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Age-related macular degeneration (AMD) is a leading cause of blindness in the elderly worldwide and is characterized by degeneration of the photoreceptor, retinal pigment epithelium, Bruch membrane and choriocapillaris complex.Impairment of RPE cell function is an early and critical event in the molecular pathways leading to clinically relevant AMD changes.Programmed cell death (PCD) plays an important role in response to stress and regulation of homeostasis and disease.In recent years, multiple studies have shown that apoptosis, pyroptosis, necroptosis and ferroptosis are likely involved in RPE cell PCD and correlate with the onset and development of AMD.There may be interaction or synergy between the various death pathways.This article reviewed the pathogenic mechanism of apoptosis, pyroptosis, necroptosis and ferroptosis in retinal pigment epithelial cell and their research progress in AMD, which might provide new approaches for the prevention and treatment of AMD.
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Objective This study was to investigate the characteristics of posterior corneal astigmatism (PCA) and aberration in cataract patients with high myopia.Methods A retrospective study was designed.Two hundred and eighty-two eligible eyes of 190 cataract patients were enrolled in Eye and ENT Hospital of Fudan University from September to December,2014.The eyes were classified into two groups according to axial length (AL):high myopia group with 139 eyes (AL≥26 mm) and control group with 143 eyes (AL was 20 to 25 mm).The mean keratometric mid-radius of curvature (Km),corneal central thickness (CCT),astigmatism and aberrations were measured by the rotating Scheimpflug System (Pentacam),and the AL were measured by the partial coherence interferometry (IOL Master).This study followed the Helsinki declaration,and was approved by the Ethic Committee of Eye and ENT Hospital,Fudan University.Informed consent was signed from each patient.Results In high myopia group,the mean PCA was 0.3 D (range 0 ～ 0.9 D) and 92.8％ eyes had PCA values ＜0.5 D.The steep corneal meridian was aligned vertically (60°～ 120°) in 87.1％ eyes for the posterior corneal surface.There was no significant difference in PCA between the high myopia group and the control group (P =0.797).Significant positive linear correlations was found between PCA and anterior corneal astigmatism (ACA),PCA and anterior corneal root mean square (RMS),PCA and anterior lower-order RMS,PCA and posterior corneal RMS,PCA and posterior high-order RMS,PCA and posterior lower-order RMS (r =0.235,P =0.005;r =0.217,P =0.010;r =0.229,P =0.007;r =0.395,P =0.000;r =0.243,P =0.004;r =0.384,P =0.000).Compared with total corneal astigmatism (TCA),anterior corneal measurements overestimated with-the-rule astigmatism (WTR) by a mean of (0.27 ± 0.18) D in 65.67％ eyes,underestimated against-the-rule astigmatism (ATR) by (0.27 ± 0.18) D in 88.10％ eyes and underestimated oblique astigmatism (Obl) by (0.22 ± 0.10) D in 63.33％ eyes.Compared with total corneal aberrations,anterior corneal aberrations measurements overestimated by (0.275 ±0.176) μm in 87.05 ％ eyes,and the anterior corneal astigmatism types had no effect on the result.Conclusions In high myopia group,92.8％ eyes had PCA values ＜0.5 D and the main astigmatism type in posterior corneal surface was ATR.The posterior corneal astigmatism and aberration were needed to consider in choosing intraocular lens (IOL) before cataract surgery.
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Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract,accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However,relative study is rare.Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method.Methods A serial cases-observational study was performed,and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery in Second People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes),grade Ⅲ (9 eyes),grade Ⅳ (7 eyes) and grade Ⅴ (3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for grade Ⅱ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes,and phacoemulsification combined MCTR insertion and IOL implantation,or lens loop nucleusdeliver,anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months,and optimal operation timing,best corrected visual acuity (BCVA),intraocular pressure (IOP),complications and anterior capsular opening,IOL position were assessed.Results In the patients with phacodonesis,CTR was inserted in 10 eyes,and MCTR was inserted in 3 eyes,and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and l eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens,only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation,and other 4 eyes received lens loop nucleus-deliver,anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was ＞0.5 in 4 eyes,＞0.3-≤0.5 in 6 eyes,＞0.1-≤0.3 in 8 eyes,≤0.1 in 5 eyes,which was better than that before surgery (X2 =17.29,P＜0.01).The IOP was (16.82 ±2.25) mmHg before surgery and reached (16.12±2.67) mmHg 3 months after surgery,with a significant difference between them (t=0.108,P＞0.05).The intra-and post-operative complications included small pupil,corneal edema,residual cortex and posterior capsular opacification.Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect,hardness of lens nuleus,with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC.
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Objective To investigate the effectiveness and safety of anterior vitrectomy combined with capsular retractor and Cionni modified capsular tension ring (MCTR) in traumatic lens subluxation surgery with anterior vitreous prolapse.Methods This study comprised 16 patients (16 eyes) of traumatic lens subluxation with anterior vitreous prolapse,in which iridodialysis was in 3 eyes,express implantation in 1 eye and Ahmed glaucoma valve implantation in 1 eye.According to the severity of lens subluxation,the patients were divided into three levels,including 90°-120° (7 eyes),120°-180° (5 eyes) and 180°-270° (4 eyes).Considering the anterior vitreous prolapse,anterior vitrectomy or/and pars plan vitrectomy was conducted with assistance of triamcinolone acetonide.After continuous curvilinear capsulorhexis,two to four capsular retractors were placed in the capsulorhexis to support and center the capsule.MCTR was inserted with scleral suture fixation after phacoemulsification.At last,the foldable IOL was implanted to capsular bag.Postoperative visual acuity,intra-and post-operative complications,anterior capsular opening,IOL positions and intraocular pressure (IOP) were assessed during 3 months' follow up.Results All patients had successfully undergone phacoemulsification,MCTR insertion and IOL implantation.Seven eyes were inserted with 2-eyelet MCTR and nine eyes were inserted with 1-eyelet MCTR.The postoperative visual acuity was better than 0.5 in 9 eyes,between 0.3 and 0.5 in 4 eyes,between 0.1 and 0.3 in 2 eyes,and less than 0.1 in 1 eye.Compared with pre-operation,the difference in the visual acuity was statistically significant (x2 =17.503,P =0.000).The scheimpflug images obtained from the Pentacam,which demonstrated that the IOL was well centered,and no MCTR and IOL decentration occurred.The common intraand post-operative complications were residual cortex,aqueous misdirection syndrome,anterior capsular tears,anterior capsular phimosis and posterior capsular opacification.Conclusion The effective application of anterior vitrectomy is the key point to reduce surgical complications.Anterior vitrectomy combined with insertion of capsular retractor and MCTR is an ideal surgical option for patients of traumatic lens subluxation with anterior vitreous prolapse.