Causes and treatments of traumatic secondary glaucoma.

PURPOSE: To study the cause, treatment, and cure of traumatic secondary glaucoma in 103 cases (103 eyes). METHODS: The records of 103 patients (103 eyes) were reviewed. Causes of the high intraocular pressure (IOP) were analyzed according to the time after trauma. Most patients achieved a better visual acuity and ideal IOP after positive medical, neodymium:Yttrium aluminium garnet (Nd:YAG) laser, or surgical treatment. The operations included anterior chamber irrigation, filtering operation combined with mitomycin C, lensectomy, vitrectomy, and combination surgery. RESULTS: Clinical findings of secondary glaucoma associated with ocular trauma are complex. Causes resulting in high IOP include intraocular bleeding, lens dislocation, phacoanaphylaxis, angle recession, and siderosis. After medical, laser, or surgical treatment, the IOP of most patients could be ideally controlled. After follow-up for half a year, the IOP of 3 cases (2.91%) was below 10 mmHg and 92 (89.32%) cases between 10 and 21 mmHg; only 8 cases (7.77%) still had IOP over 21 mmHg. CONCLUSIONS: In traumatic secondary glaucoma, antiglaucoma medication should be used at the early stage, and surgery should be carried out when medical treatment does not reduce the elevated IOP, or in difficult cases to avoid severe complications. The postoperative IOP of most injured eyes was controlled within the safe range.

Exogenous Tissue Inhibitor of Metalloproteinase-2 Affects Matrix Metalloproteinase-2 Expression in Conjunctival Filtering Blebs and Bleb Scarring in Rats.

OBJECTIVE: To examine the effect of tissue inhibitor of metalloproteinase-2 (TIMP-2) on conjunctival filtering bleb scarring. METHODS: A model of conjunctival filtering bleb was established whereby rats were injected with saline, blank adenoviral vector, or adenoviral vector carrying TIMP-2 into the bleb. Filtration bleb formation and matrix metalloproteinase-2 (MMP-2) expression were examined. RESULTS: All operated eyes formed obvious elevated blebs on day 1. In the normal saline group, empty plasmid group, and gene transfection group maintenance time of filtrating blebs was 5-14, 5-14, and 6-16 days, and average survival time was 8.24, 8.16, and 9.44 days, respectively. MMP-2 expression increased slightly in the gene transfection group at 3 and 5 days after surgery, reached a peak after 14 days, and then gradually decreased. MMP-2 expression was weakly positive in the normal conjunctival epithelium, but was hardly detected in the lamina propria. Seven days after surgery, the epithelium and lamina propria of the conjunctival filtering bleb exhibited strong positive expression in the empty plasmid group but only weak expression in the adenovirus group. CONCLUSION: Exogenous TIMP-2 interfered with local MMP-2 expression, delaying peak expression of MMP-2 and slowing the scarring of filtering blebs during wound healing of subconjunctival tissue.

Prevalence and Related Factors for Myopia in School-Aged Children in Qingdao.

PURPOSE: To investigate the prevalence and related factors for myopia in school-aged children in the Economic and Technological Development Zone of Qingdao, Eastern China. METHODS: A total of 4890 (aged 10 to 15 years) students were initially enrolled in this study. 3753 (76.75%) students with completed refractive error and questionnaire data were analyzed. The children underwent a comprehensive eye examination. Multiple logistic regression models were applied to assess possible factors associated with myopia. RESULTS: The prevalence of myopia increased as the children's grade increased (χ2 = 560.584, P < 0.001). Low myopia was the main form of myopia in adolescent students (30.22%). With the growth of age, students spent significantly more time on near work (P = 0.03) and less time on outdoor activity (P < 0.001). In multivariate models, only the following variables were significantly associated with myopia: age, two myopic parents, outdoor activity time, and continuous near work without 5 min rest. CONCLUSIONS: The prevalence of myopia increased as the grade increased. Age, two myopic parents, and continuous near work time without 5 min rest were risk factors for myopia. Outdoor activities had protective effect for myopia.

Correlation between Tissue Characterization and Dynamic Expression of Matrix Metalloproteinase-2 and Its Tissue Inhibitor in Conjunctival Filtering Bleb of Rats.

PURPOSE: Using rat conjunctival bleb model, we correlated changes morphology and histology in the bleb with changes in MMP-2 and TIMP-2 levels. METHODS: Filtering surgeries were performed on rats. Dynamic changes in morphology and histopathology were observed using HE staining. Expression of MMP-2 and TIMP-2 was determined by immunofluorescence microscopy and western blotting. RESULTS: Well-elevated filtering blebs formed and persisted for an average of 12 days. Histological examination showed that inflammatory was dominant in postoperative days 1-3, and proliferating manifestation became the main sign 5 days later. Western blot showed that MMP-2 was downregulated 1 day after surgery, upregulated at 3 days, and observed with a peak at 7 days; then it persisted until 28 days. The difference was statistically significant (F = 280.18, p < 0.01).TIMP-2 was upregulated 1 day after surgery and observed with a peak at 5 days; then it persisted until 28 days. The difference was statistically significant (F = 145.34, p < 0.01). CONCLUSIONS: During the processes of conjunctival filtering bleb and scar formation in rats, the changes in MMP-2 and TIMP-2 levels in the filtering area, together with a corresponding proliferation of fibroblasts and the accumulation of collagen fibres, resulted in scarring of filtering blebs.

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma.

AIM: To evaluate the efficacy and safety of intravitreal ranibizumab (IVR) with panretinal photocoagulation (PRP) followed by trabeculectomy compared with Ahmed glaucoma valve (AGV) implantation in neovascular glaucoma (NVG). METHODS: This was a retrospective comparative study. We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included: diabetic retinopathy (25 eyes), and retinal vein occlusion (20 eyes). All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities (BCVA) were converted to the logarithms of the minimum angle of resolution (logMAR) for the statisitical analyses. Intraocular pressure (IOP), the logMAR BCVA and surgical complications were evaluated before and after surgery. The follow-up period was 12mo. RESULTS: A total of 39 cases showed complete regression of iris neovascularization at 7d after injection, and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12mo after trabeculectomy and AGV implantation, respectively. In the trabeculectomy group, the logMAR BCVA improved at the last follow-up in 14 eyes, remained stable in 6 eyes and decreased in 2 eyes. In 4 cases, slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group, the logMAR BCVA improved in 14 eyes, remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases, and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery (F=545.468, P<0.05), and the mean postoperative logMAR BCVA was also significantly improved (F=10.964, P<0.05) with no significant difference between two groups. CONCLUSION: It is safe and effective to treat NVG with this combined procedure, and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.

[The experimental study of effect of pressure on rat retinal Muller cell in vitro].

OBJECTIVE: To observe the changes of morphology, activity and ability of metabolizing glutamate in Muller cell and investigate the role of Muller cell in the damage induced by glaucoma. METHOD: Cultured Muller cells were divided into two groups at random, one was control group without any treatment, in the experimental group the cells were cultured under pressure of 50 mm Hg (1 mm Hg = 0.133 kPa) for 1 hour, after 3 days additional incubation, the morphology of the cells in two groups was observed by inverse phase microscope and electron microscope, the cells survival were evaluated by MTT colorimetry assay and the expression of mRNA of glutamine synthetase was semi-quantified by RT-PCR. RESULT: No obvious morphology changes were found by inverse phase microscope in the two groups, swelling mitochondrion and Vacuoles in cytoplasm were found in pressured group by electron microscope; the numbers of MTT reading and the mRNA expression in the cells under pressure were decreased, the differences was statistic significance compared with control (P < 0.05). CONCLUSION: Morphology changes were found in the cells under pressure, and the ability of metabolizing glutamate was decreased, which may be one of the reasons of the elevated level of glutamate in the vitreous of glaucoma patients.

[Reliability of successive automated static perimetry].

OBJECTIVE: The purpose of the present study was to explore the reliability of successive automated static perimetry in suspect and manifest glaucoma patients. METHODS: Retrospective investigation was performed on 82 glaucomatous eyes and 80 suspect glaucoma eyes which were tested twice or more during Aug 1994 and June 2000 with the Octopus 1-2-3 automated perimeter. False-positive response rate (FP), false-negative response rate (FN) and reliability factor (RF) were calculated and analyzed. RESULTS: According to the reference criterion provided by the manufacturer (Interzeag company), in suspect glaucoma patients, only 5.1% visual field test results (8 eyes) were unreliable, while the unreliable rate was 18.1% (20 eyes) in manifest glaucoma patients. FP, FN and RF all had highly skewed distributions in each subgroup of suspect and manifest glaucoma patients. The FN of each subgroup of manifest glaucoma patients was significantly higher than that of suspect glaucoma patients (P < 0.01). CONCLUSIONS: Automated perimetry can provide a reliable result in most suspect glaucoma eyes. A few unreliable results may be regarded as sporadic events. FN in glaucoma patients are related to the status of visual field defects.

Visual outcome following intraocular foreign bodies: a retrospective review of 5-year clinical experience.

PURPOSE: To determine the main prognostic factors related to final visual acuity (VA) after intraocular ocular foreign body (IOFB) extraction. METHODS: We performed a retrospective chart review of 80 patients (84 eyes) who underwent surgical removal of IOFBs and repair of associated ocular trauma. Data on age, gender, presenting clinical features, characteristics of IOFB, complications, interval between time of injury and IOFB removal, and final VA were recorded and analyzed. RESULTS: Male adults were the major population affected by IOFBs. Improved vision outcome was obtained after the removal of IOFBs and surgical repair of the eyes (p=0.011). Factors showing statistical association with final VA included initial VA (p=0.000), size of IOFB (p=0.010), IOFB location inside the eye (p=0.000), and preoperative retinal detachment (p=0.011). Factors showing no statistical association with final VA included nature of IOFB (p=0.445), entrance wound location, other IOFB-related complications (such as cataract, vitreous hemorrhage, secondary glaucoma, hyphema, endophthalmitis, siderosis, and atrophia bulbi), and interval between injury and IOFB removal. CONCLUSIONS: Prognostic factors for poor final VA related to IOFBs included poor initial VA, large IOFB size, posterior segment location, and preoperative retinal detachment.