[Clinical observation of ocular injury caused by chestnut burr].

Objective: To analyze the clinical characteristics and treatment of ocular injury caused by chestnut burr. Methods: Retrospective case series study. Data of 48 patients (48 eyes) with ocular injuries caused by chestnut burrs hospitalized in Qingdao Eye Hospital were collected from January 2013 to March 2019. All patients were followed up for at least 3 months. The time of seeking medical advice, lesion region, and characteristics and treatment methods were analyzed. Results: There were 48 patients, including 33 males and 15 females, aged 19 to 74 years [mean, (56±10) years]. The time of injury was late September (25 cases) and early October (23 cases). The shortest time to visit our hospital was 3 hours after injury, and the longest was 8 months after injury. There were 13 cases (27.1%, 13/48) with corneal and/or scleral foreign bodies. All patients were treated with corneal or scleral foreign body extraction. Twenty-four patients (50.0%, 24/48) developed fungal keratitis. Among them, 18 patients had a corneal ulcer, and the infection involved the superficial or full-thickness corneal layer. Six patients had no corneal ulcer, and the infection involved the deep stroma and corneal endothelial surface. The positive rate of fungal examination by confocal microscopy was 87.5% (21/24). Antifungal drugs (2 cases), corneal debridement (5 cases), conjunctival flap covering (2 cases), corneal stroma injection (1 case), and penetrating keratoplasty(14 cases) were given according to the depth of fungal infection. Most of the pathogens were Alternaria spp. Eleven patients (22.9%, 11/48) with necrotizing scleritis were treated with exploration of the sclera. Three patients had scleral foreign body residues on ultrasound biomicroscopy examination, which were removed by operation. Four patients were found to have fungi at the necrotic site of the sclera. Conclusions: The main types of ocular injuries caused by chestnut burrs are corneal and/or scleral foreign bodies, fungal keratitis, and necrotizing scleritis. Chestnut burr foreign bodies should be removed as soon as possible. In the case of fungal keratitis, a drug or surgical intervention should be carried out as early as possible. Necrotizing scleritis is often induced by long-term foreign body retention. Scleral incision and exploration is an effective form of treatment. (Chin J Ophthalmol, 2020, 56: 370-375).

[Surgical treatment of keratoglobus: key techniques of bridge-shaped flap penetrating keratoplasty and whole lamellar keratoplasty with corneoscleral limbal].

Objective: Introduce the surgical techniques of bridge-shaped flap penetrating keratoplasty and whole lamellar keratoplasty with corneoscleral limbal and the comparison of therapeutic effects on keratoglobus. Methods: Five patients (eight eyes) with keratoglobus from January 2010 to December 2015 were included. Three eyes received bridge-shaped flap penetrating keratoplasty (two eyes with corneal penetrating injury due to trauma, one eye with descemet's membrane detachment) and five eyes received whole lamellar keratoplasty with corneoscleral limbal. Results: The patients (four male, one female) aged 3 to 67 years old. Three younger patients were complicated with blue sclera. The visual acuity of all the patients pre-operation were lower than 0.05. The average visual acuity after whole lamellar keratoplasty (LKP) surgery was 0.2, while the average visual acuity after bridge-shaped flap penetrating keratoplasty (PKP) was 0.5. The corneal epithelium of the three eyes received bridge-shaped flap PKP surgery was completely healed within a week with no recurrence of corneal epithelial defect. Whereas one eye after whole LKP surgery arised persistent corneal epithelial defect and healed after blepharorrhaphy. The corneal epithelial of another eye after whole LKP surgery healed slowly and was completely healed after wearing a bandage lens on corneal for 2 months. The corneal epithelial of the remaining three eyes after whole LKP surgery was completely healed within a week. Two eyes received bridge-shaped flap PKP surgery arised corneal graft rejection 2 months after operation and recovered after anti-rejection treatment. No corneal graft rejection arised in the patients receiving whole LKP surgery. Conclusions: The whole lamellar keratoplasty with corneoscleral limbal could effectively reinforce corneal, avoid corneal penetrating injury caused by minor trauma, and improve visual acuity in keratoglobus whose corneas were gradually thinning and corrected vision cannot be improved. The patients with corneal perforating injury or descemet's membrane detachment could obtain good visual prognosis receiving bridge-shaped flap penetrating keratoplasty. (Chin J Ophthalmol, 2019, 55:916-922).

[Clinical features and treatments of retrocorneal fungal infection].

Objective: To evaluate the clinical features of retrocorneal fungal infection and the therapeutic effects. Methods: This was a retrospective, noncomparative study of nine patients with retrocorneal fungal infection and an intact corneal epithelium treated at Qingdao Eye Hospital. The history, clinical features, diagnostic methods, pathogens and therapeutic effects were analyzed. Results: Five patients had a history of trauma by plant, two had a non-plant injury, and two had unidentified reasons. The duration between the initial onset and the first visit to our hospital was 7.9 months (range, 3 months to 2 years). There was endothelial plaque and sometimes with white infiltration in the deep stroma, but the corneal epithelium remained integrated, and the anterior stroma was uninfected. The patients were misdiagnosed as uveitis, herpes simplex keratitis or bacterial keratitis in the other hospitals. Visual acuity was 20/200 in four eyes, 20/60 in one eye, 20/40 in two eyes, and 20/30 in two eyes. Fungal hyphae were detected by confocal microscopy in six eyes. All the eyes had poor response to the antifungal medication before penetrating keratoplasty was performed. The smear examinations of the corneal endothelial plaque showed fungal hyphae in six eyes. Alternaria Nees, Apospory, Phialophora verrucosa, and Fusarium were identified. Conclusions: Plant injury is the most common risk factor of retrocorneal fungal infection. Slow onset and no initially obvious symptoms may lead to delayed diagnosis and misdiagnosis. The diagnosis can be confirmed by confocal microscopy before surgery. The effect of antifungal medication is usually poor. (Chin J Ophthalmol, 2017, 53:758-765).

[The observation of tacrolimus eye drops preventing the early immunological rejection after penetrating keratoplasty for fungal keratitis].

Objective: To observe the early immunological rejection prevention effect of tacrolimus eye drops combined with glucocorticoids on fungal keratitis patients who received penetrating keratoplasty (PKP). Methods: In a retrospective case series study, medical records of fungal keratitis patients who received PKP in Shandong Eye Institute from March 2013 to December 2015 were reviewed. Twenty-six patients (26 eyes) were given tacrolimus eye drops, and 24 patients (24 eyes) were given 1% cyclosporine A eye drops immediately after PKP. Two weeks after PKP, these patients were given low concentration of glucocorticoids if no fungal recurrence was found. Immune rejection, fungal recurrence, intraocular pressure, and drug irritation symptoms were monitored. Data were analyzed by chi-square test and independent t-test. Results: The average follow-up was 7 months (range, 3 to 12 months) postoperatively. The rejection rate was 15.3% in the tacrolimus group and 47.8% in the cyclosporine A group (χ(2)=5.510, P<0.05). One patient in the tacrolimus group and two patients in the cyclosporine A group suffered fungal recurrence. Two patients in the tacrolimus group and four patients in the cyclosporine A group had secondary glaucoma. The intraocular pressure was controlled. Three patients receiving tacrolimus eye drops and 13 patients receiving cyclosporine A eye drops had mild irritation symptoms. Conclusions: Tacrolimus eye drops combined with low concentration of glucocorticoids can prevent the early immunological rejection after PKP for fungalkeratitis effectively and safely. (Chin J Ophthalmol, 2017, 53:305-310).

Changes of pituitary and penile structure in male adult rats following castration and high-fat diet.

AIM: To investigate the influence of low androgen levels and high-fat diet on the structure of pituitary and penis in male rats. METHODS: Ten-week-old adult male Sprague-Dawley rats were randomly divided into 2 groups, one fed a high-fat diet the other fed a normal diet; each group consisted of 3 subgroups: controls, castrated rats (with low androgen), and castrated rats given undecanoate replenishment. After 11 weeks, the structure of pituitary and penis were observed under light microscopy. Immunohistochemistry was used to assess the expression of FSH in pituitary and cyclooxygenase-2 (COX-2) in corpora cavernosa penis. RESULTS: The structures of pituitary and penis in castrated rats were injured, and were more damaged in castration together with high-fat diet. Immunohistochemistry showed FSH expression in castrated rats pituitary while castrated rats on a high-fat diet had less positive staining than those on a normal diet. Vascular structure of corpora cavernosa penis, showed a strongly positive COX-2 expression in high-fat diet rats. CONCLUSIONS: Castration and high-fat diet could induce structural damages of pituitary and penis in male rats. Replacement with testosterone could partially restore the impaired structure. The positive expression of COX-2 implied inflammatory pathway existence on vascular structure of penis in high-fat diet and low-androgen male rats.