[The effect of descemet-stripping automated endothelial keratoplasty combined with phacoemulsification cataract surgery or lens exchange].

OBJECTIVE: To evaluate the effect and explore the complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification cataract surgery or lens exchange in corneal endothelial dysfunction eyes with lens disorders. METHODS: Retrospective case series. Eighteen consecutive cases (20 eyes) were performed DSAEK combined with lens surgery from December 2007 to December 2008 in Department of Ophthalmology, Peking University Third Hospital. Five cases (7 eyes) were performed DSAEK combined with phacoemulsification and intraocular lens (IOL) insertion. Seven cases were combined with anterior chamber IOL extraction, anterior vitrectomy and posterior chamber IOL insertion. Six aphakia cases were performed with DSAEK combined with anterior vitrectomy and sclera fixation posterior chamber IOL insertion. Postoperatively, the visual acuity, corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD) and complications were observed during the follow-up. RESULTS: The irritation was disappeared in all of patients. All of the corneas became transparent. The preoperative and postoperative mean CCT of the recipient beds was 859 µm and 553 µm respectively. T value was 5.303 (t = 5.303, P < 0.01). It was extremely significant difference. The mean ECD of the donors was 2987 cells/mm(2). The ECD was 1803 cells/mm(2) in three months postoperatively. The rate of endothelial cells loss was 41%. The visual acuity improved significantly except 9 eyes which had fundus disorders. Six eyes were better than 0.8. It was 55% in normal retinal function patients (6/11). The inflammatory reaction of the anterior chamber IOL eyes was most serious. Six eyes underwent graft dislocation. Five cases underwent high intraocular pressure. One case occurred graft rejection. These complications occurred in anterior chamber IOL eyes. CONCLUSIONS: DSAEK combined with phacoemulsification cataract surgery or lens exchange is a safe and effective surgical treatment for corneal endothelial dysfunction with lens disorders. More complications occur in anterior chamber IOL eyes. DSAEK should be cautiously chosen in abnormal iris and chamber angle structural eyes.

The in vitro study of pressure change effect on corneal birefringence.

PURPOSE: To study the change of corneal birefringence at different pressures in vitro to determine whether corneal birefringence changes along with pressure. METHODS: The pattern of corneal birefringence was recorded at different intraocular pressures. The pressure differences were 0.10, 0.50 and 1.00 mm Hg, respectively. To compare the pattern sequence at two pressure values, a nonpaired t test was performed. RESULTS: Statistical analysis indicates that the difference of the corneal birefringence is significant when the pressure difference was more than 0.50 mm Hg in polarized light. CONCLUSION: The results of corneal photoelasticity in vitro demonstrate that the change in pressure on the cornea leads to a change in corneal birefringence.

[Clinical study of Descemet membrane stripping with automated endothelium keratoplasty].

OBJECTIVE: To investigate the clinical efficacy, prevention and management complications and choice of indication with Descemet membrane stripping with automated endothelium keratoplasty (DSAEK). METHODS: Clinical case series. Nine patients (9 eyes) with bullous keratopathy underwent DSAEK procedure from Peking University Eye Center, Peking University Third Hospital during September to December in 2007. Visual acuity, cornea transparency, graft position, corneal thickness, curvature, astigmatism and endothelial cells density (ECD) were observed over 3-7 month follow-up period. RESULTS: One patient with iris cornea endothelium syndrome was fail to insert graft into anterior chamber and changed procedure to penetrating keratoplasty. Eight patient successfully performed procedure. One graft dislocation in was managed in first day after surgery. All 8 grafts remained transparent and improved visual acuity. After surgery, mean corneal thickness was (775 +/- 30)microm. Mean corneal curvature was (44.19 +/- 2.28) D. Mean corneal astigmatism was (2.20 +/- 0.83) D. Mean endothelial cells density was (1439 +/- 296) cells/mm(2). CONCLUSIONS: DSAEK is a less damage, faster recovery vision, safer procedure. It is expected to be the important procedure to treat bullous keratopathy.

Endothelial keratoplasty: the use of viscoelastic as an aid in reattaching the dislocated graft in abnormally structured eyes.

PURPOSE: To explore the feasibility of reattaching the dislocated graft with viscoelastic in abnormally structured eyes after Descemet-stripping automated endothelial keratoplasty (DSAEK). DESIGN: Retrospective case series. PARTICIPANTS: Five pseudophakic bullous keratopathy cases (5 eyes) with a history of vitrectomy and/or iris-lens diaphragm injury. METHODS: After DSAEK, graft dislocation occurred in each of the 5 cases (5 eyes). We attempted to fill the anterior chamber (AC) with an air bubble to push up the dislocated graft, but this was not successful. We then injected balanced salt solution into the vitreous body to obtain normal intraocular pressure (IOP) and injected a small amount of viscoelastic (Healon GV) to support the AC. Next, we injected an air bubble into the AC. MAIN OUTCOME MEASURES: The position of the grafts was checked with a slit lamp and anterior segment optical coherence tomography (AS-OCT). The IOP was observed with Goldmann tonometer. The best visual acuity was checked. RESULTS: As observed through the slit lamp and AS-OCT, the grafts reattached well in all patients. The IOP was normal in all patients except one, who had high IOP 1 month postoperatively. After receiving drug treatment, the patient's IOP returned to normal. The grafts had slight edema on postoperative day 1, but became transparent between days 5 and 8. CONCLUSIONS: Viscoelastic aided in the reattachment of the dislocated graft in eyes with a history of vitrectomy and/or iris-lens diaphragm injury. The presence of viscoelastic in the AC in the early period of post-DSAEK was well tolerated in this small series.

Identification of a genetic locus for autosomal dominant infantile cataract on chromosome 20p12.1-p11.23 in a Chinese family.

PURPOSE: To map a gene responsible for infantile cataract in a large four-generation, non-consanguineous Chinese family. METHODS: Twenty-two family members including 17 cataract patients in the Chinese family were analyzed clinically. All family members were genotyped with 382 microsatellite markers that provide genome-wide coverage every 10 cM. Linkage analysis was performed to identify the chromosomal location of the infantile cataract gene in the family. Candidate genes were studied by direct DNA sequence analysis. RESULTS: Genome-wide linkage analysis provided evidence for a genetic locus for infantile cataract on chromosome 20p12.2-20p11.23. The maximum LOD score was 5.15 for marker D20S471 at a recombination fraction of 0. Fine mapping defined the cataract gene within a 7.4 Mb interval between markers D20S915 and D20S912. No mutation was detected in potential candidate genes, BFSP1 and CHMP4B. CONCLUSIONS: Our results suggest that there is a new gene for infantile cataract on chromosome 20p12.2-p11.23. Our results suggest that new genes for infantile cataract could be found through further study of candidate genes at the 20q locus, which may provide insights into the pathogenic mechanisms of cataracts.

[Spherical aberration, contrast sensitivity and color discrimination after cataract surgery with the aspherical intraocular lens].

OBJECTIVE: To determine whether implantation of an intraocular lens (IOL) with a modified prolate anterior surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. METHODS: Consecutively 72 eyes were selected from 53 senile cataract patients who had received phacoemulsification and IOL implantation in Peking University Eye Center. Each was randomly assigned to receive Tecnis Z9001 IOL or Sensar AR40e (both made by AMO). Three months after operation, the eyes underwent several tests including visual acuity, optometry and wavefront aberration examination. Mesopic contrast sensitivity test was measured with ROLAND BA-4 Contrastometer. RESULTS: The eyes treated with Tecnis Z9001 had significantly less spherical aberration. The eyes treated with Tecnis IOL got lower C12 coefficient and RMS4 than those with Sensar AR40e (P<0.05). The mesopic contrast sensitivity and color discrimination were not significantly different between the two IOL groups. CONCLUSION: A significant reduction in spherical aberration after Tecnis Z9001 IOL implantation was achieved, but mesopic contrast sensitivity was not affected by the aspheric silicone IOL as compared with spherical acrylic IOL.

Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation.

AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS: DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity (BCVA), IOP and mean central endothelial cell density (ECD) were recorded. RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION: DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.

[Cloning, expression and cytotoxin to human lens epithelial cells of targeting toxin DT389-hbFGF].

OBJECTIVE: To construct pGEX-DT(389)-hbFGF plasmid, express and identify the cytotoxicity to human lens epithelial cells (HLECs). METHODS: Extracting DNA of dead diphtheria bacillus and RNA of 12-week fetal brain cortex. The fragments of truncated diphtheria toxin (containing 389 amino acids of N-terminus, DT(389)) and full length human bFGF gene (encoding 18kd protein) were amplified by PCR technique respectively. The two fragments were inserted into prokaryotic expression vector pGEX-4T-1. After testing sequence, the expressing plasmid was transformed into E.Coli BL21 strain and induced expression under IPTG. The expressed fusion protein was purified and identified. MTT experiment tested cytotoxicity of the fusion protein to HLECs in vitro. The way of HLECs death under different dosage was identified by flow cytometry. RESULTS: The gene fragments of DT(389) and human bFGF were accurately amplified. The expression vector including DT(389)-hbFGF fused gene was constructed and expressed successfully. DT(389)-hbFGF fusion protein can induce HLECs apoptosis in a dosage dependence manner during certain range. The LD(50) was about 3.8 x 10(-11) mol/L. CONCLUSION: The successful cloning and expression of DT(389)-hbFGF immunotoxin lay a foundation for accelerating lens epithelial cells apoptosis and the targeting therapy toward posterior capsule opacification.

[Clinical pathological study of the anterior lens capsule abnormalities in familial congenital aniridia with cataract].

OBJECTIVE: To observe the pathological changes of the lens and anterior lens capsule of the patients with familial congenital aniridia, and discuss the histopathological etiology of the fragility of the anterior capsule and the significance of surgical project. METHODS: Anterior lens capsules and lens specimens were obtained from aniridic patients during cataract surgery. The intraoperative behavior of each capsule was noted, after which the specimens were submitted for histopathologic evaluation and electron microscope examination. RESULTS: The anterior lens capsule was extremely fragile and remarkably thin. Degenerative changes(degeneration, necrosis, loss) of the lens epithelium and discontinuity of the lens epithelium were found in some specimens. Proliferation and double layer of the epithelial cells in some area of the specimens can be seen also. Ply structure of the anterior capsule became thin or disappeared. CONCLUSION: Degenerative or proliferative changes of the lens epithelial cells were associated with the thinness and extreme intraperative fragility of the anterior lens capsules in familial aniridia with cataract. Greater awareness of anterior capsule fragility in some aniridic patients with cataract may reduce the risk of capsule complications and lead to safer surgical outcomes.

Signaling pathway involved in methionine enkephalin-promoted survival of lymphocytes infected by simian immunodeficiency virus in the early stage in vitro.

Methionine enkephalin, the endogenous opioid peptide, has a diversity of effects on the immune system. Although the biological effects of the pentapeptide have been well documented, little is known about the intracellular events involved in the effects of opioids on human immunodeficiency virus (HIV) infected immune cells. In the present investigation, the possible mechanism of apoptosis alleviated by exposure of methionine enkephalin at 1 micromol/l to CEM x 174 cells, the hybrid lymphocytes, infected with simian immunodeficiency virus (SIV) in vitro is elucidated. Apoptosis and cell cycle analysis is carried out by flow cytometry, the phosphorylation of mitogen-activated protein kinases (MAPK) ERK1 and ERK2 is detected by Western blotting assay, and changes of calcium concentration were analyzed using the calcium-sensitive dye Fluo-3 AM. The results exhibit that methionine enkephalin at the concentrations of 1 micromol/l increase remarkably the proportion of vital cells and decrease the apoptotic cells based on annexin V binding assay. In response to the treatment with methionine enkephalin, SIV-infected cells display a prolonged survival and are accumulated in G1 phase. Methionine enkephalin increase obviously the content of intracellular calcium in normal cells within 1-2 min and maintains a high level within monitoring time. However, the intracellular calcium reaches the highest level at 1 min and subsequently decline to background in SIV infected group. In addition, methionine enkephalin also elevates the levels of protein kinase C (PKC) activity and phosphorylated extracellular signal-regulated kinase (ERK) 1/2. It is proposed that calcium-PKC-MAPK cascade is involved in methionine enkephalin-prolonged survival of SIV-infected cells in the early stages of virus infection. The results provide a further evidence for potential use of methionine enkephalin on the therapy of Acquired Immunodeficiency Syndrome (AIDS).

A new cytokine: the possible effect pathway of methionine enkephalin.

AIM: To investigate experimentally the effects of methionine enkephalin on signal transduction of mouse myeloma NS-1 cells. METHODS: The antigen determinate of delta opioid receptor was designed in this lab and the polypeptide fragment of antigen determinate with 12 amino acids residues was synthesized. Monoclonal antibody against this peptide fragment was prepared. Proliferation of Mouse NS-1 cells treated with methionine enkephalin of 1 x 10(-6) mol x L(-1) was observed. The activities of protein kinase A (PKA) and protein kinase C (PKC) were measured and thereby the mechanism of effect of methionine enkephalin was postulated. RESULTS: The results demonstrated that methionine enkephalin could enhance the proliferation of NS-1 cells and the effect of methionine enkephalin could be particularly blocked by monoclonal antibody. The activity of PKA was increased in both cytosol and cell membrane. With reference to PKC, the intracellular activity of PKC in NS-1 cells was elevated at 1 x 10(-7) mol x L(-1) and then declined gradually as the concentration of methionine enkephalin was raised. The effects of methionine enkephalin might be reversed by both naloxone and monoclonal antibody. CONCLUSION: Coupled with the findings, it indicates that the signal transduction systems via PKA and PKC are involved in the effects of methionine enkephalin by binding with the traditional opioid receptors,and therefore resulting in different biological effects.

Morphine-promoted survival of CEMx174 cells in early stages of SIV infection in vitro: involvement of the multiple molecular mechanisms.

Progression of HIV infections to AIDS is a complex process and it differs considerably among individuals infected with HIV, influenced by both genetic and environmental factors. Opiates have been implicated to be a cofactor in HIV infections leading to AIDS. However, little is known about the molecular mechanisms involved in the effects of opioids on HIV infected immune cells. Cell cycle analysis was carried out by flow cytometry, the phosphorylation of mitogen-activated protein kinases ERK1 and ERK2 was detected by Western blotting assay, and changes of calcium concentration were monitored by scanning intracellular fluorescence intensity. In response to the treatment with morphine, SIV-infected cells were accumulated in G1 phase. Morphine increased the content of intracellular calcium in a time-dependent manner. In addition, morphine also elevated the levels of PKC activity and phosphorylated ERK1/2. Therefore, it is implicated that the calcium-PKC-MAPK cascade is involved in morphine-prolonged survival of SIV-infected cells in the early stages of virus infection.

[The cause and management of intraocular lens dislocation into anterior vitreous cavity].

OBJECTIVE: To study the causes and management of the intraocular lens (IOL) dislocation into anterior vitreous cavity. METHODS: The author retrospectively analyzed the causes of the IOL dislocation treated in the past 10 years. Twenty-eight dislocated IOLs were replaced after anterior vitrectomy. RESULTS: The causes of the IOL dislocation were: (1) IOL vertically sank down into the vitreous cavity through the broken inferior zonules. (2) The superior haptics were not placed in the ciliary sulcus and overturned down into vitreous cavity because of the vitreous prolapse closing the ciliary sulcus. (3) Inferior haptics were put behind the posterior capsule and into the vitreous cavity. After follow-up for 6 months to 10 years, the postoperative best-corrected visual acuities (BCVAs) of 28 patients were 20/100 to 20/20. No complications happened. CONCLUSIONS: The IOL dislocation into anterior vitreous cavity was related to the rupture of the posterior capsule, break down of the lens zonules, prolapse of the vitreous, improper position of implanted IOL and iris complication. The simplest and most effective method for management of IOL dislocation into anterior vitreous cavity is to directly remove the IOL from vitreous cavity after anterior vitrectomy and re-fixate it in the ciliary sulcus.

Pigment dispersion glaucoma induced by the chafing effect of intraocular lens haptics in Asian eyes.

PURPOSE: To study the possible mechanism and treatment for pigment dispersion glaucoma (PDG) caused by single-piece acrylic (SPA) intraocular lens (IOL) ciliary sulcus fixation in Asian eyes. MATERIALS AND METHODS: Patients referred for PDG caused by SPA IOL ciliary sulcus fixation to our hospital from April 2005 to June 2011 were included. The patients' general information, IOL type, interval between initial surgery and PDG occurrence, examination findings, antiglaucoma medicine regimen and surgical interventions were recorded. RESULTS: In total, six eyes from five Chinese patients were included in this study. The intraocular pressure (IOP) increased 19-30 days after cataract surgery and was not satisfactorily controlled with antiglaucoma medication. Dense pigmentation was deposited on the IOLs and on the anterior chamber angle. IOL haptic chafing was noted on the rear iris surface. IOL repositioning in the capsular bag was performed in three eyes and was combined with trabeculectomy in two eyes with progressive glaucoma. An IOL exchange with three-piece IOL ciliary sulcus fixation was performed in the other three eyes. Scanning electron microscopy of the explanted IOLs demonstrated a rough edge on the IOL haptics. CONCLUSIONS: SPA IOLs were not suitable for ciliary sulcus fixation. The chafing effect of the IOL haptics on the posterior iris pigment epithelium could induce PDG in Asian eyes. IOLs should be positioned in the capsular bag or a three-piece IOL should be used instead.