Difference of anterior and posterior orbital development in patients with congenital microphthalmia: a retrospective cohort study from China.

AIM: To evaluate volume differences between anterior and posterior orbit and demographic characteristics of Chinese patients with congenital microphthalmia. METHODS: A retrospective cohort study, involving 169 unilateral congenital microphthalmia patients aged between 1 and 57 years old was conducted. Three-dimensional images of the orbit were generated from past CT scans, and digital orbital volume comprehensive measurement was done. The measured data included orbital volume (OBV), posterior orbital volume (POV), orbital width (OBW), orbital height (OBH), orbital depth (OBD), and posterior orbital area ratio. RESULTS: Significant differences were observed among OBV, POV, OBW, OBH, and OBD of the affected and unaffected eyes in different age-based groups (all P<0.001). Among them, OBH had the greatest different. The mean microphthalmic to contralateral ratio (MCR) of OBV, POV, OBW, and OBH continuously increased from 1 to 3 years old, whereas the MCR of POV decreased from 3 to 17 years old. The MCR of OBD was not found to be correlated to age. There was no significant difference between OBV, POV, OBW, and OBH in ages from 13 years old to adulthood (all P>0.05). The difference in posterior orbital area ratio between the affected and unaffected groups was not statistically significant (P>0.05). CONCLUSION: OBH is maximally affected, whereas OBD is minimally affected by microphthalmia. Posterior orbital retardation began 2y prior to orbital retardation and occurred at 3 years old in the affected eye, suggesting that intervention therapy should be done before the age of 4.

Tear-derived exosomal biomarkers of Graves' ophthalmopathy.

Graves' ophthalmopathy (GO), the most frequent extrathyroidal manifestation of Graves' disease (GD), can lead to a significant decline in the quality of life in patients. Exosomes, which contain proteins, lipids and DNA, play important roles in the pathological processes of various diseases. However, their roles in Graves' ophthalmopathy are still unclear. We aimed to isolate exosomes and analyze the different exosomal proteins. Tear fluids were collected from twenty-four GO patients, twenty-four GD patients and sixteen control subjects. The numbers of tear exosomes were assayed using nanoparticle tracking analysis. A Luminex 200 kit and ELISA kit were used to confirm the different cytokine concentrations in serum. Extraocular muscle from GO patients and controls was extracted, and western blotting was used to assay the levels of Caspase-3 and complement C4A. Our study demonstrated that the number of tear exosomes differ from GD patients and control. The expression levels of cytokines, including IL-1 and IL-18, were significantly increased in the tear exosomes and serum from GO patients compared with GD patients and controls. The levels of the exosomal proteins Caspase-3, complement C4A and APOA-IV were significantly increased in GO patients compared to GD patients and controls. Orbital fibroblasts from GO patients showed significantly higher levels of Caspase-3 and complement C4A than those from controls. The levels of serum APOA-IV in GO patients were significantly higher than those in GD patients and controls. Specific proteins showed elevated expression in tear exosomes from GO patients, indicating that they may play important roles in GO pathogenesis.

Comparison of ocular axis and corneal diameter between entropion and non-entropion eyes in children with congenital glaucoma.

BACKGROUND: Children with congenital glaucoma are often accompanied by acquired epiblepharon in the lower eyelid, which causes entropion of the lower eyelid and damages the cornea. AIM: To infer the possible causes of lower eyelid entropion by comparing the difference of ocular axis and corneal diameter between inverted and non-inverted ciliary eyes in children with congenital glaucoma. METHODS: A total of 15 patients (11 males and 4 females) diagnosed with congenital glaucoma between July 2016 and January 2019 at Tongren Hospital were included. Five patients had bilateral glaucoma, and ten had unilateral glaucoma. Each patient had only one eye with lower eyelid entropion which is associated with congenital glaucoma. All the patients had no entropion in another eye. The clinical data were collected. Main outcome measures were the ocular axis and corneal diameter. RESULTS: The average age of the 15 patients was 1.85 ± 0.49 years. Paired t-test showed that the average ocular axis of congenital glaucoma eyes with lower eyelid entropion (24.86 ± 3.44 mm) was significantly longer than that of congenital glaucoma eyes without lower eyelid entropion (20.79 ± 1.34 mm; P < 0.001). The average corneal diameter of congenital glaucoma eyes with lower eyelid entropion (13.61 ± 0.88 mm) was also significantly greater than that of congenital glaucoma eyes without lower eyelid entropion (11.63 ± 0.48; P < 0.001). CONCLUSION: The rapid growth of the ocular axis and corneal diameter may be the main cause of congenital glaucoma with acquired lower eyelid entropion. Therefore, children with poor control of intraocular pressure and excessive growth of ocular axis and corneal diameter must be observed for the existence of acquired epiblepharon.

Medial Canthoplasty Combined with Conjunctivodacryocystorhinostomy for the Treatment of Delayed Medial Telecanthal Deformity.

BACKGROUND: Rupture of the medial canthal ligament can be caused by many events. It remains a challenge to rebuild the drainage system and restore the function. The aim of this study was to evaluate the clinical efficacy of medial canthoplasty combined with conjunctivodacryocystorhinostomy (CDCR) in patients with medial telecanthal deformities and lacrimal drainage system damage. METHODS: Twenty-two patients (22 eyes) treated with medial canthoplasty and CDCR during June 2012 to June 2014 were included in this retrospective study. For all patients, a self-tapping, titanium, low-profile head microscrew was drilled into the solid bone on the posterior aspect of the anterior lacrimal crest at the attachment position of the medial canthal ligament. Medpor-coated tear drainage tubes were applied. Distance of patient's lateral displacement before and after operation was recorded and compared. The complications of CDCR were described. RESULTS: Before the surgery, distance of patient's canthal displacement was 4-6 mm. The canthal distance between two eyes of patients with surgery was 1 mm or less. Among patients with CDCR, four patients had proximal obstruction and two patients had distal obstruction. Five patients had tube malposition, for example, tube extrusion 1-3 months after surgery. CONCLUSIONS: Medial canthoplasty combined with CDCR is an effective surgical method for treatment of patients with medial telecanthal deformity and lacrimal drainage system obstruction. The study indicates that medial canthoplasty combined with CDCR surgery rebuilds normal appearance of eyelid and contour of the medial canthus and successfully repairs the function of the lacrimal drainage system.

[Clinical features of blepharochalasis and surgical treatment of associated deformities].

OBJECTIVE: To describe the clinical features of blepharochalasis and the effect of surgical treatment of associated deformities. METHODS: A retrospective study reviewed 54 patients (98 eyes) with blepharochalasis. The main features analyzed included sex, age of onset, duration and clinical signs. Surgical treatment for the correction of deformities includes blepharoplasty; resuspension of the prolapsed lacrimal gland, ptosis repair, surgical correction of lower eyelid retraction and lateral canthoplasty. Follow-up ranged from 6 to 60 months. RESULTS: The average age of onset was 9.3 years. The duration in all 54 patients (32 females and 22 males) lasted for 2 - 16 years and different periorbital deformities were presented. After surgical repair, all patients were satisfied with their bilateral symmetrical creases in upper eyelids and the contour of upper eyelids. The appearance of floppy eyelids has been improved distinctly. The lateral canthus moved to the normal position. No patients complained epiphora or dry eye symptoms. Prolapse of the lacrimal gland recurred in two patients (three eyes). They underwent reoperation with no further recurrence. Overcorrection in blepharoptosis surgery of five patients was fixed with suture adjustment of the levator aponeurosis. CONCLUSIONS: Blepharochalasis onset often occurs around age 10 years and stabilizes till adolescence. Since it involves bilateral or unilateral, local eye tissues or periorbital tissues, clinical manifestations may vary in blepharochalasis. Ophthalmic plastic surgery to correct blepharochalasis and its associated deformities in the quiescent stage is usually safe and with satisfactory cosmetic effects.

[Efficacy of reconstruction for congenital microphthalmos].

OBJECTIVE: To investigate the therapeutic procedures and their efficiencies for the treatment of congenital microphthalmos during or after the developing period. METHODS: It was a retrospective case series study. Eighteen cases with congenital microphthalmos, aged less than 12 years, underwent self inflating osmotic hydrogel expanders. Among them, 11 cases were treated by implantation with sphere self-inflating hydrogel expanders into the retrobulbar space and 5 cases had implantations into the conjunctival socket. The remaining 2 cases were treated with implantation of injectable self-inflating hydrogel pellet expanders. Twenty eight cases with congenital microphthalmos, aged more than 12 years, accompanied with other deformities, were treated with proper reconstruction surgery. Fourteen cases were treated with medial canthoplasty, 12 cases were treated with medial and lateral canthoplasty, 3 cases were treated with ptosis correction and medial or lateral canthoplasty and 2 cases with socket reconstruction. T-test was used for the comparison between groups. RESULTS: Sixteen cases obtained satisfactory results without any complications. In one case, the hydrogel expanders migrated inferiorly in the orbit and underwent adjustment. In another case, although the hydrogel expander prolapsed from the socket, the socket was still expanded. In the developing period, the length of palpebral fissure was (15.83 ± 1.87) mm before the operation, and that made much wider after the operation (18.67 ± 1.74) mm. There were statistically significant differences between them (t = -4.029, P = 0.01). The height of palpebral fissure was (1.33 ± 0.67) mm and (6.00 ± 0.58) mm before and after the operation, respectively, which were statistically significant (t = -5.813, P = 0.00). Patients who aged more than 12 years and underwent eyelids and eye socket reconstruction, also obtained satisfactory appearance. CONCLUSION: Patients with congenital microphthalmos could obtain the development of orbit and satisfactory appearance by reconstruction treatment according to different period of development.

Treatment of retinal vein occlusion in rabbits with traditional Chinese medicine Fufang XueShuan Tong.

BACKGROUND: Retinal vein occlusion (RVO) is one of the most common causes of visual loss. Many approaches have been tried to treat central retinal vein occlusion (CRVO), and branch retinal vein occlusion (BRVO) with various results. However, there is no defined protocol and limited evidence to support the interventions currently used. The aim of this study was to assess the efficacy of the traditional Chinese medicine Fufang XueShuan Tong (FXST) in treating experimentally created RVO. METHODS: RVO model was first induced in forty-four pigmented rabbits through photocoagulation following injection of rose Bengal. The rabbits were divided into four groups based on the dose of FXST administered (212 mg/kg, 424 mg/kg, 848 mg/kg and control group). The rabbits were observed for four weeks after the procedure, using color fundus photography, fundus fluorescein angiography and electroretinogram examination. Vascular endothelial growth factor (VEGF), interleukin-6 and nitric oxide (NO) levels in the vitreous and histopathologic evaluation were monitored. RESULTS: The obstructed vessels in the treatment groups reopened or anastomosed faster than those in the control group (P < 0.05). The amplitude of maximum b wave and the oscillatory potential were significantly higher in the treatment groups than in the control group (P < 0.01). At both two weeks and four weeks, VEGF and IL-6 levels in the vitreous were significantly decreased in the treatment groups (P < 0.01), while NO levels were significantly elevated (P < 0.01). At the same time, histopathologic evaluation showed different retinal neuroepithelium structures in the different groups. Immunoreactivity of VEGF was greater in the control group than in the treatment groups. CONCLUSION: FXST was helpful in reconstructing retinal vessels in the RVO model, protecting retinal structures and improving visual function, and could inhibit the neovascular factor.

[Risk factors and prognosis of peripheral retinal breaks complicating pars plana vitrectomy].

OBJECTIVE: To assess the risk factors and prognosis of peripheral retinal breaks complicating pars plana vitrectomy. METHODS: Retrospective observational case series. Four hundred and four consecutive vitrectomies performed on eyes without preexisting retinal breaks or retinal detachments were retrospectively reviewed. Cases with peripheral retinal breaks found during or after the vitrectomy were recorded and analyzed. RESULTS: Of the 404 vitrectomies, 32 eyes had 55 iatrogenic peripheral retinal breaks with an average incidence of 7.9%. Peripheral retinal breaks were most common in cases with branch retinal vein occlusion (BRVO) (13.3%) and less common in proliferative diabetic retinopathy (PDR) (3.7%) (chi2 =9.18, P<0.01). Of the 55 breaks, 51 (92.7%) occurred around the sclerotomy sites, and 29 (52.7%) in the quadrant corresponding to the predominant hand of the surgeon. Cases with breaks detected during surgery had a better outcome of retinal reattachment as compared with cases identified postoperatively. CONCLUSIONS: Peripheral retinal breaks complicating pars plana vitrectomy is mainly sclerotomy-related and is more common in cases with BRVO than in cases with PDR. Early detection during surgery tends to have a better outcome.