[The expression level of MMP-2 and collagen of hydroxyapatite modified titanium for keratoprosthesis in the corneal stroma of rabbits].

OBJECTIVE: To investigate the expression level of metalloproteinases-2(MMP-2) and Collagen in a hydroxyapatite surfaced-modified of three Pan type titanium keratoprosthesis after that implanted into the corneal stroma of rabbits, further evaluate its biological compatibility. METHODS: Experimental study. Twenty-four New Zealand white rabbits, 2.0-2.5 kg, were respectively divided into three groups. Surgery was performed in right eye of all animals. skirt of HA-Ti and Ti were respectively inserted into the corneal stroma of rabbit of experimental group A and group B; only a sack was made without implantation in control group C . Cornea edema and corneal neovascularization were observed at scheduled times after operation; animals were sacrificed 2, 4 and 16 weeks after operation and their cornea was removed and examined under light microscopy; the surface of skirt was observed under scanning electron microscope. RESULTS: During the study period, all skirts were stable without infected, dissolved and excluded. Different degree of cornea edema and neovascularization was revealed after surgery. MMP-2 were absent in the normal corneal matrix. The expression level of MMP-2 in group A was higher than group C at all time points (F = 6.083, P < 0.05), and was increased than group B at 4th (F = 47.074, P < 0.01), and was increased than group C at 16th weeks too (F = 6.079, P < 0.05) . Corneal organization has a large green 4 weeks type III collagen and yellow red type I collagen, 16 weeks corneal mainly for bright red when within the collagen type I, still have a small amount of collagen type III. CONCLUSIONS: Rabbit cornea implanted HA-Ti skirts cause MMP-2 activation, continuous high expression didn't cause the cornea to dissolve; Collagen -III turned into collagen-I gradually in the extracellular matrix around the skirts. Hydroxyapatite modified titanium for Keratoprosthesis promoted the corneal neovascularization and improve the interfacial bio integration of skirt and host cornea.

Experimental study of the mechanism of tolerance induction in dexamethasone-treated dendritic cells.

BACKGROUND: The aim of this study was to investigate the mechanisms underlying tolerance induction of dexamethasone (Dex)-treated dendritic cells (DCs). MATERIAL/METHODS: Well-grown DC2.4 cells were randomly assigned to receive control, 50 µg/L, 100 µg/L, or 200 µg/L of dexamethasone and then were cultured for 6 days. The expressions of CD80, CD86, galectin-9, and PD-L1 on the surface of DC2.4 cells were analyzed with flow cytometry and the level of IL-12 secreted by DC2.4 cells was determined by ELISA. The stimulating activity of DC2.4 cells on allogeneic T cells was assessed with mixed lymphocyte reaction. Dexamethasone-treated DC2.4 cells were co-cultured with allogeneic splenic lymphocytes and the Foxp3 expression in naive T lymphocytes was determined with flow cytometry. RESULTS: Compared with the control group, the expressions of CD80, CD86, galectin-9, and PD-L1 on the surface of DC2.4 cells exposed to different doses of dexamethasone showed no significant changes; however, dexamethasone treatment significantly reduced IL-12 secretion and inhibited DC2.4's stimulation on the proliferation of allogeneic T lymphocytes. Moreover, dexamethasone-treated DC2.4 cells effectively promoted FOXP3 expression in naive T lymphocytes. CONCLUSIONS: DC2.4 is a stable cell line with high expressions of CD80, CD86, and PD-L1. Dexamethasone does not significantly change the cell phenotype of DC2.4 cells, but inhibits the secretion of IL-12 cytokine and attenuates DC2.4's stimulation of the proliferation of allogeneic T cells. Dexamethasone-treated DC2.4 cells also effectively promote FOXP3 expression in naive T lymphocytes.

[Clinical and histopathologic analysis of superficial tissue proliferation following the implantation of keratoprosthesis].

OBJECTIVE: To investigate the clinical and histopathologic features of the superficial tissue proliferation (STP) following the implantation of MICOF keratoprosthesis, and to analyze the formation and treatment of STP. METHODS: Retrospective study. Eighty-five patients (85 eyes) received MICOF keratoprosthesis surgery from January 2000 through December 2009 in General Hospital of PLA, which included 72 males and 13 females. The mean age of the patients was (45 ± 15) years. Preoperative diagnoses were ocular burn (56 eyes), end-stage of autoimmune dry eye (14 eyes), severe ocular trauma (10 eyes) and repeated graft failure (5 eyes). Postoperatively, STPs of Kpro were observed and treated. The membranes anterior to the optical cylinder were removed and investigated by histological and immunohistochemical methods, and anterior segment specimens from normal eyes were taken as control. RESULTS: Twenty-two (26%) patients presented STP during the follow-up, and proliferations occurred ranging from 2 to 63 months (median, 7 months). The incident rates of STP were 34% (19/56 eyes) in burned eyes, 14% (2/14 eyes) in end-stage dry eye, 10% (1/10 eyes) in severe mechanical ocular trauma, and none in repeated grafts failure. Difference among four groups did not arrive significance statistically (χ(2) = 5.93, P = 0.11). The epithelial proliferations were observed in 11 patients, which were removed easily. To prevent from recurrence, the height of the cylinder was adjusted. Other 4 patients underwent ultra-high frequency ocular surface plastic operation and 7 patients received membranectomy. Histologically, the superficial proliferative membrane was composed of proliferative epithelium and fibrovascular tissue incorporating inflammatory cells. The immunohistochemical staining demonstrated the expression of PCNA increased in the epithelium, compared with control cornea and conjunctiva. Many vimentin-positive fibroblasts and a few α-SMA-positive myofibroblasts presented in the interstitial tissue, and the numbers of CD45RO-positive T cells, CD11c-positive dendritic cells, and CD68-positive macrophages were increased in proliferative membranes. CONCLUSIONS: The tissue proliferation around optical cylinder results in membrane formation anterior to the Kpro. The excessive inflammation at the prosthesis-corneal junction and the unsuited height of the optical cylinder might have been the main reasons of STP.

[The effect of recombinant bovine basic fibroblast growth factor on the LASIK-induced neurotrophic epitheliopathy and the recovery of corneal sensation after LASIK].

OBJECTIVE: To observe the effects of recombinant bovine basic fibroblast growth factor (r-bFGF) on the LASIK-induced neurotrophic epitheliopathy (LINE) and the recovery of corneal sensation after LASIK. METHODS: Prospective clinical study. LINE was found in 60 patients out of 1154 cases of LASIK (5.2%). The 60 cases were randomly divided into three groups, each group including 20 cases. Group A was treated with r-bFGF eye drops (fusion protein), four times a day. Group B was treated with r-bFGF eye-gel, four times a day. Group C was treated with 0.1% sodium hyaluronate eye drops as a control. The treatment started since LINE was diagnosed. The typical clinical finding of LINE was punctate corneal erosion, which could be evaluated by slit-lamp examination and fluorescein staining. Masked Cochet-Bonnet esthesiometer was performed in the central cornea one week preoperatively and 1, 3, 6 and 12 months postoperatively. RESULTS: (1) The average times of corneal erosion occurrence were (28.57 ± 37.48) d, (30.82 ± 35.08) d and (16.84 ± 23.70) d in group A, group B and group C respectively. No significant differences were observed among the three groups (F = 1.456, P = 0.238), and the average times of corneal erosion disappearance were (7.19 ± 8.23) d, (2.86 ± 1.73) d and (7.00 ± 6.40) d in group A, group B and group C, respectively. The punctate corneal erosion cured significantly faster in r-bFGF eye-gel treated group (P(1) = 0.007, P(2) = 0.014). (2)The loss of corneal sensation was greatest at 1 week after LASIK in all the three groups and improved at all subsequent examination time points. The corneal sensation gradually recovered through 12 months observation, but the r-bFGF eye-gel treated group showed faster recovery in comparison with the other two groups, had no statistic different at 6 month compared with pre-operation values (F = 0.55, P = 0.064). CONCLUSION: The r-bFGF eye-gel is effective for both punctate corneal erosion (especially for severe LINE) and recovery of corneal sensation following LASIK surgery.

[The observation of the effects of a micromolecular compound J2 on rat corneal allograft using atomic force microscopy].

OBJECTIVE: To study the cell membrane of corneal endothelium with a micromolecular compound J2 in corneal allograft of rat using atomic force microscopy (AFM). METHODS: Cohort study. Subjects were divided into two groups: group A (n = 15): experimental group; group B (n = 15): placebo control group. At the fifth, tenth, fifteen, twentieth, twenty-fifth day after penetrating keratoplasty, the donor implant was separated from receipt bed, one part of which was stained by HE and the others fixed into AFM sample. Amplitude and height images were obtained in the tapping mode with a scan rate of 2 Hz and an integral gain of 0.3 to 0.5. Statistical analysis was performed using single-factor analysis of variance and P value was calculated. RESULTS: The average transplant survival time in group A was (33.12 ± 6.80) d, and those in group B was (18.87 ± 4.19) d. There were significant difference between two group (F = 47.7449, P = 0.00). There were obvious differences on ultrastructure measured by AFM between two groups. At the fifth day after penetrating keratoplasty, regular hexagonal structure of corneal endothelium was observed by AFM in both two group. The diameter of corneal endothelium was about 15 µm, uneven microstructure of cell could be found. The time being, different changes were arose in two group: a clear microstructure could be found in group A, however the microstructure of cell could not be recognized in group B. One way analysis of variance showed that significant differences on parameters (Ra, Rp and Rv) were found between two groups (P < 0.05). At the fifth day after penetrating keratoplasty, group A: Ra (97.64 ± 31.58) nm, Rp (297.79 ± 25.19) nm, Rv (545.55 ± 25.83) nm; group B: Ra (112.61 ± 34.29) nm, Rp (265.06 ± 24.17) nm, Rv (544.41 ± 21.78) nm (Fa = 30.9416, P = 0.0000; Fp = 263.6018, P = 0.0000; Pv = 1.2013, P = 0.2735). At the tenth day after penetrating keratoplasty, group A: Ra (102.98 ± 32.98) nm, Rp (711.38 ± 21.94) nm, Rv (639.89 ± 22.58) nm; group B: Ra (222.85 ± 31.28) nm, Rp (111.22 ± 20.35) nm, Rv (746.49 ± 23.17) nm (Fa = 2086.4535, P = 0.0000; Fp = 53768.4676, P = 0.0000; Pv = 3257.3178, P = 0.0000). At the fifteenth day after penetrating keratoplasty, group A: Ra (87.44 ± 34.97) nm, Rp (344.18 ± 21.09) nm, Rv (482.61 ± 22.27) nm; group B: Ra (197.64 ± 35.72) nm, Rp (510.76 ± 24.98) nm, Rv (545.62 ± 23.17) nm (Fa = 1458.1057, P = 0.0000; Fp = 7788.6963, P = 0.0000; Pv = 1153.2860, P = 0.0000). At the twentieth day after penetrating keratoplasty, group A: Ra (85.85 ± 32.53) nm, Rp (348.69 ± 21.26) nm, Rv (367.65 ± 23.12) nm; group B: Ra (201.36 ± 34.12) nm, Rp (788.58 ± 20.34) nm, Rv (563.33 ± 21.01) nm (Fa = 1801.1215, P = 0.0000; Fp = 67 057.9516, P = 0.0000; Fv = 11 770.2195, P = 0.0000). At the twenty-fifth day after penetrating keratoplasty, group A: Ra (104.97 ± 32.47) nm, Rp (395.05 ± 20.38) nm, Rv (396.17 ± 21.59) nm; group B: Ra (43.85 ± 31.28) nm, Rp (249.88 ± 20.79) nm, Rv (154.88 ± 22.37) nm (Fa = 551.4134, P = 0.0000; Fp = 7458.9255, P = 0.0000; Pv = 18 070.5189, P = 0.0000). CONCLUSIONS: The morphology and ultrastructure of corneal endothelium in group A with J2 were different from group B by observation with AFM. J2 was an effect micromolecular in prevention of corneal allograft rejection.

[Outcome after treatment of myopia with implantable Collamer lens].

OBJECTIVE: To evaluate the efficacy, predictability, stability, and safety of the surgical correction myopia using implantable Collamer lenses (ICL) in phakic eyes. METHODS: A prospective study was performed to analyze 91 eyes of 48 patients who had the implantation of ICL for the treatment of myopia from July 2008 to February 2010. Patients were examined preoperatively and followed at 1 week, 1, 3, 6, and 12 months postoperatively. The examinations included the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, contrast sensitivity, wavefront aberration, intraocular pressure, space between crystal lens and intraocular lens (vault), endothelial cell density (ECD), anterior chamber depth (ACD), surgical complication, etc. RESULTS: Successful implantation was achieved in all patients. The mean follow-up time was (9.54 ± 4.12) months (SD)(range 1 to 12 months). The mean preoperative SE was -12.38 diopters (D) (range -5.0D to -23.0D). Postoperatively, UCVA was maintained or improved in all eyes. UCVA achieved 1.0 in 58 eyes (64%) and BCVA gained more than 1 line in 69 eyes (75.9%). The glare and no glare contrast sensitivity were improved at 3cd, 12cd and 18cd, with the exception of 6cd. The aberration decreased in RMS, spherical and coma. Post operative ACD (1 week after operation) diminished 8.92% as compared with the preoperative ACD. The mean vaulting was (452 ± 216.38) µm (6 months) and ranged 130 - 1080 µm at different follow-up periods. There was no statistically significant difference in vaulting between postoperative data at different periods (t = 0.200, P > 0.05). The mean postoperative ECD decreased but had no statistically difference compared with the preoperative ECD. ACD decreased 31% after surgery in 2 eyes (2.1%). Transient high IOP was observed in 13 eyes (2.1%) one week after the operation. CONCLUSION: These results indicate that ICL implantation in the treatment of myopia is efficient, predictable, safe, and reliable.

Ocular trauma score in transferred fireworks-related ocular injuries: a case series.

BACKGROUND: Our aim was to review the characteristics of transferred fireworks-related ocular damage and to evaluate the prognostic value of the ocular trauma score (OTS) for these injuries. METHODS: This study included 22 transferred patients (19 male, 3 female; mean age 22.6±14.9 years) (25 eyes). The data were retrospectively reviewed, including the characteristics of the geography, types of fireworks, status of injuries, therapeutic procedures, and the best-corrected visual acuity (BCVA). All the injured eyes were classified using the OTS at the time of the initial examination. RESULTS: Twenty eyes (80%) were in OTS category 1, three eyes (12%) were in OTS category 2, and two eyes (8%) were in OTS category 3. All cases received surgical therapy. Six eyes (24%) were enucleated, four (16%) of which achieved an improvement in their final BCVA. There was a statistically significant improvement in final BCVA between OTS category 1 and the other two OTS categories (p=0.016). CONCLUSION: The aforementioned transferred fireworks-related ocular injury cases occurred mainly in young adults, men and active participants, all of which incurred serious vision loss and blindness. The OTS is quite effective for classifying the status and estimating the prognosis of transferred fireworks-related ocular injuries.

Changes in objective vault and effect on vision outcomes after implantable Collamer lens implantation: 1-year follow-up.

PURPOSE: To investigate the changes in vault and the effect on visual outcomes 1 year after implantable Collamer lens (ICL) implantation. METHODS: In this retrospective study, 127 eyes of 66 patients undergoing ICL implantation were examined both before and up to 1 year after the surgery. The examination contents included white-to-white (WTW) diameter, central vault of the ICL (distance between posterior surface of ICL and anterior surface of crystalline lens), refractive error, and wavefront high-order aberration (HOA). All statistical analyses were performed using SPSS 13.0 software. RESULTS: A significant decrease in vault was noted up to 1 month, after which the value stabilized (p=0.001). The moderate vault decreased significantly after the first 3 months postsurgery (paired-samples t test, p<0.05). Low vault showed a tendency to increase and high vault showed a tendency to decrease, but not significantly, over time. There was no statistically significant correlation between the amount of vault and the refractive error (Pearson correlation coefficient R=0.111, p=0.473) and there was a statistically significant correlation between the vault and HOAs (R=0.304, p=0.024). CONCLUSIONS: Implantable Collamer lens vault over the crystalline lens had the tendency toward a slight decrease with time and did not significantly affect the vision outcome 1 year after surgery.

[Construction of lentiviral expression vector containing Foxp3 gene and its expression in DC2.4 cell line].

AIM: To construct a Foxp3 lentiviral vector and transfer it into DC2.4 cells, which provides Foxp3+DC cells for further study on its immune modulation. METHODS: We cloned mouse Foxp3 gene into lentiviral vector(pGC-FU) and acquired the plasmid pGC-FU-Foxp3. PCR and sequencing analysis were made for verifying the positive clones. The virus packaging plasmids(pGC-FU-Foxp3, pHelper1.0 and pHelper2.0) were contransfected into 293T cells, and the Lentivirus-Foxp3 was harvested from 293T cells. The Lentivirus-Foxp3 was used to infect DC2.4 cells in vitro and the expression of Foxp3 in infected DC2.4 cells was detected with flow cytometry(FCM). RESULTS: PCR and sequencing revealed that the pGC-FU-Foxp3 plasmid was correctly constructed. The Lentivirus-Foxp3 with a titer of 2×10(8); TU/mL was successfully packaged. Foxp3 expression in DC2.4 cells infected with the Lentivirus-Foxp3 was increased significantly compared with negative control lentivirus. CONCLUSION: The pGC-FU-Foxp3 plasmid has been successfully constructed and the Lentivirus-Foxp3 has been successfully packaged. Foxp3 can be enhanced in DC cells infected with the Lentivirus-Foxp3.

New surgical therapy for conjunctival lymphangiectasia.

AIM: To report 7 cases of conjunctival lymphangiectasia, introduce a simple operation method and discuss the result of the pathological examination. METHODS: Clinical data including medical history, physical examination, previous surgery history were collected in 7 patients with conjunctival lymphangiectasia. Ocular data including visual acuity, Slit-lamp biomicroscopy were released, as were results of histopathology studies. Surgical method was also introduced by video. RESULTS: Seven eyes of 7 patients (4 male and 3 female) with biopsy-proven conjunctival lymphangiectasia underwent the resection. Despite different surgical intervention, the optima method has been founding to treatment conjunctival lymphangiectasia. It is to reduce recurrence that the most concerned problem. In these 7 cases reported, patients kept healthy for 18 months without any one recurrence, whose visual acuity were not affected. Pathological report showed cystic tissue consists of squamous epithelium with significant hyperplasia. CONCLUSION: This operation method is simple and easy to complete, as it is deserved to accept for surgeons and patients on the basis of its advantages.