[Surgical treatment for correcting abnormal complicated head posture in nystagmus].

OBJECTIVE: To demonstrate the surgical choices for patients with complicated head posture associated with nystagmus. METHODS: It was a retrospective clinical study. Thirty-eight cases of congenital nystagmus with abnormal head posture in all three axes without strabismus were retrospectively analyzed. Twenty-nine(76.32%) cases whose dominant head posture were with face turn, 3 cases (7.89%) with chin up or down , respectively, were performed horizontal null zone shift as well as vertical null zone transposition; 2 cases (5.26%) with head tilt as the dominant position were underwent one tendon width transposition of all four vertical muscles;4 cases (10.53%)basically with the same degree for face turn and chip up or down, 2 cases were preferred with recess a group of horizontal yoke muscles and a group of vertical yoke muscles, the other 2 cases were combined with weaken both synergistic oblique muscles. SPSS 13.0 was used to analyse the difference of them. RESULTS: In 29 patients with horizontal head posture dominanted, 15 cases (68.18%) with 25 °-30 ° in horizontal head posture were corrected completely, 5°-15° was the residue for 7 cases (31.82%) with 35 °- 40 °degree in horizontal before surgery. 15 °-20° was residue for 3 cases larger than 40 ° before operation after modified Parks procedure. Anderson procedure can correct the angle of 15°-20° in 4 cases. The horizontal, vertical and torsional components of 22 cases whose predominant head posture were in horizontal with 25°-40° (3.18° ± 1.01°, 4.32° ± 1.14°, 4.55° ± 1.95°) were significantly reduced (t = 63.13, 3.57, 3.95;P < 0.01) after Parks procedure. Recession a group of vertical muscles 5mm or combined with oblique muscles in 3 patients could correct the 20° of vertical head posture, but the improvement of the other two axes was about 5°-10°.One tendon width transposition of all four vertical muscles in 2 cases could correct the 10° of head tilt and 10°-15°of chip up or down. Recession a group of horizontal and vertical muscles can correct 20°-25° of face turn and 20° of vertical head posture. CONCLUSIONS: When head turn with 25°-40°predominates over the vertical and torsional components, recess the horizontal muscles could be effective way in diminishing the abnormal head position on all three axes.When vertical or torsional head posture predominates for the complicated nystagmus, individual designs should be considered.When necessary, reoperations should be needed.

Small interference RNA targeting vascular endothelial growth factor gene effectively attenuates retinal neovascularization in mice model.

BACKGROUND: The mechanism of retinal neovascularization is not understood completely. Many growth factors are involved in the process of retinal neovascularization, such as vascular endothelial growth factor (VEGF) and pigment epithelium-deprived factor (PEDF), which are the representatives of angiogenic and antiangiogenic molecules respectively. Oxygen induced retinopathy (OIR) is a useful model to investigate retinal neovascularization. The present study was conducted to investigate the feasibility of small interference RNA (siRNA) targeting VEGF gene in attenuating oxygen induced retinopathy (OIR) by regulating VEGF to PEDF ratio (VEGF/PEDF). METHODS: In vitro, cultured EOMA cells were transfected with VEGF-siRNA (psi-HI(TM)/EGFP/VEGF siRNA) and Lipofectamine(TM) 2000 for 24, 48, and 72 hours, respectively. Expression of VEGF mRNA was evaluated by real time polymerase chain reaction (PCR) and the level of VEGF protein was analyzed by Western blotting. In vivo, OIR model mice were established, the mice (C57BL/6J) received an intra-vitreal injection of 1 µl of mixture of psi-HI(TM)/EGFP/VEGF siRNA and Lipofectamine 2000. Expressions of retinal VEGF and PEDF protein were measured by Western blotting, retinal neovascularization was observed by fluorescein angiography, and quantified. RESULTS: In vitro psi-HI(TM)/EGFP/VEGF siRNA treatment significantly reduced VEGF mRNA and protein expression. In vivo, with decreased VEGF and VEGF-PEDF ratio, significant attenuation of neovascular tufts, avascular regions, tortuous, and dilated blood vessels were observed in the interfered animals. CONCLUSIONS: VEGF plays an important role in OIR, and the transfection of VEGF-siRNA can effectively downregulate VEGF expression in vivo, accompanied by the downregulation of VEGF-PEDF ratio, and simultaneous attenuation of retinal neovascularization was also observed. These findings suggest that VEGF/PEDF may serve as a potential target in the treatment of retinal neovascularization and RNA interference targeting VEGF expression, which represents a possible therapeutic strategy.

[Effects of bone marrow mesenchymal stem cell transplantation on retinal cell apoptosis in premature rats with retinopathy].

OBJECTIVE: To explore the effects of marrow mesenchymal stem cell (BMSC) transplantation on retinal cells apoptosis and changes to neurotrophin-3 (NT-3 and ciliary neurotrophic factor (CNTF) in rats with retinopathy of prematurity (ROP). METHODS: Seven-day-old Sprague-Dawley rats were randomly divided into normal control (CON), ROP, BMSC transplantation (BMSCs were transplanted 5 days after oxygen conditioning) and phosphate buffered saline (PBS) groups. The ROP model was prepared according to the classic hyperoxygen method. Seven days after transplantation, TUNEL/DAPI, NT-3/API and CNTF/DAPI double-labeled immunofluorescence were used to examine the effects of BMSC transplantation on both the apoptosis of retinal cells and the expression of NT-3 and CNTF protein in the retinal cells of the ROP rats. RESULTS: Seven days after BMSC transplantation, there were few TUNEL+ DAPI+ cells observed in the CON group. There were fewer TUNEL+DAPI+ cells observed in the BMSC group than in the ROP group (P<0.01), but there was no significant difference between the ROP and PBS groups (P>0.05). There were few NT-3+DAPI+ cells and CNTF+DAPI+ cells in the CON group. There were more NT-3+DAPI+ and CNTF+DAPI+ cells in the ROP group than in the CON group, but there was no significant difference between the ROP and CON groups (P>0.05). More NT-3+DAPI+ and CNTF+DAPI+ cells were observed in the BMSC group compared with the ROP group (P<0.01), and there was no significant difference in either NT-3+DAPI+ or CNTF+DAPI+ cells between the ROP and PBS groups (P>0.05). CONCLUSIONS: BMSC transplantation therapy could alleviate the apoptosis of retinal cells in ROP rats, and its mechanisms might be associated with promoting the expression of NT-3 and CNTF protein in retinal cells.

[Recession of both horizontal rectus muscles in Duane Retraction Syndrome with significant globe retraction].

OBJECTIVE: To evaluate the effect of Recession of both horizontal rectus muscles in Duane Retraction Syndrome with significant globe retraction. METHODS: Sixteen cases with DRS were summarized retrospectively. All patients had undergone surgery with recession of both horizontal rectus muscles. All clinical records, including sex, age, types of DRS, clinical features, surgical methods and clinical outcomes were analyzed. All patients were followed up for 3 months to 1 year. RESULTS: Fifteen cases had only monocular involvement while one had both eyes. The number of type I DRS was 3 cases, 1 case was esotropia while others were orthotropic in primary position. Type III DRS was observed 13 cases. Esotropia was seen in 6 cases (7 eyes), exotropia of 1 cases and orthotropic in primary position of 6 cases. 10 cases exhibited marked face turn. An upshoot or downshoot and variable severity of retraction of globe were found in all patients on attempt adduction of the affected eye. All patients had undergone surgery with recession of both horizontal rectus muscles. The medical rectus muscles were recessed from 5 mm to 7 mm and lateral rectus muscles 3 mm to 9 mm simultaneously, which was based on the amount of primary position deviation. Among these 2 cases were combined with Y-splitting of lateral rectus muscle. After surgery, all patients were orthotropic in primary position. Their symptom of unacceptable abnormal head position, significant globe retraction, noticeable narrowing of the palpebral fissure and significant upshoot or downshoot were ameliorated or disappeared. Especially the recession of lateral rectus muscle in addition to Y-splitting combining with the simultaneous medial rectus recession resulted in further amelioration of globe retraction in addition to upshoot and downshoot. CONCLUSION: Recession of both horizontal rectus muscles is effective in the treatment of significant globe retraction in Duane syndrome. Type III DRS with significant globe retraction but has no marked deviation and face turn can adopt this method to ameliorate their aspect. The method of lateral rectus muscle in addition to Y-splitting plays an important role in the treatment of upshoot and downshoot.

Vertical deviation and A pattern of type III Duane retraction syndrome.

BACKGROUND: Researches in ocular electromyography (EMG) and Magnetic resonance imaging (MRI) of patients with Duane retraction syndrome (DRS) suggest that there may be additional abnormalities such as paradoxical innervation between horizontal rectus muscles and vertical rectus muscles, hypoplasia of vertical rectus muscle and that oblique muscles may also contribute to the heterogeneity of the clinical manifestation of DRS. This paper reports the results of superior rectus recession for vertical deviation and A pattern in DRS Type III and discusses the pathogenesis of the disease. METHODS: Superior and lateral rectus recession were performed in 5 cases of Huber type III DRS to treat vertical deviation and A pattern strabismus. Before operation, MRI of the brain, brainstem, cavernous sinus, and orbits were performed. RESULTS: All subjects had unilateral limitation of both abduction and adduction, with palpebral fissure narrowing and globe retraction in adduction. Three cases had A pattern of strabismus, three cases had hypertropia. The abducens nerves (CN6) were either absent or hypoplasitic in the brainstem in all patients. Two eyes had larger oculomotor foramen. Two eyes had hypoplasia of the superior rectus and the inferior rectus. There was presumably a branch of the third cranial nerve (CN3) innervating the lateral rectus (LR) in one eye. While in another eye, two branches of CN3 sent into medial rectus were revealed. After surgery, vertical deviation in the primary position was reduced in all patients and A pattern was eliminated in 3 patients. One patient developed 10Δ consecutive esotropia postoperatively. CONCLUSION: The results suggest that structural abnormalities of vertical muscle and abnormal orbital innervation may be related to vertical deviation and the presence of A pattern in DRS type III. Recession of the superior rectus muscle seems to be a safe and effective treatment for vertical deviation and A pattern strabismus in DRS Type III.

[Exploration of using microscope in strabismus surgery in China].

The opening of time of microsurgery by introduction of operation microscope into ophthalmic surgery rendered the coming of a new era of modern cataract surgery and vitreous surgery. However, after this time goes through half a century, telescopic loupes are still been advocated by most surgeons internationally. Is microsurgery a patent only for use in intraocular operations? Although an earliest exploration of using microscope in strabismus surgery in China was reported in the 90 s that discussed the technique of rectus ciliary vessel separation under microscope, no more followed after that. Since this century, some experts often as intraocular surgeons and some young doctors with background of microscopic training continued persistence in the exploration of microscopic strabismus surgery. During this process, the council of strabismus and pediatric ophthalmology of COS has been engaged in guiding its healthy development, unearthing its value in strabismus surgery and pursuing the raise of operation quality. This issue was hotly communicated and discussed at the 14 th national meeting of strabismus and pediatric ophthalmology held in Jinan in June, 2011. This article summarized the goal and the importance of microscopic strabismus surgery and suggested the measures for the healthy development of microscopic strabismus surgery according to the current status.

[Surgical treatment of myopic strabismus fixus by modified Yokoyama's surgery].

OBJECTIVE: To evaluate the surgical results of modified Yokoyama's procedure for treating myopic strabismus fixus. METHODS: Retrospective analysis of records of 5 patients (7 eyes) with high myopic strabismus. Pre- and postoperative orthoptic measurements were recorded and analyzed. Anatomic relationships between the muscle cone and globe were analyzed using MRI or CT scan. The surgical procedure is a modification of Yokoyama's technique and medial rectus muscle was also recessed. RESULTS: The average axis length of 7 eyes was 32.62 mm (SD1.84). The mean preoperative horizontal deviation was 82.86 PD (SD 37.62) esotropia and mean vertical deviation was 20 PD (SD 7.91) hypotropia. All patients had marked limitation of elevation and abduction. Displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by CT or MRI scan of the orbits and by observation during surgery. After surgery, the supertemporal dislocation of globe was improved. Both the horizontal and vertical deviations decreased significantly, and the abduction and sursumduction motility were also improved gradually. The average follow-up was 5 months, all patients achieved satisfactory results and remained stable. CONCLUSIONS: In high myopic patients, if the deviant paths of the LR and SR muscles were demonstrated by MRI or CT scan, the surgical procedure to restore the dislocated globe back into the muscle cone by uniting muscle bellies of the superior rectus and lateral rectus muscles is effective and recommended.

[Molecular genetics advances of congenital idiopathic nystagmus].

Congenital idiopathic nystagmus (CIN) is genetically heterogeneous. Autosomal dominant, autosomal recessive and X-linked patterns of inheritance have described. At least three distinct loci are related to autosomal dominant and X-linked patterns. One causative gene for X-linked form has been identified (FRMD7, Xq26.2) through linkage analysis. The molecular genetics advances of the congenital idiopathic nystagmus (CIN) are reviewed.

[The progress of intermittent exotropia].

Intermittent exotropia is a type of strabismus between exophoria and constant exotropia. The onset age is usually one to four years old. Different from other types of strabismus, intermittent exotropia patient can maintain normal binocular vision in a long period of time. So how to choose the optimal timing and effective treatment is a challenge for clinicians. The objective of this article is to review the recent research progress of intermittent exotropia, including the severity classification, non-surgical treatment, timing of surgery and surgical methods, overcorrection and under correction treatment etc., and give some recommendations for the treatment of intermittent exotropia.

[Retrospective study on clinical characteristics and surgical treatment of bilateral DRS].

OBJECTIVE: To investigate the clinical characteristics and surgical treatment of bilateral Duane retraction syndrome. METHODS: To collect 24 cases with bilateral DRS among 123 cases with DRS from hospital data during 2005.7 to 2009.11. Retrospective study included the clinical types, characteristics, plus diseases and surgical treatments. RESULTS: Fourteen male cases (58.3%) and 10 female cases (41.7%), aging 2 to 23-year-old. 16 cases were type I (66.7%), 1 case was type II (4.2%). 7 cases were type III (29.1%), in which patients with esotropia or exotropia were 3 and 4 cases respectively. 11 cases had up- or down-shoot pre-operation, which disappeared or improved post-operation in 8 cases (73%). 15 cases had abnormal head posture (AHP) and AHP disappeared or improved in all. Seven cases (29%) were associated with other congenital ocular or systemic anomalies. For horizontal deviation, unilateral medial or lateral rectus weakening procedures were performed in 13 cases and bilateral procedures in 11 cases. Post-operation, horizontal deviation was less than ± 10(Δ) in 21 patients (91%), 1 case was under-corrected and 2 cases were overcorrected. Simultaneously, the restriction of ocular motility and global retraction were improved in all the patients. Additional vertical or oblique muscle procedures were performed in 4 patients among 7 with vertical deviation more than 10(Δ) and up- or down-shoot. CONCLUSIONS: Bilateral DRS has more frequency in male, obviously horizontal deviation in primary position and more cases with vertical deviation which is related with up- or down-shoot phenomenon. The key point for successful surgery are forced duction test pre- and during operation to conform to relieve the mechanical factor and estimating abnormal innervation in horizontal and vertical rectus.

[To expand the grand prospect of Chinese Journal of Ophthalmology following the fine tradition].

When we celebrate the diamond jubilee of Chinese Journal of Ophthalmology (CJO), we also reviewed its past and prospected its future. Under the effort by the editorial members and the great majority of ophthalmologists for sixty years, CJO has become the most authoritative and academic journal in ophthalmology in China, and has formed the fine tradition of "to respect the profession, to believe the truth and to advance bravely". At present, CJO has a basis to further become the most authoritative academic journal in ophthalmology not only in the domestic but also in the world. For realizing the grand prospect, we should do more arduous effort for facing the all kind of the challenges in our ways forward; we should let the editorial committee to play the full role in our work; we should continue to raise the professional level of all editorial personnel; we should make great efforts to find and edit more and more articles with the high quality; we should observe the morals and ethics for editorial personnel; we should hear and accept the opinions, suggestions and criticisms; we should strength the international cooperation and communication.

[Progress in research of pediatric ophthalmology and strabismus in China in past 5 years].

In the past 5 years of the new century, with the development of national power and the accompanied increase of international academic communication, the researchers and clinical scientists of pediatric ophthalmology and strabismus in China actively participated in the international academic communication and competition and made great achievements. Many excellent works of clinical studies or basic researches in this field were recognized by the academic community of the world. Young ophthalmologists in pediatric ophthalmology and strabismus have been trained and well developed. The position of Chinese pediatric ophthalmology and strabismus in the global academic community has been moved up gradually.

[The anti-thyroid drug methimazole aggravated neovascularization in the oxygen-induced retinopathy rat model of ROP].

OBJECTIVE: To determine the effect of methimazole (MMI) on retinal vascular development in the oxygen-induced retinopathy neonatal rat. METHODS: It was an experimental study. Control and MMI-exposed newborn rats were raised either in room air or variable oxygen (40%/15%) every 24 hours until P14. All groups were then exposed to room air between postnatal day P14 and P18. Dams drank either tap water or water containing 0.1% MMI. Eyes in all groups were fixed, and retinas were dissected and stained with adenosine diphosphatase, then analyzed for retinal vascular areas, vascular density, and NV incidence and severity. Serum IGF-1 level was measured by radioimmunoassay. Body weight were measured every day. NV incidence between groups were analyzed with Chi-square tests. Ratio of peripheral avascular area to the whole retina area, vascular density, the nucleus of vascular endothelial cells breaking inner limiting membrane count and Serum IGF-1 level between groups were tested by One-Way ANOVA analysis and independent-samples t-test. RESULTS: Compared with untreated 40%/15% pups, 40%/15% newborn rats receiving MMI exhibited significant changes in NV incidence (26%:57%, χ(2) = 4.38 P = 0.04) and the nucleus of vascular endothelial cells breaking inner limiting membrane count (33.17 ± 3.06:65.64 ± 3.85, t = 17.73, P = 0.00). Ratio of peripheral avascular area to the whole retina area of MMI treated 40%/15% rats was 6.37% ± 1.23%, and the development of retinal blood vessels in other groups reached periphery. Retinal NV was not found in MMI control retinas, although retinal vascular density was significantly lower (P < 0.05) in MMI-treated pups (52.57 ± 4.14) than in the control group (95.21 ± 6.17). Serum IGF-1 levels were markedly (P < 0.05) reduced in MMI treated control rats (235.94 ± 29.09) mg/L compared with untreated control animals (536.43 ± 32.65) mg/L and in MMI treated 40%/15% rats (227.24 ± 19.59) mg/L compared with untreated 40%/15% group (526.50 ± 26.83) mg/L. Compared with non-MMI pups, newborn rats receiving MMI exhibited significant growth retardation in body weight. CONCLUSIONS: MMI aggravates NV in oxygen-induced retinopathy neonatal rats. This may be mediated by the initial suppression of serum IGF-1. The relationship between the temporal course of serum IGF-1 and NV in immature retinas needs further investigation.

[Research on the visual performance and effects of higher order aberration after Epi-LASIK for myopia].

OBJECTIVE: To investigate changes of visual performance and effects of higher order aberration on visual performance after Epi-LASIK for myopia. METHOD: In this prospective study, 102 patients were included. The trial group had 52 patients with Epi-LASIK, and 50 cases with LASIK as the control group. Ocular higher order aberrations were measured with the Hartman-shack wavefront analyzer, and high (100%), moderate (25%), low contrast (10%) and very low contrast (5%) visual acuity with and without glare were measured with Multi-Function Visual Acuity Tester under mesopic condition preoperatively and 4 - 6 months after surgery. 35 subjects in Epi-LASIK and 33 cases in LASIK were followed up 4 - 6 months later. Paired t test were used to analyze different contrast visual acuity before and after Epi-LASIK. Multiple linear regression analysis was performed to find the explanatory aberrations which contributed to the visual acuity. The Pearson correlation was used to explore the correlation between high- and low-contrast visual acuity and the explanatory higher order aberrations. The independent t test was used to analyze the difference of refraction power and visual acuity between Epi-LASIK and LASIK. RESULTS: There were significantly statistical differences at 5% and 10% contrast level compared to preoperation with glare and with no glare. With no glare, the mean logMAR visual acuity at 5% and 10% contrast level were 0.32 + or - 0.14 and 0.21 + or - 0.12 preoperatively, and 0.47 + or - 0.15 and 0.33 + or - 0.16 postoperatively (t = -4.863, 3.950; P = 0.000, 0.000). With glare, the mean logMAR visual acuity were 0.37 + or - 0.20 and 0.22 + or - 0.13 preoperatively, and 0.46 + or - 0.18 and 0.30 + or - 0.17 postoperatively (t = -1.949, -2.283; P = 0.047, 0.029). Using stepwise multiple linear regressions to evaluate which higher order aberration was significantly associated with each contrast VA. For each order RMS, S(4) was positive correlated with 5% contrast visual acuity (r(2) = 0.282;P = 0.025); S(4) was positive and S(5) was negative correlated with 10% contrast visual acuity (r(2) = 0.192;P = 0.033). None of the higher order RMS can significantly affect the 25% and 100% contrast visual acuity. For each Zernike coefficients, C(4)(0) and C(6)(4) were positive correlated with 5% contrast visual acuity (r(2) = 0.233; P = 0.024); C(4)(-4) was negative, C(4)(0) and C(5)(-5) were positive correlated with 10% contrast visual acuity (r(2) = 0.289; P = 0.013); None of Zernike coefficients had a significant correlation with 25% and 100% contrast visual acuity. The Pearson correlated coefficients between S(4), C(4)(0) and each contrast visual acuity increased as the contrast level decreased. S(4) and C(4)(0) were associated significantly with 5% contrast visual acuity, the correlation coefficients were 0.378 and 0.390 (P = 0.025 and 0.021). The visual acuity under 100% contrast with no glare was a little poorer than in LASIK. CONCLUSIONS: At the early stage after Epi-LASIK, the visual acuity for lower contrast level was worse compared to preoperative with glare and with no glare. Spherical aberration and the spherical-like aberration may contribute to this.

[Visual quality evaluation on changes of MTF and wavefront aberration after laser in situ keratomileusis].

OBJECTIVE: To investigate the changes of the Modulation Transfer Function (MTF) and its effect on visual and optical quality with or without low and higher order wavefront aberration after conventional and wavefront guild laser in situ keratomileusis. METHODS: It was a comparative case series. An aberrometer with Hartmann-shark sensor was used to measure the monochromatic aberration of eyes. One hundred and two cases entered the study; 38 cases were randomized to LASIK and 64 were randomized to WFG-LASIK. MTFs of optical system were calculated at various pupil size (3, 4, 5 and 6 mm) respectively and compared pre and 3 month postoperatively between conventional and wavefront guide ablation with or without higher order aberration. RESULTS: There was a significant increase in MTF positively compared with preoperative values at all spatial frequency (5-60 cycles per degree, c/d ), P < 0.05. MTF values got more improvement without spherical aberration than without coma aberration after LASIK surgery and there was significant different at a spatial frequency of 5 c/d. Higher MTFs were showed in the WFG-LASIK group although there were no significant difference between conventional LASIK group and WFG-LASIK group. However, there were apparently changed without high order aberration as compared to that with high order aberration at all spatial frequency (5-60 c/d. ) in WFG-LASIK group and higher MTFs were showed in the WFG-LASIK group compared with conventional LASIK group and there were significant different (P < 0.05) by calculation and evaluation. CONCLUSION: Spherical aberration have more negative role on visual quality than coma aberration after LASIK surgery. With the optical benefits expected from correcting higher aberration, wavefront guide ablation have shown a great benefit for low and high order aberration but it still leave a small amount of high order aberration and need further investigation. MTF is a sensitive and extensive in demonstrating the optical quality in refractive surgery.

[Expression of vascular endothelial growth factor and pigment epithelium derived factor in mouse oxygen-induced retinopathy and its significance].

OBJECTIVE: To investigate the expression and significance of vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) in oxygen-induced mouse retinopathy. METHODS: This experiment was a control experiment study. Newborn C57BL-6 mice were exposed to hyperoxia, and then returned to normoxia to induce retinal neovascularization. Mice were sacrificed at postnatal days 12, 14 and 17 and the retina were processed for RT-PCR, Western Blot and fluorescein angiography. Analysis of variance and Dunnett's t3 was used to compare the mRNA and protein level of VEGF and PEDF between experiment and control groups. Statistical difference was considered significant at a P value less than 0.05. RESULTS: At any of the time points tested, there was significant difference at VEGF protein level (A value) between the experiment (0.47 +/- 0.12, 2.15 +/- 0. 46, 5.49 +/- 0.97) and control (l.81 +/- 0.50, 0.90 +/- 0.05, 0.88 +/- 0.91) groups (P = 0.009, 0.010, 0.000, respectively); the same situation occurred at PEDF protein level (P = 0.002, 0.046, 0.000, respectively). At postnatal day 12, 14 and 17, a significant difference at VEGF protein level was observed among the different experiment groups (P = 0.002, 0.001, 0.000, respectively); the same situation occurred at PEDF protein level (P = 0.009, 0.010, 0.000, respectively). There was significant difference at VEGF mRNA level between the experiment and control groups (P = 0.001, 0.000, 0.001); at postnatal day 12 and 14, the same situation occurred at PEDF protein level (P = 0.001, 0.000, respectively), but there was no significant difference at postnatal day 17 (P = 0.612). At postnatal day 12, 14 and 17, a significant difference at VEGF mRNA level was observed among different experiment groups (P = 0.000, 0.001, 0.000, respectively); the same situation occurred at PEDF mRNA level (P = 0.000, 0.001, 0.000, respectively). The time course of the decrease of PEDF was consistent with the increase of VEGF expression. VEGF/PEDF ratio change was correlated with the development and progression of retinal neovascularization. The time course of PEDF mRNA down-regulation was consistent with the VEGF mRNA up-regulation, similar with the changes of the protein. The change of VEGF and PEDF mRNA was prior to that of the protein. CONCLUSIONS: One of the mechanisms for development of retinal neovascularization is the changes of VEGF\PEDF level in the retina.

[A novel mutation in the myocilin gene identified in a Chinese primary open angle glaucoma family].

OBJECTIVE: To determine the possible myocilin molecular genetic defect underlying POAG in China and to identify the pathogenic mutation causing the disease. METHODS: The majority of 1 branch of a large Chinese POAG family were personally examined by two senior ophthalmologists. The diagnoses were made by both doctors according to the signs of elevated intraocular pressure, glaucomatous optic neuropathy and glaucomatous visual field defect. All coding sequences of the myocilin gene plus the flanking sites were amplified by polymerase chain reaction (PCR) using genomic DNA from all examined family members followed by sequencing of the PCR products. One hundred normal control subjects were screened by single strand confirmational polymorphism analysis for the mutation. RESULTS: This Chinese pedigree exhibited autosomal dominant mode of inheritance. The onset age ranged from 26 to 59 years. A novel disease-causing missense mutation T455K in the third exon of the myocilin gene was identified in all affected family members, all glaucoma suspects and 4 individuals who have not shown apparently signs of glaucoma. None of the subjects without the mutation had glaucoma. Affected individuals with the T455K mutation showed variable onset between 26 and 59 years of age. Filtering surgery was performed on all of 7 affected family members. The T455K mutation in myocilin gene was not found in the normal controls. A previously reported polymorphism IVS2+35(A to G)was detected in 4 individuals. CONCLUSION: The novel myocilin sequence alteration T455K that is highly associated with the development of glaucoma and locates in a very conserved residue is proven to be a disease-causing missence mutation. All affected individuals and all POAG suspects in this family are identified to have this mutation. The mutation in this family is associated with a phenotype characterized by mix-onset open angle glaucoma and associated with a high penetrance. It is important for the mutation screening and periodical checkups of presymptomatic individuals belonging to the family of a POAG patient with T455K mutation.

Ocular higher-order aberrations features analysis after corneal refractive surgery.

BACKGROUND: The recent studies have shown that visual performance might be affected by the ocular aberration after the corneal refractive surgery, and try to minimize it. This study was to investigate the effects of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) on the higher order of wavefront aberration and analysis of their characteristics. METHOD: This prospective study involved 32 eyes with similar refractive powers (-5.0 D to -6.0 D preoperatively). LASIK and PRK were performed with the same parameters of 6 mm diameter optical zone and 7 mm diameter transition zone ablation. Wavefront aberrations were tested using a ray tracing technique preoperatively and 3 months postoperatively. Three measurements were obtained for each condition; the root mean squared wavefront error (RMS), values for overall wavefront aberrations and each order of the Zernike aberrations were analyzed using the Matlab software. The 2-tailed t test was used for statistical analysis. RESULTS: Overall higher order aberrations were increased from (0.550.26) microm preoperatively to (0.930.37) microm for PRK and (0.790.38) microm for LASIK postoperatively. This was a 1.69 fold increase in the PRK group (t = 3.95, P < 0.001) and a 1.43 fold increase in the LASIK group (t = 2.60, P < 0.05). At 3 months, the mean RMS value for higher-order (3rd to 6th) were significantly increased compared with the corresponding preoperative values (P < 0.05). The fourth order aberrations, spherical like aberration, were dominant by a 2.64 fold in PRK and a 2.31 fold in LASIK. Different influences of the PRK group and LASIK group were shown in the various zernike components. The statistically significant differences were seen in C(4)(0), C(4)(+4), C(5)(+1), C(5)(+3), C(5)(+5) and C(6)(+2) of the PRK group and C(3)(-3), C(4)(0), C(5)(-5), C(5)(+5), C(6)(-2) of the LASIK group, which represents a 7.42, 3.58, 9.21, 2.72 and 5.3 fold increases in PRK group, and 6.40, 10.80, 11.06, 3.47 and 6.09 fold increases in LASIK group, respectively. C(3)(-3) in LASIK was higher and C(5)(+1) and C(5)(+3) were lower than those in the PRK group. C(4)(0) (spherical aberration) values were similar between PRK and LASIK, however, C(3)(-1) and C(3)(1) (coma) in LASIK were higher than those in PRK, but these differences are of no statistical significance. CONCLUSIONS: PRK and LASIK may increase ocular higher-order aberrations, but they both have their own features. The difference between the two types of surgery may be correlated with the change of the corneal shape, the conversion of biodynamics, the healing of the corneal cut, and re-structured corneal epithelium and/or the stroma.