Sex Differences in Characteristics, Treatments, and In-hospital Outcomes of Patients Undergoing Coronary Angiography or Intervention.

Background: Whether women have a higher risk of adverse events compared with men following coronary angiography (CAG) and percutaneous coronary intervention (PCI) remains controversial. We aimed to investigate the sex differences in characteristics, treatments and outcomes among patients undergoing CAG and PCI in a large Chinese cohort. Methods: We analyzed patients undergoing CAG and/or PCI in this multi-center registry cohort study Cardiorenal ImprovemeNt II (CIN-II) in 5 Chinese tertiary hospitals from 2007 to 2020. Clinical characteristics, treatment (discharge medication and PCI) and in-hospital outcomes (mortality and major bleeding) were compared between women and men. Results: Totally 141,459 patients underwent CAG (44,362 [31.4%] women), of which 69,345 patients underwent PCI (15,376 [22.2%] women). Women were older (64.4 vs. 60.8 years), had more chronic comorbidities and lower PCI rate for stable coronary artery disease (CAD) than men (52.8 vs. 64.2%). Women received less CAG and PCI procedures. Among women undergoing PCI they received similar discharge medication treatment. In addition, women undergoing PCI had mildly lower rate of major bleeding (0.2 vs. 0.3%, P = 0.033) but higher in-hospital mortality (1.2 vs. 0.8%, P < 0.001). After adjustment, women had a higher risk in the major bleeding (adjusted odds ratio, 2.04 [95% CI: 1.07 to 3.62]), and the in-hospital mortality (adjusted odds ratio, 1.87 [95% CI: 1.36 to 2.56]). Conclusion: Among our Chinese cohort, women are older with more chronic comorbidities, receiving less PCI procedure and similar discharge medication treatment. Women have nearly 90% higher risk of in-hospital mortality and over 1-fold increased risk of major bleeding after PCI compared with men.

A study of medial and lateral temporal lobe epilepsy based on stereoelectroencephalography.

BACKGROUND: Patients with temporal lobe epilepsy (TLE) originating from different seizure onset zones had distinct electrophysiological characteristics and surgical outcomes. In this study, we aimed to investigate the relationship between the origin and prognosis of TLE, and the stereoelectroencephalography (SEEG) features. METHODS: Thirty patients with TLE, who underwent surgical treatment in our functional neurosurgery department from January 2016 to December 2017, were enrolled in this study. All patients underwent anterior temporal lobectomy after an invasive pre-operative evaluation with SEEG. Depending on the epileptic focus location, patients were divided into those with medial temporal lobe seizures (MTLS) and those with lateral temporal lobe seizures (LTLS). The Engel classification was used to evaluate operation effectiveness, and the Kaplan-Meier analysis was used to detect seizure-free duration. RESULTS: The mean follow-up time was 25.7 ±â€Š4.8 months. Effectiveness was 63.3% for Engel I (n = 19), 13.3% for Engel II, 3.3% for Engel III, and 20.0% for Engel IV. According to the SEEG, 60.0% (n = 18) had MTLS, and 40.0% (n = 12) had LTLS. Compared with the MTLS group, the operation age of those with LTLS was significantly greater (26.9 ±â€Š6.9 vs. 29.9 ±â€Š12.5 years, t = -0.840, P = 0.009) with longer epilepsy duration (11.9 ±â€Š6.0 vs. 17.9 ±â€Š12.1 years, t = -1.801, P = 0.038). Patients with MTLS had a longer time interval between ictal onset to seizure (67.3 ±â€Š59.1 s vs. 29.3 ±â€Š24.4 s, t = 2.017, P = 0.008). The most common SEEG ictal pattern was a sharp/spike-wave rhythm in the MTLS group (55.6%) and low-voltage fast activity in the LTLS group (58.3%). Compared with the LTLS group, patients with MTLS had a more favorable prognosis (41.7% vs. 77.8%, P = 0.049). Post-operative recurrence was more likely to occur within three months after the operation for both groups, and there appeared to be a stable long-term outcome. CONCLUSION: Patients with MTLS, who accounted for three-fifths of patients with TLE, showed a more favorable surgical outcome.

Aging, rather than Parkinson's disease, affects the responsiveness of PBMCs to the immunosuppression of bone marrow mesenchymal stem cells.

Whether aging or Parkinson's disease (PD) affects the responses of peripheral blood mononuclear cells (PBMCs) to immunosuppression by bone marrow­derived mesenchymal stem cell (BM­MSCs) and which cytokines are more effective in inducing BM­MSCs to be immunosuppressive remains to be elucidated. PBMCs were isolated from healthy young (age 26­35), healthy middle­aged (age 56­60) and middle­aged PD­affected individuals. All the recruits were male. The mitogen­stimulated PBMCs and proinflammatory cytokine­pretreated BM­MSCs were co­cultured. The PBMC proliferation was measured using Cell Counting Kit­8, while the cytokine secretion was assayed by cytometric bead array technology. The immunosuppressive ability of BM­MSCs was confirmed in young healthy, middle­aged healthy and middle­aged PD­affected individuals. Among the three groups, the PBMC proliferation and cytokine secretion of the young healthy group were suppressed more significantly compared with those of the middle­aged healthy and middle­aged PD­affected group. No significant differences were identified in the PBMC proliferation and cytokine secretion between the patients with PD and the middle­aged healthy subjects. Interferon (IFN)­Î³ synergized with tumor necrosis factor (TNF)­α, interleukin (IL)­1α or IL­1ß was more effective than either one alone, and the combinations of IFN­Î³ + IL­1α and IFN­Î³ + IL­1ß were more effective than IFN­Î³ + TNF­α in inducing BM­MSCs to inhibit PBMC proliferation. The results of the present study suggested that aging, rather than PD, affects the response of PBMCs toward the suppression of BM­MSC, at least in middle­aged males. Patients with PD aged 56­60 remain eligible for anti­inflammatory BM­MSC­based therapy. Treatment of BM­MSCs with IFN­Î³ + IL­1α or IFN­Î³ + IL­1ß prior to transplantation may result in improved immunosuppressive effects.

Investigating the nonlinear effect of ego depletion on safety compliance: The moderating role of rumination.

INTRODUCTION: A general view in previous research is that employees are reluctant to follow safe work procedures when confronting the shortage of self-control resources. However, this argument is constrained by the restricted view of ego depletion. To fill this gap, this study constructs the nonlinear relationship between ego depletion and safety compliance drawing from the perspective of dual-process theory. METHOD: Regression analysis and hierarchical linear model are used to test our hypothesis. RESULTS: By investigating 241 medical staffs, we find that the relationship between ego depletion and safety compliance is U-shaped. This U-shaped relationship is replicated through 221 daily data for 50 medical staffs. In addition, the U-shaped relationship between ego depletion and safety compliance can be enhanced by rumination. DISCUSSIONS: Findings of our study contribute to providing a nuanced explanation about the effect of ego depletion on safety compliance. Also, this study has important implications for High Reliability Organizations to motivate depleted employees to engage in safety compliance behaviors.

[Effects of tobramycin dexamethasone eye ointment for blepharitis: multi-center clinical trial].

OBJECTIVE: To realize the effectiveness and security of Tobramycin and Dexamethasone Eye Ointment for blepharitis treatment. Design Case control studies. Participants 148 patients be diagnosed as blepharitis including 81 cases as research group and 67 cases as control group. METHODS: Multi-center randomized controlled clinical trial. The patients met the inclusion criteria from First Hospital Peking University, Beijing Tongren Hospital, Southwest Hospital, Ophthalmology Center Zhongshan University and Third Hospital Peking University were divided into two groups in Aug. to Dec. 2011. Tobramycin dexamethasone eye ointment was applied to eye lid in research group while patients in control group used tobramycin eye ointment. All patients were informed to apply warm compress to the lids, mechanically washing to the eyelids and artificial tears. At the beginning, the 7(th) day, the 14(th) day and the 28(th) day of treatment, observation of symptom, sign and side effect were recorded. RESULTS: Before treatment the difference of the symptom scores of burning sensation, tears, photophobia and itch of two groups has no statistically significant (t = 1.87, 0.43, -0.64, 0.93, P > 0.05), but the symptom scores have a statistically significant decrease (t = 1.99 - 6.90, P < 0.05) at the 7(th) day, 14(th) day, 28(th) day. Before treatment the difference of signs scores have no statistically significant except the term of new blood vessels (t = 2.32, P = 0.02) while all the signs scores have a statistically significant decrease at the 7(th) day, 14(th) day, 28(th) day. Side effect: the number of patients with elevated intraocular pressure of research and control group is 3 and 1 respectively and the ratio is 3.7% and 1.5%. CONCLUSIONS: The tobramycin dexamethasone eye ointment can improve signs and symptoms of blepharitis patients. Some patients have to face with the risk of elevated intraocular pressure and it's necessary to monitor the intraocular pressure.

[Emphasis treatment on eyelid during perioperation].

The eyelid and conjunctival sac of healthy individuals inherently supports a small population of bacteria. Alterations in the concentration and type of bacteria present in blepharitis and meibomian gland dysfunction have been reported. The most common sources of the bacteria causing endophthalmitis of postcataract surgery and corneal infections following laser in situ keratomileusis attribute to the eyelids and conjunctiva of the patients, It has become a routine admitting antibiotic eye drops during perioperation and irrigating conjunctival sac before operation, but it is not paid enough attention for dealing with eyelid. So, this article will discuss the impact of eyelid on surgical outcome, and it is helpful for reducing postoperative infection.

[An experimental study on the fate of the amniotic membrane after amniotic membrane transplantation for acute alkaline burn of rat cornea].

OBJECTIVE: Use three different methods of amniotic membrane transplantation for acute alkaline burn of rat cornea, to investigate the difference on operation time, reabsorption time of amniotic membrane, integration patterns of amniotic membrane into the cornea among the three amniotic membrane transplantation methods. METHODS: SD rats were randomly assigned into five groups. Group A: simply alkaline burn of cornea; Group B: inlay method; Group C: overlay method; Group D: sutureless method; Group E: normal. Prepared the model of corneal alkaline burn of the right eyes of group A-D rats, performed three different methods of amniotic membrane transplantation on Group B-D rats respectively within 24 hours after alkaline burn. The operation time was recorded. Observed the eyes with slit-lamp microscopy after transplantation, recorded the reabsorption time of amniotic membrane. HE staining and immunohistochemical staining against human collagen IV were performed for pathological study. The results were analysed with Image-Pro Plus 6.0 software. The integration patterns of amniotic membrane into the cornea after amniotic membrane reabsorbed were observed. RESULTS: (1) Operation time: Group B was (35.500 ± 2.878) minutes; Group C was (33.375 ± 2.973) minutes; Group D was (9.875 ± 1.246) minutes. There was statistical significance between group B and group D (P < 0.001), group C and group D (P < 0.001). There was no statistical significance between group B and group C (P = 0.102). (2) Reabsorption time of amniotic membrane: Group B was (16.625 ± 3.662) days; Group C was (9.250 ± 2.188) days; Group D was (12.833 ± 2.483) days. There was statistical significance among group B, C, D (P < 0.001). (3) There was significant inflammatory reaction around the suture in Group B and Group C, and there was inconspicuous inflammatory reaction in Group D. (4) There were three integration patterns of amniotic membrane into the cornea after amniotic membrane reabsorption: superficial localization, intraepithelial and intrastromal. We could find one or more integration patterns in same method of amniotic membrane transplantation, there was no statistical significance among group B, C, D (P = 0.86). CONCLUSIONS: Amniotic membrane can integrate into the cornea after amniotic membrane reabsorption. Sutureless amniotic membrane transplantation which has short operation time and inconspicuous inflammatory reaction is better than traditional amniotic membrane transplantation, and it will be used extensively in the ophthalmology field in future.

[Advancement of the study in meibomian lipids].

Meibomian lipids are believed to compose the lipid layer of tear film and play important roles in maintaining the stability of tear film. Changes in composition of meibomian lipids contribute to the ocular surface disease, such as dry eye. The understanding of composition and role of meibomian lipids can help us understand the cause of these disease. This review is intended to summarize the current state of knowledge about meibomian lipids, lipidomic analysis of meibomian lipids and changes of medium regarding to diseases.

[Evaluation of grating visual acuity development in normal infants].

OBJECTIVE: To assess the grating visual acuity of Chinese normal infants from 5 to 24 months, evaluate the development of grating visual acuity in infants. METHODS: The Teller acuity card(TM) II (Stero-Optical Company, America) was used to assess the grating visual acuity of 244 infants aged from 5 to 24 months, who met the eligible criteria. Binocular visual acuity and monocular visual acuity were both assessed. They were divided into 19 groups according to their age sequence from 5 to 24 months. Average binocular and monocular visual acuity of every group were recorded and calculated. The relationship between visual acuity and age were analyzed. The practicality and possibility of the application for the Teller acuity card in infants were assessed. RESULTS: Binocular visual acuity was obtained in 241 infants (98.77%). Monocular visual acuity from both eyes was completed in 89.2% infants. All the tests can be finished in 2 to 5 minutes. The average of binocular visual acuities of the 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21, 24 months separately was: 0.17, 0.21, 0.22, 0.23, 0.23, 0.25, 0.26, 0.30, 0.33, 0.32, 0.37, 0.39, 0.42, 0.47, 0.56, 0.60, 0.83. The average of monocular visual acuities separately was: 0.15, 0.19, 0.19, 0.20, 0.20, 0.21, 0.21, 0.27, 0.23, 0.26, 0.24, 0.35, 0.26, 0.41, 0.40, 0.56, 0.80. The binocular visual acuity was slightly higher than the monocular visual acuity. The difference was less than one octave. The intraocular acuity difference was less than one octave. There were no significant differences between left and right eyes. Visual acuity of the infants aged form 5 to 14 months increased slowly from 5.1 to 9.6cpd, about 1 octave. There was an increase started from 15 months. Everyone who was reached 24 months got a visual acuity of 26cpd (snellen = 0.833), closed to the adult level. Compared to the visual acuity of 12 months age, 1.5 octaves were increased. CONCLUSIONS: TAC is useful and practical for age norms of visual acuity of infants in clinical and vision research. Visual acuity increases progressively with age. The development of visual acuity shows a different speed in different age period. Monocular visual acuity is slightly lower than binocular visual acuity. There is a balanced visual development of both eyes.

[Retrospective analysis of ocular cicatricial pemphigoid].

OBJECTIVE: To analyze the clinical characterization of ocular cicatricial pemphigoid (OCP). METHODS: It was a retrospective series case study. Five consecutive patients referred for the evaluation of possible OCP from January 2005 to October 2008 in Departments of Ophthalmology and Dermatology of Peking University First Hospital. History and clinical characterization of 5 cases (10 eyes) OCP having been misdiagnosed were analyzed to find the causes of misdiagnosis. RESULTS: All of cases were diagnosed as chronic conjunctivitis during the early stages of the diseases, one case was diagnosed as Stevens-Johnson syndrome and one as Sjögren syndrome during the later stage. It was two to five years from the first time to see a doctor to definite diagnosis. All of cases have been prescribed antibiotic eye drops for a long times, one case has been undergone three times trichiasis operation and made the disease progression. Among the five patients with OCP, 3 eyes were diagnosed Stage II, 5 eyes Stage III, 2 eyes Stage IV. Three cases were positive of bacterial culture. Only in 1 case, there was slight increase of iron protein as tumor mark. Inflammation was controlled by the end of the study, but cicatrization of 2 cases still progressed. CONCLUSION: Manifestation of OCP can mimic chronic conjunctivitis during the early stages, it is important to pay high attention to OCP, misdiagnosis may be stopped.

[The transient PVEP acuity assessment for 2 to 5 years old normal children].

OBJECTIVE: To evaluate the practicality of transient PVEP (pattern visual evoked potential, PVEP) acuity assessment for 2 to 5 years old normal children from September 2007 to January 2008. METHODS: Pattern acuity and transient PVEP-A of 179 (355 eyes) normal children between 2 to 5 years were detected and analyzed. Pattern acuity data were got from test for single uncorrected eye with pattern acuity table. PVEP-A was measured by the horizontal gratings evoked potential, voyich were cognizable response. chi2 and rank tests methods were used to analysis. The value of PVEP-A was converted to international standard acuity, and then comparison to pattern acuity with Logistic regression method. RESULTS: With the growth of age, pattern acuity was gradually increased and the value was greater than 0.4. The positive correlation also existed among PVEP-A and age, PVEP-A from test children was all greater than 3.4 c/d. The analysis result of rank regression was P<0.01, that weaned PVEP-A difference among four groups had statistics significance. The correlation coefficient of PVEP-A with pattern acuity was good (r=0.673). The difference of PVEP-A and pattern acuity between two eyes was correlated(r = 0.664). The result also pointed out PVEP-A growth was earlier than pattern acuity among 179 children. CONCLUSION: Stabilization and reliability PVEP is a good objective visual assessment for younger and handicapped children.

[Toxicity of topical ocular anti-allergic agents on human corneal epithelial cells in vitro].

OBJECTIVE: To investigate the cytotoxic effect of three kinds of topical ocular anti-allergic agent, including olopatadine 0.1% (A group), ketotifen fumarate 0.025% (B group) and pemirolast potassium 0.1% (C group), on cultured human corneal epithelial cells in vitro. METHODS: Primary human corneal epithelial cells were cultured with keratinocyte serum-free medium. The cells were exposed to three kinds of topical ocular anti-allergic agent for a period of 10 min, 30 min, 2 h, 6 h, 12 h and 24 h. Toxicity was examined in three ways. MTT assay was used to quantify cytotoxicity. Cell membrane permeability and intracellular esterase activity were analyzed with live-dead viability staining of fluorescent calcein-AM/ethidium homodimer. The morphologic analysis was performed by light and scanning electron microscopy. Statistical methods adopted one-way ANOVA (analysis of variance) and Student-Newman-Keuls q test between each group. The P-value of 0.05 was considered statistically significant. RESULTS: (1) Morphologic changes: The Findings under the light microscopy were demonstrated that cells became round or edematic and detached from dishes after exposure to topical ocular anti-allergic agent. The cellular damage was more severe with longer exposure time and increasing concentration. Likewise, the electron microscopy examination showed reduced microvilli with longer exposure time and increasing concentration. The cellular changes of 20.0% olopatadine 0.1% were reduced when compared to the other agents. (2) Live/dead viability/cytotoxicity assay: Ethidium homodimeric permeates damaged cell membranes and results in red fluorescence. These results indicated that cell membrane damage caused by 20.0% olopatadine 0.1% at 6, 12, 24 h was less than those of ketotifen fumarate 0.025% and pemirolast potassium 0.1%. The data of A group were (29.7 +/- 2.6)%, (36.9 +/- 3.2)%, (51.2 +/- 4.3)%, B group were (36.5 +/- 3.1)%, (48.5 +/- 4.3)%, (75.5 +/- 3.8)% and C group were (37.1 +/- 2.2)%, (52.7 +/- 3.4)%, (71.1 +/- 5.1)%, respectively. The q values of A to B group and A to C group at 6 h were 3.27, 4.31, respectively (P < 0.05). The green fluorescent staining of calcein-AM indicated intracellular esterase activity was decreased after incubation with increasing concentration and longer exposure time. There was no significantly different result between each group (P > 0.05). The proportion of green staining cell of A, B and C group at 24 h were 100.0% with 50.0% concentration and were (23.2 +/- 4.6)%, (29.5 +/- 5.2)%, (31.1 +/- 5.5)% respectively with 20.0% concentration (F = 1.97, P = 0.377). (3) MTT assay: The results of the three groups revealed cell viability decreased significantly with increasing concentration and longer exposure time at all the concentrations except 0.8%. MTT values for A, B and C group at the concentration of 20.0%, at 6 h were 0.429 +/- 0.028, 0.367 +/- 0.038, 0.379 +/- 0.012 and 4% at 24 h were 0.457 +/- 0.025, 0.401 +/- 0.008, 0.387 +/- 0.012, respectively. The data for olopatadine 0.1% were significantly improved over those of ketotifen fumarate 0.025% and pemirolast potassium 0.1%. The q value of A to B group, A to C group were 3.01, 3.77 (P < 0.05) at the concentration of 20.0%, 6 h and were 3.63, 4.11 (P < 0.05) at the concentration, 24 h. There were no statistical significant results at other concentrations. CONCLUSIONS: The topical ocular anti-allergic agent, olopatadine 0.1%, showed less toxic effects on human corneal epithelial cells compared to ketotifen fumarate 0.025% and pemirolast potassium 0.1%. Olopatadine 0.1% may offer a safer option to the corneal epithelium when used to treat allergic keratoconjunctivitis over an extended period of time.

[Retrospective analysis of clinical characteristics of toxic anterior segment syndrome].

OBJECTIVE: To investigate the etiology, clinical features, treatment and prognosis of toxic anterior segment syndrome (TASS). METHODS: It was a retrospective series case study. The clinical data of eight definite diagnosed TASS cases were retrospectively analyzed. RESULTS: Among eight TASS cases, seven were post cataract surgery cases and one was post cornea penetrating injury. Three cases were caused by residual povidone iodine on instruments, 2 cases resulted from the misuse of distilled water as intraocular irrigating liquid during cataract surgery, 2 cases were produced by the countercurrent of antibiotic solution via the cornea-scleral incision into anterior chamber during subconjunctival injection at the end of the surgery, and 1 case was induced by the injection of the distilled water into the anterior chamber at the end of the surgery. Three TASS cases occurred during operation and 5 cases occurred at 1 day after operation. All eight cases suffered from the painless blurred vision. Three cases occurred during operation presented with decrease of corneal transparency and depigmentation of iris. On the first day after operation, all cases had diffuse corneal stroma edema and severe anterior uveitis. Dexamethasone 0.1% or prednisolone acetate 1% eye drops, three times per day or one time per hour was used in all cases. Carteolol 2% eye drop, two times per day, was used for the cases with ocular hypertension. The cornea was clear in 6 cases, but corneal endothelial decompensation in 2 cases after therapy. CONCLUSION: Various toxic agents injected into anterior chamber by misuse can result in TASS. All these misuse can be avoided. Early diagnosis and proper management may be important to improve the prognosis of TASS.

[Preliminary observation the correlation between lid-wiper epitheliopathy and dry eye].

OBJECTIVE: To investigate the prevalence of lid-wiper epitheliopathy (LWE) and risk factors in dry eye patients. METHODS: One hundred forty-one patients (141 eyes) were recruited in Peking University First Hospital from September 2006 to March 2007. These patients were divided into three groups based on the dry eye symptoms and the results of break up time, Schirmer I test and corneal fluorescein staining. Group A: 60 patients (60 eyes) with no dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group B: 51 patients (51 eyes) with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group C: 30 patients (30 eyes) with dry eye. The patients in group A and group B were further divided into two subgroups based on wearing contact lens. Subgroup A1:30 patients (30 eyes) with no contact lens wearers; Subgroup A2:30 patients (30 eyes) with contact lens wearers. Subgroup B1:21 patients (21 eyes) with no contact lens wearers; Subgroup B2: 30 patients (30 eyes) with contact lens wearers. Lid-wiper staining was graded in all patients following the instillation of fluorescein and lissamine green dyes. Impression cytology (IC) was made up in the patients in group C and the patients with LWE in group B. RESULTS: The prevalence of LWE was 18.3% (11 patients), 86.3% (44 patients) and 100.0% (30 patients) in group A, B, C respectively. The prevalence of LWE was 13.3% (4 patients), 23.3% (7 patients), 81.0% (17 patients) and 90.0% (27 cases) in subgroup A, A2, B1, and B2. There was a significant statistical difference in the prevalence of LWE among groups A, B and C (X2 = 78.256, P < 0.01). There were no statistical difference in the prevalence of LWE between subgroup A2 and subgroup A1 (X2 = 1.002, P = 0.253), subgroup B2 and subgroup B1 (X2 = 0.854, P = 0.301). In group B, IC was graded as mark zero in 74.0% of patients with LWE, as mark one in 26.0% of patients with LWE. In group C, IC was graded as mark one in 40.0% of patients, as mark two in 50.0% of patients, and as mark three in 10.0% of patients. There was a significant statistical difference in grade of IC between group B and C (M-W = 36.0, P < 0.01). The result of the corneal fluorescein staining was positive in 18.8% of patients with LWE. The result of lissamine green staining was positive in 14. 1% of patients with LWE. However, the result of both fluorescein and lissamine green staining was 67. 1% in patients with LWE. CONCLUSIONS: The prevalence of LWE is higher in patients with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. LWE may be an early manifestation of the dry eye.

[Changes of corneal limbus in long-term soft contact lens wearers by using laser confocal microscope].

OBJECTIVE: To investigate corneal limbus changes in long-term soft contact lens wearers using laser confocal microscope. METHODS: All examinees were chosen from people who received pre-refractive surgery examination or regular physical examination in Department of Ophthalmology of Peking University First Hospital during October to November, 2004 and May to October, 2006. The contact lens wearer (CLW) group consisted of 22 eyes of 22 patients (age distribution, 23 - 50 years) with a history of refractive errors and more than ten-year soft contact lens wear. Thirty-eight eyes of 38 patients (age distribution, 18 - 52 years) with refractive errors but no history of contact lens wear were observed as the controls. After detailed examinations of slit lamp biomicroscopy, superior and inferior limbus were examined by laser confocal microscope. Corneal microstructure and cell morphology were analyzed, and cell densities were measured. RESULTS: Images of corneal limbus could be observed clearly in both groups. The arrangement of limbal epithelium in CLW group showed irregular as compared to the control group. Epithelial microcystic changes and highly reflective dots among epithelium were found in CLW group which were not found in the control group. The Langerhans cell density of both superior limbus and inferior limbus in CLW group were higher than that of the control group (P < 0.05). There were highly reflective microdot deposits in the limbal corneal stroma in CLW group which were not appeared in the control group. Keratocyte density in anterior stroma of both superior and inferior limbus in CLW group was lower than that of the control group (P < 0.05). Keratocyte density in posterior stroma of both superior and inferior limbus in CLW group was lower than that of the control group (P < 0.05). The average stroma thickness of both superior and inferior limbus in CLW group was also lower than that of the control group (P < 0.05). CONCLUSIONS: Long-term soft contact lens wear can induce many changes in corneal limbus, such as microcystic changes in epithelial cells, microdot deposits in corneal stroma, increase of Langerhans cell density and decrease of keratocyte density, etc.

[Aware of glaucoma in the patients after excimer laser refractive surgery].

The prevalence of glaucoma in myopic patients is about two to three times than in general population, in which the prevalence of glaucoma is about 1%-2%. Millions of patients have been performed excimer laser refractive surgery for their refractive error. Thus, tens of thousands of the patients who received the refractive surgery will suffer from glaucoma in the next two decades. Some studies have found intraocular pressure (IOP) in patients with refractive surgery is lower, most likely due to the reduced central corneal thickness and intralamellar cyst syndrome. The use of steroid after the refractive surgery can increase IOP in the steroid responders. Therefore, the refractive surgeons should pay more attention to patient follow-up and surveillance of IOP.

[In vivo study of normal human limbal and central corneas using laser confocal microscope].

OBJECTIVE: To observe the microstructure and cellular populations of normal human limbal and central corneas using laser confocal microscope. METHODS: The study was consisted of 28 eyes of 15 examiners (age distribution, 16-61 years). After examinations with slit lamp biomicroscopy and ophthalmoscope, the images of superior, inferior limbus and central cornea were acquired by laser confocal microscope. Corneal microstructure and cell morphology were analyzed, and cell densities were measured. RESULTS: Lateral (x, y axis) and axial (z axis) images of limbal and central cornea were clear and vivid. Limbal palisades of Vogt were visible at the superior and inferior limbus. The red blood cells in the vessel of limbus were visible. The arrangement of surface epitheliums was rather loose, with bright borders and dark cell bodies. The surface epithelial cell density was (812 +/- 297) cells/mm(2) at the superior limbus and (785 +/- 263) cells/mm(2) at the inferior limbus. There was no statistical difference between the two group (P > 0.05). The bright and dendriform Langerhans cells were readily visible just under the epithelial cells. The Langerhans cell density was (288 +/- 102) cells/mm(2) at the superior limbus and (254 +/- 127) cells/mm(2) at the inferior limbus. There was no statistical difference between the two group (P > 0.05). At central cornea, the surface epithelial cells were loose, the borders of the cell were clear and bright, and the cell bodies were dark. The cell density was (1098 +/- 315) cells/mm(2), there were more cells in central cornea than other area of superior and inferior limbus (P < 0.05). The arrangement of basal epithelial cells was tight. Nerve plexus at subepithelium and anterior stroma were prominent with strong brightness. Langerhans cells were occasionally visible, and cell density cannot be measured. Subepithelial nerve fibers were thin with high tortuosity and a lot of branches, and deeper ones were thick with low tortuosity and few branch. In the stroma, separated keratocytes were visible under dark background, the boundaries were vague, the nucleis were bright and spindly. Hexagonal endothelial cells were arranged in order with light cell bodies and dark borders. The thickness of whole cornea, stroma or epithelium was (543.0 +/- 62.9), (462.0 +/- 69.5), (59.9 +/- 11.2) microm respectively. CONCLUSIONS: Laser confocal microscopy provides non-invasive, real-time, in vivo images of limbal and central corneas characterized with refined image definition, exact depth localization. It is valuable for basic research and clinical diagnosis of corneal disease.

[Effects of lens opacity on AccuMap multifocal objective perimetry in glaucoma].

OBJECTIVE: To investigate the effect of lens opacity on the performance of the multi-focal visual evoked potential (mfVEP) test in patients with glaucoma and its relationship with the Humphrey's automated static perimetry. METHODS: This is a prospective, non-randomized study. Twenty-two patients were enrolled with moderate cataract and primary glaucoma scheduled for cataract surgery with or without glaucoma surgery. Humphrey visual field and mfVEP test were preformed before surgery and after 6 - 8 weeks of post-operation. Lens opacity was evaluated with slit lamp according to LOCS III (lens opacity classification system, version III) by the same ophthalmologist. RESULTS: The improvement of AccuMap objective visual field was noted after lens removal in glaucoma patients. The amplitude of the AccuMap was significantly (P < 0.01) increased after cataract surgery compared to pre-operation (382.6 nV +/- 146.7 nV vs 308.0 nV +/- 96.6 nV). AccuMap severity index (ASI) was significantly (P < 0.001) decreased following lens removal compared with pre-operation (48.6 +/- 42.4 vs 90.0 +/- 54.8, P < 0.001). Latency was little changed before and after surgery (1207.5 ms +/- 67.7 ms, 1191.2 ms +/- 61.9 ms, respectively, P = 0.289). There were no correlations between the changes of amplitude and the degree of lens opacity (Spearman correction, P = 0.09). For Humphrey visual field, the mean deviation (MD) of pre- and post-operative was significantly (P < 0.001) affected by lens opacity (-12.2 +/- 7.8, -9.6 +/- 8.8, respectively, P < 0.001), but pattern standard deviation (PSD) had no such changes (6.5 +/- 3.2, 6.3 +/- 4.0, respectively, P = 0.748). There were well correlated between the ASI and the MD both pre- or post-operation (Pearson correction, P = 0.013, P < 0.001), and between the ASI changes and the MD changes after lens removal (Pearson correction, P = 0.017). CONCLUSIONS: Lens opacity affects the AccuMap objective visual field in patients with glaucoma, especially the amplitude of the AccuMap. The ASI is sensitively correlated with the MD of Humphrey perimetry.

[Be aware of toxicity of eye drops to ocular surface].

Ocular surface toxicity caused by the abuse of eye drops is often overlooked. The clinical signs are usually nonspecific and can be mistaken resulting from other eye surface diseases. Pathogenic mechanisms vary widely with different application of eye drops. Ophthalmologist should be aware of the ocular surface toxicity induced by eye drops and its prevention and treatment.