compared with the injury group at all time points. CONCLUSION: ZGP may have protective effects on rat optic nerve and RGCs after contusion by promoting the nestin and GFAP expressions in Müller cells of the retina.

[Long-term clinical observation of an accommodative 1CU after implantation].

OBJECTIVE: To evaluate the clinical effectiveness and accommodative range after implanting the 1CU. METHODS: It was a prospective case series study. From March in 2004 to December in 2007, 23 cases (28 eyes) had phacoemulsification and implantation of 1CU (HumanOptics). Naked and best corrected distant acuity, Naked acuity at 35 cm and best corrected near, the amplitude of accommodation measured with subjective and objective techniques and the change in the anterior chamber depth were measured at 3-6 months, 18-24 months and over 36 months after surgery. RESULTS: After implantation, the 1CU had good centered and stable and no IOL-specific complications. Naked distant acuity of the three groups are 0.84+/-0.23, 0.81+/-0.19 and 0.78+/-0.17, between them there are no significantly statistical differences (F=0.759, P>0.05). The best corrected distant acuity of the three groups were 0.97+/-0.13, 0.99+/-0.17 and 1.00+/-0.17, between them there are no significantly statistical differences (F=0.17, P>0.05). The near acuity at 35 cm was 0.66+/-0.24, 0.52+/-0.14 and 0.47+/-0.12, between them there are significantly statistical differences (F=9.312, P<0.01). The best corrected near acuity were 0.97+/-0.13, 0.94+/-0.22 and 0.90+/-0.21, between them there are no significantly statistical differences (F=0.915, P>0.05). The accommodative range measured with subjective were 0.89+/-0.34, 0.72+/-0.17 and 0.56+/-0.16, between them there are significantly statistical differences (F=13.43, P<0.01). The accommodative range measured with objective were 3.58+/-0.54, 3.01+/-0.89 and 2.50+/-0.54, between them there were significantly statistical differences (F=17.886, P<0.01). The anterior chamber depth measured by application of 2% pilocarpine eyedrops were 0.88+/-0.40, 0.54+/-0.23 and 0.33+/-0.20, between them there were significantly statistical differences (F=26.589, P<0.01). CONCLUSIONS: The eyes with 1CU have good visual acuity and increased accommodative range more than the single-focus IOL. With the extension of time after surgery, the ability of 1CU regulation gradually declines, and nears point swift away gradually.

[Labeling neural stem cells with superparamagnetic iron oxide in vitro and tracking after implantation with MRI in vivo].

OBJECTIVE: To evaluate the feasibility of monitoring the neural stem cells implanted into the brain by the technique of labeling with superparamagnetic iron oxide (SPIO). METHODS: Neural stem cells were isolated from the cerebral cortex of newborn Wister rats and cultured. SPIO particles and poly-L-lysine were added into the medium to be co-cultured foe one hour. After the formation of neurospheres, Prussian blue staining was conducted and transmission electron microscopy was used to identify the iron particles in these neural stem cells. Sixteen adult female Wistar rats underwent transplantation of labeled neural stem cells into the right side of brain and non-labeled cells were transplanted into the contralateral part as controls. 1, 2, 4, 6, and 7 weeks after the transplantation, MRI examination with the scanning sequences of SE T2WI, FSE T2WI, and GRE T2 * respectively was conducted on the brains of the rats. Four rats at each time point were killed and their brains were taken out to undergo HE staining and Prussian blue staining to track the presence of labeled-cells. RESULTS: After the addition of SPIO the neurospheres continued to proliferate and differentiate normally. Electron microscopy showed vacuolar structures of different sizes under the cytoplasma membrane within and outside which there were high-density iron particles. Prussian blue staining showed numerous blue stained particles in the cytoplasm of the labeled cells. Remarkable low signal change was seen in the right brain transplanted with labeled cells, especially in the condition of scanning sequence of GRET2. Such change could be seen up to 7 weeks after the transplantation. No signal change was found in the left brain. CONCLUSION: SPIO labeling technique is useful in monitoring the outcome of transplanted neural stem cells.